RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago

pne of the drawbacks of not having a LIbrary is accessing hot of the press articles. Katest issue of H Human Hypertension I could look at was the J...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

Dr. Besarab- good question. See Zhang CY, et al J Human Hypertens. July 16, 2025. Open Access. Very timely paper, just publushed last week. -----...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

Dr Glassock Another test does not hit the mark. In all three of my case of negative saline suppression (including myself), the Melby test show...

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RE: Bartter's syndrome vs primary hyperaldosteronism 6 hours ago

Thanks- another highly touted test bites the dust (like TTKG and UAG). ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Kidney transplantation in a patient with monoclonal C3G 6 hours ago

Two recent episodes of Pseudomonas bacteremia, persisting monoclonal gammopathy and clonal plasma cell expansion in the marrow are major concerns a...

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RE: Bartter's syndrome vs primary hyperaldosteronism 7 hours ago

FYI, recent article in Ann Internal Med ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO ...

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RE: Kidney transplantation in a patient with monoclonal C3G 10 hours ago

Difficult case. What is his current C3level? I assume that the lambda MC is interfering with the action of CFH in the circulation and causing a C-d...

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Kidney transplantation in a patient with monoclonal C3G 11 hours ago

Dear colleagues, I'd like your thoughts about a case of a 40 y.o. man on hemodialysis for monoclonal C3G (Dense deposit disease) Here's a brief s...

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RE: FSGS with progressive worsening of renal function 14 hours ago

Was APOL-1 genetic testing done and if variant present could this help explain his path ------------------------------ Jonathan Slater MD Renal &...

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RE: FSGS with progressive worsening of renal function 1 day ago

Here is another explanation: Secondary FSGS as Dr. Aledan stated Interstitial inflammation is manifestation of obstruction/reflux (especially ...

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RE: CKD , with pathology- higher Lambda than Kappa 1 day ago

Hello, kappa 53 lambda 43 ratio 1.2 Thank you! ! ------------------------------ Eithan Orlev MD Cincinnati OH (513) 488-6279 -------...

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RE: sglt2 1 day ago

Sheldon, I consider cost. as an important outcome variable poorly examined in our RCTs. Lets start with ARB of ACE., add a second or third generati...

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RE: sglt2 1 day ago

" I see too many patients over-medicated ARB or ACEi SGLT2i , Diuretics, Finerenone, and GLP-1. There needs to be SOME glomerular capillary pressur...

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RE: CKD , with pathology- higher Lambda than Kappa 1 day ago

What are the serum free light chain levels? ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 208-1459 --------------...

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RE: FSGS with progressive worsening of renal function 1 day ago

In addition to the above could you tell us whether his corrected serum calcium was normal? Also vitamin D levels, if done?Long term vitamin D thera...

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RE: sglt2 1 day ago

UACR undetectable.UPCR 170mg/gSent from my iPhone

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RE: CKD , with pathology- higher Lambda than Kappa 1 day ago

Can we presume that albumin staining of TBM is negative? (the patient has T2DM). Unclear in the report. ------------------------------ Richard Gl...

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RE: FSGS with progressive worsening of renal function 1 day ago

Agree that this is secondary FSGS and AIN and agree with Dr. Venkat to slowly taper steroids. Any evidence of urosepsis? Did he received antibioti...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

The report is not clear as to which basement membrane show dominant lambda staining, it says the glomerular are negative in basement membrane show ...

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RE: FSGS with progressive worsening of renal function 2 days ago

Fenofibrate can cause true AKI (in addition to impairing proximal tubular creatinine secretion) with or without rhabdomyolysis. Was total CPK measu...

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RE: FSGS with progressive worsening of renal function 2 days ago

Albumin normal. Home meds amLODIPine 5 mg, aspirin 81 mg , atorvastatin 10 mg ,Coenzyme Q10, fenofibrate 145 mg,finasteride 5 mg,Synthroid 0....

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RE: FSGS with progressive worsening of renal function 2 days ago

Agree with Dr. Glassock that therapy directed against FSGS is not warranted. SCr was already decreasing (5.94 mg --> 4.8 mg/dL) even before prednis...

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RE: Severe AIN with Crescents 2 days ago

yes 1mg/kg of steroids, cr slow trend down from peak of 4.6 ( 7/6/25) to 3.0 ( 7/25/25). will update EM findings and photomicrographs if possible b...

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RE: Severe AIN with Crescents 2 days ago

Questions: 1. Did you treat patient with steroids for AIN? 2. EM findings? 3. SCr trend over last 2 weeks? ------------------------------ K.K. Ve...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

Thank you Dr Glassock for your input! ------------------------------ Eithan Orlev MD Cincinnati OH (513) 488-6279 ------------------------------

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RE: sglt2 2 days ago

Given biopsy findings of proteinaceous tubular casts and protein reabsorption droplets in tubular epithelial cytoplasm, it is important know UAlb/C...

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RE: FSGS with progressive worsening of renal function 2 days ago

The biopsy finding are not compatible with Primary FSGS (although no serum albumin reported) so IS therapy is not indicated for this reason, The re...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

Now I see that 4 gloms were present in IF (one globally sclerotic and three intact). The intact glomeruli slow "linear" deposits of Lambda > Kappa ...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

The attachment ------------------------------ Eithan Orlev MD Cincinnati OH (513) 488-6279 ------------------------------ Files Attached ...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

Thank you Dr Fogo Congo red was negative. No EM were done ( no glomeruli). I have attached the scan of the IF. Would any one repeat bio...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

I only see the summary of the report in the attachment. It would be important to have information on how many glomeruli were available for the immu...

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RE: sglt2 2 days ago

thank you everyone, ------------------------------ Shivangi Patel Nephrology Morristown NJ ------------------------------

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FSGS with progressive worsening of renal function 2 days ago

77/m with past medical history of HTN, HLD, CKD, BPH, OSA on CPAP, normal renal function until september 2024, with abnormal cr of 2.4 in April'202...

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RE: Severe AIN with Crescents 2 days ago

Final biopsy result now available Chronic, focally active crescentic glomerulonephritis (see note). Markedly active interstitial nephritis (w...

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RE: sglt2 2 days ago

"Cr 2.20-2.70 over last 6 months. eGFR 30-38 Off Lithium since 2023. UACR undetectable. UPCR 170mg/g On SGLT 2 since 3/2024 based on EMPA-KIDNEY ...

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RE: sglt2 2 days ago

Well said, Dr Glassock .Agree 100% ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 -----------...

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RE: sglt2 2 days ago

I agree that shaed decision making is important. However, I would like to caution that large weight gains can occur in a few susceptible patients. ...

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RE: sglt2 2 days ago

The EMPA KIDNEY Study showed no benefits in patients with UACR < 300 mg/ g. ( NEJM 2023;338:117) We need to be more careful in extrapolating data...

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

Thank you Dr Glassock! ------------------------------ Eithan Orlev MD Cincinnati OH (513) 488-6279 ------------------------------

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RE: CKD , with pathology- higher Lambda than Kappa 2 days ago

I would probably disregard thus finding in a single sclerotic glomerulus as it has insufficient diagnostic utility for a MGRS. Just an opinion. Inp...

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CKD , with pathology- higher Lambda than Kappa 2 days ago

I have a 74 y/o female with a PMH of: CKD stage IIIb, (last labs: Cr 1.7 , eGFR 31, UACR 68 mg/gr) , type 2 DM, gastric carcinoid stage IV ( sta...

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RE: sglt2 2 days ago

In the EMPA-Kidney trial there was no benefit on progression of CKD seen in non-albuminuric CKD,. Do we know what the UACR was before SGLT2 inhibit...

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RE: sglt2 2 days ago

In my opinion- RASi, SGLT21 and GLP1RA are NOT universally indicated in CKD. They should be used selectively in patients likely to receive a benefi...

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RE: Treatment Of Sarcopenia In HD 2 days ago

Thanks all for you comments. So the best strategy is a combination of nutrition and exercise plus increase frequency and time on dialysis and poss...

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RE: sglt2 2 days ago

Agree with your assessment of EMPA KIDNEY as do the KDIGO guidelines which give the use of SGLT2i’s in individuals with an eGFR between 20-45 ml/mi...

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RE: GFR measurement in AKI with stable serum creatinine 3 days ago

The supplement in the paper will explain the amount of creatinine excreted and retained at any time interval and when sampled gives the same result...

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RE: GFR measurement in AKI with stable serum creatinine 3 days ago

Thanks- of course the law of mass conservation only applies to one unit of time (per minute, per hour , per day, etc. ) over extended periods of ti...

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RE: sglt2 3 days ago

with virtually no albuminuria and 150 mg total proteins/g Cr. appears to have tubular proteinuria. Dr Glassock, could one get tubular casts with no...

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RE: GFR measurement in AKI with stable serum creatinine 3 days ago

That is a rather tricky question. One does assume that creatinine production falls 2 to 3% per day in a hospital patient depending on their catabol...

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RE: sglt2 3 days ago

"Cr 2.20-2.70 over last 6 months. eGFR 30-38 Off Lithium since 2023. UACR undetectable. UPCR 170mg/g On SGLT 2 since 3/2024 based on EMPA-KIDNEY ...

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