RE: CKD , with pathology- higher Lambda than Kappa 2 hours 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 hours 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 3 hours 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 3 hours ago

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

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FSGS with progressive worsening of renal function 3 hours 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 4 hours ago

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

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RE: sglt2 4 hours 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 5 hours ago

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

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RE: sglt2 5 hours 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 6 hours 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 7 hours 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 7 hours 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 9 hours 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 11 hours 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 12 hours 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 13 hours 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 14 hours 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 20 hours 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 21 hours 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 21 hours 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 22 hours 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 23 hours 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 23 hours ago

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RE: Treatment Of Sarcopenia In HD 1 day ago

I would recommend adding more dialysis time, both by adding more hours and increased frequency of treatments. IDPN and slow incremental physical ac...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

Dr. Mellas- thanks for the paper. I should not be ignored. How do you interpret a "stable " serum creatinine concentration when endogenous producti...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

Dr Rodby is correct with all due respect to the other opinions. When ΔCr/ Δt = O, the creatinine production = excretion and the CrCl can be calcula...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

Agree. And sometimes onse sees where there is a very slow recovery after the initial phase so on cannot be sure that the function recovered is at i...

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RE: Refractory Vasculitis in a young woman 1 day ago

I agree with Dr. Aledan- why not try OBI + DARA combination as a last resort before moving to CAR-T. The latter, if successful might contraindicate...

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RE: Refractory Vasculitis in a young woman 1 day ago

Canot add more to discussion. Attached a abstract of a paper on dual vasculitis. Ubable to get full PFd Also a case on use of ANCa treated wit...

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RE: Natural History of treated IgAN 1 day ago

Very well, thank you ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Associates In Kidney Care, PLC Des Moin...

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RE: sglt2 1 day ago

"Proteinaceous casts are present in the tubules w/o cellular reaction. Protein reabsorption droplets are seen in the tubular epithelium. .............

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RE: Natural History of treated IgAN 1 day ago

Both are possible in this case. The only way to distinguish the Alport + IgAN from the non-Alport TBMD + IgANis to do genetic testing. About 1/3 of...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 1 day ago

The treating physician has written "I think the patient will do great on PD". (I can hear JoAnne Bargman nodding "absolutely") Why not do PD? The...

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RE: sglt2 1 day ago

I agree with Dr Glassock Having a SGL2on board adds no real benefit unless the agent by inhibiting proximal tubular reabsorption of LI allows ma...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

Besides decreased muscle creatinine generation, increasing extrarenal (particularly intestinal) degradation of creatinine also contributes to stabi...

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RE: Refractory Vasculitis in a young woman 1 day ago

Dear Dr. Glassock, I was answering Dr. Rodby suggestion of possible using Bortezomib “would you consider Bortezomib) so my suggestion is that Dara ...

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RE: Natural History of treated IgAN 1 day ago

Dr Glassock: though I don't disagree with you at all conceptually, are you implying that here is a patient in whom IgAN & Alport's are co-existing,...

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RE: Refractory Vasculitis in a young woman 1 day ago

ANCA-MPO titers only transiently normalized for a few months following plasma exchange but have remained persistently elevated since the last vascu...

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RE: Refractory Vasculitis in a young woman 1 day ago

She has already received 5 of 8planned doses of Daratumumab and remains with active, seropositive , symptomatic vasculitis and dialysis-dependent E...

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RE: Refractory Vasculitis in a young woman 1 day ago

Agree with the expert opinion and I agree for Dara and preferred over Bortezomib from recent data on desensitization of highly sensitized patients ...

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RE: Refractory Vasculitis in a young woman 1 day ago

Here is my take on this very unique (at least from my experience reference point) and very unfortunate patient. After nearly a year on dialysis the...

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RE: Natural History of treated IgAN 1 day ago

With borderline THin BM and unexplained persistent hematuria , I would recommend Genetic testing for Alport Spectrum disorder in this patient. Whil...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

I will take a somewhat different position compared to Dr. Rodby- defining a "steady state" by a stable plateau of Scr during recovery from AKI can ...

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RE: sglt2 1 day ago

We need to know the value of eGFR and UACR . What were the indications for a kidney biopsy? . Is the patient still receiving Lithium? . In the abse...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 1 day ago

This is a bit odd "fairly normal appearing kidneys, 30% fibrosis". Is he a liver patient? I would not do PD. Did he get PLEX? You can try Obi...

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sglt2 1 day ago

posting for colleague, 41y w htn, no dm, lithium for bipolar, bmi mid 30s Diagnosis: Focal and segmental glomerulosclerosis, perihilar varia...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

If you are in steady state, creatinine stable, I dont think it matters if it is CKD or AKI , and a 24 hour urine should give you a reliable creatin...

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RE: Refractory Vasculitis in a young woman 1 day ago

unreal story. poor woman! Seems she has had CYC 3 times, a large cumulative CYC amount, but this is life threatening disease and I believe warra...

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Refractory Vasculitis in a young woman 2 days ago

I would really appreciate input for this tough case…. 21-year-old female under follow-up for ESRD on peritoneal dialysis, secondary to ANCA vasculi...

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GFR measurement in AKI with stable serum creatinine 2 days ago

Greetings to all community members If a patient developed AKI and serum creatinine stabilised at certain level for 3 days, is it valid to measure...

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