RE: GFR measurement in AKI with stable serum creatinine 10 minutes 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...

View Discussion

RE: Refractory Vasculitis in a young woman 17 minutes 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...

View Discussion

RE: Refractory Vasculitis in a young woman 17 minutes 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...

View Discussion

RE: Natural History of treated IgAN 21 minutes ago

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

View Discussion

RE: sglt2 24 minutes ago

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

View Discussion

RE: Natural History of treated IgAN 28 minutes 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...

View Discussion

RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 33 minutes 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...

View Discussion

RE: sglt2 38 minutes 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...

View Discussion

RE: GFR measurement in AKI with stable serum creatinine 43 minutes ago

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

View Discussion

RE: Refractory Vasculitis in a young woman 45 minutes ago

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

View Discussion

RE: Natural History of treated IgAN 1 hour 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,...

View Discussion

RE: Refractory Vasculitis in a young woman 4 hours ago

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

View Discussion

RE: Refractory Vasculitis in a young woman 6 hours ago

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

View Discussion

RE: Refractory Vasculitis in a young woman 8 hours ago

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

View Discussion

RE: Refractory Vasculitis in a young woman 13 hours 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...

View Discussion

RE: Natural History of treated IgAN 14 hours ago

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

View Discussion

RE: GFR measurement in AKI with stable serum creatinine 14 hours 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 ...

View Discussion

RE: sglt2 14 hours 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...

View Discussion

RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 16 hours 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...

View Discussion

sglt2 17 hours ago

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

View Discussion

RE: GFR measurement in AKI with stable serum creatinine 18 hours 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...

View Discussion

RE: Refractory Vasculitis in a young woman 18 hours 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...

View Discussion

Refractory Vasculitis in a young woman 19 hours 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...

View Discussion

GFR measurement in AKI with stable serum creatinine 20 hours 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...

View Discussion

RE: Natural History of treated IgAN 21 hours ago

Here is the message I received from the nephropathologist: "I took 100 measurements of GBMs with a mean of 269 nm, range = 126-384 nm. This is ...

View Discussion

RE: Treatment Of Sarcopenia In HD 22 hours ago

Great question. As far as I know, nutritional supplementation and exercise ( *often intra-dialytic) are the main recommendations. Pharmacologic the...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 23 hours ago

the ARR in the review paper cited by Dr. Balan to distinguish PA in pregnancy is a threshold 40 using picomoles per L for serum aldosterone and dir...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 23 hours ago

Dear. Dr. Besarab, I have attached a good review article on the subject, I hope it helps ------------------------------ Vito M Campese Pro...

View Discussion

RE: Another hypokalemia case 23 hours ago

What is unique i this case is the very high Aldo level, high aldo/renin ratio, yet K+ almost overcorrected while 16 mEq/day taken 4h. So the dose i...

View Discussion

RE: Natural History of treated IgAN 23 hours ago

To my eye, some of the GBM appear "thin". I would request that pathology conduct a formal morphometric analysis of GBM thickness and if abnormally ...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 23 hours ago

Here is the article ------------------------------ Satish Balan MD DM DNB Senior Consultant Department of Nephrology Kerala Institute of ...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

Dear Dr. Campese Could not find the refrence on he Journal website and PYb Med is down. Would you have a pdf of the article to share? ---------...

View Discussion

RE: Natural History of treated IgAN 1 day ago

Here are the anonymized EM pictures ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Associates In Kidney Car...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

I think a final diagnosis at this stage is very difficult. The renin above 5, the low ARR ratio and the normal BP (although this could be explained...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

50 posts in the thread- second highest for 2025-so far.!! Great participation and a fantastic learning opportunity. Thanks to Dr. Jebur for startin...

View Discussion

RE: Another hypokalemia case 1 day ago

Thank you both, that is the current plan. ------------------------------ Graham Rodwell MD Palo Alto Medical Foundation Palo Alto CA -----------...

View Discussion

RE: Another hypokalemia case 1 day ago

I agree with Dr. Rodby. Stop the K supplemental Oral K and repeat the PRA and serum Aldosterone once the hypokalemia recurs, if it does at all.. ...

View Discussion

RE: Natural History of treated IgAN 1 day ago

I wonder what segmental attenuation means. Can you post a de- identified EM photomicrograph showing the structure of GBM? With such a relatively fa...

View Discussion

RE: Natural History of treated IgAN 1 day ago

Thx very much.....these days so much emphasis is placed on persistence of hematuria (as an indicator of persisting glom inflammation) in IgAN pts e...

View Discussion

RE: Natural History of treated IgAN 1 day ago

https://qxmd.com/calculate/calculator_499/international-igan-prediction-tool-at-biopsy-adults# ------------------------------ Roger Rodb...

View Discussion

RE: Another hypokalemia case 1 day ago

can you say anything about an aldo level when the K is this "high" (not low)? -6/4/2025: aldo 106, PRA 1.06, K 5 -6/13/2025: aldo 133, PRA 1....

View Discussion

RE: Another hypokalemia case 1 day ago

Proven Prinary Hyperaldosteronism (in non-pregnant patients) without hypertension is very uncommon but numerous case reports have well documented t...

View Discussion

RE: Natural History of treated IgAN 1 day ago

Below is the EM part of the Bx: One block is prepared. Ultrastructural evaluation of a glomerulus reveals basement membranes that are segmentally...

View Discussion

RE: Refractory MCD 1 day ago

Secondary steroid and RTX resistance implies a poor prognosis and a very high risk of recurrent Disease post -transplant . He likely has Prinary FS...

View Discussion

Another hypokalemia case 1 day ago

Wonder where others might go with workup for the following case, hypokalemia without HTN, initially normal aldo followed by rpt in the 100 range, w...

View Discussion

RE: Refractory MCD 1 day ago

https://www.kireports.org/article/S2468-0249(25)00389-4/fulltext ------------------------------ Marwan Abu Minshar MD, FASN Essentia health Fa...

View Discussion

RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

Like Dr Rogby, I have seen several cases of cANCA and pANCA ELISA negative necrotizing GN biopsies and one autopsy case of necrotizing GN with diff...

View Discussion

RE: Bartter's syndrome vs primary hyperaldosteronism 2 days ago

Thank you for your illuminating discourse. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 --...

View Discussion

RE: Treatment Of Sarcopenia In HD 2 days ago

I have attached a LONG review on this Assuming you are not missing a diagnosis (endocrine, cancer etc) which I will assume you are not, M...

View Discussion

RE: Refractory MCD 2 days ago

did you check CD 19 to see if rituximab did what it is supposed to do? If so and CD 19 were deleted with rituximab, I wonder about the advantage...

View Discussion