RE: What FSGS is that ? 1 hour ago

I guess I will do whole exome sequencing. Will figure out ancestry and consanguinity. Next time she flares..will repeat biopsy. My thought was...

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RE: C3GN in a patient with VEXAS s/p SCT and metastatic SCC on immunotherapy 1 hour ago

Hello, C3 presentation on LM , can be MPGN, Mesangial Proliferation and even Membranous in rare cases . For PSGN, they will have alternate pathw...

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RE: renal limited microangiopathy 1 hour ago

Interesting case indeed! It is sad that the patient is heading towards dialysis. As you know in TMA usually elevated LDH and low haptoglobin are n...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 2 hours ago

May I ask if for some reason plasma Cr. is not correlating GFR due to poor muscle mass for example. Do we have Cystatin C? Hard to believe that som...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 6 hours ago

https://journals.physiology.org/doi/epdf/10.1152/ajprenal.00195.2024 See this attached article- might help with understanding the pathophysiology....

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RE: anti gbm/mpo +ve in young female 7 hours ago

i avoid IV CyC because of problems in calculating dosage in anuric patients. Oral CyC is standard care- no evidence at all that IV CyC is more effe...

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RE: C3GN in a patient with VEXAS s/p SCT and metastatic SCC on immunotherapy 7 hours ago

Thank you Dr. Glassock and Dr. Dastoor for your replies! C3 was low (77.9), C4 was normal (25.4). The complement functional asssys and complement a...

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RE: anti gbm/mpo +ve in young female 9 hours ago

Update - patient having iv cyclo 3 month with plex till anti gbm -ve Microcytic anaemia - heavy period but with normal Cxr could it be sub clinic...

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RE: What FSGS is that ? 9 hours ago

Thanks for case If you were to repeat biopsy and it showed 100% full effacement you could call it primary fsgs then I guess? Is there 2 pathology ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 9 hours ago

Dr. Rubin- Thanks for making this thread such an excellent example of how the Open Forum works at its highest level. When dealing with a complica...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 11 hours ago

I just received a response from Dr. Eric Engles from NIH which I am posting below. In addition, I am attaching the recent literature he suggested. ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 12 hours ago

Thank you. Apology accepted. Mario

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 12 hours ago

Dear Dr. Buhary, I am curious what led to the diagnosis of adenocarcinoma of a sigmoid colon in your patient. Was this picked up on surveillance co...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 12 hours ago

Dear Dr. Rubin, I apologize for misspelling your last name and if you look back at my post, I have corrected it in each of the above post prior to ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 13 hours ago

@Mark Lerman Thank you for the reference and your thoughts. I would add 2 points: My name is RUBIN and not RUBIO. I wanted to clarify this poi...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 13 hours ago

Sorry for the typo. Would you consider changing CyA to Tacrolimus ? ------------------------------ Dr Mohamed Buhary MBBS, FRCP, FASN Consultant ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 13 hours ago

Thanks very much indeed for your valuable input. Much appreciated. I will discuss with the patient. I One more question. If MMF is discontinued a...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 14 hours ago

Background: Kidney transplant recipients (KTRs) experience improved survival and quality of life compared to dialysis treatment, but chronic immuno...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 14 hours ago

https://doi.org/10.3390/cancers17203352 thanks, Dr. Rubin for your very appropriate reply. The point of my post was not to disagree with your re...

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RE: What FSGS is that ? 15 hours ago

The absence of a diffuse podocytopathy by EM makes Primary FSGS very unlikely. The "response" to steroids is puzzling. I might do genetic testing a...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 15 hours ago

My guess is that this is pseudohypoaldosteronism secondary to marked surgical reduction of nephron mass with maladaptive glomerular and tubular inj...

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RE: Hemodialysis Associated Headache 16 hours ago

Thank you for your response. The headache starts one after starting HD. It seems like migranous headache. I will use O2 therapy during next HD and ...

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RE: Membranous Nephropathy and necrotizing GN 16 hours ago

CD 19 not below 1% and HBV -DNA negative. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ---------------...

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RE: Membranous Nephropathy and necrotizing GN 17 hours ago

I would agree to Dr Dastoor's comment on CD19. If the CD 19 was not below 1percent, would consider obi, though not evidence based but based on clin...

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RE: What FSGS is that ? 17 hours ago

Respoonse to prednisone meaning uACR 3206 at 4.12.2025...and albumin to creatinine zero at 7.1.2026 and again (0mg/g) at 11.1.2026. ------------...

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What FSGS is that ? 17 hours ago

A 47 year old woman with BMI 30, Hashimoto, hypothyroidism ,smoker, history of "proteinuria" at pregnancies but no preeclampsia. . came in at 202...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 17 hours ago

Remnant kidneys can increase single nephron K excretion significantly . Would need to rule out : 1. Pseudohyperkalemia 2. Check urine K , Na and...

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One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 17 hours ago

A 63 yr old male with a hx of left total nephrectomy for RCC (2012) followed by right lower partial nephrectomy (2013) with a normal eGFR of ~80 an...

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RE: Membranous Nephropathy and necrotizing GN 18 hours ago

Normal kidney size, about 10% IFTA, serum creatinine from 1 to about 2.5mg/dL over 3-4 months. Initial 3+ now trace only. ---------------------...

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RE: Membranous Nephropathy and necrotizing GN 20 hours ago

When in doubt I would biopsy, especially if there is hematuria and worsening ANCA titers . Would definitely want to know if there is progression of...

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RE: C3GN in a patient with VEXAS s/p SCT and metastatic SCC on immunotherapy 20 hours ago

The biopsy seems like C3G , as was stated . The rapid decline in renal function , is not the typical presentation for C3G unless it presents as a C...

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RE: Membranous Nephropathy and necrotizing GN 21 hours ago

I think ponticelli protocol is more potent in achieving remission in these tough cases. What about adding Cyclosporin to her current regimen, cauti...

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RE: Membranous Nephropathy and necrotizing GN 21 hours ago

SCr trend since onset with time period of evolution? IFTA extent? Kidney ultrasound results? If above indicate salvageability, may consider ritux...

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Membranous Nephropathy and necrotizing GN 1 day ago

I have recently seen a case of elderly man with biopsy proven MN (high levels of PLA2R -> 150RU/ml- antibody and PLA2R antigen positive, with very ...

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RE: AI Is Refilling Prescriptions Without Real-Time Clinician Sign-Off: Why Nephrologists Should Pay Attention 1 day ago

Thank you for raising the clinical-intent perspective Dr @Richard Glassock. The shift from AI as assistant to AI performing a clinical task (withou...

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RE: AI Is Refilling Prescriptions Without Real-Time Clinician Sign-Off: Why Nephrologists Should Pay Attention 1 day ago

------------------------------ Karin Bergling MD, PhD Research Scientist Renal Research Institute New York NY ------------------------------

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RE: AI Is Refilling Prescriptions Without Real-Time Clinician Sign-Off: Why Nephrologists Should Pay Attention 1 day ago

That's a really good point Dr @Ibrahim Elali. If the alternative is delayed or no access to essential, maintanace medications, I think most clinici...

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RE: C3GN in a patient with VEXAS s/p SCT and metastatic SCC on immunotherapy 1 day ago

It depends on the full biopsy report. Is thus IC-MPGN or C3GN- ? maybe cluster analysis will help to separate these two related disorders. What is ...

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RE: ocular disequilibrium syndrome in hemodialysis any clinical experience 1 day ago

Back in the late 70's, mannitol was frequently used for the prevention of dialysis disequilibrium. As nephrologists followed the principle that "ha...

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RE: ocular disequilibrium syndrome in hemodialysis any clinical experience 1 day ago

Very interesting. I don't have a strong opinion that it's a good idea (and I would be surprised if it's available on an outpatient basis ???), bu...

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C3GN in a patient with VEXAS s/p SCT and metastatic SCC on immunotherapy 1 day ago

Hi! Need input on this case of C3GN: 62 y.o. male with h/o metastatic SCC (on Cemiplimab), VEXAS syndrome s/p SCT in July 2022, lichen planus of...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 1 day ago

@Richard Glassock My AI consultant and the meta-analysis which I have attached, do clearly state that the incidence of colon cancer is increas...

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RE: AI Workshop and ASN Community: Join Us! 1 day ago

I fully agree with @Melissa West. This is an excellent opportunity for fellows to gain practical, hands-on exposure to AI in nephrology and to enga...

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RE: Negative IF and EDD on EM from paraffin block 1 day ago

agreed would be useful. I though they were done, but I realize the report said immunoperoxidase stain not pronase on the repeat stains. Unless opti...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 1 day ago

Thanks Dr. Rubin. Very interesting results from an AI consultation. I have a question- since the incidence of distal colorectal cancer is not not i...

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RE: Hemodialysis Associated Headache 1 day ago

When do the headaches begin relative to the start of the hemodialysis session? Are they the migranous or non-migranous in character ? Why don't you...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 1 day ago

@Richard Glassock Please see the attached summary from AI (ChatGPT) which includes good references. I think the message is clear and I agree 100%...

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RE: Negative IF and EDD on EM from paraffin block 1 day ago

What about a "concealed" monoclonal gammopathy of renal significance. Is Pronase digestion and IF an alternative here? --------------------------...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 1 day ago

If there are no causal inferences for a role of Immunosuppression in colon cancer post transplantation, what would be the justification for discont...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 1 day ago

@Mark Lerman Can you please provide reference 3 as shown in the paragraph that you posted. If I understood you correctly, based upon this single ...

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