RE: IgA nephropathy with nephrotic syndrome 1 hour ago

Thecsame is true with anti-APRIL and anti-APRIL .BAFF- when the drugs are stopped proteinuria returns and eGFR declines. No currently available dru...

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RE: IgA nephropathy with nephrotic syndrome 3 hours ago

Thanks prof glassock For colleagues reading this thread This case is NOT STANDARD Ig A nephropathy I was looking into the question “does MMF wor...

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RE: Hypokalemia , what is happening! 4 hours ago

Chronic hypokalemia causes chloride loss- NKCC2 inhibition in loop of henle --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrol...

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RE: Hypokalemia , what is happening! 7 hours ago

The urine creatinine concentration seems quite high. Are you sure these are correct (in mg/dL) What is the 24 hour urine volume? ----------------...

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RE: Hypokalemia , what is happening! 9 hours ago

Nice explanation! I didnt factor in the supplements into the mix. That fits nicely! Thank you ------------------------------ Marwan Abu Minshar M...

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RE: Hypokalemia , what is happening! 10 hours ago

Seems a case extra renal losses of potassium with persistent alkalosis due to post hypokalemia alkalosis ( chronically hypokalemic ) the urine ch...

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Hypokalemia , what is happening! 11 hours ago

The questions 1. is this renal potassium loss ? 2. how can I explain an elevated urine chloride in setting of a serum bicarb of 31 49 female ...

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RE: IgA nephropathy with nephrotic syndrome 11 hours ago

Yes- I think this is a valid study. MMF monotherapy added to Standard of care can have real benefits, but this trial dies not help much in identify...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 11 hours ago

Thanks- I would stop the hydralazine., even though it is not the cause of the IgM deposition disease. It is just too risky. . You have done what yo...

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RE: Gap Acidosis 11 hours ago

Do u know if the liter of bicarbonate was in D5w ? On possible scenario, if this is a ketoacidosis ( starvation ) that quickly resolved with the ...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 13 hours ago

Hydralazine was initiated only after admission for acute GN (presenting SBPs >200s); no known prior exposure. Home meds before presentation include...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 14 hours ago

C3 123 mg/dL, C4 17 mg/dL, RF < 13 IU ------------------------------ Lawrence Kwon MD Westchester Medical Center Valhalla, NY (845) 330-3541 ----...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 14 hours ago

Thank you very much for your quick response. C3/C4 normal, RF negative. Cryoglobulins pending. Hep B/C and paraprotein workup negative. I'll consul...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 14 hours ago

I see now that SSA and SSB are negative... hard to buy this SS related with this information I'd still do C3 C4 and RF. and clearly MPGN oth...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 14 hours ago

IgM dominant non-cryoglobulinemic MPGN has been reported as a possible drug induced disease - any history of Hydralazine use? Was the Polytypism of...

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RE: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 15 hours ago

the MPGN pattern in a pt with SS is highly suggestive of mixed cryo and is often a SS related lymphoma related to chronic lymphocytic stimulation. ...

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RE: IgA nephropathy with nephrotic syndrome 15 hours ago

Thanks prof glassock. Appreciate your input and learn from you . JAMA Netw Open. 2023 Feb 6;6(2):e2254054. doi: 10.1001/jamanetworkopen.2022.5405...

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RE: IgA nephropathy with nephrotic syndrome 16 hours ago

In open label (placebo controlled) trials where the patient knows what drug is being given, subjective adverse events,( pain .nausea, headache, fat...

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RE: IgA nephropathy with nephrotic syndrome 16 hours ago

Thanks prof glassock . I was curious to look into why Rituximab does not work in IgA ( standard IgA cases not like in this case ) I then came acro...

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RE: Gap Acidosis 17 hours ago

She was not on SGLT2i. When bicarb dropped to 13 on Day4, it didn't make any sense to me and requested Betahydroxybutyrate, Osmolal gap, and trigly...

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Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) 17 hours ago

Subject: Steroid taper in IgM-dominant immune complex GN (Sjögren's uncertain) Dear colleagues, I would appreciate input on steroid strategy in t...

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RE: Proteinuria after kidney transplant 18 hours ago

Please see Shamseddin M et al 2011; 6:1786-1793 for a very well done study of the expected levels of proteinuria shortly following kidney transplan...

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RE: Proteinuria after kidney transplant 19 hours ago

Thank you all for sharing your thoughtful insights. To address the points raised sequentially: There was indeed gross hematuria immediately af...

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RE: Gap Acidosis 19 hours ago

Thanks Dr. Emmett. How many days of use is required for Paracetamol use to deplete glutathione? Could a diabetic kidney transplant recipient be pre...

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RE: IgA nephropathy with nephrotic syndrome 19 hours ago

Dr. Soobadar- it is still debated wihether a diffuse podocytopathy in "IgAN" is the consequence of an uncommon variant IgAN ir merely the consequen...

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RE: Gap Acidosis 19 hours ago

Well these chemistries have me stumped. I converted the units on day 5 to mg% for our USA members (like me) who may be challenged by IU s. Na 133/K...

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RE: New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 20 hours ago

I agree with Dr. Nauman. This case requires a great deal of clinical judgement weighing the balance between risks vs benefits of various opinions o...

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RE: IgA nephropathy with nephrotic syndrome 21 hours ago

Dr. Soobadar I think you are misinterpreting the Lafayette trial. It very likely did not contain any patients with a diffuse podocytopathy - maximu...

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RE: IgA nephropathy with nephrotic syndrome 21 hours ago

Thanks prof glassock If diffuse podcytopathy agree iptacopan no effect But if iga with diffuse podcytopathy not sure ? I take your point about mm...

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RE: What is next 22 hours ago

the high BUN to Cr ratio (how high?) increases the possibility--esp if no other etiology is likely or found-- that the recent increase in Cr may re...

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RE: IgA nephropathy with nephrotic syndrome 22 hours ago

@ prof glassock Could it be ig a variant ( ig a with foot process effacement ) one disease rather that 2 pathology I agree about IG a deposit ...

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RE: IgA nephropathy with nephrotic syndrome 1 day ago

Dr. Soodabar- this patient is behaving likexa diffuse podicytopathy superimposed on IgA deposits. We do not have a biopsy teport with EM. We do not...

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RE: Gap Acidosis 1 day ago

This looks like Paracetamol induced pyroglutamic acid metabolic acidosis to me. ------------------------------ Richard Glassock MD, FASN Laguna W...

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RE: What is next 1 day ago

Her urine ACR is 9 mg/g which is normal. She diabetic neuropathy and diabetic retinopathy but her ophthalmologist didn't comment on what she has ex...

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RE: New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 1 day ago

Agree with Dr Glassock, chance of it anything other than MN or MCD is very low. Rituximab will cover both bases and there is now enough literature ...

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Gap Acidosis 1 day ago

70 yr old lady ESRD secondary to diabetic Nephropathy, S/P Deceased donor kidney Tx May/25, baseline Cr 110umol/L, hospitalized for UTI and empiric...

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RE: IgA nephropathy with nephrotic syndrome 1 day ago

https://pmc.ncbi.nlm.nih.gov/articles/PMC5373458/ --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: IgA nephropathy with nephrotic syndrome 1 day ago

Thank for case and prof glassock Why mmf and steroids and not steroid only? Any use of complement blockers here? Rituximab does not work in ig a ...

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RE: New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 1 day ago

Thanks for case I think we can do biopsy safely by using either iv heparin and stopping 4-6 hours prior to biopsy Or lmwh and stopping for exampl...

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RE: LN 1 day ago

Very instructive case. After 8 years of Class IV+V LN and triple therapy the patient is left with a lot of scarring and persistent proteinuria and ...

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RE: LN 1 day ago

Thanks for case . What was activity score and chronicity score in first biopsy ? My humble opinion this might be more chronic damage than active d...

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LN 1 day ago

Hope to get some opinions for immunosuppression guide from various forum members. 35 y/o Caucasian female with lupus by clinical manifestations an...

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RE: New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 1 day ago

Urinary IgG/albumin ratio maybe can help to distinguish between MCD vs MN. --------------------------------- Edgard Wehbe MD, FASN Wichita Nep...

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RE: New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 1 day ago

Addendum- My clinical impression is that treatment of NS is needed now, and the best empiric choice would be RTX (without steroids) please-review...

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RE: Foot process effacement and subendothelial deposits 1 day ago

Anti-nephrin antibodies in MCD can be seen as dense deposits in EM or they are only detected by immunostaining like anti-GBM antibodies in Anti-GBM...

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RE: New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 1 day ago

The answers to your questions will very much depend upon the results of pending serology. A kidney biopsy is out of the question, at least for now....

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New-Onset Nephrotic Syndrome Complicated by Acute Pulmonary Embolism: Questions on Biopsy Timing and Immunosuppression 1 day ago

A 33-year-old man with no significant past medical history presents with progressive lower-limb and periorbital edema for 2 weeks. He reports froth...

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RE: What is next 1 day ago

From "Renal Pathology"; Tisher and Brenner "The arteries and arterioles manifest some of the most striking alterations"......" subintimal hyaline...

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RE: What is next 1 day ago

I agree with Dr. Glassock that we need to recognize two types of CKD in the diabetic (especially type-2) population: 1. Diabetic glomerulopathy/glo...

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RE: What is next 1 day ago

Diabetic Nephropathy is not synonymous with Diabetic glomerulosclerosis in my opinion, and I have Co-managed many (more than a half dozen) non-albu...

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