RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 3 hours ago

Could you post some de-identified pictures of the LM findings?. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geff...

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RE: Fibronectin glomerulopath 4 hours ago

Have you confirmrd fibronectin Glomerulopsthy by appropriate staining or other analysis of the kidney biopsy? i so, I would taper and eventually st...

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Fibronectin glomerulopath 5 hours ago

65yr old lady HYPERTENSION detected 11/2025 12/2025 H/O PEDAL EDEMA + TOOK torsemide from local hospital 12/2025 creatinine- 0.9/ACR 1670 4/2026 ...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 7 hours ago

Does your immunohistologist routinely perform a positive control with each kidney biopsy to be sure that the reagents are working properly.? ----...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 9 hours ago

Dr. Dastoor- PLEX is designed to remove circulating antibody, not tissue deposited antibody . CYC, not RTX , is standard of care for anti-GBM antib...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 9 hours ago

Yes, but false positive anti-GBM antibody is equally implausible. If spikes were seen on LM ( silver Methenaminec-Jones stain) with might be anti-G...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 11 hours ago

Seems like u could be dealing with dual positive anti GBM and Membranous Nephroapthy. I also wonder if some of the improvement you see is related t...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 11 hours ago

Thank you prof Glassock. I will ask the histopathologist about that although it would very unlucky to get 6 in IF sample that all sclerosed -----...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 11 hours ago

I forgot to mention that eGFR although dipped to 18ml/min it did come up to 23 while treating the ecoli bacteraemia and she has had excellent urine...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 11 hours ago

This is not "atypical anti-GBM disease. Such "atypical " disease is characterized by negative serum anti-GBM antibodies by conventional tests and b...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 11 hours ago

False positive anti-GBM antibody tests by conventional ELISA using COLIV alpha 3 NC1 domain as the target antigen are very uncommon. ([More]

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Crescentic GN With Raised Anti-GBM But No Immune Deposit 13 hours ago

Dear expert colleagues, We currently have a patient with a slightly atypical presentation of anti-GBM disease, and we would be very grateful for ...

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RE: Post Partum AKI 14 hours ago

Unlikely to be antiGBM disease with this degree of proteinuria, but it is still possible . If anti-GBM disease then PLEX , CYC and steroids. If "pa...

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RE: Post Partum AKI 16 hours ago

All immunological tests including ANKA , complement C3, C4 , ANA and ds DNA antibodies are negative. Anti GBM antibody was not done. Biopsy showed ...

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RE: SIADH conundrum 18 hours ago

I had the opportunity and privilege of working with Dr. Goldberg when he moved from Penn to Temple University in Philadelphia several decades ago. ...

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RE: Help me make sense of this 24 hr urine study for stones. 18 hours ago

One additional perspective from pediatric nephrology and crystallization physiology: What I find particularly interesting here is that the patient...

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RE: Help me make sense of this 24 hr urine study for stones. 19 hours ago

Dr Ali, Thank you for sending the prior 24 hr urine. A couple of comments about it. The urine creatinine is significantly lower than the most re...

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RE: SIADH conundrum 19 hours ago

The electrolyte-free water clearance was first proposed by Marty Goldberg, Medical Clinics of North America, March 1981, pages 251-269. ---------...

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RE: Potential donor with mutation in NR3C2 Gene 20 hours ago

I think she is , but l have to verify, we always ask for availability of alternative donors when face such difficult decisions -----------------...

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RE: Potential donor with mutation in NR3C2 Gene 20 hours ago

I forgot to ask an important question on earlier post - is this the only potential living donor candidate ? if answer is yes - does your program ha...

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RE: Post Partum TMA 22 hours ago

Dear Satish, if you believe she had DIC and deranged coagulation, then there is definitely no reason to start her on Eculizumab, as Professor Richa...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

What is the patient's BMI or waist circumference? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Me...

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RE: Post Partum TMA 1 day ago

I believe in interpreting the clinical picture to reach a diagnosis more than other parameters. This is a lady who had a preterm delivery at her ho...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

This is a follow-up on the case: her aldosterone level was 5.3 ng/dL (reference range 0–30), and plasma renin activity was 0.763 ng/mL/h (reference...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

@john asplin ....thanks for the amazing review on citrate and bicarbonate metabolism . I always assumed that in addition to citrate being converted...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

The patient is consuming a high sodium diet, around 5 grams per day, he must be using the salt shaker liberally. This needs attention. I guess that...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Dr. Asplin, Thank you so for much for the response. The patient reports he only meats one portion of meat (Like the size of a hamburger patty) 4 ...

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RE: Post Partum TMA 1 day ago

Thai case has all of the hallmarks of aHUS, even though Post-Partum RCN is strongly suggest. A full reading of the kidney biopsy is not yet availab...

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RE: Post Partum AKI 1 day ago

What did the kidney biopsy show? Thanks. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medici...

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RE: Post Partum AKI 1 day ago

A patient with 13 gm of proteinuria , low albumin, with generalized edema and acute kidney injury (AKI), showing fast deterioration. Is there any h...

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RE: Post Partum TMA 1 day ago

Thank you for sharing this case. It presents significant challenges, as postpartum Thrombotic Microangiopathy (TMA) could be associated with Thromb...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Dr Dastoor, As for a combo of Kcitrate and Kbicarb, I view it no differently than Kcitrate. The increase in urine citrate is from the alkali load...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

What is the density (Hounsfield units) of the stones on the CT? While this doesn't discriminate perfectly among stone compositions, [More]

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Would you consider replacing K citrate and Na bicarb with Sybnial ( k citrate and K bicarb) ... What's your experience with drug in stone managemen...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Note high BUN and Sodium -- likely due to high animal protein intake (? likely processed meat which recently has been labeled as a carcinogen). E...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

In order to interpret the urine I'm going to make a few assumptions: 1) The patient has formed uric acid stones in the past and that is why he is t...

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RE: SIADH conundrum 1 day ago

I do not use urine osmolality. Using osmolality will give you solute free water clearance, which includes urea as a solute in it. Using urea for tr...

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RE: SIADH conundrum 1 day ago

I still adhere to the teaching of Dr. Rose (see page 252 of the 3rd edition of his book). ------------------------------ Mario Rubin, M.D. Houst...

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RE: SIADH conundrum 1 day ago

@John Mellas You are absolutely correct. We all "estimate" an ADH effect using the calculation you have so nicely reinforced. On the other hand, ...

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RE: Post Partum TMA 1 day ago

I agree with Dr. Balan's cogent comments - Classic post.Partum RCN initiated by abruptio placenta or marked intra- or post-partum hemorrhage is not...

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RE: SIADH conundrum 1 day ago

Mellas is correct that it is the electrolyte-free water clearance and not the free water clearance that is most useful. the free water clearance re...

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RE: SIADH conundrum 1 day ago

The attached paper is certainly relevant and more precise from a strictly physiologic perspective. The formula is a little bulky for bedside use an...

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RE: Post Partum TMA 1 day ago

Most of the TMA in a post partum bleed with severe AKI is secondary to DIC. What was the prothrombin time and partial thromboplastin time at diagno...

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RE: SIADH conundrum 2 days ago

@Kambiz Kalantari Please clarify how you can calculate CH20 (free water clearance) without actually measuring the urine osmolality (see below). A...

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RE: SIADH conundrum 2 days ago

I agree with you that this is SIAD from encephalitis. I also like what you are doing now. If the patient is responding well with no changes in ment...

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RE: Total Hip Replacement in ESRD 2 days ago

She clearly should have a hip replacement, though healing may be a bit delayed, it should not be to complicated ------------------------------ St...

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RE: complex case of nephrotic syndrome in liver transplant patients 2 days ago

Small underpowered uncontrolled study of moderate non-renal, non-organ threatening disease. 50% ANCA negative - No cases of RPGN. outcomes based on...

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

Probably has high acid excretion .. his urine Na , urine uric acid , urine sulphates , UUN are all high or on the higher side which will necessaite...

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

@John Asplin ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773) 505...

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RE: complex case of nephrotic syndrome in liver transplant patients 2 days ago

Dr. Soobadar -in regards to the use of campath -I am not a liver transplant specialist but review current guidelines campath is not recommended for...

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