arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 14 minutes ago

I have a 44-year-old patient who has been on dialysis for two months and has hypertension that is consistently accompanied by severe headaches, and...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 18 minutes ago

Clearly a very difficult case. I agree with Professor Glassock and would not proceed with surgery as healing is generally poor and can result in fu...

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RE: Is Hypertonic Saline appropriate here 1 hour ago

I am not sure the "acute vs chronic" issue is outdated as much as sometimes hard to know as an outpatient (and therefore, warranting caution). In t...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 hour ago

I find it interesting that with such high phosphorus, his PTH is only 200-300 (presume pg/ml?). This would limit adding calcimimetic as an adjunct ...

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RE: Is Hypertonic Saline appropriate here 2 hours ago

A few minor points; [Na] remains an effective osmole, while [Glu] has a transient effect on s osm and tonicity. I understand the concept of expan...

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RE: Case of FSGS with IgM and C3 post transplant 3 hours ago

Thank you all for your comments . Very useful. Will definitely cover with anti proteinuric drugs and consider anti B cell therapy. Best Daniel ...

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RE: Case of FSGS with IgM and C3 post transplant 13 hours ago

I agree with Dr. Glassock that stopping CNI may increase proteinuria. Hope is whatever component of reversible CNI-toxicity is still there can be e...

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RE: Case of FSGS with IgM and C3 post transplant 14 hours ago

Once you taper the CNI do not be surprised if the proteinuria increases. CNI have a direct anti-proteinuric effect on glomeruli, quite independent ...

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RE: Case of FSGS with IgM and C3 post transplant 16 hours ago

While you pursue alternative immunosuppressants such as obintuzumab or ACTHAR, since DSA is negative repeatedly and since there is no other evidenc...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 18 hours ago

Thank you, Dr Glassock. Yes, we have tried almost all available binders. However, their use is limited by pt's c/o "diarrhea" and after experienci...

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RE: Novel COL4A3 Variant and Kidney Transplantation 18 hours ago

The patient is homozygous for a COL3 VUS, yet the mother is negative on screening. I presume that same VUS in a heterozygous state should be detect...

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RE: Novel COL4A3 Variant and Kidney Transplantation 18 hours ago

Dear colleagues, Thank you for your valuable comments. Regarding the sibling's renal biopsie electron microscopy unfortunately was not performed,...

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RE: Case of FSGS with IgM and C3 post transplant 19 hours ago

Thank you so much Dr Glassock very helpful. ------------------------------ Daniel Guevara-Pineda MD West Hartford CT ---------------------------...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 21 hours ago

Tough case. But I doubt that surgical removal of these extra osseus calcinosis deposits is a viable option, as wound healing would likely be poor a...

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RE: Case of FSGS with IgM and C3 post transplant 21 hours ago

On balance, I favor a recurrence of permeability factor related Primary FSGS in this case. If EM was performed on the early graft biopsies.this mig...

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RE: Case of FSGS with IgM and C3 post transplant 21 hours ago

Also primary NOS disease was in the nephrotic range prior to transplant. Post transplant proteinuria pick at 4gr improved with RAS blockage Get O...

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RE: Case of FSGS with IgM and C3 post transplant 21 hours ago

Thank you I thought about that possibility therefore i run a renasight which is negative Get Outlook for iOS

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RE: Case of FSGS with IgM and C3 post transplant 21 hours ago

As Dr. Awais mentioned , DFE with non nephrotic range proteinuria raises the tiny possibility of genetic FSGS ------------------------------ Dr....

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RE: Case of FSGS with IgM and C3 post transplant 22 hours ago

Thank you for sharing this paper dr Venkat this make the diagnosis and management much for complex to date i dont have clear diagnosis for this p...

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RE: Case of FSGS with IgM and C3 post transplant 22 hours ago

Also, please see following reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC5577650/#:~:text=There%20were%20significant%20positive%20correlati...

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RE: Case of FSGS with IgM and C3 post transplant 22 hours ago

From Google AI: "Yes, secondary focal segmental glomerulosclerosis (FSGS) can show IgM deposition. While IgM staining is commonly associated with p...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 23 hours ago

Thank you , Dr Venkat. L spine x ray showed diffuse osteopenia and Hip xray no significant arthropathy ( per report ) Alk phos is normal - 43 ...

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RE: Case of FSGS with IgM and C3 post transplant 23 hours ago

My bad, now I understand your point , to consider that the donor had a COL4 variant , the evaluation of the donor was not done in US , I do not hav...

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RE: Case of FSGS with IgM and C3 post transplant 23 hours ago

thank you Dr Nauman Mother lives in India , from what I gather in the family history , she is doing very well We have a completely negative R...

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RE: Case of FSGS with IgM and C3 post transplant 23 hours ago

This may be a long shot but lack of nephrotic range proteinuria despite diffuse FPE, mother to child donation, I wonder if its genetic FSGS rather ...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 23 hours ago

Serum alkaline phosphatase and bone-specific alkaline phosphatase? Are hand, skull and spine x-rays suggestive secondary hyperparathyroidism? Besid...

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RE: Is Hypertonic Saline appropriate here 23 hours ago

Dr. Abdullah: As I am sure you know, use of IV sodium bicarbonate therapy in metabolic acidosis is a controversial topic. It is generally agreed th...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

thank you Dr Venkat for your comment very much appreciated 1 : is a possibility but his tacro trough have been rather low running 4 to 6 , also ...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

"There is striped interstitial fibrosis with proportional atrophy involving ~40% of the cortical tissue............................ IgM shows 2+ se...

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treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 day ago

Hello, I wanted to get some advice/opinions on how to proceed with management of this unfortunate ESKD pt. 63-year-old male, on PD since Augu...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

Genetists at our institution typically test the whole family unless someone does not consent. This makes interpretation of VUS easier. Though I und...

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Registration Kidneycon 2026 1 day ago

Nephrologists & Trainees Transform Kidney Care Together- 10 years of all things kidney- mentoring and network building..travel grants open. http:/...

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KidneyCon Invite! 1 day ago

http://kidneycon.org/registration please come and also share with tour trainees. KidneyCon is around the corner..- Nephrologists & Trainees Transfo...

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Case of FSGS with IgM and C3 post transplant 1 day ago

Dear Colleagues , I would appreciate your input and advice on this complex case , my apologies for this long post 36-year-old Male with proteinu...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

80% glomeruli sclerosed ... 90% IFTA... Plan for transplant --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of...

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RE: Is Hypertonic Saline appropriate here 1 day ago

I am not sure if I would give IV Na Bicarbonate, given it's Na load . Would try to get away with slow correction of the acidosis with oral Na Bicar...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

Did the EM include examination of a non-sclerotic glomerulus.? I am also curious to see the findings if double contours with mesangial interposit...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

No election dense deposits by EM raises p possibility that the IF is "false positive". We need to see the IF images. ----------------------------...

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RE: Is Hypertonic Saline appropriate here 1 day ago

On an unrelated note, if a patient with advanced ckd has concurrent metabolic acidosis, would you consider giving 8% sodium bicarbonate, would you ...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

The presence of immune deposits by IIF without electron dense deposits by EM would make Pronase digestion an unlikely tool to make a diagnosis . Ju...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

Markedly thickened GBM consistent with diabetic glomerulopathy. Extensive podocyte effacement can occur in heavily proteinuric diabetic glomerulopa...

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RE: Lupus Nephritis 1 day ago

I am not sure if there is any literature showing a benefit of a non Voclosporin CNI ,like Tacrolimus , especially in non nephrotic lupus . In such ...

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RE: Lupus Nephritis 1 day ago

CNIs are effective in higher baseline proteinuric LN but does not mean it is less or less preferable in low baseline proteinuric LN as they have 2 ...

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RE: Lupus Nephritis 1 day ago

I could not open the biopsy report , but if it is indeed Class 4 , I would consider a treatment regimen of Steroids , Mycophenolate and Belimumbab....

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RE: Lupus Nephritis 1 day ago

I fall in the Mayo Clinic School of management of this case. I would not use protocol re- biopsy but follow serology (C3/C4 ; anti-ds DNA antibody ...

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RE: Lupus Nephritis 1 day ago

I think your treatment plan is good. What will be your third medication? MMF + voclosporin or MMF + belimumab? I know that rituximab has not been...

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RE: Lupus Nephritis 1 day ago

Complete remission and hence long-term renal outcome is higher with triple therapy. Some opt for triple and some for double therapy, the vital issu...

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RE: Is Hypertonic Saline appropriate here 1 day ago

Great discussion. One issue which has not been addressed. Is the volume status of your patient. You indicated to me by email that the urine protein...

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RE: Lupus Nephritis 1 day ago

Since early aggressive therapy of Severe LN is important in securing an optimal long term outcome, why not use the best therapy available for initi...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

I concur with Dr. Balan's analysis - we need to know the specific details of the genetic mutations in the recipient and perhaps her affected siblin...

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