RE: Latent TB and Membranous Nephropathy 50 minutes ago

Thanks prof glassock hepatitis b /c negative Appreciate help Patient on treatment dose enoxparin with peak And trough level monitoring Have asked...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 3 hours ago

Was any renal work up including biopsy done in April 2025 when he had worsening renal function and on set of UACR 1600 mg per gm creatinine -----...

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RE: Anti-gap positive metabolic acidosis 7 hours ago

@Michael Emmett any thoughts ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Panc...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 8 hours ago

Dr. Rodby' points are all well taken. I would agree that supportive care should consist of an ACEi or an ARB plus an Endothelin antagonist (Atrasen...

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RE: Anti-gap positive metabolic acidosis 9 hours ago

Sorry, I wasn't clear about the Tylenol. The mother only gives Tylenol and not aspirin, but he has not had any Tylenol for several months. Sent fro...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 9 hours ago

Primary or secondary I'm not sure really matters at this point. This degree of ckd portends a bad long term renal prognosis. There is nothing wrong...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 9 hours ago

This case illustrates the aphoristic situation of "being between a rock and a hard place" The IgAN is most likely an association with Psoriasis , b...

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RE: Anti-gap positive metabolic acidosis 10 hours ago

Since pt got Tylenol it could have brought out an inherited glutathione deficiency? 5-oxoproline toxicity (also known as pyroglutamic acidosi...

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IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

Dear all, can I please get your thoughts with my patient. 48-year-old male with psoriatic arthritis and hypertension presents with worsening kidn...

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RE: Anti-gap positive metabolic acidosis 1 day ago

I agree venous pH is important just a little more difficult in a two year-old that I was consulted on the phone for a " curbside" consult .He was a...

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RE: Anti-gap positive metabolic acidosis 1 day ago

I'm an adult nephrologist. Blood work is just harder to get on little kids but working on it. Sent from my iPhone On Sep 5, 2026, at 06:56, James H...

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RE: Anti-gap positive metabolic acidosis 1 day ago

You're not critical, but there are some logistical issues. I was curbside consulted on the phone about this case. A pediatric nephrologist saw the ...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Yes I was thinking of hunting zebras. The child is nearly 3 and at the 50th percentile in both height and weight with normal intellectual function ...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Child voided in the laboratory and the mother reports the lab results were ready in less than an hour. Child hasnever received aspirin only acetami...

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RE: Hyponatremia 1 day ago

Drs. Hirsch and Rodby - thank you. I think we largely agree clinically; my remaining points concern the limits of individual measurements. Dr. Hir...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Mother denies salicylate ingestion, and she is quite reliable person Sent from my iPhone

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RE: Anti-gap positive metabolic acidosis 1 day ago

Please forgive me if I'm being critical, but Venus blood gases are so important in the initial evaluation of the serum electrolytes and anion gap. ...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Agree if previous recommended studied unraveling and VBG consistent with MA and osmolar gap are unrevealing Then plasma amino acids, acylcarniti...

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RE: Anti-gap positive metabolic acidosis 1 day ago

The abdominal pain may be a non specific symptom of the acidosis. The elevated U Na suggests the unmeasured anion is being excreted in the urine. A...

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RE: Hyponatremia 1 day ago

Thank you, Dr Liu, very nice. > However, in SIADH, the urine is concentrated (or at least not maximally dilute), so you will not have a vast u...

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RE: Latent TB and Membranous Nephropathy 1 day ago

Be sure to screen for any HBV before giving RTX or OBI ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School ...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Also intense thirst and polyuria are often seen in the early phases of salicylate intoxication. The blood salicylate levels should prove to be inte...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Venus, blood gas is ordered, but not yet obtained. Ultrasound of abdomen is normal. Minimal to no abdominal tenderness.I forgot the blood sugar ear...

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RE: Anti-gap positive metabolic acidosis 1 day ago

The alkaline urine and HAGMA suggests salicylate intoxication. However, if the urine pH was not tested immediately after voiding , it could be a sp...

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RE: Anti-gap positive metabolic acidosis 1 day ago

venous BG? ketones? BG? acetylsalicylic acid level? B-hydroxybutyrate ?, BP? imaging for abdominal tenderness? assume no glucose or ketones in urin...

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RE: Latent TB and Membranous Nephropathy 1 day ago

With a Hemoglobin of 10.8 there is no rush to give EPO. The severe Hypoalbuminemia can be an indication for Warfarin prophylaxis of VTE but the GI ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

The therapy of polygenic LN is the same as with no famiky members involved. I do not know if Mendelian LN should be treat differently -too rare, no...

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RE: Latent TB and Membranous Nephropathy 1 day ago

Any one can help me with questions? Appreciate it --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

If genetic lupus proven does that change management ? And if say children of patient were to have microscopic Haematuria and positive dna would w...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Thanks for case Agree with colleagues Is this not a NFH class V MLN with possibly class 2 Did the urine dip have red cell cast ? I would also us...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

I agree with Dr. Venkat. ------------------------------ Song Liu MD Assistant professor New Mexico University Hospital Albuquerque NM (505) 456-7...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

I agree with your plans to proceed with complement and genetic studies and deferring biopsy at present. Please do post follow-up information and ed...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Dear Professors Glassock and Liu, Thank you. I agree that biopsy and complement/genetic evaluation are complementary. However, since September 1,...

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Anti-gap positive metabolic acidosis 2 days ago

I was called to consult by phone on an interesting case. I am baffled and I'm hoping you'll be able to help me. 2 year 10 month old male with his...

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RE: Hyponatremia 2 days ago

Thank you, Dr. Hirsch - I agree that chronic SIADH generally reaches sodium balance and that superimposed gastrointestinal loss or post-diuretic vo...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

I think the bottom line is if TMA is confirmed and TAC is reasonably implicated it should not be restarted. Belatacept would be indicated IMO rathe...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

I agree- TAC induced TMA is an idiosyncratic reaction . Difficult or impossible to predict and not dose related, so it can occur or recurr even at ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

i don't disagree with restarting tac but FYI CNI associated TMA is not dose related. ------------------------------ [Mark] [Lerman] [MD,FASN,FACP...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Thank you very much. The actual donor is a 23-year-old living-related female. Preoperative typing demonstrated limited HLA matching: 2/10 alleles (...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

What about not restarting TAC and giving Belatacept instead? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen S...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Dr. Al-Saegh: Thanks for the update. Your patient is young. This increases risk of rejection if tacrolimus is withheld for too long. What was the ...

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RE: Hyponatremia 2 days ago

Agree with Dr's Neilson and Rodby. The standard teaching is that chronic SIADH is a state of Na balance: what goes in, goes out, U Na will reflect ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Thank you. From POD2–POD7, urine output recovered after hemorrhagic shock and has remained satisfactory. Creatinine improved sequentially from 2.31...

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RE: Hyponatremia 2 days ago

In pure SIADH the urine sodium is a function of diet so it can be anything. I agree with Rodby that a low urine sodium is somewhat unusual. I don't...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 3 days ago

FYI-See Nipp R et al Case Rep Onc Med 2014: 27: 165670 for a very similar case, ------------------------------ Richard Glassock MD, FASN Emeritus...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 3 days ago

Addendum - a meaningful but fairly small subset of Waldenstroms Macroglobulinemia patients display Rheumatoid factor (anti-IgG ) activity of the Ig...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 3 days ago

This new data clearly reclassifies the patients Disease from a MGRS to a neoplastic process demanding specific therapy for Waldenstroms Macroglibuk...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 3 days ago

Update to thread - new molecular result Thank you all for the discussion so far; your insights are most valuable. I suspect this to be clone resi...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 3 days ago

I agree with Dr. Aledan - the EM shoes typical findings of an early rather segmental form of MN, probably Class V LN or conceivably a NELL 1 MN sup...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 3 days ago

Thanks Dr. Mohammed- interesting information. I believe that Mendelian inheritance of SLE is very rare - about 1% and most often seen in young chil...

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