RE: Would you Re biopsy this IgA? 49 minutes ago

@Richard Glassockwould you consider ET1a antagonist at this eGFR?? --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional...

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RE: Would you Re biopsy this IgA? 59 minutes ago

I would not rebiopsy but would add GLP1RA, small doses of RASi, SGLT2i and, if tolerated , Finerenone. I see no indications for immunosuppression a...

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RE: Puzzling Case of Post-Transplant Proteinuria 1 hour ago

Dr. Venkat - can you find out what happened to the other kidney from this deceased donor. ? If similar proteinuria developed, this would point to a...

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RE: Would you Re biopsy this IgA? 1 hour ago

Thank you Dr. Venkat. I also think so but do I need confirmation; any chance that management could change based on any other findings (I have ...

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RE: Would you Re biopsy this IgA? 2 hours ago

Fluctuating proteinuria could have been due to interruptions in RAAS-blockade and SGLT2-I therapies. SAlb level trend? Kidney size/echogenicity cor...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 hours ago

Dr. Lerman: After retirement, I function as an honorary teaching attending at my former hospital. I no longer have any patient management privilege...

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Would you Re biopsy this IgA? 3 hours ago

57-year-old man with biopsy-proven IgA nephropathy diagnosed at age 19, lost to follow up for multiple years, now with CKD and persistent significa...

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RE: SGLT2i & renal tubular creat secretion 4 hours ago

https://pubmed.ncbi.nlm.nih.gov/36736537/ --------------------------------- Oded Friedman ---------------------------------

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RE: SGLT2i & renal tubular creat secretion 4 hours ago

Oded: Makes sense. Do you have a reference for this plz? ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Ass...

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RE: Puzzling Case of Post-Transplant Proteinuria 5 hours ago

When I first read this post, I thought of donor-derived RME failure, eg biallelic cubilin mutations, worsened by the ATI but then the progression a...

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RE: SGLT2i & renal tubular creat secretion 5 hours ago

An increased mClcreat/mGFR ratio post-SGLT2i could reflect pseudo-chromogen effect of glycosuria on (some) Jaffe Ucreat (assays) rather than an act...

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RE: Puzzling Case of Post-Transplant Proteinuria 7 hours ago

Sorry I meant the genetic testing in the donor. In Turkey, since more than 90% of kidney transplants are performed from living donors, we usually h...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 9 hours ago

Indefinite therapy duration with Pegcetacoplan is probably not feasible or appropriate . Incomplete penetrance and modifier genes ate going to impa...

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RE: Puzzling Case of Post-Transplant Proteinuria 12 hours ago

dear Dr. Venkat- did you post this unexplained case of post transplant significant proteinuria for a colleague or do you have direct management ? I...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 12 hours ago

While pegcetacoplan works broadly across the cohort, the Valiant trial doesn't define the optimal duration of therapy. In patients with a proven, l...

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RE: SGLT2i & renal tubular creat secretion 12 hours ago

Thank you Dr Glassock> Yes, I was aware of the initial hemodynamic effect. My qstn had to do more with a longer duration of observation, like a chr...

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RE: SGLT2i & renal tubular creat secretion 12 hours ago

So far as I know there are no established effects of SGLT2 inhibitors on tubular secretion of creatinine. The rise of serum creatinine after initia...

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RE: Puzzling Case of Post-Transplant Proteinuria 13 hours ago

You must mean genetic test in the donor not the recipient- to evaluate donor derived dieease. ------------------------------ Richard Glassock MD,...

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SGLT2i & renal tubular creat secretion 13 hours ago

Hello Folks: Is anyone aware of a publication (human or animal study) that has directly examined this qstn ? Much appreciated. AI sites do not seem...

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RE: Puzzling Case of Post-Transplant Proteinuria 13 hours ago

We had a couple of cases with post-transplant early proteinuria like this which unexpectedly came up to have COL4A mutation. Dr Venkat, I think it ...

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RE: nephrotic syndrome 14 hours ago

If you think you need to biopsy a solitary kidney in order to manage this patient, I see no reason for a delay. You will have to stop all anticoagu...

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RE: nephrotic syndrome 16 hours ago

Although FSGS lesion due to Cabozantinib much more likely, another differential could be RCC causing AA Amyloid? Especially with massive protienuri...

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RE: Biopsy or not 1 day ago

Thank you, everyone, for the very helpful insights and discussion. To answer some of the questions raised, her UA showed trace hematuria with 5 R...

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RE: Biopsy or not 1 day ago

Dr. Hirsch- thanks for your well framed words- a delight to read them- they validate a long life filled with curiousty. All my best to you!! ----...

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RE: Biopsy or not 1 day ago

Dr. Lee's post mentions "trace" hematuria. It will be helpful to know how many RBCs/HPF, if they were dysmorphic and any casts were seen. Not convi...

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RE: Biopsy or not 1 day ago

Microscopic hematuria has been described in "10-35%" of patients with proven DM nephropathy so I doubt that this alone (without RBC casts, and with...

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RE: Biopsy or not 1 day ago

Great response Dr.Dastoor- maybe shared decision making is the answer. How will having a precise diagnosis help the patient. --------------------...

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RE: Biopsy or not 1 day ago

I agree that with untreated diabetes and uncontrolled HTN there is a rapid decline . In fact it was suggested that the average egFr decline correla...

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RE: nephrotic syndrome 1 day ago

Looking at the literature, there are cases of severe proteinuria with cabozantinib. We were impressed by the 23 grams. We hesitated to perform a ...

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RE: Biopsy or not 1 day ago

I agree with Dr Glassock: In the modern era of aggressive DM treatment and great success we sometimes forget that the natural history of poorly tre...

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RE: nephrotic syndrome 1 day ago

Thank you both for your comments. IgG 560 mg/dl ------------------------------ Ioannis Giatras MD N. Erythrea 2106771540 ------------------...

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RE: nephrotic syndrome 1 day ago

"IgG low" How low is the IgG level? This may influence choice of rituximab vs steroids for treatment of podocytopathy. ------------------------...

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RE: Biopsy or not 1 day ago

May repeat kidney ultrasound. With diabetic nephropathy and amyloid, kidneys may not become smaller. However, marked increase in echogenicity compa...

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RE: Biopsy or not 1 day ago

It won't modify management at this stage , but perhaps help in diagnosis , if the patient is inclined.. risks of bleeding also increase with lower ...

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RE: nephrotic syndrome 1 day ago

I meant to say MCD/FSGS (a diffuse podocytopathy ) from cabozinitib (a VEGFR inhibitor) ------------------------------ Richard Glassock MD, FAS...

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RE: nephrotic syndrome 1 day ago

The clinical features suggest MCD as a complication from ICI (nivolumab) . You could treat empirically with steroids or RTX if you are concerned ab...

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RE: Biopsy or not 1 day ago

According to my experience and the available literature the rate if decline of eGFR expected in DN is quite broad- between 2 and 20 ml/min/1.73M2/ ...

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nephrotic syndrome 1 day ago

I would appreciate your input on the following case: Male 53 years old, no previous history August 2022: iliac bone biopsy metastatic RCC (...

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RE: Biopsy or not 1 day ago

Dr. Dastoor. Do you think that a kidney biopsy has a chance of modifying management.? If so, what is your estimate of the likelihood of such an out...

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RE: Biopsy or not 1 day ago

DM nephropathy - eye exam Amyloid as was suggested Genetic FSGS - any family hx IgA -??? Renal limited TMA ( hx of preeclampsia) Could be sever...

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RE: Biopsy or not 1 day ago

Your patient has many of the hallmarks of Diabetic Nephropathy and it is highly unlikely that a kidney biopsy will change management in any signifi...

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Biopsy or not 2 days ago

Hello everyone, I wanted to discuss about my case of 41 y.o. Caucasian female with history of uncontrolled type 2 DM, hypertension, rheumatoid...

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RE: Likely Active C3G before transplant 2 days ago

Living related. His potential kidney donor is his mother (47 y) --------------------------------- Ahmed Emara MD, FASN Ain Shams University CA...

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RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

I'm surprised how cheap sparsentan is in UAE, but assuming that reflects the unique characteristics of the US healthcare system! But for full trans...

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RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

Agree with Dr. Hirsch and Rodby about their comments. Because at UPCR of 05-0.7 g/g, there are still residual risk and the younger the patients, th...

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RE: Likely Active C3G before transplant 2 days ago

from AI consultant- KDIGO 2020 recommends NOT excluding C3G candidates from transplantation (1B), because 5-year allograft survival exceeds 5...

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RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

Thanks for the response , I am surprised that ET1 blocker costs USD 27k a month . The prices of drugs in Abudhabi, mirror that of the US . 30 day p...

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RE: Likely Active C3G before transplant 2 days ago

Persistently low c3 means the alternative pathway is continuously activated at fluid phase which makes future graft involvement high. Better to def...

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RE: Likely Active C3G before transplant 2 days ago

As noted, C3G has a high risk of recurrence. If you have access to Iptacopan or pegcetacoplan, I would have no qualms about proceeding. I would cou...

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RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

I appreciate this thoughtful discussion on a complex and nuanced topic of treating IgA nephrophathy with the proliferating class of newer drugs. ...

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