RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 23 minutes ago

I had a different take on Wagner's review. It was an excellent review of previous data and the history, but it really didn't add much to today's di...

View Discussion

RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 6 hours ago

Agree with the need to review unlabeled biopsy report. Allograft 27 yrs since transplant would be expected to have IFTA and possibly evidence of ch...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 6 hours ago

It should read that repeat gado dosing should be avoided. ------------------------------ Mark Perazella MD, MS, FASN Boynton Beach FL (203) 464-...

View Discussion

RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 7 hours ago

Any prior kidney transplant biopsies over the 27 years post-transplant? Were these free of findings suggestive of IgA nephropathy? Has SCr been sta...

View Discussion

RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 20 hours ago

See Haas et al KI Reports 2025 for a recent study of recurrent vs de novo IgAN in Allografted kidneys. ------------------------------ Richard Gla...

View Discussion

RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 21 hours ago

No personal experience with April- or April-BAFF inhibitors in this situation. De novo IgAN in renal allografts is pretty rare so no literature..Ho...

View Discussion

Immunotherapy For De Novo IgA Nephropathy Post Transplant 22 hours ago

62 year old with reflux nephropathy and LRD kidney transplant in 1999. De novo IgAN on biopsy. Currently on Envarsus, prednisone, sparsentan and da...

View Discussion

RE: Anti-PLA2R antibody +ve MN on a background of malignancy 1 day ago

Thank you so much Dr.Lambeau for your valuable input, that was very useful! ------------------------------ Safa Nowrooz MD Dr. Governmental Hospi...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

Less gadolinium is better. But, you don't want to limit gado dose and not get adequate images. Also, avoiding repeat dosing within short time inter...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

Thanks for the input , agree for not only MRI but for all other tests to be done when only necessary One more question, is using a low dose gadoli...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

We were among the first to enlighten Gadolinium toxicity. Although small, the risk is never zero. I would organize to meet the radiologist and the ...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

Besides NSF, there is evidence of Gd deposition (mainly with linear, but with 2nd generation as well) in the brain. Not just in CKD but in patients...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

My 2 cents. Are the new gado agents completely safe. Nope. However, their benefit when used to diagnose serious illnesses far outweighs their relat...

View Discussion

RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 1 day ago

That would be highly unusual for Cryo GN Do you have EM available? You should try to look for masked deposits by protease digestion and IF on fo...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

@Mark Perazella Fell free to pipe in on this, clearly there is lot more to this, there is reported chronic gadolinium syndrome (not skin) that re...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 2 days ago

thank you-I read the review which is excellent. reinforcing the view that MRI with Gadolinium is not a zero risk especially in CKD/ESRD. NSF was an...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 2 days ago

I agree, mostly; however, I do think there is a risk associated with gadolinium (see Brent Wagner's recent CJASN review), and I do my best to avoid...

View Discussion

RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 2 days ago

No.. there was no restriction on biopsy.. Suprisingly.. the IF was negative for all deposits.. I presume the cryo nature of the deposits might have...

View Discussion

RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 2 days ago

Thanks for the response. Will try to get the cryocrit levels.. Is there any explanation for why a clone could not be identified, despite clear evid...

View Discussion

RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 2 days ago

How was the light chain IF of the kidney biopsy, any light chain restriction? I think a rituximab based therapy (either 375 mg/m^2 or 1 g q2weeks)...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 2 days ago

He has started plex one session but not had any yesterday . He had a new line yesterday Will get anti gbm level today tho might be reduced but wil...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 2 days ago

did you repeat ANTI-GBM as suggested? If remains high as before then even if biopsy IF is inadequate IMO nothing changes ------------------------...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 2 days ago

How many glomeruli in the DIF.. ? were the extensively sclerosed or disrupted. False negative DIF has been seen in antiGBM disease when the DIF sam...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 2 days ago

My reply “Sorry to hear that . I was hoping to have IF as differential remain and infectious process and full house staining might make think about...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 2 days ago

Thanks everyone for help From histopatholgist “just did the DIF. It's negative across the board. However, I do have slight misgivings about the qu...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 2 days ago

Dr. Soobadar: is the immunofluorescence result available yet? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 --------------...

View Discussion

Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 3 days ago

I would greatly appreciate your opinion regarding the management of the following challenging case. A 42-year-old woman presented with fever, fat...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

Thanks , appreciate the advice --------------------------------- Aymen Al-Duajili MD Gulf Coast Nephrology Sugar Land TX (832) 526-1343 ------...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

let look at this from another perspective-agree with doing MRI with gadolinium using newer generations ( we all agree risk is low) but consequences...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

I assume linear IgG on biopsy. With oliguria , nearly 100% glomerular crescents and dialysis dependency his prognosis for recovery of useful renal ...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

I basically agree with Dr. Rodby. For what it's worth, we have an institutional policy on this and we do not initiate dialysis on a patient to dial...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

Anti-GBM antibody disease can present with fever in the elderly patient with a poor prognosis. Will find a paper and post it. --------------------...

View Discussion

RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

The vast majority of the nephrology community does not believe that there is any appreciable risk to the newer Gad compounds. And while Gad is dial...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

await IF and EM prior to stopping Plex. continue dialysis unless uo improves and evidence of intrinsic renal function. If any viable glomeruli (whi...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

Thanks prof lerman You would not immunosuppress stop steroid and plex and plan for dialysis? --------------------------------- Muhammad Soobada...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

"All renal screen negative . Cryoglobulin not sent ( complement normal )" per DR. Soobadar .IF REPEAT ANTI-GBM still high-then not likely infection...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

C3/c4 normal Histopathologist felt inflammatory changes in glom leads to tin Not concerned about infection IF and degree of chronicity awaited to...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

"significant glomerulitis": Does this mean endocapillary cellular infiltration ("exudative GN")? Especially, if there are abundant endocapillary ...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

and is daily plex or alternate day plex? ------------------------------ Muhammad Soobadar MBChB UK ------------------------------

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

patient had biopsy yesterday and plex today with octaplas and albumin. we need to remove femoral line tomorrow and insert temporary jugular line. ...

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

provisional histopathology report Notes LM- florid crescentic necotising GN almost all glomeruli glomerular tuff show significant glomeru...

View Discussion

RE: Lupus planning pregnancy, now with low C3/C4. 3 days ago

would think of patient as whole . If kidney biopsy is negative for LN but complement have gone done ds dna up and extra renal manifestation of lupu...

View Discussion

RE: Lupus planning pregnancy, now with low C3/C4. 3 days ago

I would be interested to know your thoughts on advising her if she undergo a kidney biopsy and that was negative for LN? Would you recommend that s...

View Discussion

3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

Dear colleagues I have a pt with progressive diabetic CKD IV/V, baseline cr 3.2-3.5, gfr 14-16, proteinuric Head ct scan showed left parietal lobe...

View Discussion

RE: Lupus planning pregnancy, now with low C3/C4. Wednesday, August 5 @ 12:11 PM

i think if she proceeds with pregnancy-you must monitor UPC, SEDIMENT, RENAL FUNCTION(CREATININE) OFTEN AT LEAST EVERY 2 WEEKS. could add CNI ,cont...

View Discussion

Apply to Participate in the ASN FIT Bowl at Kidney Week 2026 Wednesday, August 5 @ 8:40 AM

Hi All, Test your knowledge against your peers! Win ultimate bragging rights at Kidney Week! Join the American Society of Nephrology (ASN) F...

View Discussion

Encourage Your Fellows to Participate in the FIT Bowl at Kidney Week 2026 Wednesday, August 5 @ 8:39 AM

Encourage your fellows to join the American Society of Nephrology (ASN) Fellows-in-Training (FIT) Bowl at Kidney Week 2026 in Denver, CO. This year...

View Discussion

RE: Colleague Managing Home Hd Cohort Tuesday, August 4 @ 7:21 PM

Thanks a lot --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: anti gbm serology postive with fever and raised inflammatory markers Tuesday, August 4 @ 6:38 PM

Thanks prof lerman will definitely post as soon as available Best wishes --------------------------------- Muhammad Soobadar MBChB UK ---------...

View Discussion

RE: Lupus planning pregnancy, now with low C3/C4. Tuesday, August 4 @ 6:37 PM

7( continue to try pregnancy ) --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion