RE: Biopsy or not 42 minutes 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 3 hours 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 5 hours 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 6 hours 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 6 hours ago

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

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RE: nephrotic syndrome 6 hours 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 6 hours 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 7 hours 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 8 hours 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 9 hours 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 10 hours 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 10 hours 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 11 hours 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 12 hours 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 13 hours 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 19 hours 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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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RE: A case of Acute Kidney Injury. 1 day ago

Dr Glassock- Albumin is 2.2. First Biopsy was mostly medullary. Dr Friedman- Thanks for the comment. Interesting! Dr Lerman- Anticoagulation i...

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RE: Role Of endothelin blockers In igA Nephropathy 1 day ago

The clinical reasoning of Drs. Hirsch and Rodby is quite fair and sensible. The dictum is that the "lower the proteinuria the better", especially w...

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RE: Role Of endothelin blockers In igA Nephropathy 1 day ago

I am partial to Dr Rodby's thinking here. I have given Sparsentan recently to several IgA patients in the 500-1000 mg range. It is based on extrapo...

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RE: A case of Acute Kidney Injury. 1 day ago

The discrepancies between the first and second kidney biopsy specimens is striking.. any explanations for this phenomenon. Is it all sampling error...

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RE: Likely Active C3G before transplant 1 day ago

C3GN is not an absolute contraindication for renal transplant though high risk for recurrence. IMO low C3 does not necessarily increase risks for r...

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RE: Likely Active C3G before transplant 1 day ago

is expected transplant living related, unrelated, or DD? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Me...

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

Yes, but in post-hoc analyses like this we need to be cautious in interpreting an association as proof of causation. ----------------------------...

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

this article seems to suggest that lowering proteinuria to less than 0.3 g/g is significantly renoprotective --------------------...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

Makes sense. Thank you. ------------------------------ B. Andre' Weinstock, PhD Scientist & Alport syndrome-COL4A5 patient Somerville, MA USA ---...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

In my opinion , genetic testing has limited value in Family planning for C3GN- genetics determines susceptibility, not destiny . Variable penetranc...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

Given incomplete and variable penetrance, except for CFHR5 nephropathy ,,a positive result can't give a child-specific risk estimate - most carrier...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

If readily available, genetic testing might be considered to aid in family-planning decision making of a diagnosed parent and partner. ----------...

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

The value of adding an ET Blocker (Atrasentan) or switching to a DEARA (Sparsentan) in such patients with IgAN to get the proteinuria below 0.3gms ...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

i agree- genetic testing in C3 GN is primarily of research interest- at least for now. ------------------------------ Richard Glassock MD, FASN E...

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RE: Pre-conception Strategy in CKD 3 with Proteinuria (Preserved Albumin)re: Biopsy Timing, Genetic Panel, and Pregnancy Monitoring 2 days ago

I agree with Dr. Rodby, except I would do genetic testing first as the results may make kidney biopsy unnecessary. This will be a very high risk pr...

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

"However from an economic standpoint does it make sense to introduce these drugs , considering studies on ET1a was mainly in patients with more tha...

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Likely Active C3G before transplant 2 days ago

Hello everyone we have 22y guy, ESKD on dialysis (twice weekly since august 2026). He has a long history of chronic GN with last biospy in 202...

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RE: A case of Acute Kidney Injury. 2 days ago

I assume the sensitivity of intratubular RBCs/RBC casts decays over time in ARN. And from the dates reports were printed, it would seem at least 1 ...

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Role Of endothelin blockers In igA Nephropathy 2 days ago

We have a couple of patients with IgA Nephroapthy, who have been treated in the past with IS therapy , some without IS therapy. But all of them on...

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RE: Pre-conception Strategy in CKD 3 with Proteinuria (Preserved Albumin)re: Biopsy Timing, Genetic Panel, and Pregnancy Monitoring 2 days ago

I would push for a biopsy after a Natera full screen (assuming negative) I suspect she has a secondary FSGS of some sort. PCR seems a bit high fo...

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Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

In my opinion — no. Would like the community's input on this. Unlike aHUS, genotype doesn't drive diagnosis, treatment, monitoring, stopping decisi...

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RE: A case of Acute Kidney Injury. 2 days ago

What was the patients serum albumin level when he presenterd with AKI and marked proteinuria? ------------------------------ Richard Glassock MD,...

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RE: A case of Acute Kidney Injury. 2 days ago

"As far as anticoagulation is concerned, he had a stroke off anticoagulation 2 years ago, so he is still on it as of now. Ongoing discussion with c...

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RE: A case of Acute Kidney Injury. 2 days ago

Dr Lerman and Dr Glassock for your valuable input. Also all others who contributed their time and expertise. I already started tapering steroi...

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RE: A case of Acute Kidney Injury. 2 days ago

Thanks, unless I'm missing something I don't see any convincing evidence for tubular obstruction from red blood cells that would explain or suggest...

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RE: A case of Acute Kidney Injury. 2 days ago

The biopsy report shows no evidence of nodular glomeruloscleroisis . No increase GBM thickness . No IgA deposits. The frequency of intratubular RBC...

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