RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 hours ago

Why not the whole picture is just LN without systemic thromboembolic events as SLE can present with thrombosis events independent of APS. Agree fo...

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RE: Drug-induced lupus and ANCA GN 2 hours ago

Is it safe to use hydralazine in patients with MPO MPA Anca vasculitis ? The reason I ask, is that we have a patient in the ICU, with severe MPO v...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 hours ago

Yes he was being PLexed with albumin. --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh S...

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RE: MCD-IgA nephropathy 2 hours ago

I saw the patient today, follow up labs with improving UPCR to 1.5 g/g, still on high dose steroids 60 mg daily, but he reported skin rash on his a...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 10 hours ago

‘ADAMTS13…no antibodies.’ ‘PLEX with FFP’. Had he been PLEXed leading up to recheck of ADAMTS13 activity & if so, was albumin being used then i...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 16 hours ago

Dr. Dastoor. Many thanks for the clarification. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of M...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 17 hours ago

Apologies, the lack of hematuria progress was in the IgA patient. The FSGS patient has no discernable hematuria ---------------------------------...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 23 hours ago

I suppose that the lack of any beneficial effect of Atrasentan on hematuria in genetic FSGS should not be a surprise, since the glomerular lesion i...

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RE: unexplained renal failure 23 hours ago

Thanks - of course and elevated ESR occurs in patients with active AS but the initial post " year old male patient who is a known case of ankylosin...

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RE: unexplained renal failure 1 day ago

Thank you Dr. Glassock! We will update our website to make this clearer. And yes, Wake Forest does testing for MUC1 unlike some of the other labs...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 1 day ago

this is the hematuria trendoverlast1year-essentiallyunchanged ------------------------------ Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of...

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RE: Nephrogenic Diabetes Insipidus 1 day ago

Dr. Sands, there are new guidelines to diagnose NDI without Water Deprivation Testing by measuring unstimulated serum Copeptin levels. The Jo...

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RE: unexplained renal failure 1 day ago

To answer to one of the questions posed, the elevated sed rate in ankylosing spondylitis is quite classic, and hence he likely has active disease (...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

We reviewed the case again today His renal function is improving with creatinine decreasing from peak of 400 umol/l to 250 umoll ( 3 mg/dl) the...

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RE: Nephrogenic Diabetes Insipidus 1 day ago

1) limit solute intake (low salt low protein diet may help) I think this is under appreciated 2) Thiazides... Slippery slope if on Li which is m...

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Are International Kidney Disease Guidelines Equally Applicable Across Different Healthcare Settings? 1 day ago

International guidelines provide an essential foundation for evidence-based nephrology. However, implementing their recommendations may be challeng...

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RE: Nephrogenic Diabetes Insipidus 1 day ago

Therapy of NDI, and its success, has not changed much in the last decade. Specifically - find and treat the cause (Lithium, hypercalcemia , etc) ; ...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 1 day ago

I share the words of caution of Dr. Glassock regarding atresantan. This drug had no fortune in the management of hypertension because of significan...

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Nephrogenic Diabetes Insipidus 1 day ago

I am interested in the current treatment for nephrogenic diabetes insipidus (NDI). How are people currently treating NDI? How effective is this the...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

In my opinio this is not CAPS but rather macro-vascular thrombosis In patients with severe LN and hydralazine induced Anti-MPO due to non-criteria ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

My only suggestion is that this patient needs "triple immunosuppressive therapy " for aggressive Proliferative LN .pi woukd avoid any exposure to a...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 1 day ago

I agree- adding Atrasentan to a stable (maximal) dose of RASI should be "as good as " switching to Sparsentan (for supportive care in IgAN) , but t...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

How long was hydralazine exposure? What was Salbumin at presentation? Did he have a ‘bubble’ echo study? What about anti-beta2GPI? “Lesions of TM...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

thanks , the ADAMS TS13 activity is normal and no antibodies I would just like to add that on admiision his creatinine was 420 umoll/l ( 4.8 mgdl...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

"I would go with a diagonis of SLE , and associated TMA suggested by fibrin thrombi" agree but you have called this renal limited TMA, remembe...

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Atrasentan in Genetic FSGS and IgA Nephropathy 2 days ago

As we still do not have Sparsentan in our formulary , i wanted to highlight and share with the community our expreience with Atrasentan , in select...

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Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

48 year old male from the UAE . Apparently was normal and working in the military . 4 weeks ago noticed that he had SOB and was diagnosed as PE and...

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RE: unexplained renal failure 2 days ago

Susan-thanks for your suggestion-question assuming AS in this patient is not active how would you explains ESR > 100 if ADTKD and no family history...

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RE: unexplained renal failure 2 days ago

It is not entirely true that ADTKD will not reveal itself on a kidney biopsy. PAS + glycoprotein aggregates surrounding the TAL with associated inf...

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RE: unexplained renal failure 2 days ago

It could be ADTKD? Autosomal Dominant Tubulointerstitial Kidney Disease. Genetic testing is the only way to diagnose (will not show up in a biopsy)...

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RE: MCD-IgA nephropathy 2 days ago

I would still treat as a podocytopathy, worth the try, but I wold go with Rituximab alone, steroid sparing avoiding ----------------------------...

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RE: unexplained renal failure 2 days ago

I would do genetic testing first (if available) before renal biopsy, we have picked up a few COL4A3-4 alports (yes even without hematuria) or some ...

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RE: unexplained renal failure 3 days ago

Vascular Or tubulointerstitial amyloidosis is more common in AL and ALECT2 amyloidosis rather than AA amyloidosis which more commonly cause glomeru...

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RE: unexplained renal failure 3 days ago

Yes very uncommon but can present without proteinuria (albumin) ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [...

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RE: MCD-IgA nephropathy 3 days ago

Three kidney diseases in one patient. Dr Hickam was correct!!! ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen...

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RE: MCD-IgA nephropathy 3 days ago

Because of biopsy proven Stage 3 DN in this case I would stress, Metformin, SGLT2i, GLP1RA and Finerenone for ongoing management after successful t...

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RE: unexplained renal failure 3 days ago

First rule out obstruction (ultrasound) and light chain cast Nephropathy (serum FLC and Immunofixation) . If unrevealing , a kidney biopsy is neede...

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RE: MCD-IgA nephropathy Saturday, October 24 @ 4:17 PM

I would not give immunomodulators to target IgAN if proteinuria improved and has complete remission. ------------------------------ Sarah Al Zou...

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RE: unexplained renal failure Saturday, October 24 @ 11:34 AM

Renal AA amyloidosis with deposits confined to or predominantly in the vascular/tubulointerstitial compartments, while uncommon, is a possibility. ...

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RE: unexplained renal failure Saturday, October 24 @ 10:50 AM

Agree with what had mentioned already. Simultaneous UPCR and UACR is important first step to look for plasma cell dyscrasia. AS associated kidney...

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RE: MCD-IgA nephropathy Saturday, October 24 @ 9:35 AM

Dr . Sarah, the article didn’t mention the add-on therapy for DFPE non-MCD like IgAN, maybe MMF for Asian ancestry or CYC for crescentic IgAN. For...

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RE: unexplained renal failure Saturday, October 24 @ 8:55 AM

Agree need SLC and urine protein ekectrophoresis - would also get CRP - kidney biopsy may be necessary if noninvasive is unremarkable ----------...

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RE: unexplained renal failure Saturday, October 24 @ 8:45 AM

Thank you dr weal for sharing this case . How long has his creatinine been at this level? Medication history is important, especially for chronic u...

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unexplained renal failure Saturday, October 24 @ 6:19 AM

72 year old male patient who is a known case of ankylosing spondylitis, not on medication currently, with no features of active disease, he is hype...

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RE: MCD-IgA nephropathy Saturday, October 24 @ 5:53 AM

If the nephrotic syndrome improves and reverse to normal with prednisolon, I mean no proteinuria, is it still indicated to treat the underlying IgA...

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RE: MCD-IgA nephropathy Friday, October 23 @ 11:18 PM

I would agree with a probable auto-immune diffuse Podocytopathy superimposed on IgAN and stage III Diabetic nodular Glomerulosclerosis - would have...

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RE: MCD-IgA nephropathy Friday, October 23 @ 9:54 PM

Thank you Dr. Rodby! I agree, he has mesangial deposits on EM but likely missed on the report! Would you add any of the novel treatments for I...

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RE: MCD-IgA nephropathy Friday, October 23 @ 9:49 PM

Thank you for your thoughts. Agreed with you about the diagnosis, he doesn't seem to have signs and symptoms of infection, diabetes was controlle...

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RE: MCD-IgA nephropathy Friday, October 23 @ 9:41 PM

That's very helpful, thank you.. I think he fits more into MCD-like IgA, I will take a look to the publication.. Was the type of other IS for non-M...

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RE: MCD-IgA nephropathy Friday, October 23 @ 9:26 PM

Thank you.. how long would you wait while on steroids, assuming DM is controlled on insulin? ------------------------------ Sarah Al Zoubi MD Oak...

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