RE: C3 or IgA 51 minutes ago

It is very clear that CFHR5 mutations are associated with an INCREASED risk of both C3GN and IgAN. ------------------------------ Richard Glassoc...

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RE: C3 or IgA 54 minutes ago

He had a biopsy at 3 months and 6 months post transplant . He also got 1 dose Eculizumab, 1 week prior to the transplant and a second dose 2 weeks ...

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RE: C3 or IgA 59 minutes ago

Thanks for the follow-up. How long following kidney transplantation is follow up available. I would judge that there is a high risk of recurrence o...

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RE: C3 or IgA 1 hour ago

I was under the same assumption as Dr. Balan. That is the generic mutations causing aHUS/C3 , were protective against IgA . These mutations are ver...

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RE: C3 or IgA 1 hour ago

This patient had a successful kidney transplant . His post transplant biopsy is pristine , no IgA or C3 . On a regimen on Tac and MMF ------------...

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RE: C3 or IgA 2 hours ago

Addendum- I Would probably stop the Pegacetocoplan and start MMF and moderate does of steroids or even Iptacopan. But who really knows how to treat...

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RE: C3 or IgA 2 hours ago

This provides the Answer to your question. This mutation (CFHR5) is associated with an increased risk of BOTH C3GN and IgAN!!! Why the Pegacetocopl...

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RE: C3 or IgA 3 hours ago

See attachments --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidney Care. Nephrology Consulta...

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RE: Renal phosphate wasting 4 hours ago

Another suggestion. If you are thinking of Albers Schonberg disease, (and which seems likely here), then please screen other family members as this...

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RE: C3 or IgA 5 hours ago

What was the genetic variant in this patient? To add to the complexity, CHFR variants are known to protect against IgA nephropathy -------------...

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RE: C3 or IgA 12 hours ago

I also suppose that in such counter-intuitive outcomes, a technical error needs to be given serious consideration. Time will tell. -------------...

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RE: C3 or IgA 13 hours ago

Btw... The first 2 biopsies were done in the Kingdom of Bahrain, I did try to contact them but was unsuccessful . I could make another push though ...

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RE: C3 or IgA 13 hours ago

Agree this is a strange and counter-intuitive outcome. All the more reason to pursue the cause with greater intensity and depth. Nature may be tryi...

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RE: C3 or IgA 13 hours ago

This thread only has 2 cases , my patient with C3G had 3 biopsies --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consul...

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RE: C3 or IgA 13 hours ago

Come to think of it , C3 inhibitors such as Pegcetacoplan are being trialled in IgA nephroapthy... So for them to cause igA deposits would be stran...

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RE: Initiating Statin In Dialysis Patient 14 hours ago

For thosw who do not use the international units for various blood components, would be helpful to provide the values in amount/dL or L, or also pr...

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RE: C3 or IgA 14 hours ago

Thinking out loud. How would the intial insult that led to C3 disease be followed by IgA qhich requires a first hit by the lymphoid tissue in the g...

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RE: Renal phosphate wasting 14 hours ago

This is a very interesting case and I agree with Dr Glassock that the combination of what sounds like Osteopetrosis and phosphaturia suggests an Os...

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RE: C3 or IgA 16 hours ago

The first approach would be to be to stain the post therapy biopsy with KN55 (anti-gdIgA) and the second would be to do Pronase digestion and Paraf...

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RE: C3 or IgA 19 hours ago

I really don't have an answer ... was hoping for the forum to assist , as this case has been on my mind for a few months . ----------------------...

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RE: C3 or IgA 19 hours ago

So are these cases examples of drug induced (Secondary) IgA deposit disease (not true de novo Primary IgAN)? I think this is very possible. Further...

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RE: C3 or IgA 20 hours ago

The patient also had significant Generic mutations consistent with C3G. So am inclined to believe it's not Pseudo C3 deposits -------------------...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 20 hours ago

Are you worried about RTX reactivating HBV with + anti-HBc antibody.? I am. ------------------------------ Richard Glassock MD, FASN Laguna Woo...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 23 hours ago

Cr now normal after ritux steroids and plex for Pauci immune GN with pulmonary hemorrhage in setting of MULTIPLE infections. what is urinalysis n...

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RE: C3 or IgA 1 day ago

These are "ominous" findings. Is it possible that the apparent "de novo" IgAN represents an IgA antibody response to "planted"Pegacetocoplan or Ecu...

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RE: C3 or IgA 1 day ago

Unable to explain the reason but have observed the same in one of my patient, initial biopsy C3GN, second biopsy after treatment with Eculizumab, s...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 1 day ago

Thank you all for the valuable and enriching discussion. We had a case of bilateral lower limb dry gangrene, and calciphylaxis was suspected, we d...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

Tough case. Judgement call. No data to support any particular regimen as best. MMF has been marginally effective in maintaining remission in AntiPR...

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RE: C3 or IgA 1 day ago

The patient had an URTI , followed be Nephrotic syndrome . First biopsy : had 30% IFTA ; Second Biopsy : had 40% IFTA The gap between the seco...

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RE: Initiating Statin In Dialysis Patient 1 day ago

Thanks . Not diabetic Cholesterol 4.9 mmol/l LDL 3 mmol/l Triglyceride 2.4 mmol/l Hdl 0.8 mmol/l --------------------------------- Muhammad Soob...

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RE: Recalcitrant severe hyponatremia 1 day ago

Thank you, Dr. Rodby, for your article. In it, 7 control and 8 hyponatremic psychiatric patients in the setting of a Clinical Research Center and r...

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RE: C3 or IgA 1 day ago

De novo IgAN following Pegacetocoplan therapy. I doubt it. Can you arrange for Pronase digestion and Paraffin IF on the prior two kidney biopsies.?...

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RE: Initiating Statin In Dialysis Patient 1 day ago

Go with the Data. No reason to start a statin What is his lipid profile? is he a diabetic? ------------------------------ Richard Glassock MD, F...

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C3 or IgA 1 day ago

I have a young 29 year old male from Pakistan He had an infection, followed by worsening renal function Biopsy 1: C3G, C3 deposits 2+ ( externa...

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RE: Renal phosphate wasting 1 day ago

When I've ordered intact FGF23 from Mayo in the past the lab comes with the disclaimer below. I wonder if the FGF23 levels of 68 pg/ml and 74 pg/ml...

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Initiating Statin In Dialysis Patient 1 day ago

72 male patient established on hd Previous T cell Lymphoma in remission Bg left atrophic kidney Having transplant work up done Primary care doc...

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RE: Renal phosphate wasting 1 day ago

When uou do the Alk phos, consider doing both total and bone specific Alk Phos. Might give some clues as to what the bone turnover is. ----------...

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RE: Renal phosphate wasting 1 day ago

Subject: Re: Renal Phosphate Wasting with Elevated BMD - Further Thoughts Dear Dr. Landry, Thank you again for presenting such a compelling and u...

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RE: Renal phosphate wasting 1 day ago

I have a very similar patient, also male. Equally stumped. Genetic testing also negative. PTH, FGF-23, vitamin D, SPEP, imaging all negative. Manag...

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RE: Recalcitrant severe hyponatremia 1 day ago

Thank you everyone. It has been very informative! I have tried to approach this case via physiology. The pre treatment urine sodium [More]

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

Positive PR3 would put her at high risk of recurrence ... Pulmonary lesions in AAV are usually life threatening ---------------------------------...

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RE: Recalcitrant severe hyponatremia 1 day ago

Dr. Rodby- 'a touch of SIADH , polydipsia and low solute intake " - a triple Hickam!!! . I think you are probably correct, ----------------------...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

PR3 was 148 - 23rd Apr prior to PLEX ---> recent PR3 is 75 ( two weeks after completing PLEX). Planning to repeat in two weeks antiHBc was POSITI...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

"In thus case, a "do no harm" perspective would be appropriate". Indeed, that's exactly are my thoughts too. She only received PLEX and Prednisol...

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RE: Recalcitrant severe hyponatremia 2 days ago

forgot to attach , here it is ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Ch...

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RE: Recalcitrant severe hyponatremia 2 days ago

"Although I am not clear as the diagnosis of hyponatremia in this patient, I wanted to raise the issue of what is maximally dilute urine. Most text...

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RE: Recalcitrant severe hyponatremia 2 days ago

Although I am not clear as the diagnosis of hyponatremia in this patient, I wanted to raise the issue of what is maximally dilute urine. Most textb...

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RE: Renal phosphate wasting 2 days ago

Thank you for this suggestion. It would appear that a mild form of autosomal dominant osteopetrosis (Albers-Schonberg disease as the authors descri...

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RE: Renal phosphate wasting 2 days ago

My apologies for leaving out PTH: it is 45 I did a screen for paraprotein with SPEP with no monoclonal protein detected He has a normal bicarbo...

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RE: Renal phosphate wasting 2 days ago

Po4 is regulated by FGF 23 , Pth (do you have a PTH?) in advanced Vit D deficiency, and then there is Fanconi. is there any other evidence of Fan...

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