RE: IgA Kappa PGMID and EGPA 12 hours ago

KM55 has been shown to be negative in a small # of IgA-PGNMID cases but again data here are very limited but if positive would push me towards an u...

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RE: IgA Kappa PGMID and EGPA 12 hours ago

No worries :) ------------------------------ Jonathan Zuckerman MD, PhD UCLA Los Angeles CA (310) 794-1485 ------------------------------

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RE: IgA Kappa PGMID and EGPA 12 hours ago

I retired from patient care in 2017. I do only voluntary teaching of fellows now. Even 8 years ago, biopsy of both native and transplant kidneys wa...

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RE: IgA Kappa PGMID and EGPA 12 hours ago

Correction It should read DrZuckerma Apologies for the mistake --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 ...

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RE: IgA Kappa PGMID and EGPA 13 hours ago

That was our experience , particularly when Fellows made the passes., They tended to i deeper and ger more medulla and we would have a few glomerul...

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RE: IgA Kappa PGMID and EGPA 13 hours ago

Would KM55 staining help in this situation DrZuckman? --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 -----------...

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RE: IgA Kappa PGMID and EGPA 13 hours ago

Thanks Dr. Zuckerman for your very cogent, sage and helpful comments. One wonders if this is really an "atypical IgAN " whether RTX is a good choic...

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RE: IgA Kappa PGMID and EGPA 14 hours ago

Pronase IF may be helpful to confirm kappa LC predominance; although given the trace-1+ lambda staining in the first biopsy, I would be careful abo...

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RE: IgA Kappa PGMID and EGPA 16 hours ago

If plenty of glomeruli are available in the Paraffin embedded blocks, I would not do a repeat biopsy just to get additional frozen material.. do wh...

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RE: IgA Kappa PGMID and EGPA 18 hours ago

With respect to preservation of fertility. She is from Algeria and delivered a live child while on therapy for IgA PGNMID then developed Churg-Stra...

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RE: IgA Kappa PGMID and EGPA 18 hours ago

Thanks .i understand the limitations posed by scarce frozen tissue. But Pronase can be dine on Paraffin embedded tissue You are looking to unmask l...

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RE: IgA Kappa PGMID and EGPA 19 hours ago

Thank you to both for replying. Unfortunately, there is limited tissue left over for further IF. We will try to stain for KM55 and IgA subclass a...

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RE: IgA Kappa PGMID and EGPA 1 day ago

I applaud your present approach, but agree with Dr Glassock IgA LC restriction is usually lambda and typically does not represent a MGRS when pre...

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RE: IgA Kappa PGMID and EGPA 1 day ago

Troubling case. IgA kappa PGNMID is very rare-most cases are IgA lambda . Can you stain the biopsy for gdIgA with KN55.? Can you look for IgA1 vs I...

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IgA Kappa PGMID and EGPA 1 day ago

I have a patient with RPGN for whom trying to establish a unifying diagnosis and best treatment plan is proving challenging: 39-year-old Algerian w...

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RE: Diffuse proliferative GN 2 days ago

I agree that if the aortic regurgitation is of new onset this fact makes endocarditis a distinct possibility despite negative BC and a negative TTE...

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RE: Diffuse proliferative GN 3 days ago

Do we know aortic regurgitation is new any previous Echo How high was the rheumatoid factor because Rheumatoid factor can be positive at this age i...

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RE: Diffuse proliferative GN 3 days ago

I would still hold Endocarditis high in the DD. Other opinions welcome. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA ...

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RE: Diffuse proliferative GN 3 days ago

Update on the patients. Blood cultures, Borrelia, Bartonella and Q fever are all negative. RF is positive. Cryoglobulins are negative. They d...

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RE: Hypercalcemia in a patient with SLE/MCTD Friday, July 4 @ 10:38 AM

Dr. Venkat. Both bisphosphonates and Calcitonin are effective in treating hypercalcemia due to Vitamin D intoxication so the benefits observed in t...

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RE: Hypercalcemia in a patient with SLE/MCTD Friday, July 4 @ 10:10 AM

Dr Venkat, I agree. I think we will never know the exact mechanism but the case does teach us what e do not know. . ----------------------------...

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RE: Hypercalcemia in a patient with SLE/MCTD Friday, July 4 @ 8:05 AM

When she was hospitalized with serum calcium of 13.7 mg/dL, treatment with IV calcitonin and zoledronic acid decreased serum calcium to 7.1 mg to 7...

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RE: Hypercalcemia in a patient with SLE/MCTD Friday, July 4 @ 4:27 AM

I suppose that given the circumstances and the absence of a 25 -OH Vitamin D level at the time of hypercalcemia that we cannot fully exclude the po...

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RE: Hypercalcemia in a patient with SLE/MCTD Thursday, July 3 @ 8:39 PM

Agree, a fascinating chronologic story. "Increased bone resorption due to inflammatory cytokines and/or SLE-associated Increased bone resorption du...

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RE: Hypercalcemia in a patient with SLE/MCTD Thursday, July 3 @ 7:00 PM

Fascinating, very educational experience. That fir posting the follow -up. Agree that exogenous Vitamin D intoxication seems very unlikely -----...

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RE: Hypercalcemia in a patient with SLE/MCTD Thursday, July 3 @ 6:17 PM

Update on this patient To recapitulate, this 40-year-old female with SLE/MCTD had presented with the following features: 1. Severe hypoalbuminemia ...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 4:26 PM

Thank you. I don't really have much of an option. Nothing to lose by doing the genetic studies. I had discussed this with the patient after the pla...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 4:19 PM

Thanks. The initial proteinuria is a bit out of the range typically seen with genetic FSGS and the "partial response" to steroids and CNI is seen i...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 3:41 PM

Thank you That is correct. Patient was clinically very nephrotic with significant edema, low albumin and proteinuria of more than 10g/day at the ...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Thursday, July 3 @ 11:55 AM

Possible that if you post the genotype @John Lieske can tell you based on Mayo Clinic database if it is B6 responsive. Since you won't be able to d...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Thursday, July 3 @ 11:01 AM

Unfortunately, since you're a patient who died six months after simultaneous LK transplant Apparently did not receive intensive perioperative dialy...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 8:19 AM

If my reading of the thread is correct, the patients has demonstrated resistance to therapy with High disease of steroids , CNI and one course of R...

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Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 7:25 AM

Good evening I re biopsied the patient whose case I presented in May. I have attched the original thread below and the biopsy report from the 2n...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Thursday, July 3 @ 3:23 AM

"What treatment for recurrent PH did your patient with SLKT receive who did not survive?" intensified HDF dialysis 10 days before transplant + B6...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Wednesday, July 2 @ 7:34 PM

Please let us know the management plan you intend to pursue for this patient. Many thanks. ------------------------------ Richard Glassock MD, F...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Wednesday, July 2 @ 9:09 AM

One should also note that Alnylam has a compassionate use program for lumasiran that you can apply for. We have just received access to lumasiran f...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 8:08 PM

"How will detection of a pyridoxine sensitive mutation alter the planned sequence of LT and KT.?" It would not IMO but in the absence of Lumisari...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 8:02 PM

What treatment for recurrent PH did your patient with SLKT receive who did not survive? ------------------------------ [Mark] [Lerman] [MD,FASN,F...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 4:11 PM

In this setting pronase IF may be helpful in evaluating the hyaline pseudothrombi deposits which were seen by LM but did not appear to be captured ...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 3:18 PM

I resonate with Dr. Venkat's analysis, but organized deposits are not typically seen in Type III cryoimmunoglobulinemia. I still would do Pronase d...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 3:13 PM

What a great discussion of a very formidable and challenging management issue, complicated greatly by the un-Availability of Lumisarin. I sense agr...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 2:16 PM

I am going to be hyperbolic (I dont think that is the right expression but you get the idea) here: Whatever you do do it soon, This is what hap...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 11:19 AM

CLKT vs kidney tx results in better kidney graft survival but similar patient survival in B6 unresponsive PH Was that B6 responsive PH for which...

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RE: Question about HDF convection volume target Tuesday, July 1 @ 11:02 AM

When you ultrafilter 23L /BSA , how accurately can yoy achve the remova;of theinterdialytic fluid accumilated which can cary form 1 to 4?:. This ma...

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RE: Question about HDF convection volume target Tuesday, July 1 @ 10:01 AM

We are implementing a convection volume target of 23 liters per 1.73 BSA in our unit but we are not sure of the best target to monitor. In the best...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 9:32 AM

Is your patients genotype B6 responsive? CLKT vs kidney tx results in better kidney graft survival but similar patient survival in B6 unresponsiv...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 9:30 AM

IgG and IgM3+ with negative IgA on immunofluorescence certainly suggests possibility of cryoglobulinemia , type III (given lack of monoclonality by...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 9:23 AM

I don't have any personal experience in this area. Rapid access to and prompt availability of oxalate blood level results will be critical since ne...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 9:21 AM

Thanks Dr Glassock and Dr Rodby. HCV Ab and syphilis screening was negative. ANA was 0 by CMIA and neg by IFA. Our lab does not run ENA profile i...

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RE: Question about HDF convection volume target Tuesday, July 1 @ 9:01 AM

I believe in individualization, However, calculation of BSA as our normalization factor for persons of different weight and height but same gender ...

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