RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 6 hours ago

FYI-See Nipp R et al Case Rep Onc Med 2014: 27: 165670 for a very similar case, ------------------------------ Richard Glassock MD, FASN Emeritus...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 7 hours ago

Addendum - a meaningful but fairly small subset of Waldenstroms Macroglobulinemia patients display Rheumatoid factor (anti-IgG ) activity of the Ig...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 7 hours ago

This new data clearly reclassifies the patients Disease from a MGRS to a neoplastic process demanding specific therapy for Waldenstroms Macroglibuk...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 9 hours ago

Update to thread - new molecular result Thank you all for the discussion so far; your insights are most valuable. I suspect this to be clone resi...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 12 hours ago

I agree with Dr. Aledan - the EM shoes typical findings of an early rather segmental form of MN, probably Class V LN or conceivably a NELL 1 MN sup...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 12 hours ago

Thanks Dr. Mohammed- interesting information. I believe that Mendelian inheritance of SLE is very rare - about 1% and mist often seen in yourng chi...

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RE: Hyponatremia 12 hours ago

liver disease is a potent stimulus Na (renin) AND water (ADH) reabsorption, I agree I would have a hard time diagnosing SIADH in ANY liver patie...

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RE: Hyponatremia 12 hours ago

Can a diagnosis of a "simple " case of SIADH be made with a urine Sodium of < 10mM/L in the presence of severe chronic liver disease ? In short, I ...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 12 hours ago

Dr, Dastoor thanks for you kind remarks. Much appreciated. Here are my responses to your questions- 1) differentiation of monoclonal B cell ...

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RE: Hyponatremia 13 hours ago

Agree. I have seen cases in which there is an obvious non-volume etiology of ADH release but the U Na is low. For example, with superimposed GI los...

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RE: Hyponatremia 13 hours ago

I would like to add the caveat that the UNa as a surrogate for effective circulating volume is only valid if the urine is concentrated. The urine N...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 13 hours ago

First , I want to applaud @Richard Glassock. He has this amazing talent , where he simplifies a tortous and complicated case , then interprets it's...

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RE: Hyponatremia 13 hours ago

Yes, that illustrates the critical role of the U Na in hyponatremia.If it is high, then you can make the diagnosis of euvolemic ADH release and you...

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RE: Hyponatremia 14 hours ago

"NS Saline is not the treatment of choice for SIADH. " Depending on the urine osmolality and unless true volume depleted isotonic saline (NS) may ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 17 hours ago

Agree that this is early class V LN and in sub-nephrotic proteinuria and normal renal function, I would use a combination of GC and MMF per KDIGO 2...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 19 hours ago

Very complex patient. My impression is that this may well be a disease manifestation of late HCV driven type II mixed Cryoglobulinemia in which the...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 19 hours ago

Tough case! Thanks for sharing. On the “reactive paraprotein” conclusion. I would respectfully differ with the haematology assessment. The clone h...

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Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 23 hours ago

63-year-old Caucasian woman presented to clinic for evaluation of CKD in the context of rising serum Cr. and proteinuria. System review positive fo...

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RE: MPGN Pattern 1 day ago

I agree with Dr. Song- the IC-MPGN pattern-of-injury is most often thec result of an underlying disease, especially in older adults , - auto-immune...

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Hyponatremia 1 day ago

As a non-academic Nephrologist, it is obvious that the confusion in diagnosing and management of Hypontremia persists. I would have treated him as...

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RE: MPGN Pattern 1 day ago

Also request for serum DNAJB9 and stain the paraffin immunohistochemistry for DNAJB9 for FGN. Given the IgG4 positive IF and possible history of m...

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RE: Latent TB and Membranous Nephropathy 1 day ago

would colleagues use EPO or wait for biopsy or stomach polyp in case cancer? i would start EPO small dose and unlikely for polyp to be malignant ...

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RE: Latent TB and Membranous Nephropathy 1 day ago

update OGD- 1mm polyp in antrum biopsied Colonoscopy- Left Sided Diverticulosis PET scan No evidence of occult FDG avid malignancy. Ig G...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Dr. Al-Saegh: Over the past few days, what has been the further trends in urine output, serum creatinine, hematological values and hemolysis marker...

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RE: MPGN Pattern 1 day ago

Thank you for sharing this case. My read: IgG-dominant immune-complex MPGN with crescents; low C3 with normal C4 suggests alternative pathway activ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Why isn’t this class II (not I or V)? ‘Mesangial hypercellularity (of any degree) or mesangial matrix expansion…a few isolated subEPI (or subENDO) ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Thanks Dr. Saja , I am usually not using CNI unless nephrotic and nowadays have been switching to OBI for neohrotics and Belimumbab for non nephrot...

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MPGN Pattern 1 day ago

Dear colleague May I consult you regarding this 58 years old patient with no known medical desease smoker refered to us due creatinine 1.67 no ...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 1 day ago

I am wondering given the progression of her TBM disease to early onset failure and the phenotypic appearance of MG perhaps this phenotypic appearan...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Fine job - would have loved to know what the urine sodium was when the serum sodium corrected ------------------------------ [Mark] [Lerman] [M...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Dear prof Dastoor Autosomal recessive familial SLE with identified targeted gene have been identified among omani cohort Target gene mut...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Good morning This presentation is much more suggestive of early post-transplant TMA than ATG-induced hemolysis. Although ATG can certainly cause...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 1 day ago

I wanted to thank Prem Chandran MD who actually uploaded the report of response of myasthenia gravis to dialysis. I agree with Dr. Rodby that ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Back to baseline. Some things take time.. ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 31453...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

No, he did not receive tolvaptan. It is not readily available in the hospitals I consult (cost of procurement is still high I’m told) -----------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

He never received Tolvaptan, correct? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UC...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Dr. Lerman, in his case, the Na corrected gradually-123 this past Friday, 127 on Sat, 131 Sunday and 135 yesterday and today and he was discharged ...

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RE: Obstructing Urinary Stone 2 days ago

Thanks- the obstructing stone was uneventfully removed via ureteroscopy last week . The patient is now home without any symptoms , I am awaiting ne...

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RE: Obstructing Urinary Stone 2 days ago

So sorry; I know no one may be interested in this thread anymore; but I did talk to a few of our endourologists about this. In my experience, the...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

Thanks , have attached the final report from Thailand for review. --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisio...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

I agree with Dr. Rodby. This is not Class I LN . The subepithelial depidits inducted an early Class V +II lesion. I would treat with MMF + low dose...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

subepithelial and mesangial deposits on EM I suspect this is an early lupus membranous (V) responsible for the proteinuria, at 1 gram, I thin...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

If the transplant biopsy reveals TMA, I would definitely evaluate complement activity and perform genetic analyses. -----------------------------...

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RE: Sarcoidosis? 2 days ago

I do not but I think anything approaching 2 I think I would avoid. Epocrates says CrCl (eGFR) 10-50 usual dose by 50%, [More]

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Re tolvaptan: Dr Hirsch: "Something like...I give 7.5 mg in the AM and check the Na later that day. If it is increasing at an acceptable rate, ju...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 2 days ago

Thanks for the follow-up! You should report this. Case reports are case reports but when you have a case like this, it feels like a seminal event. ...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 2 days ago

Dear Colleagues: Thank you all for your great responses, and i will let you know what happened. To recap, the patietn developed kidney failure of u...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Dr. Anand-how quickly did serum sodium rise in relation to iv Bumex , have you repeated urine sodium. I want to discuss the risk if any regarding C...

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RE: AKI & Immune complex GN 2 days ago

Her serologies including lupus, and compliments were normal at the beginning of the workup, and were not repeated. She's coming back next week. I ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Thank you, Drs. Lerman and Venkat. I am glad the Page-kidney report was helpful. Professor Glassock, I agree that an allograft biopsy, once the pl...

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