RE: Would you Re biopsy this IgA? 39 minutes ago

Thank you All. Patient believes he can get me the biopsy results from 40 years ago, had bleeding complication at the time of the biopsy. Is on...

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RE: Puzzling Case of Post-Transplant Proteinuria 1 hour ago

Alport with NRP at 20 g/g and BOTH (basically) normal EM x 2 despite P having quadrupled AND no hematuria has got to be about as rare as hen’s teet...

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RE: Would you Re biopsy this IgA? 2 hours ago

I fully agree with Dr. Hirsch. The therapy for advanced CKD , obesity and diabetes should be optimized. Unfortunately , there are no non-invasive d...

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RE: Likely Active C3G before transplant 5 hours ago

please give us followup on your decision if possible -thanks for posting ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST K...

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RE: Puzzling Case of Post-Transplant Proteinuria 5 hours ago

Dr. Mahmut Altindal- I think you've made an excellent point. It is possible that the deceased donor kidney in this particular case of unexplained s...

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RE: Would you Re biopsy this IgA? 6 hours ago

It is hard for me to believe that after at least 38 years of disease with extensive CKD and increased echogenicity that the risk v benefit calculat...

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RE: Would you Re biopsy this IgA? 6 hours ago

Dr. Kaur: If it is not certain that he had IgA nephropathy on the original biopsy and if serological tests currently are non-diagnostic, rebiopsy m...

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RE: Would you Re biopsy this IgA? 8 hours ago

Hello, I routinely perform kidney biopsies myself at my hospital. For this particular patient, the main question is: is this progressio of the unde...

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RE: nephrotic syndrome 8 hours ago

I thank you all for your comments. We hesitate to perform a KB because of the bleeding risk (according to the literature around 4 weeks ). The...

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RE: nephrotic syndrome 10 hours ago

Recovery from proteinuria from VEGF inhibitors typically takes several weeks and may take several months. I about 40% the effects are irreversible ...

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RE: nephrotic syndrome 11 hours ago

if this is related to Cabozanitinib, why not waiting to see if the proteinuria will resolve after stopping it? ------------------------------ M....

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RE: Would you Re biopsy this IgA? 11 hours ago

Dr. Dastoor- good point. . The addition of Atrasentan or a conversion from RASi to Sparesentan could certainly be considered but the level of eGFR ...

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RE: Puzzling Case of Post-Transplant Proteinuria 13 hours ago

Dr Venkat, with all due respect; carriers of COL4 mutations may have very subtle GBM changes. I could not find any other explanation to this case (...

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RE: Would you Re biopsy this IgA? 16 hours ago

@Richard Glassockwould you consider ET1a antagonist at this eGFR?? --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional...

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RE: Would you Re biopsy this IgA? 17 hours ago

I would not rebiopsy but would add GLP1RA, small doses of RASi, SGLT2i and, if tolerated , Finerenone. I see no indications for immunosuppression a...

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RE: Puzzling Case of Post-Transplant Proteinuria 17 hours ago

Dr. Venkat - can you find out what happened to the other kidney from this deceased donor. ? If similar proteinuria developed, this would point to a...

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RE: Would you Re biopsy this IgA? 18 hours ago

Thank you Dr. Venkat. I also think so but do I need confirmation; any chance that management could change based on any other findings (I have ...

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RE: Would you Re biopsy this IgA? 18 hours ago

Fluctuating proteinuria could have been due to interruptions in RAAS-blockade and SGLT2-I therapies. SAlb level trend? Kidney size/echogenicity cor...

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RE: Puzzling Case of Post-Transplant Proteinuria 18 hours ago

Dr. Lerman: After retirement, I function as an honorary teaching attending at my former hospital. I no longer have any patient management privilege...

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Would you Re biopsy this IgA? 19 hours ago

57-year-old man with biopsy-proven IgA nephropathy diagnosed at age 19, lost to follow up for multiple years, now with CKD and persistent significa...

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RE: SGLT2i & renal tubular creat secretion 20 hours ago

https://pubmed.ncbi.nlm.nih.gov/36736537/ --------------------------------- Oded Friedman ---------------------------------

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RE: SGLT2i & renal tubular creat secretion 20 hours ago

Oded: Makes sense. Do you have a reference for this plz? ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Ass...

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RE: Puzzling Case of Post-Transplant Proteinuria 21 hours ago

When I first read this post, I thought of donor-derived RME failure, eg biallelic cubilin mutations, worsened by the ATI but then the progression a...

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RE: SGLT2i & renal tubular creat secretion 21 hours ago

An increased mClcreat/mGFR ratio post-SGLT2i could reflect pseudo-chromogen effect of glycosuria on (some) Jaffe Ucreat (assays) rather than an act...

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RE: Puzzling Case of Post-Transplant Proteinuria 23 hours ago

Sorry I meant the genetic testing in the donor. In Turkey, since more than 90% of kidney transplants are performed from living donors, we usually h...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 1 day ago

Indefinite therapy duration with Pegcetacoplan is probably not feasible or appropriate . Incomplete penetrance and modifier genes ate going to impa...

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RE: Puzzling Case of Post-Transplant Proteinuria 1 day ago

dear Dr. Venkat- did you post this unexplained case of post transplant significant proteinuria for a colleague or do you have direct management ? I...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 1 day ago

While pegcetacoplan works broadly across the cohort, the Valiant trial doesn't define the optimal duration of therapy. In patients with a proven, l...

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RE: SGLT2i & renal tubular creat secretion 1 day ago

Thank you Dr Glassock> Yes, I was aware of the initial hemodynamic effect. My qstn had to do more with a longer duration of observation, like a chr...

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RE: SGLT2i & renal tubular creat secretion 1 day ago

So far as I know there are no established effects of SGLT2 inhibitors on tubular secretion of creatinine. The rise of serum creatinine after initia...

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RE: Puzzling Case of Post-Transplant Proteinuria 1 day ago

You must mean genetic test in the donor not the recipient- to evaluate donor derived dieease. ------------------------------ Richard Glassock MD,...

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SGLT2i & renal tubular creat secretion 1 day ago

Hello Folks: Is anyone aware of a publication (human or animal study) that has directly examined this qstn ? Much appreciated. AI sites do not seem...

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RE: Puzzling Case of Post-Transplant Proteinuria 1 day ago

We had a couple of cases with post-transplant early proteinuria like this which unexpectedly came up to have COL4A mutation. Dr Venkat, I think it ...

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RE: nephrotic syndrome 1 day ago

If you think you need to biopsy a solitary kidney in order to manage this patient, I see no reason for a delay. You will have to stop all anticoagu...

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RE: nephrotic syndrome 1 day ago

Although FSGS lesion due to Cabozantinib much more likely, another differential could be RCC causing AA Amyloid? Especially with massive protienuri...

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RE: Biopsy or not 1 day ago

Thank you, everyone, for the very helpful insights and discussion. To answer some of the questions raised, her UA showed trace hematuria with 5 R...

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RE: Biopsy or not 1 day ago

Dr. Hirsch- thanks for your well framed words- a delight to read them- they validate a long life filled with curiousty. All my best to you!! ----...

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RE: Biopsy or not 1 day ago

Dr. Lee's post mentions "trace" hematuria. It will be helpful to know how many RBCs/HPF, if they were dysmorphic and any casts were seen. Not convi...

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RE: Biopsy or not 1 day ago

Microscopic hematuria has been described in "10-35%" of patients with proven DM nephropathy so I doubt that this alone (without RBC casts, and with...

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RE: Biopsy or not 2 days 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 2 days 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 2 days 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 2 days 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 2 days ago

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

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RE: nephrotic syndrome 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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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