RE: Denovo Idiopathic MPGN of Renal Allograft 3 hours ago

What was the evidence that the disease of the native kidney was IgAN? I agree with Dr. Rodby that excluding an infection or PGNMID is very importan...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 5 hours ago

Thanks Dr. Lerma. Very helpful advice. I also agree with the suggestions of Dr. Dastoor, but I am not optimistic about favorable response to Pegcet...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 5 hours ago

Can you please post the reference for this figure? Thank you. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 --------...

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RE: Denovo Idiopathic MPGN of Renal Allograft 5 hours ago

I always go back to this for MPGN and with the Igs on biopsy, you are on the left side have infections been completely ruled out? I would get...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 5 hours ago

The attached image kind of summarizes what you should expect in terms of uPCR and eGFR response to therapy with a Complement blocker. Having used...

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Denovo Idiopathic MPGN of Renal Allograft 5 hours ago

57-year-old woman with ESKD secondary to IgA nephropathy s/p kidney transplant in 2016, maintained on tacrolimus monotherapy, with baseline creatin...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 6 hours ago

Agree no absolute contraindication to trying Iptacopan or Pegcetacoplan in this patient but patients profile suggests unlikely to prevent ESRD give...

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Applications Due 10/31: NephSIM Nephrons 7 hours ago

Dear all, Applications are now open for the 2027 NephSIM Nephrons Program, a 6-month virtual mentoring and education program for medical student...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 15 hours ago

Very challenging case. The posted single EM image seems to have features of DDD- how did you conclude that this was C3GN . The patients has a very ...

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Management Challenges in a Patient with C3 Glomerulonephritis 21 hours ago

Dear colleagues, I would like to get some suggestions from you. Patient is a 31-year-old male. In 11/2017(age 22), he was found to have cr 2.3 a...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 2 days ago

Was he taking hydralazine? ------------------------------ Levi Short MD, FASN Wichita Nephrology Group PA Wichita KS ---------------------------...

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RE: NUP133 Mutation 2 days ago

Yes, it makes a lot of sense Dr Rodby. Nevertheless, this is recommended by standard practice in medical genetics. Indeed we do recommend it in our...

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RE: NUP133 Mutation 2 days ago

"Tough post-conception discussion if the stars do not align.". Powerful statement.. a life altering decision. Why take any chance. I am convinced. ...

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RE: NUP133 Mutation 2 days ago

This gets to the root of so many daily decisions we make as doctors, We dont look for everything in everybody regardless of risk, we draw the line ...

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RE: NUP133 Mutation 2 days ago

Yes, and these are wild estimates completely agnostic of population structure and cultural habits of the actual patient. Plus this is a truncating ...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 2 days ago

Another puzzling case of unexplained IC-GN, I would screen for infections in particular SBE. Any extraglomerular staining (TBM, vessels) that may ...

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RE: NUP133 Mutation 2 days ago

Maybe I’m looking at this wrong, but if the highest population-specific allele F for this variant is 0.2372%, the estimated carrier F is 0.4733%, g...

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RE: NUP133 Mutation 2 days ago

Agree is a rare form of NS/FSGS, but unfortunately this is how recessive diseases occur. This is a single variant cascade testing so it's usually i...

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RE: NUP133 Mutation 2 days ago

With a gene frequency for this mutation of 1 in 16000 individuals in the general population, screening of non-non-relatives will not likely detect ...

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RE: Hypokalemia in Pregnancy 3 days ago

Dear ALL Thank you very much for your valuable comments and suggestions. I want to send you an updating about the blood and urine tests result...

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RE: NUP133 Mutation 3 days ago

unless she plans on marrying a relative, is screening potential spouse really necessary for this rare gene? ------------------------------ Roger...

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RE: NUP133 Mutation 3 days ago

@Edgard Wehbethanks , we have a few nutcracker girls, but almost all have either painless or painful hematuria...they have mild proteinuria but thi...

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RE: NUP133 Mutation 3 days ago

When you mentioned that the patient was skinny, it reminded me of a young patient we saw a few weeks ago for proteinuria. The workup revealed ortho...

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RE: NUP133 Mutation 3 days ago

Thanks! Agree, current data do not support an effect of single heterozygous variants in recessive genes to contribute to nephrotic syndrome/FSGS. S...

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RE: NUP133 Mutation 3 days ago

As an asymptomatic unaffected carrier of an autosomal recessive gene, she may want to have potential mates tested, but for now simple reassurance s...

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RE: Hypokalemia in Pregnancy 3 days ago

The ABG on the evening of October 1 are consistent with a normal term pregnancy. (Chronic respiratory alkalosis ). The serum creatinine and serum K...

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RE: NUP133 Mutation Thursday, October 8 @ 3:33 PM

Given the autosomal recessive inheritance the etherozygous pathogenic or likely pathogenic variant should make her a carrier and she should not dev...

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NUP133 Mutation Thursday, October 8 @ 1:43 PM

Am following a 19 year old college girl who came to me for review of her proteinuria She has been complaining of occasional bubble in the urine ...

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A Special ASN Kidney Week 2026 Event for Fellows: Immigration Journeys, Career Success Stories, and Networking Thursday, October 8 @ 1:27 PM

Hi all, Do you have questions about navigating the US immigration system while building a career in nephrology? There is an amazing opportunity a...

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RE: Hypokalemia in Pregnancy Thursday, October 8 @ 1:04 PM

Was there a history of diarrhea? A metabolic acidosis makes it more like a distal RTA and unlikely to be Gitelman or Gellery syndrome. I think a GI...

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RE: Hypokalemia in Pregnancy Thursday, October 8 @ 12:42 PM

I am gravitating to a mitochondriopathy precipitated by the metabolic stress of her pregnancy & febrile illness (all would also contribute to her e...

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RE: Hypokalemia in Pregnancy Thursday, October 8 @ 12:41 PM

The RTA and AKI would seem to make a Gitelman or Geller syndrome unlikely. I do not disagree with genetic testing (I seldom am) but this clinical e...

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RE: Hypokalemia in Pregnancy Thursday, October 8 @ 11:36 AM

I doubt a singe dose of gent did anything but she may have Gitelman, often symptomatic until pregnancy. is Genetic testing available? Is her BP o...

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Hypokalemia in Pregnancy Thursday, October 8 @ 7:00 AM

Dear All Good day hoping you are doing well, I'm seeking your input in this case, please A 33-year-old woman, gravida 1 para 0, at 39+4 weeks...

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RE: Would you Re biopsy this IgA? Thursday, October 8 @ 2:59 AM

Unfortunately, at present there are no non-invasive tests that will confidently exclude or include IgAN in the diagnose. . . --------------------...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 8:21 PM

Dr. Venkat, I think you are right, for completeness sake serology is easy to get, if all negative even more reason not to biopsy. I'll add. Thank y...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 8:15 PM

Dr. Kaur: My suggestion to obtain serological tests was based on non-availability of the kidney biopsy report from the past. While it may not be ab...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody Wednesday, October 7 @ 4:16 PM

My mind is a bit slow today.. but am not sure of the diagnosis The IF is apparently full house but is being treated as a pauci immune GN with Avac...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 11:38 AM

AS above: The COOPERATE trial 2002 JAMA found addition of ARB to ACEi lowered proteinuria more than more ACEi alone. then in 2009 JAMA retracte...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody Wednesday, October 7 @ 11:36 AM

what did EM show? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transpla...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 11:32 AM

diuretics do not change 24 hour urine sodium per se, when you first take them you are in a negative Na balance, but once you reach steady state, an...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 9:21 AM

Good morning Dr. Venkat, he did not have RBCs/casts in urine… would you still order serology? I did not add. But good point, if I am contemplating ...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 9:05 AM

I do not give ACEI+ ARB any more, but that's only because we now have better alternatives. OTOH, I do not believe there should be a taboo against i...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 8:57 AM

Just to ask another practical point, how accurate would a urine 24 hour sodium be if the patient is on a diuretic? ----------------------------...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody Wednesday, October 7 @ 8:20 AM

With this much glomerulosclerosis and IFTA one would not expect much improvement in GFR with immunosuppression. Were any steroids given with.the RT...

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A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody Wednesday, October 7 @ 7:11 AM

I am posting this case for a colleague, and I would appreciate the community members input on this case: The patient is a 20-year-old African Ame...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 12:36 AM

I too have several patients with IgAN who have done very well (in stable remission with low proteinuria ., no hematuria and unchanged eGFR) on comb...

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RE: Would you Re biopsy this IgA? Wednesday, October 7 @ 12:31 AM

A reasonable estimate of 24 hour urinary Na excretion can be obtained from a mid-day spot urine Na/creatinine ratio multiplied by estimated 24 urin...

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RE: Would you Re biopsy this IgA? Tuesday, October 6 @ 11:20 PM

I have a few patients on ARB and ACEi, a leftover from 15 years ago, they're doing great with minimal protein urea. Should I continue or stop it? ...

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RE: Would you Re biopsy this IgA? Tuesday, October 6 @ 10:00 PM

Did start on Torsemide at the clinic visit for volume, HTN and since increased Losartan. Although do recommend low Na diet [More]

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