RE: C3 or MGRS 1 hour ago

Thanks Dr. Dastoor. The fact that she was treated with immunosuppression and did not develop any clinically apparent infection makes IRGN unlikely....

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RE: AKI - 3 weeks post normal vaginal delivery 4 hours ago

I can only see partial notes from the outside system. It still says "ATN resolving preliminary results". No mention of glomeruli. But does not se...

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RE: AKI - 3 weeks post normal vaginal delivery 4 hours ago

Did the biopsy show patchy cortical necrosis is or acute tubular necrosis?. ------------------------------ Richard Glassock MD, FASN Emeritus Pr...

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RE: AKI - 3 weeks post normal vaginal delivery 5 hours ago

What did the kidney biopsy show? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 5 hours ago

Does your patient have diarrhea or aType 1 DM? Has the skin lesion been biopsied? Is it Psoriasis or Eczema.?I am thinking of IPEX syndrome - a ver...

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RE: C3 or MGRS 6 hours ago

I agree that this might be a C3GN pattern of injury due to a PGNMID. Temporary therapy with Pegcetacoplan might be effective, but for the long term...

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RE: IgA nephropathy with crescents 7 hours ago

I agree with Dr.Dastoor, but I would use MMF as well. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School o...

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RE: C3 or MGRS 8 hours ago

Thank you. As of now there has been no infections detected . She has been on high dose steroids and MMF and that would have activated an occult inf...

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RE: C3 or MGRS 13 hours ago

Hi Dr. Dastoor, this is my opinion only I think there's definitely too much IgM to call it C3G and that this patients should be carefully evalua...

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C3 or MGRS 14 hours ago

I would like to reintroduce the case presented here 4 weeks ago . 39 year old female , who presented with sudden onset of nephrotic syndrome. He...

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RE: IgA nephropathy with crescents 14 hours ago

Pulse steroids , followed by a course of 2. oral steroids and 3. Iptacopan , if insurance permits . Hit hard and hit fast , would be the way to go....

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RE: Tumoral calcinosis in a PD patient 15 hours ago

Sounds like the phos is getting under control, how high was it. Not sure you need to add tenepanor, though it may be helpful. would definitely chec...

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RE: Tumoral calcinosis in a PD patient 16 hours ago

Thank you all for the excellent comments, especially regarding the adynamic bone possibility and due precautions: avoiding bisphosphonate and alumi...

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RE: Tumoral calcinosis in a PD patient 16 hours ago

Is a pth of 230 really a concern for adynamic bone disease? I would however stop the vit D for that reason and also especially in the setting of tu...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 16 hours ago

i think the psoriasis treatment can wait until the nephrotic syndrome is in remission, even if by chance rituximab exacerbates it (?). As frequen...

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RE: High output HF from AVF? 16 hours ago

"Cardiology did not comment as "high output failure", I believe they were not involved other than reading the TTE," I find that there are cardiol...

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Fellows - Your Input Is Needed: 2026 ASN Fellow Survey 18 hours ago

Dear Fellows, 😀 A quick reminder to please complete the 2026 ASN Nephrology Fellow / Transplant Nephrology Fellow Survey if you have not already ...

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RE: High output HF from AVF? 19 hours ago

And he did have a permcath placed in 2022 when his initial LAVF failed, but no signs of central vein stenosis. ------------------------------ Esr...

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RE: High output HF from AVF? 19 hours ago

Cardiology did not comment as "high output failure", I believe they were not involved other than reading the TTE, which, this time doesn't show PHT...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

I have done a little more research (with the help of AI) and the story gets more complicated. A connection between Rituximab therapy an d worsening...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

The label and literature suggests that Guselkumsb and a Rituximab should not be administered because of a risk of profound impairment of Tvcell and...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

I am not sure that a kidney biopsy will be all that helpful. I think that so long as he is fully responsive I think RItuximab (or Obinutuzumab ) is...

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Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

Would appreciate thoughts on a difficult adolescent case. I’m managing a 16-year-old boy with autism and longstanding psoriasis who has now presen...

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RE: IgA nephropathy with crescents 1 day ago

I fully realize that a more nuanced definition if RPGN might be used for justification for CYC use in this case , but the KDIGO definition of RPGN ...

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RE: IgA nephropathy with crescents 1 day ago

I would point out that CYC and steroids are only recommended by KDIGO for RPGN and extensive crescents in IgAN While this patient does not have RPG...

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RE: IgA nephropathy with crescents 1 day ago

All serologies including ANCA were negative. ------------------------------ Amita Vasudeva MBBS University of Missouri-Kansas City Stilwell KS (...

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RE: IgA nephropathy with crescents 1 day ago

Thank you Dr. Rodby. The crescents and drop in gfr were precisely why I went with cytoxan and steroids. My patient had no signs or symptoms of Ig...

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RE: Tumoral calcinosis in a PD patient 1 day ago

What is his phosphorus. I would avoid aluminum at this time as I would be concerned as suggested by Prof Glassock that he has low turnover bone and...

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RE: IgA nephropathy with crescents 1 day ago

Dr Glassock's advice is based on KDIGO Guidelines and experts (UpToDate), what is he thinking? :) 17% crescents, eGFR dropping, I believe this is...

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RE: IgA nephropathy with crescents 1 day ago

I would use the UpToDate suggested regimen in thus case and seriously consider Iptacopan as well. I personally would not use Nefecon in this patien...

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RE: IgA nephropathy with crescents 1 day ago

Thank you for response Dr. Glassock. He has already one dose of Cytoxan. Will it be okay to switch him to Nefecon only at this time and other suppo...

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RE: IgA nephropathy with crescents 1 day ago

This patient has features of typical IgA N with crescents (MEST-C score of C1) without the syndrome of RPGN. IgA Vasculitis is always possible, so ...

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IgA nephropathy with crescents 1 day ago

I need advice/ thoughts on a patient. I really appreciate this community. I have a 44 year old caucasian male who presented with microscopic hem...

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RE: Pd Patient And Lipid Lowering Agent 2 days ago

Dr. Soobadar- Are you using Fish Oils in these doses in your HD patients. If so , what kind of side effects are the patients experiencing? Just c...

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RE: Pd Patient And Lipid Lowering Agent 2 days ago

The Fish oil dosing regimen is described in the NEJM paper . It is 4.0 gms of Fish daily containing 1.6 gm of EPA and 0.8 gm of DHA. Give itca try....

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RE: Pd Patient And Lipid Lowering Agent 2 days ago

Richter scale: >7 Wow, this is big. Thank you Dr Glassock. Can you also please help us about the amount of fish oil to reach these goals? ----...

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RE: AKI - 3 weeks post normal vaginal delivery 2 days ago

Thank you Dr. Mohammed. ANA panel negative, complements negative. MPO/PR3 negative. Cryo pending. ADAMTS13 pending. patient has transferr...

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RE: AKI - 3 weeks post normal vaginal delivery 2 days ago

Thank you for sharing this case for discussion. While TMA renal limited is possible, it is not classical. Postpartum is one of the important trigge...

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RE: High output HF from AVF? 2 days ago

Thank you for sharing this case. What is the cardiology team's opinion on the assessment for high-output heart failure? Is there any evidence of pu...

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RE: Tumoral calcinosis in a PD patient 2 days ago

Would it be time to consider Aluminum binders? After a few months check levels Anyone checking calcidiol levels and supplementing? Would hemodiafil...

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RE: Tumoral calcinosis in a PD patient 3 days ago

I would definitely avoid bisphosphonates in this situation. What is the current serum PO4?Do you feel comfortable decreasing or stopping the calcit...

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RE: Tumoral calcinosis in a PD patient 3 days ago

His Pth is 230. Ionized calcium is actually 1.0, lower than normal so I have been avoiding sensipar and even bispgospanate for the time being and s...

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RE: AKI - 3 weeks post normal vaginal delivery 3 days ago

Dr, Mellas raises an important question. My impression from the littersaturec is that the elevation in serum LDH is very much related to the durati...

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RE: AKI - 3 weeks post normal vaginal delivery 3 days ago

Thanks Dr. Mellas, LDH was hovering normal upper, today in 400s. Patient left last night to be at her transplant center for higher level of ca...

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RE: AKI - 3 weeks post normal vaginal delivery 3 days ago

A few questions to Dr Kaur. If the patient has renal cortical necrosis why is LDH not higher? Why can you not give gadolinium if Group II or II...

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RE: AKI - 3 weeks post normal vaginal delivery 3 days ago

Thank you Dr. Glassock! Renal biopsy done. Renal function worsening. ------------------------------ T. Kaur, MD FACP Nephrologist/HTN/Kidney Sto...

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RE: Non-necrotizing granulomatous interstitial nephritis 3 days ago

I shall. I agree with you. Hematopathology has become an integral part of onco-nephrology. For educational purposes, I was underscoring the phenoty...

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RE: Non-necrotizing granulomatous interstitial nephritis 3 days ago

Thank you! Please let me know of any typos so I can correct them for the final version! 😀 Regarding CLL diagnosis, we should consult with hemato...

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RE: Non-necrotizing granulomatous interstitial nephritis 3 days ago

Got your paper Lynn. Now, I have a lovely weekend reading material! KUDOS! I guess, looking for CD5 expression will aid in the diagnosis of CLL. Ma...

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RE: transplant recurrent FSGS 3 days ago

Thank you Dr. Cravedi. Very helpful information. I guess the final chapter remains to be written. Best. Mario ------------------------------ M...

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