RE: SLE with proteinuria 15 hours ago

I agree fully with Dr. Rubin's skepticism concerning the hypothess of A T-Cell cytokine mediation of Lupus Podocytopathy. I know of no direct evide...

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RE: SLE with proteinuria 15 hours ago

Thank you Dr. Wehbe for the references. They are all outstanding descriptions of the clinical entity of "Lupus Podocytopathy". I was referring to b...

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RE: SLE with proteinuria 15 hours ago

https://pubmed.ncbi.nlm.nih.gov/15548564/ J Am Soc Nephrol. 2005 Jan;16(1):175–179. doi:10.1681/ASN.2004050350. https://pubmed.ncbi.nlm.nih.gov/26...

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RE: SLE with proteinuria 17 hours ago

Could the proteinuria be due to Sulfasalazine ? , Case reports of non-nephrotic proteinuria , normal LM and IF and moderate FP effacement by EM hav...

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RE: SLE with proteinuria 21 hours ago

My pleasure. Your guess is as good as mine. Let's ask Dr. Radhakrishnan for his thoughts. He was part of the very early description(see below) of t...

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RE: SLE with proteinuria 21 hours ago

Thanks Dr. Rubin for this helpful reference, According to these criteria (and these of Olivia-Damaso )) this patient cannot be unequivocally catego...

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RE: SLE with proteinuria 22 hours ago

I am attaching a great editorial by the Columbia group which provides a very simple diagnostic approach to this entity and is easy to understand an...

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RE: SLE with proteinuria 22 hours ago

@Edgard Wehbe Can you please provide a reference(s) that support your point (i.e. lupus podcytopathy is a T-Cell disorder). Thank you ---------...

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RE: SLE with proteinuria 22 hours ago

Dear Dr Glassock Thanks for the information Attaching the reference ------------------------------ Satish Balan MD DM DNB Senior Consult...

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RE: SLE with proteinuria 23 hours ago

According to the Olivia- Damaso criteria (Olivia-Damaso, N et al, Adv Chronic Kidney Disease, 2019;;26:369-375) mesanfual immune deposits are not a...

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RE: SLE with proteinuria 23 hours ago

I thought that the diagnosis of lupus podocytopathy required the presence of mesangial deposits. In this case there are no deposits whatsoever. The...

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RE: SLE with proteinuria 1 day ago

I agree , but the steroid and MTX therapy confound interpretation. I suppose this could be a partially treated anti-nephrin autoantibidy disease, b...

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RE: SLE with proteinuria 1 day ago

@Richard Glassock: Don't the always normal SAlb, subnephrotic proteinuria and (I presume) lack of edema make lupus podocytopathy unlikely, unless o...

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RE: SLE with proteinuria 1 day ago

I would continue with conservative approach for now. Along the lines, I might consider using voclosporin. My understanding, that lupus podocytop...

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RE: SLE with proteinuria 1 day ago

In light of the modest proteinuria (albuminuria) , normal serum albumin and kidney function, along with tge kidney biopsy findings I would lean tow...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 1 day ago

Thank you so much for your input In 2012, she was 16, had an obstructive stone, lithotripsy done. Stone analysis showed 80% calcium oxalate, 5% C...

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RE: SLE with proteinuria 1 day ago

Dear Dr. Glassock, Thank you for your insightful comments. I would like to add a few final remarks. I have already proposed switching metho...

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RE: SLE with proteinuria 1 day ago

Thanks for the details. These findings essentially rule out an overflow proteinuria and greatly increase the possibility of a (partially treated ) ...

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RE: SLE with proteinuria 1 day ago

Dar Drs. Glassock, Rodby and Beggah, Many thanks for the very helpful comments. Below are the requested clarifications. Albumin vs. tota...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 1 day ago

Could you provide the actual values for PTH and simultaneous serum Ca that you have obtained, along with the reference ranges for the PTH and 1,25 ...

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RE: SLE with proteinuria 1 day ago

Hello Thanks for the post IF negative bizarre !!! what a odd case , assuming red cango negative ( background of RA ) , and she is not pregnant ? ...

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RE: SLE with proteinuria 1 day ago

What does "dipstick" proteinuria show.? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------...

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RE: SLE with proteinuria 1 day ago

Pending answers to Dr Glassock's query, Very odd case. 50% FPE doesn't excite me and I personally do not think that is the issue here, even wit...

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RE: SLE with proteinuria 2 days ago

Fascinating case of SLE with multiple autoantibodies and isolated proteinuria (increased UPCR). Before considering any change in therapy, I would m...

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SLE with proteinuria 2 days ago

Dear colleagues, I would appreciate your input on the therapeutic management of the following case. Patient 33-year-old woman with a complex aut...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 2 days ago

Interesting idea, but I doubt that reduced bone density has any diagnostic value in this setting., due to the lack of disease specificity..just an ...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 2 days ago

Can you check bone mineral density? If truly incomplete RTA bones will be participating in buffering and this would result in minerals dumped in ur...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 2 days ago

Dent Disease seems very unlikely. The resukts gene panel used does not exclude a 24 Hydroxylase defivisncy , but makes it less likely. I would stil...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 2 days ago

Dents is X linked recessive Symptomatic disease is almost exclusively confined to males, with inheritance being X-linked recessive --------------...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 2 days ago

Dr. @Richard Glassock, Dr. @Awais Nauman, and Dr. @Satish Balan The gene pane was the Invitae Nephrolithiasis Panel, 40 genes. included ...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

I didn't see the urine protein excretion in original post, that's why asked if the patient had Proteinuria or not. Agreed without it would extremel...

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RE: lupus membranous nephropathy treatment 3 days ago

Thank you Dr Glassock! I give Atovaquone- she did not respond well to Bactrim in the first time. Thank you again for the advise! --------...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

@Awais Nauman, Dents seems to be a fascinating diagnosis here. But the dominant feature of Dents is low molecular weight proteinuria which is not p...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

Low OH-D, highish 1,25Oh-D, hypercalciuria, lowish serum phosphate and normal PTH are reminiscent of Dent Disease. She had genetic testing so I gue...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

Thanks- the 1,25 dihydroxy D levels seems pretty high to me, and the iPTH levels are normal. I think I would still measure 24,25 hydroxy D levels i...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

Thank you for providing these great teaching points to allow further discussion. Dr. @Joseph Crivelli I appreciate your valuable input. She repor...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

Dr. Asplin. Many thanks for your very helpful (as usual ) commentary. I wonder what significance you attribute to the intermittent hypercalciuria i...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

Looking at the baseline urine from 11/2/23 ( the urine from 11/1/23 is undercollected) the patient has a slightly high urine pH with a normal urine...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 3 days ago

I tend to agree with Dr. Reen, concerning the diagnosis of Lupus-related MN and Non-Lupus full house Glomerulopathy . It may take a long time for e...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 3 days ago

This is no lupus full house Membranous untill proven otherwise Not any disease to treat Obi will be my choice as already suggested Have 2 patients...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 3 days ago

There's been growing interest in SLC4A1 variants, with several new recent reports. See below, from Kidney Week 2025. Case 1 involves a mutation jus...

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RE: lupus membranous nephropathy treatment 3 days ago

I don't think you should be concerned with over-Immunosuppression by substituting OBI for RTX. I would give OBI once the UPCR comes back over 1.5-2...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 3 days ago

If the cream does not contain ammoniated mercury and was used for some purpose other than skin lightening I do not believe that this is sufficient ...

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RE: lupus membranous nephropathy treatment 3 days ago

Thank you Dr Rodby, I appreciate the advice. And the same question I asked Dr Glassock- what will be a good timing? after all she got 1+ partia...

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RE: lupus membranous nephropathy treatment 3 days ago

Thank you Dr Glassock ( as always). My main concern us the pt got already one dose and a partial second dose so I'm not sure when will be a good ...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 3 days ago

What kind of cream is that? Any skin whitening cream exposure? Can you send for NELL-1 antibody staining on the biopsy? Sounds like mercury indu...

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RE: lupus membranous nephropathy treatment Friday, January 16 @ 8:40 AM

A longer version of my response might also be- while OBI has never (yet) been tested for safety and efficacy in pure Class V LN it seems to be ve...

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?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis Friday, January 16 @ 2:15 AM

Hello I would appreciate some ideas on how to further approach and help this patient. 31 yo F, stones since the age of 16, passes 9-10 stones ...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy Thursday, January 15 @ 9:59 PM

Thanks for the input 1. Am trying to get her to bring the cream to us , initially assumed it was like a skin Whitening cream that many use , but s...

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RE: Role of Complement Blocker in Infectious GN ?? Thursday, January 15 @ 9:50 PM

Yes we have access to C3NeF, will order it next week. --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha...

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