RE: C3 Nephrite Factor with normal Urine normal renal function 7 minutes ago

C3NeF assayed in a good lab like this one must be taken seriously, but from a renal point of view I would simply monitor urine for albumin frequent...

View Discussion

RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 30 minutes ago

@Roger Rodby My bad Some correction Bx IF was 1+ IgM with 1+ kappa and lambda in the mesangium only C3. 3+ No IgG or IgA Only few mesangial depos...

View Discussion

RE: oxalate nephropathy 1 hour ago

Thanks Dr Rodby. Is there a role for Pyridoxine prior to testing? ​ ------------------------------ Priyanka Govindan MBBS Lynchburg Nephrology Phys...

View Discussion

RE: oxalate nephropathy 1 hour ago

Oxalate nephropathy from OTC Vitamin C is not rare at all. I would assume this is iatrogenic. I suppose he could have primary hyperoxaluria, the wa...

View Discussion

oxalate nephropathy 1 hour ago

​54 yo male taking liposomal Vit C, no GI surgery presented with AKI - creatinine went from 1.2 in January to 3.9 in April. No urinary obstruction ...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 3 hours ago

I think that is a good point. Hard to tell from the report provided us. To really sort this out I would review the pathology with my nephropatholog...

View Discussion

RE: Advanced FSGS and treatment utility 3 hours ago

From post "FSGS, advanced with focal collapsing features, 43/60 globally sclerotic glomeruli with severe interstitial fibrosis and tubular atrophy....

View Discussion

RE: Advanced FSGS and treatment utility 3 hours ago

"Apparently, pt had labs done in 2018 at outside hospital/state which showed creat of 2.08 and UPCR 1.5 grams." This suggests that primary FSGS or ...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 4 hours ago

This may be just semantics.  Segmental fibrinoid necrosis of arteries suggests an acute process, most likely from severe hypertension. However, no ...

View Discussion

RE: Unexplained TMA On Kidney Biopsy 6 hours ago

Total gloms 13. Capillary and arteriolar microthrombi in 5. Endocapillary hypercellularity- segmental 1. Segmental sclerosis, including FSGS varian...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 8 hours ago

“What is the evidence that this is SRC besides the HTN and the TMA?” No alternative explanation given + SS diagnosis raises possibility of overlap ...

View Discussion

RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 9 hours ago

@Roger Rodby I am a lumper not a splitter. Lupus often has a pauci immune immune GN, looks just like a AAV (except perhaps some background mesangi...

View Discussion

RE: Advanced FSGS and treatment utility 10 hours ago

With that Serum albumin it sure doesn't seem like a primary FSGS. Your question is valid, should we at least try? He is young, this us ESRD. And I ...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 10 hours ago

What is the evidence that this is SRC besides the HTN and the TMA? --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rus...

View Discussion

RE: Advanced FSGS and treatment utility 18 hours ago

Actually, I did not consider measuring 24 hr creatinine clearance because of such high serum creatinine His BMI was 27 and wt was about 205 lbs. No...

View Discussion

RE: Advanced FSGS and treatment utility 18 hours ago

Thank you serum albumin 3.3 to 3.7 LDL 157 father had kidney disease- specifics unknown EM shows some segmental folding and wrinkling of GBM. No el...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 18 hours ago

I don't know exactly the cause of hypertensive emergency Dr.@ Oded Friedman. Patient was not hypervolemic at presentation to suspect volume depende...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 19 hours ago

So what was the proximate cause of the hypertensive emergency? No cryoGN on biopsy. Way too much for diclofenac. Not expected with SS-related AIN. ...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 19 hours ago

Thank you for input Dr. @Roger Rodby . ANCA is negative by IIF​. ------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 0100...

View Discussion

RE: Advanced FSGS and treatment utility 20 hours ago

Do you have a measured CrCL to estimate his residual renal function? I think it is too late for treatment to work given an dialysis-entry creatinin...

View Discussion

RE: GPA treatment choices ? 20 hours ago

I agree with Dr. Rodby-  hecis at moderate risk for relapse and needs maintenance therapy probably for several years.. ----------------------------...

View Discussion

RE: Advanced FSGS and treatment utility 20 hours ago

What is the serum albumin Level? Any Family History of Kidney disease? Any GBM abnormality by EM.  This mat be a genetic form of FSGS.  I'd he is a...

View Discussion

RE: C3 Nephrite Factor with normal Urine normal renal function 20 hours ago

C3NeF may very well have nothing to do with anything including her urticaria but I found this citation interesting: ‘It is worth mentioning that if...

View Discussion

RE: Bone mineral case 21 hours ago

FGF23 has to be much higher in that disorder like in thousands

View Discussion

Advanced FSGS and treatment utility 21 hours ago

Hello everyone, I have a 53 yo white male who presented to our ED with BUN 130, creatinine 21.7, Hco3 11 and Hb of ~ 7.0.  BP of 160/100 on admissi...

View Discussion

RE: GPA treatment choices ? 21 hours ago

If C-ANCA/PR3 now normal, I would give maintenance Rituxan 500-1000 once every 6 months, follow the C-ANCA/PR3 and CD 19. He is 78, I thin I'd go w...

View Discussion

RE: C3 Nephrite Factor with normal Urine normal renal function 22 hours ago

But her C3 is normal She also has a CRP of 23 and 25 normal is less than 3 although ESR is 5 --------------------------------- Shahzad Safdar MD M...

View Discussion

RE: SLE/sjogren, cryoglobulinemia, TMA 23 hours ago

1) what may be the probable cause of TMA? accelerated hypertension?, scleroderma renal crisis inspite of negative anti scl 70, atypical HUS? antiph...

View Discussion

RE: C3 Nephrite Factor with normal Urine normal renal function 1 day ago

C3NeF has been associated with urticarial vasculitis. --------------------------------- Oded Friedman ---------------------------------

View Discussion

C3 Nephrite Factor with normal Urine normal renal function 1 day ago

31-year-old Caucasian female with history of chronic spontaneous urticaria since 2016 on second generation Histamine blockers without much improvem...

View Discussion

RE: GPA treatment choices ? 1 day ago

Patient has been on in center hemodialysis , from  March, 2020, as Monday Wednesday Friday. He has been refusing transplant as well as home dialysi...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Hard to know Recent papers look at the podocyte genetic markers. This will be hypothesis generating research 1) do people with genetic mutations of...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Interesting points. Please provide a reference(s) which supports them. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -...

View Discussion

RE: Membranous Nephropathy progressing despite Rituximab 1 day ago

In my opinion, RTX resistance should be defined according to immunological remission.  Advanced irreversible GBM damage in MN can lead to clinical ...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Although CNI are "anti-proteinuric" agents (probably via a direct effect on Podocytes) I doubt that they are truly disease modulating drugs, as rel...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Since CNIs must get into the nucleus when massive NS  the blood levels can be very high without nephrotoxicity. Sometime very high doses and levels...

View Discussion

SLE/sjogren, cryoglobulinemia, TMA 1 day ago

42 yr old male patient presented to ER (2/4 2021) with convulsions. BP was 200/100 mmgh. MRI revealed PRES and laboratory workup revealed marked az...

View Discussion

RE: Membranous Nephropathy progressing despite Rituximab 1 day ago

That was my exact point, that if the PLA2R is coming down what would be the role for alternate agents.  from  https://pubmed.ncbi.nlm.nih.gov/29852...

View Discussion

RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

" Hi all ? How often do we see dual positive mpo and pr3 anca as well as Ana positive with dsdna? I had a case of aki with crescentic gn the other ...

View Discussion

RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

Dual ANCA positivity (along with positive ANA and anti-dsDNA antibody)-is quite uncommon, but when present most often indicates a drug-associated e...

View Discussion

RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

Hi all ? How often do we see dual positive mpo and pr3 anca as well as Ana positive with dsdna? I had a case of aki with crescentic gn the other da...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Thank you for your input.I guess one rationale for monitoring the trough would be ensure that the level does not remain supra-therapeutic for a pro...

View Discussion

RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

By the Mayo Clinic assay for ant-MPO antibodies a value of > 8 is very, very high.  At least 8 times greater than the upper limit of normal and pro...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

None of these studies really address the question-  what is the added value of routine  trough monitoring in TAC ((or CSA) treated FSGS? ----------...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Tumlin combined ACTH with tacrolimus and used a dose of 1.0-3.0 mg bid for a trough of 5-10: https://datastudio.google.com/s/nJgyJnDyi6s (reported ...

View Discussion

RE: Unexplained TMA On Kidney Biopsy 1 day ago

Can you please post the (deidentified) renal biopsy report? How extensive was the "acute TMA"? If the microthrombi were scanty, it may not be right...

View Discussion

RE: anti-PLA2R Ab and crossmatch 1 day ago

As far as I know a positive anti-PLA2R antibody should not produce a positive T or B cell cross match. The antibody systems are entirely different....

View Discussion

RE: Membranous Nephropathy progressing despite Rituximab 1 day ago

Sorry about the typo in your name, Dr. Tejas Desai. Dr. Rodby: Besides the lack of a steady downward trend in proteinuria, the other concern in the...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Many experienced Nephrologist aim for an initial TAC trough level of 5-10ng/ml but then reduce the dose  to achieve a trough level of 3-7ng/ml afte...

View Discussion

RE: CNIs for tip lesion FSGS 1 day ago

Is this for a patient with steroid-resistant Nephrotic Syndrome? What is the level of Renal function?  Practice varies in respect to monitoring blo...

View Discussion