RE: IgA nephropathy and MCD 1 minutes ago

steroid responsive NS , steroid dependent NS, I suspect the IgAN is background but I'm not sure it matters the only odd thing I see is th FPE of...

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RE: transplant cases 1 hour ago

Just to clarify I agree that ATG can be given for ACR 1B my point was if Cyclophosphamide is going to be used to treat IgA i would be very careful ...

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IgA nephropathy and MCD 1 hour ago

Hello, 49 year old female, african, presented in 2022 for nephrotic syndrome, nl creatinine. kidney biopsy: LM: No hypercellularity, necrosis or...

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RE: DNAJB9-positive fibrillary GN with a distal acidification defect and recurrent calcium stones 1 hour ago

I'll take a shot at this QUESTIONS Has anyone seen DNAJB9-positive fibrillary GN alongside a distal acidification defect, and did a secon...

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RE: transplant cases 2 hours ago

Agree with Dr. Lerman that not all Banff grade IB TCMRs respond to methylprednisolone boluses alone. If the IB TCMR is causing marked and progressi...

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RE: transplant cases 2 hours ago

"MR: Treated with pulse methylprednisolone. I would hold ATG - Grade IB without vascular involvement is usually steroid-responsive"-for the record ...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 4 hours ago

Dr. Paramasivam: Lack of hematuria further strengthens the impression that IgA nephropathy is incidental and not causal to this patient's renal pro...

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DNAJB9-positive fibrillary GN with a distal acidification defect and recurrent calcium stones 4 hours ago

Posting a case where I suspect I am looking at two processes, anyone who has seen this combination? CASE Woman in her early 40s. Recurrent calc...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 4 hours ago

trace blood seen in one sample - however no rbc seen in UA Latest Reference Range & Units 05/21/24 09:09 08/28/24 08:40 05/16/25...

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RE: AKI & Immune complex GN 13 hours ago

This case can mist likely be categorized as a pattern of injury lesion characterized by mesangioprliferstivev ( not Membranoproliferative GN or Lup...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 13 hours ago

Also, look at the variables used in the kidney failure prediction equations (Tangri et al)) ------------------------------ Richard Glassock MD, F...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 17 hours ago

Almost an impossible question to answer. The eGFR trajectory. is so heterogeneous depending on the nature of the injury,, glomerular , tubular, vas...

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RE: transplant cases 18 hours ago

Good point Dr Glassock this article was published this month https://www.sciencedirect.com/science/article/pii/S0149291826003103 -------------...

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RE: transplant cases 22 hours ago

Based on very limited evidence, all observational, I prefer Steroids + Iptacopan or steroid + RTX therapy over Steroids + CYC for therapy of recurr...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

Thanks for case . To summarise Options 1 Tac / mmf as maintenance with pulse methyl pred and warning oral steroid + iv ig 6 session 2 tac / mmf...

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RE: transplant cases 1 day ago

Good morning this is a challenging case we saw a similar case 1 month ago . This is a mix picture of acute TCMR Grade IB (t2/3, i2/3, v0) wit...

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RE: AKI & Immune complex GN 1 day ago

Correct, blood cultures are negative. We had an HIV test came back negative. She just had an echo, TTE, I have to get the final report but the p...

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RE: AKI & Immune complex GN 1 day ago

Roger- thanks for digging deeper I to this issue. I stand corrected. The frequency of a positive RF depends on the duration of the SBE. The longer ...

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RE: AKI & Immune complex GN 1 day ago

you had mentioned blood cultures and an echo - they were done and negative I assume Dr Glassock mentioned that a negative RF essentially rules ou...

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Does the type of kidney injury determine the angle of the slope towards dialysis? 1 day ago

Can you tell me if proximal nephron injury [say diabetic injury] is worse than distal nephron injury [ obstructive injury?] ---------------------...

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RE: AKI & Immune complex GN 1 day ago

So Bartonella Quintana IgM >1:20 (borderline). We doubt it has any relation to this. AKI on the other hand is better on Prednisone 60 mg qd & Cellc...

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RE: transplant cases 2 days ago

On top of steroids with or without rATG for the TCM, the late AMR and, based on recent reports, the severe IgAN might respond to anti CD38 therapy ...

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RE: transplant cases 2 days ago

"Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria?" Dr. Glassock: I asked ...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

I think standard therapies will likely not work in this late active AMR with some chronicity. You may try daratumumab weekly four doses, then plan ...

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RE: Diamox causing kidney stones 2 days ago

In our clinical practice we do only pre and post treatment 24 hr urine electrolytes, citrate, oxalate, uric acid, PH parameters which are misleadin...

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RE: transplant cases 2 days ago

Dr. Venkat- How would you treat the severe crescentic IgAN/IgAV in this patient?-this process seems to be the major problem. --------------------...

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RE: transplant cases 2 days ago

Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria? Agree with Dr. Lerman th...

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RE: Tuberous sclerosis in 34 year old 2 days ago

Thank you for your input. Will contact Riley and see if they can see her. Will continue either with ckd management. --------------------------...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

Is there significant microscopic (or macroscopic) hematuria in this patient. I think that the IgA nephropathy is not the significant problem in thi...

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RE: Diamox causing kidney stones 2 days ago

David: As a practical approach to the potential opposing effects of citrate on stone formation (especially with CaP04), can you compare the SS for ...

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RE: Diamox causing kidney stones 2 days ago

"I've said it before here on several occasions: it could be that the increase in urine citrate is more important as an inhibitor of calcium stones ...

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RE: Diamox causing kidney stones 2 days ago

Thanks everyone, will try supplementing potassium citrate. ------------------------------ Brendan] [Mielke] [MD] [Kootenai Clinic] [Coeur d Alene...

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RE: transplant cases 2 days ago

To my knowledge, there is not specific treatment paradigm for plasma cell rich rejection and other than noting that the ACR is plasma cell rich it ...

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RE: Diamox causing kidney stones 3 days ago

Yes I agree. There's this study showing that you can increase urine citrate in patients with hypocitraturia getting topiramate. https://pmc.ncb...

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RE: transplant cases 3 days ago

both pathologies need treatment!!! Dear Muhammad Soobadar followup will be very helpful to this forum. Thanks for posting this fascinating case in ...

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RE: Diamox causing kidney stones 3 days ago

Acetazolamide directly inhibit CA at the choroid plexus reducing ICP (this is the main mechanism). Correction of systemic acidosis lower the hyperv...

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RE: transplant cases 3 days ago

Dr. Venturelli. Very good points. I can't say ,with any degree of certainty from morphological features alone, that this is IgAV or a particularly ...

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RE: transplant cases 3 days ago

Great discussion! My apology as I misinterpreted the case as positive C4d (it was G and not PTC). With these positive portfolios of DSA which are r...

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RE: Diamox causing kidney stones 3 days ago

agree with kcitrate,salt restriction, and fluids. my sources suggest giving alkali does not reverse CNS benefit of diamox follow 24 hr urines for...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 3 days ago

consider IVIG ± pulse methylprednisolone for chronic active ABMR WOULD do SPEP, urine PEP, SLC for completeness, to r/o MGRS, restart ARB for PROTE...

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RE: Diamox causing kidney stones 3 days ago

@John Asplin @David Goldfarb I know that the CA inihibtor topomax has both proximal and distal tubular CA inhibition and thus gives features...

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RE: transplant cases 3 days ago

I agree. I think it is highly probable both things are occurring and should be treated. ------------------------------ Jonathan Zuckerman MD, Ph...

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RE: transplant cases 3 days ago

Dr. Glassock perhaps I missed part of the patient's history What makes you say, without evidence of concurrent or historical systemic involveme...

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RE: transplant cases 3 days ago

Thanks Dr. Zuckerman -I am not against treating the IgA vasculitis component, but remain convinced that the acute cellular rejection.1 B should als...

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RE: transplant cases 3 days ago

I will also share case with Dr. Xin Zhou a respected renal pathologist in Dallas who has extensive experience with kidney Transplant pathology ...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 3 days ago

Thanks - great teaching case - is creatinine/eGFR stable? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past M...

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RE: transplant cases 3 days ago

This is a challenging and unusual case. Given the presence of a diffuse active necrotizing/crescentic GN with IgA dominant IF staining, there is cl...

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RE: Diamox causing kidney stones 3 days ago

The mainstay of treatment is K citrate supplementation to raise the 24 hr urine citrate > 320 mg and not to increase urine PH > 7 to decrease furth...

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RE: transplant cases 3 days ago

I can't say for sure in kidney transplant recurrence, but in IgA V involving the native kidney often has a prominent tubulo-interstitial inflammati...

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RE: transplant cases 3 days ago

Thanks - look forward to his comments- we also need to appreciate clinical picture which includes a noncompliant patient with immunosuppression and...

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