RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 5 hours ago

FLC ratio is 2.18 (k/l = 40/18). Peripehral blood flow cytometry did not pick up any clone. Will try to get bone marrow flow cytometry. Thanks. ...

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RE: SLN in Pregnant woman 7 hours ago

Glad to see we've drawn Dr. Lightstone into the conversation. Liz, have you used RTX in pregnancy? I defer to you on the RTX question in this case....

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RE: Obstructing Urinary Stone 9 hours ago

I'm a UROnephrologist! I'm with Dr. Glassock. A 7 mm stone has about a 20% chance of passing (easy to remember that a 5 mm stone is a 50/50 stone; ...

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RE: SLN in Pregnant woman 9 hours ago

But we do not yet know if it will be refractory to permissibly safe levels of pharmacotherapy in early Pregnancy. ------------------------------...

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RE: Obstructing Urinary Stone 9 hours ago

Experimental studies in normal animals has shown that the contralateral kidney increases its GFR by about 50 % within 7 days after complete unilate...

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RE: Obstructing Urinary Stone 9 hours ago

My reasoning was that the R kidney might be completely obstructed and the R kidney non-functioning, explaining the rise in SCr. I am very uncomfort...

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RE: Obstructing Urinary Stone 10 hours ago

i am not a urologist-but managed a lot of stone formers over the years. if pain control is adequate and no infection/sepsis then removing stone is ...

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RE: SLN in Pregnant woman 10 hours ago

"the consistent theme across this paper and the closely aligned contemporaneous literature is that rituximab is reserved for severe/refractory glom...

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RE: Obstructing Urinary Stone 10 hours ago

@David Goldfarb @John Asplin @Amy Yau I know you all are not urologists but what are your thoughts on this? Out pt hydration and pain control...

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RE: Obstructing Urinary Stone 10 hours ago

most stones [More]

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RE: SLN in Pregnant woman 11 hours ago

Hi Dr. Glassock! It does appear that the literature suggests that first trimester exposure may be OK but overall caution is advised; Open Evidenc...

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RE: Obstructing Urinary Stone 11 hours ago

I agree need to see urologist more urgently drop in kf, hydronephrosis , symptoms Bw --------------------------------- Muhammad Soobadar MBChB U...

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RE: SLN in Pregnant woman 11 hours ago

Interestingly, CLAUDE informs me that RTX (an IgG1 MoAb) does not cross the placental barrier at all in the first trimester of a normal pregnancy ,...

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RE: SLN in Pregnant woman 12 hours ago

Dr. August - I agree with your concerns. I have used RTX in the third trimester in a few prenatal patients with severe ANCA Vasculitis. The babies ...

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Obstructing Urinary Stone 12 hours ago

I have been consulted by a middle aged female patient with recent onset of abdominal pain. A non-contrast CT shows a 7mm very opaque stone in the R...

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RE: Modality Of Imaging For Decline In Kidney Function 12 hours ago

For pragmatic reasons US is the best choice (in non-obese subjects- ) for determining cortical thickness in CKD- rapid, very available and limited ...

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Modality Of Imaging For Decline In Kidney Function 12 hours ago

In patient with decline in kidney function what is the best modality of imaging Patient going to have CT abdomen /pelvis would we still request r...

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RE: pr3 +ve is it endocarditis ? 14 hours ago

Thanks prof glassock Would you repeat kidney biopsy ? Many thanks --------------------------------- Muhammad Soobadar MBChB UK ----------------...

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RE: Light chain proximal tubulopathy 14 hours ago

Never published it. But ran multiple gels from different subjects. It was low priority. No body picked up Dr. Batuman work, someone should. -----...

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RE: Light chain proximal tubulopathy 14 hours ago

It is my understanding from the literature that virtually 100% of free lambda light chains in serum are covalently linked dimers - the polymerizati...

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RE: pr3 +ve is it endocarditis ? 14 hours ago

The biopsy makes Vasculitis less likely but does not exclude it with certainty due to small cortical sample size. ------------------------------ ...

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RE: Light chain proximal tubulopathy 14 hours ago

The notion that Kappa is a monomer, and lambda is a dimer it is not totally accurate. At lease in the lab, frequently there is a percentage of th...

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RE: pr3 +ve is it endocarditis ? 15 hours ago

@ prof lerman / prof glassock / prof rodby prof venkat / dr dastoor @ dr satish @ dr Venturi any thoughts about my question ? ------------------...

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RE: anti gbm serology postive with fever and raised inflammatory markers 15 hours ago

Thanks prof lerman and prof glassock ( I will pass this message to histopatholgist ) --------------------------------- Muhammad Soobadar MBChB ...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 15 hours ago

Unfortunately, immunohistochemistry in the marrow is only good for detecting 1 clone. In this case, you may have a biclonal gammopathy. What are th...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 17 hours ago

Thanks all for input She referred for VP shunt or optic nerve fenestration Doctors refused both as she risky And send here back to take diamox an...

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RE: SLN in Pregnant woman 18 hours ago

I wasn't aware you could give Ritux in the first (or any) trimester. I see there is a small case series, but generally, especially without a biopsy...

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RE: anti gbm serology postive with fever and raised inflammatory markers 18 hours ago

Congratulations to your renal pathologist for the dogged pursuit of the Immunopathology in this case. As it turns out this is a classic examole of ...

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RE: SLN in Pregnant woman 19 hours ago

antiphospholipid panel is pending. my questions was mostly related to Ritux, as there is such a short window of opportunity to give it to her wit...

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RE: is it APS nephropathy 19 hours ago

Anti-coagulant Nephropathy usually is associated with gross (macroscopic) hematuria and AKI, but I concur with Dr. Balan's suggestion. If the PT is...

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RE: SLN in Pregnant woman 19 hours ago

Great point Dr. August . I just learned a clinically relevant Pearl of Wisdom. ------------------------------ Richard Glassock MD, FASN Emeritus ...

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RE: SLN in Pregnant woman 19 hours ago

I agree with the therapy suggested for her nephrotic syndrome; I would check APLA's; She's had two previous pregnancy losses (no details) and if hi...

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RE: is it APS nephropathy 20 hours ago

With that dipstick showing blood, please check INR.High INR on warfarin may indicate anticoagulant nephropathy too. If INR is in range, this would ...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 21 hours ago

Agree with the replies above. I definitely wouldn't "consider starting HD early". As Dr. Lerman alluded to, IHD can severely aggravate intracranial...

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RE: anti gbm serology postive with fever and raised inflammatory markers 22 hours ago

Agree with your excellent management - ANtI -GBM titers usually fall with in weeks to months of Plex and IS.sometimes spontaneously . If no umprove...

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RE: anti gbm serology postive with fever and raised inflammatory markers 23 hours ago

attached is biopsy report Native renal core biopsies. . CLINICAL DETAILS: Hypertension. eGFR, 56. Presented with severe acute kidney injury, me...

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RE: anti gbm serology postive with fever and raised inflammatory markers 23 hours ago

Dear team, I have handed over the patient this week to colleague He has finished 7th session of plex on Monday 17/08 2nd anti GBM after 2 or 3rd p...

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RE: pr3 +ve is it endocarditis ? 23 hours ago

Dear Colleagues, congenital heart disease have said that treatment of endocarditis would involve possibly open heart surgery they wanted to be cle...

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RE: Light chain proximal tubulopathy 1 day ago

I find Dr. Leung comments both compelling and constructive. Many Thanks . We need to know the Bone Marrow findings, serum calcium, bone survey and ...

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RE: SLN in Pregnant woman 1 day ago

Not a bad idea, but how will a positive result therapy at this time. Nephrotic syndrome may have been the cause of a DVT. Just an opinion. ------...

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RE: SLN in Pregnant woman 1 day ago

With her DVT history.. has she had antiphospholipid antibodies checked? --------------------------------- Alaa Nabih Abdalla nephrology fellow Eg...

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RE: is it APS nephropathy 1 day ago

Pretty typical aPL antibody syndrome , especially with migraine and thrombosis. Life long Warfatin is the key therapy. I see no reason to perform a...

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RE: MPGN pattern in a 43-year-old woman with a JAK2-positive hematologic disorder, portal hypertension, and a serum IgA-λ monoclonal protein 1 day ago

By the way, did the marrow showed where the monoclonal IgA lambda was coming from? In POEMS patients, the monoclonal protein can be coming from a p...

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RE: MPGN pattern in a 43-year-old woman with a JAK2-positive hematologic disorder, portal hypertension, and a serum IgA-λ monoclonal protein 1 day ago

With the absence of immune complexes, I agree this is most likely a chronic TMA. The presence of a monoclonal gammopathy raises the possibility of ...

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RE: SLN in Pregnant woman 1 day ago

She clearly has immunologically active LN and needs immunosuppressive therapy. I think the choice of AZA, CNI and steroids is a very reasonable str...

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SLN in Pregnant woman 1 day ago

I have a 26yo with SLN Class 3/4 on 2020 biopsy. Hx of Nephrotic Syndrome and DVT. She had a total of 5 pregnancies and 3 healthy kids. I saw her l...

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RE: Light chain proximal tubulopathy 1 day ago

I am still not certain that he has LCPT, and even if he does, it could be stable for years without therapy. More concerning is the high serum FLC a...

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is it APS nephropathy 1 day ago

26 M APL triple positive with low level haematuria and proteinuria has flank pain and i did MRA renal arteries normal ( no coarctation of aort...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

agree in pd patients with VP SHUNTS PERITONITIS usually does not ascend to cause CNS infection ------------------------------ [Mark] [Lerman] [MD...

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RE: Light chain proximal tubulopathy 1 day ago

No prominent lysosomes or crystals on EM. We don't t know the significance of occasional Congophilic cast without light chain restriction. -----...

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