Cysteinuria 2 hours ago

@David Goldfarb I have a 51-year-old lady with the above diagnosis with recurrent kidney stones currently on potassium citrate 45 meq tid with urin...

View Discussion

Hereditary Cystinutia 2 hours ago

@David Goldfarb I have a 51-year-old lady with the above diagnosis with recurrent kidney stones currently on potassium citrate 45 meq tid with urin...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 3 hours ago

Meanwhile, the potential recipient got admitted with sepsis for 2-3 days in Medical ICU. Thank u everyone for the great inputs. Will do urinary cal...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 5 hours ago

Sry likely -yes, but this is not curative therapy Sent from my iPad

View Discussion

RE: Potential kidney donor w parathyroid adenoma 6 hours ago

I would strongly advised against even considering a calcimimetic in such a patient.  If she has primary HPTH, then a focused parathyroidectomy woul...

View Discussion

RE: Peritoneal Dialysis in ESRD with Liver cIrrhosis and ascites 7 hours ago

The medical flora in our area here North of Charlotte NC does not permit PD catheter placement. I can not find any surgeon to place a Tenchoff, and...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 7 hours ago

Would   Cinacalcet  help this patient? ------------------------------ Sinasi Salman MD, FASN Northlake Nephrology Mooresville NC (704) 978-0052 ---...

View Discussion

RE: Medical Nephrectomy 9 hours ago

This does look like a late adult presentation of primary hyperoxaluria. Conventional dialysis is unlikely to overcome the oxalate load. Daily long ...

View Discussion

RE: Atypical ant-GBM case 9 hours ago

Will do, Thank you so much! ------------------------------ Kishore Patcha, MD ------------------------------

View Discussion

RE: Medical Nephrectomy 10 hours ago

Interesting but since renal allograft are denervated and pts still can have renal colic from ureter probably would not work- if anyone has an artic...

View Discussion

RE: Atypical ant-GBM case 11 hours ago

Will do, Thank you! ------------------------------ Kishore Patcha MD University of Utah Salt Lake City UT Kishore ------------------------------

View Discussion

RE: Atypical ant-GBM case 11 hours ago

In light of the lack of rapidly progressive GN and the limited extent of crescentic lesion, along with a negative ELISA for antiGBM antibody, I thi...

View Discussion

RE: Atypical ant-GBM case 12 hours ago

I think it is important to confirm the diagnosis Repeat antigbm antibody by Western blot If negative do ig subtyping as as i mentioned before -----...

View Discussion

RE: Atypical ant-GBM case 12 hours ago

Dr. Glassock, Thank you for reply and sharing your wealth of knowledge as always. ANA, ANCA, Syphilis, HIV - Negative,  K/L ratio, SPEP/IFE, C3, C4...

View Discussion

RE: Fibrillary GN with IgG lambda 14 hours ago

In most specialty renal pathology labs a DNAJB9 stain is routine whenever Fibrillary GN is seen by LM, IF and EM. It does not require Pronase dige...

View Discussion

RE: Fibrillary GN with IgG lambda 14 hours ago

Thank you for the comments..great learning experience. Can Pathologists do the DNAJB9 staining routinely on such a diagnosis (and with pronase) or ...

View Discussion

RE: Atypical ant-GBM case 15 hours ago

A single negative anti-GBM antibody test (by undescribed method) does not exclude classical anti-GBM disease, nor does it define “Atypical “ antiGB...

View Discussion

RE: Atypical ant-GBM case 15 hours ago

If it is ig4 yes --------------------------------- Bajinder Reen MD Brampton ON (905) 453-0821 ---------------------------------

View Discussion

RE: Atypical ant-GBM case 15 hours ago

Thank you, two questions; 1. if Igg 4 subclass negative how would you approach? 2. If Igg 4 subclass positive, clearly this patient doesn't have an...

View Discussion

RE: Atypical ant-GBM case 16 hours ago

Further there is association with memberanous and anti gbm disease i will high ly recommend subtypi g if igg --------------------------------- Baji...

View Discussion

RE: Atypical ant-GBM case 16 hours ago

I will suggest go get subtyping of igg by by Pronase parffin embeded method If it is Ig4 antibody test is negative by commomly used method If it is...

View Discussion

Atypical ant-GBM case 16 hours ago

57 year old MALE with a PMH of HTN, HCV s/p antiviral therapy undetectable viral load 2 months prior to this admission, Polysubstance abuse althoug...

View Discussion

RE: PD In Patients Who Make Up Their Weights 17 hours ago

Clearly, a very difficult problem, psychiatric disease and ESRD often do not mesh well IMHO, we should be reticent to base a treatment modality on ...

View Discussion

RE: Combined TMA and Collapsing FSGS 17 hours ago

Dr. Rodby has raised the possibility of this being just a case of TMA with secondary ischemic glomerular collapse. Perhaps, the terms collapsing gl...

View Discussion

RE: Combined TMA and Collapsing FSGS 18 hours ago

Based on the information you have shared with us, I would be very reluctant to add any immunosuppression to her treatment. Sent from my iPad

View Discussion

RE: Fibrillary GN with IgG lambda 18 hours ago

​I fully concur with Drs. Glassock and Rubin statements. Samih ------------------------------ Samih Nasr MD Mayo Clinic Rochester MN 507-284-1868 -...

View Discussion

RE: Fibrillary GN with IgG lambda 18 hours ago

The prevalence of a MGRS in DNAJB9 + Fibrillary GN is not zero, but it is probably around 1-2% or less. Therefore a MGUS in a patient with DNAJB9 +...

View Discussion

RE: Combined TMA and Collapsing FSGS 19 hours ago

I had thoughts similar to Dr. Friedman's. Lot of chronicity on biopsy. Initial SCr 6.0 mg, now ~ 7.0 mg/dL, (off dialysis?), still passing urine. S...

View Discussion

RE: Fibrillary GN with IgG lambda 19 hours ago

Thank you @Samih Nasr for a clear explanation of the current status of fibrillary GN. Therefore, is it fair to say that only cases of fibrillary GN...

View Discussion

RE: Fibrillary GN with IgG lambda 19 hours ago

I concur with Drs. Glassock, Nelson, and Cornell. Based on an upcoming large series from our center, DNAJB9-positive monotypic fibrillary FGN is ve...

View Discussion

RE: Fibrillary GN with IgG lambda 19 hours ago

Thank you @Nelson Leung . The pragmatic question still is:  should a search for monotypism be conducted in cases of DNAJB9 (+) fibrillary GN and, i...

View Discussion

RE: Fibrillary GN with IgG lambda 19 hours ago

So the issue is how is fibrillary glomerulonephritis defined.  If it is limited to DNAJB9 positivity, then monoclonal immunoglobulin is rare.  If w...

View Discussion

RE: Combined TMA and Collapsing FSGS 20 hours ago

Dear Dr Friedman,  Actually, i saw the patient after she returned back from Saudi Arabia, where she already had dialysis 3 times. All of this is ...

View Discussion

RE: Combined TMA and Collapsing FSGS 20 hours ago

Some of you recommended Eculizumab to me, It is not available here in Egypt, Would you consider additional immunosuppression? She is still passing...

View Discussion

RE: Combined TMA and Collapsing FSGS 20 hours ago

Perhaps I missed somewhere but: 1. what were her renal/urinary parameters pre-ovulation induction? & 2. did she have actually have features of OHSS...

View Discussion

RE: Combined TMA and Collapsing FSGS 20 hours ago

Thanks all for your replies, OHSS is a promising theory, never thought about it, Yes, i looked for antiphospholipid Abs and they were all negative...

View Discussion

RE: Fibrillary GN with IgG lambda 20 hours ago

According to the attached report from the Mayo Clinic, the association of fibrillary GN with diseases such as dysproteinemic disorders, leukemias, ...

View Discussion

RE: Medical Nephrectomy 20 hours ago

was etiology of recurrent stones ever determined prior to ESRD. Laprascopic bilateral NEPHRECTOMY by highly qualified surgeon would be best. inform...

View Discussion

RE: Combined TMA and Collapsing FSGS 20 hours ago

Was  EM done on the second biopsy? was TMA associated with MAHA , THROMBOCYTOPENIA.? curious if she was able to get pregnant before why ovulation s...

View Discussion

RE: Combined TMA and Collapsing FSGS 20 hours ago

Tragic case and very important to get as much information relevant to her situation now and possibly for a transplant later. While currently only a...

View Discussion

RE: Combined TMA and Collapsing FSGS 21 hours ago

I suspect you looked for antiohopholilid antibodies and other autoimmune marchers given her age and gender? But I susoect Dr Glassock is right this...

View Discussion

RE: Combined TMA and Collapsing FSGS 22 hours ago

She was not pregnant for a second time, only ovulation induction without pregnancy ------------------------------ Mohamed Elrggal, MD Alexandria Eg...

View Discussion

RE: Combined TMA and Collapsing FSGS 22 hours ago

What trimester was the patient in when she had the 2nd kidney biopsy (which revealed TMA)?  I'm asking because I'm trying to determine the type of ...

View Discussion

RE: Combined TMA and Collapsing FSGS 22 hours ago

What a disaster. Tragic case. I have had no personal experience with cases like this but the ovarian hyperstimulation Syndrome (OHSS) is associa...

View Discussion

Combined TMA and Collapsing FSGS 23 hours ago

Dear all, I want to take your opinion regarding a 25 year old female, married since 2 years, her first pregnancy was lost at the 5th month but the ...

View Discussion

RE: Rituximab in class 3/4 lupus nephritis 1 day ago

I think u need to update the biopsy findings Are  there any cresents? How much IFTA Do u have information about her previous lab results Do u have ...

View Discussion

RE: Fibrillary GN with IgG lambda 1 day ago

According to what I have read, Sent from my iPad

View Discussion

RE: PD In Patients Who Make Up Their Weights 1 day ago

I am on Dr. Rodby's side.  Trust is the base for managing patients on home dialysis.  Soon enough she might not show to appointments, will not have...

View Discussion

RE: Fibrillary GN with IgG lambda 1 day ago

According to the consensus report by the IKMG published this past year, certain monotypic forms of fibrillary GN are considered to be MGRS. @Nelson...

View Discussion

RE: Rituximab in class 3/4 lupus nephritis 1 day ago

Yes we need biopsy data to opine on reinduction. 3 grams isnt that much really and if this were potentially reversible I would probably give anothe...

View Discussion