RE: Membranous nephropathy 21 minutes ago

She is currently on 0.5mg/kg Prednisolone, Apixaban 2.5 mg twice daily and ARB ------------------------------ Jaison George MD, MBBS Kollam, Indi...

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Membranous nephropathy 23 minutes ago

I am writing to request your guidance regarding a case of a frail seventy-two-year-old lady under my care. Past history She has a history of type...

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RE: Sarcoid assoc Ca stones 40 minutes ago

Dr Slater, Is your patient male or female? What is the patient's weight? A creatinine excretion of 1613 mg doesn't automatically strike me as an ov...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 4 hours ago

Dear colleagues Agree, this is a very difficult situation.We have approached in the past by asking involved family members to come to sit with t...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 4 hours ago

I must agree with Roger's input on this. Even one family member (the 'aggressive one' as he refers to) often prevails. Some years ago, I was forced...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 5 hours ago

Dr Petersen and colleagues, This is a very instructive case, and I agree with the focus on the calcium phosphate/brushite phenotype and the limite...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 5 hours ago

This is one of the ethical related issues we see often in dialysis units especially among elderly frail patients with loads of co-morbidities. Thi...

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RE: Biopsy dilemma in setting of severe refractory ITP 14 hours ago

Thanks for your input. I will pass it on. ------------------------------ Deborah Fein MD Nephrologist Pattner and Grodstein MD Englewood NJ 201-5...

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RE: Sarcoid assoc Ca stones 16 hours ago

Pth 42.5 vit d 25 level 42 Ca 9.1 I am considering doing testing t/ d if he really has incr GI abs hypercalcuria and if we document this t...

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RE: Biopsy dilemma in setting of severe refractory ITP 16 hours ago

Dr. Leung has already referred to the off-label use of daratumumab (which is already FDA-approved for multiple myeloma) in immune thrombocytopenia ...

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RE: Biopsy dilemma in setting of severe refractory ITP 19 hours ago

I do not think so but will ask. ------------------------------ Deborah Fein MD Nephrologist Pattner and Grodstein MD Englewood NJ 201-567-0446 --...

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RE: Sarcoid assoc Ca stones 1 day ago

I think I would favor a trial of ketoconozole while monitoring urine calcium exterminator rate. Just an opinion not based on evidence. What is the ...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 1 day ago

This problem can be, potentially at least, minimized by a careful explanation to the family members what a "trial of dialysis" really means ,before...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 1 day ago

My only advice in these situations is to say if this were my family member I would not dialyze as putting the patient through dialysis will decreas...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

I was wondering about that. Have your hematologist tried daratumumab to target the CD38 cells. It has been reported to be successful in rituximab r...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Dr Peterson, Thank you for posting the 24 hr urine data. I assume the PTH and vit D data you provided are all within the reference range for your l...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

The ITP is a very long saga. She failed everything including rituximab( but very short trial with lots dropping to 3000). Splenectomy at Mskcc fail...

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RE: Pd Question 1 day ago

Request for CT Known Polyctic liver and Kidbey. Cystitis and infceted kidney cyst drain by radiological drain . Now deteriorating GCS , increasin...

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decision to stop dialysis in patients who lack capacity and family members have divergent views. 1 day ago

Frail HD patient with worsening dementia and worsening frailty and no capacity lives in care home dialysis consultant felt to stop dialysis ...

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Sarcoid assoc Ca stones 1 day ago

60-year-old diagnosed with cardiac sarcoid 10 yrs ago presented w bradycardia req PPM and is maintained on methotrexate and low does prednisone. Al...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

It's a reasonable option but would not be my first choice. If she could lower her "average USA" UNa of 186 that would be preferable. Adding to her ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Thank you so much for these incredibly thoughtful insights! It is worth noting that even with recombinant insulin, patients can develop antibodies...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Thanks Dr. Asplin and Goldfarb. Would you add a thiazide in this case because of a borderline increase in urinary Calcium excretion.? Just curious-...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Puzzling case. There are very rare case reports of ICGN from insulin therapy in Type I DM ((anti-insulin Antibody, not with recombinant Insulin . )...

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RE: uTi In Anuric Hd Patients 2 days ago

Cystitis in ESRD can happen and is very challenging to treat. If you can get few CCs of urine and culture, do. If not use a 3rd gen cephalosporin w...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

Here is the Litholink from 1/2026 ------------------------------ Emily Petersen MD, FASN Kootenai Clinic Nephrology Coeur D Alene ID (208)...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

Regarding the cystinuria genotype. Heterozygous SLC7A9 mutations, like this patient, and not SLC3A1 mutations, can cause an increase in cystine exc...

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RE: uTi In Anuric Hd Patients 2 days ago

I do not routinely examine dialysis patient's bladder or do post-void scans. These steps + obtaining catheterized specimen from bladder should be c...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

I think rituximab is a good plan. It could treat both so if the kidney function does not improve, at least the ITP could be in remission. However, ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Thank you both Drs. Venkat and Dr. Rodby. Our pathologist mentioned just a trace of C3 deposition. I will check RF as well. ----------------...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Q1. What is the known duration of type-1 diabetes? -> She was diagnosed with T1DM ~ 20 years ago. Q2. Does she have diabetic retinopathy? ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Dr Venkat's point of : "Personally, not impressed with severity of IC-GN findings in the biopsy as explanation for wosening proteinuria" is well ...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

@John Asplin "Urinary aklalinization with K citrate can aggravate stone formation" My probable oversimplified understanding of Medullary ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Questions: 1. What is the known duration of type-1 diabetes? 2. Does she have diabetic retinopathy? 3. SAlb trend? 4. Were the random/spot urine sa...

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RE: Approach to flank pain ( my case series) 2 days ago

Allow me to opine If clots can be seen from gross hematuria in severe glomerular disease such as IgAN, it must be extremely rare. Why wou...

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Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Good morning/afternoon/evening, everyone! I have a 31-year-old female patient with type 1 diabetes mellitus who developed sub-nephrotic range prot...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

Thanks Dr. Asplin . I was impressed with the medullary sponge kidney, the family history and the stone composition results. The existence of an aut...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

Yes I will try to do that later today ------------------------------ Emily Petersen MD, FASN Kootenai Clinic Nephrology Coeur D Alene ID (208) 2...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

I should have mentioned that the genetic test indicated that inheritance could be autosomal dominant or recessive ------------------------------ ...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

Dr Petersen, This is a very interesting case. Would you be able to scan a deidentified copy of her 24 hr urine so we can look at all the numbers....

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

This case would benefit from advice from Drs. Goldfarb and Asplin. Medulkary Sponge Kidney is associated with Calcium Phosphate stones and can have...

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RE: uTi In Anuric Hd Patients 2 days ago

That’s helpful Do we routinely examine dialysis patient bladder / do post void scan ? How anuric is anuric ? 24 hr volume is not often measured i...

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Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 days ago

44 yo female patient with recurrent kidney stones, approximately 5 symptomatic stones per year for many years, off and on, and has had obstructing ...

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RE: Pd Question 2 days ago

Thanks prof venkatShe is in her 50 Active on tx list ( now suspended ) Gram -ve bacilli on cyst fluid and blood cultures urine culture pending Not...

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RE: Lupus nephritis III/IV 2 days ago

Thanks dr Marwan. Not sure about this one . Feels risky to stop everything and have a flare in pregnancy But if stops and patient stable serologi...

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RE: Lupus nephritis III/IV 2 days ago

Thanks prof rodby @ prof glassock how long would you wait after switching to aza assuming serological remission and no active urine sediment ( one...

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RE: Lupus nephritis III/IV 2 days ago

thank you all for your input. I actually have this same scenario a lady who is planning pregnancy who has been on remission for >5 years, serologie...

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RE: Lupus nephritis III/IV 2 days ago

"Drs. Hirsch and Rodby- what would you do if your 25 year old patient with Class IV LN in a complete clinical remission for 1 year on MMF 2.0 gms p...

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RE: Lupus nephritis III/IV 2 days ago

Conversion from MMF to AZA would be acceptable practice if she is in a complete clinical and immunological remission (normal protin excretion, eGzf...

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RE: Approach to flank pain ( my case series) 2 days ago

Thanks-Dr. it has been a long time since I first read this seminal paper which was one of the first to draw attention to the close connection...

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