RE: Early Transplant Glomerulopathy 1 hour ago

I suppose that RTX +IVIgG is worthy of a trial, but I would not expect much change. Thus is a very difficult, , often fruitless, entity to treat. S...

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Early Transplant Glomerulopathy 6 hours ago

46 years old, living unrelated kidney transplant in 2005, s/p PTLD 2 years later, treated with R-CHOP, with complete remission. Was off CNI, ster...

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RE: heterozygous cysteinuria 8 hours ago

One point of clarification I left out of my original post, the ranges I provide for cystine excretion in hetero and homozygotes are rough estimates...

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RE: heterozygous cysteinuria 9 hours ago

Dr. Asplin - many thanks for your very cogent advice. Whether she has any CKD at all is very debatable. ------------------------------ Richard Gla...

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RE: heterozygous cysteinuria 9 hours ago

The SCL7A9 gene mutations are often characterized as being autosomal dominant with incomplete penetrance. Those homozygous for SCL7A9 mutations hav...

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RE: heterozygous cysteinuria 10 hours ago

Do heterozygotes of autosomal recessive diseases manifest the bit of the disease? I was always taught no but this is not so clear anymore. For inst...

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RE: heterozygous cysteinuria 20 hours ago

This level of eGFR may be perfectly normal for a 72 year old woman, and in the absence of albuminuria very likely indicates that true CKD is not pr...

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heterozygous cysteinuria 22 hours ago

SCL7A9 heterozygous mutation 72 yo woman with CKD stage 3aA0, GFR 52, normotensive, non-diabetic, but with chronic microscopic hematuria since her...

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RE: IgE on Renal Bx 1 day ago

Serum levels of IgE may have prognostic significance in MCD, but thus observation has not been independently confirmed and has nothing to do with I...

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RE: IgE on Renal Bx 1 day ago

Very few studies. Staining for IgE in a kidney biopsy would not change my management of MCD, one iota. I think it is a "dead issue". -------------...

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RE: IgE on Renal Bx 1 day ago

Interesting. I've seen some studies from China with the possible association of IgE (Serum) and Minimal Change Disease. I couldn't find any stainin...

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RE: IgE on Renal Bx 1 day ago

One reason- never been shown to have any clinical value in diagnosis or Management. ------------------------------ Richard Glassock MD, FASN Lagun...

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IgE on Renal Bx 1 day ago

I just have a general question. Is there any specific reason why IgE is not stained for renal biopsies with IF? ------------------------------ Chr...

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RE: Antiphospholipid syndrome in ESRD patient on HD 1 day ago

I have a patient in her early 70s with APLA on HD with rapidly increasing DVT formation and loss of HD access. She has been on Coumadin and even wi...

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RE: ; to empirically treat or not ( "primum non nocere) 1 day ago

Dr. Qualheim- after the 'show of hands" ,what did and your patient you decide to do? ------------------------------ Richard Glassock MD, FASN Lagu...

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RE: ; to empirically treat or not ( "primum non nocere) 1 day ago

Thanks for this post. Very sensible position. With The clearly demonstrated benefits of RASi + SGLT2i (and possibly HCO3 supplementation) on progre...

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RE: ; to empirically treat or not ( "primum non nocere) 1 day ago

I would agree that conservative therapy is key. Sodium bicarbonate is a simple and important addition. The recently completed STOP-ACE trial sugges...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

This lady has fairly advanced CKD which is remaining reasonably stable over time. The non nephrotic proteinuria and the lack of 'inflammmation' on ...

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RE: Gross hematuria and MGUS-->MGRS? in ADPKD patient 2 days ago

Thanks for the great FU. I commend you on your persistence. I hope this diagnosis will help the patient. By the way, how did you establish that thi...

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RE: Gross hematuria and MGUS-->MGRS? in ADPKD patient 2 days ago

I just wanted to share an update for this case since there was a recent discussion on when to get kidney biopsies. For over a 1.5yrs pt continued t...

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RE: Hypokalemia in Sjogrens 2 days ago

Hi, We biopsy all of these ladies; I used to do an isotopic GFR as well, but I rarely do that now. The underlying lesion is alays a chronic TIN; an...

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RE: Kidney Biopsy 2 days ago

Dr. Jarad- I think you have put your finger on a key issue going forward. More sophisticated analysis of kidney biopsy material combined with incre...

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RE: Kidney Biopsy 2 days ago

I am glad to see everybody goes through the same dilemmas and doubts I experience whenever I ponder doing a biopsy, experience anxiety about sendin...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

Thanks. This helps me to understand your "point of view" better. Have you considered the most likely proposition that this patient suffered from a ...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

Thanks. Appreciate the help. I'm not sure what the cardio/renal info was about... clinically doesn't have that, perhaps on a " nephron" level I und...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

In this particular case - there is a need to increase the flow in the tubules - so that whatever proteins spilled out, or the dead tubular cells - ...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

I Guess I don't understand how all of this information applies to this particular patient. So far as I can tell there are no signs of a cardio-rena...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

Nephrology Self-Assessment Program - Vol 21, No 1, April 2022 29 Article Cardiorenal Syndrome Claudio Ronco, MD Department of Medicine (D...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

Thanks- evidence for an MRGS very weak. Can only be diagnosed by kidney biopsy. degree of proteinuria compatible with TIN need UACR/UPCR ratio to...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

I should point out that measuring anti-PLA2R antibody in order to make a non-invasive diagnosis of Primary MN has never been shown to work in patie...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

As a clinician on the frontiers - here are my answers - respectfully : There are several clues already apparent. Age - senile nephrosclerosis. Som...

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RE: proteinuria in SLE - ? biopsy or not 2 days ago

Good point. Yes -we all have biases - and I do recognize and acknowledge mine. Thanks. ------------------------------ Richard Glassock MD, FASN La...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

My question is Directed to Dr. Salman, not to the original post. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 38...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

I do not understand the rationale underlying your diagnosis (no kidney biopsy) and your empiric treatment suggestions. Please explain. -----------...

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RE: ; to empirically treat or not ( "primum non nocere) 2 days ago

" - would appreciate a "show of hands" on whether to empirically treat this pleasant pt -" "- 90 yo fairly active WF . . " Likely MGRS -/+ podocy...

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RE: ; to empirically treat or not ( "primum non nocere) 3 days ago

90 Creatinine 2.35, but maybe climbing non-nephrotic proteinuria, trace hematuria only I know that lately I seem to be the one saying biopsy when o...

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RE: proteinuria in SLE - ? biopsy or not 3 days ago

"Unlike the Twitter poll, advice concerning the need for a kidney biopsy seems to be more equally divided on the ASN Communities site." I am certa...

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RE: Kidney Biopsy 3 days ago

We make these judgements without meeting the patients. That will remain, but that factor cannot be ignored. This is also part of the art. I look b...

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RE: proteinuria in SLE - ? biopsy or not 3 days ago

Very unfortunate patient (and doctor) Seems to have many reasons for CKD & proteinuria PMHx of SLE - what was the basis of the diagnosis ? How...

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Kidney Biopsy 3 days ago

We have experienced a flurry of "whether to do a kidney biopsy" of late, but this is a nearly universal thread. There are only some widely agreed u...

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RE: ; to empirically treat or not ( "primum non nocere) 3 days ago

Urinary FLC assays are uninterptetable and not recommended for diagnostic purposes. I would do a UACR/UPCR ratio to see if this is glomerular. If y...

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; to empirically treat or not ( "primum non nocere) 3 days ago

would appreciate a "show of hands" on whether to empiriclally treat this pleasant pt 90 yo fairly active WF , very appropriate family and patient ...

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RE: Hypokalemia in Sjogrens 3 days ago

> This is an important question but may not be a done deal. If the patients in the study cited were chosen because of impaired GFR (and not just R...

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RE: proteinuria in SLE - ? biopsy or not 3 days ago

I agree with Dr. Richard Glassock. What's the point in Kidney biopsy in this patient? this patient needs rehabilitation, rejuvenation along with pr...

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RE: PD in LVAD 3 days ago

Very interesting. I was not aware of this publication. Congratulations. Nice example of how ASN Communities can be leveraged. --------------------...

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RE: Hypokalemia in Sjogrens 3 days ago

Stable renal function (assessed by eGFR slope over time ) is not equivalent to a stable nephron mass in kidney disease. This needs to be taken into...

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RE: proteinuria in SLE - ? biopsy or not 3 days ago

Unlike the Twitter poll, advice concerning the need for a kidney biopsy seems to be more equally divided on the ASN Communities site. ------------...

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RE: GPA 3 days ago

Is their any clinical utility of "monitoring " serum Ig levels in long term therapy with RTX. I doubt it! Where is the evidence of benefit and cost...

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RE: PD in LVAD 3 days ago

Dr Velez and we did it with the vanco paper :) G

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RE: GPA 3 days ago

Monitor hypoglobunemia if using longterm retuximab That is why i think Avacopan should be considered --------------------------------- Bajinder R...

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