RE: Lupus nephritis III/IV 18 minutes ago

Good thread . Lot of good advice. I use serology, rather than repeat KB to determine when it is "safe" to discontinue IS in patients with treated "...

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RE: Lupus nephritis III/IV 2 hours ago

I am in the longer than shorter camp and I have patients on indefinite maintenance, but that is hardly a universal opinion and dare I say may be un...

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Lupus nephritis III/IV 2 hours ago

General question , I believe was also discussed previously but I wanted to see general opinion/practice among different doctors here. how long d...

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RE: Atypical Nephretic nephrotic syndrome 2 hours ago

EMs are still pending , if you see mesangial deposits that may go along with the almost full house IF which is not typical for PLA2R MGN. Was there...

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

Thanks Dr.Leung. Very helpful detail. I assume that you have abandoned the procedure at the Mayo Clinic for kidney biopsy . ---------------------...

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RE: Atypical Nephretic nephrotic syndrome 3 hours ago

This is a fairly common conundrum in clinical practice. One disease (Reverend Ockham's Razor) or two( (Hickams dictum )? Hard to tell in this case....

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Monosodium Urate Stone (MSU) 3 hours ago

I have a nephrolithiasis patient (in hospital for obstruction, got ureteral stents, improving), the stone analysis came back as monosodium urate. T...

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RE: Biopsy dilemma in setting of severe refractory ITP 4 hours ago

We used to do it at Mayo. Our radiologists got pretty good at it with tissue acquisition rate of over 90%. The problem is that we can no longer obt...

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RE: Atypical Nephretic nephrotic syndrome 4 hours ago

The severe interstitial led jobs are cdrtub,y compatible with NSAUD induced. the anti-PLA2R antibody may be real or a false positive-gard ti tell w...

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RE: Atypical Nephretic nephrotic syndrome 5 hours ago

Thank you for your comment , we have only serum APLA2R level , and it was 100 . Unfortunately we don't have APLA2R stain for biopsy . I really ...

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RE: Biopsy dilemma in setting of severe refractory ITP 18 hours ago

Thanks everyone The IR consultant I spoke to has done it( So junior IR consultant when I mentioned it have never heard of it) but that senior cons...

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

Correct. It is my impression that this is a procedure being performed in very ill patients and it should only be done by individuals with lots of e...

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

Thanks Dr. Rubin. Can I assume from your comments for the availability of TJKB performed by skilled operators would be unlikely in a hospital witho...

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RE: Atypical Nephretic nephrotic syndrome 19 hours ago

The antigen associated most closely with NSAID MN is PCSK6. Anti-PLA2R antibody positive MN is very rarely, if at all , caused by NSAID expisure . ...

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Atypical Nephretic nephrotic syndrome 20 hours ago

A 35-year-old previously healthy male presented to the emergency department with bilateral lower limb edema for 10 o He reported a history of upp...

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RE: Biopsy dilemma in setting of severe refractory ITP 21 hours ago

It represents Files Attached DocumentRE: Biopsy dilemma in setting of severe refractory ITP

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RE: Biopsy dilemma in setting of severe refractory ITP 23 hours ago

Just curious. How many liver Transplant programs in the USA Maintain transjugular kidney biopsy as a standard procedure in their armamentarium . Dr...

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

Dear all, I had been a part of some early attempts at trans jugular biopsy in the early aughts with a military IR procedurist who's probably a mu...

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

The perspicacious comment of Dr. Rubin is greatly appreciated. My suggestion that transjugular kidney biopsy (TJKB) is largely a museum piece , is ...

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RE: Col4A5 mutation pt - Would you biopsy? 1 day ago

I do agree with everyone that a renal biopsy would be probably redundant in this lady. I would definitely put her on Raasi. Progression to ESRD is ...

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

Personally, I think that before we close the door on this modality and find a suitable place in a museum for it, we must query those centers with v...

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RE: Col4A5 mutation pt - Would you biopsy? 1 day ago

When talking to woman of reproductive age, how do you approach the fact that having children with intact renal function is better than having chi...

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

Thanks Dr. Whittier,.. it sounds like transvenous renal biopsies are museum pieces not real procedures. I cannot ever recall being involved in this...

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

Our own IR stopped due to the time commitment of the procedure. they felt it was a negligible safety difference, and sometimes the procedures would...

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RE: Col4A5 mutation pt - Would you biopsy? 1 day ago

Dr. Rodby and Dr. Glassock, is there any chance that she may not have Alport? There is some data showing other types of pathology such as IgA or FS...

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RE: Col4A5 mutation pt - Would you biopsy? 1 day ago

Thanks to everyone for your input! very helpful. ------------------------------ Yongen Chang MD, PhD, FASN University of California Irvine Orang...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

Here is the viewpoint of a provider treating young patients: With a confirmed COL4A5 mutation and preserved kidney function, biopsy is unlikely to...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

I fully agree with Dr. Rodby. With these clinical and genetic findings a kidney biopsy would be redundant. She should be treated for X-linked Alpor...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

I would not, a clearer diagnosis without a biopsy cannot exist IMO. She will probably do OK, but bc she is only 27, I think I would still treat ...

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RE: lupus podocytopathy 2 days ago

Or unlikely --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: lupus podocytopathy 2 days ago

47 pregnancy less likely --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: lupus podocytopathy 2 days ago

Thanks dr zineb. This is systemic sle and lupus podcytopathy I would treat with mmf an steroids ( more for extra renal) I would not only focus o...

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Col4A5 mutation pt - Would you biopsy? 2 days ago

Hi, just wondering everyone's take on this - I have a 27 year old female patient with strong family history of presumed Alport's in her two brother...

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RE: Terlipressin Use and hepatorenal syndrome–AKI 3 days ago

I suppose you don't know if the patient responded to albumin as volume or a specific HRS treatment independent of volume (HRS by definition has to ...

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RE: Looking to decode this allograft biopsy 3 days ago

I do have Black and white but not colored pictures, same read on 2nd opinion. Crescents are likely pseudo as mentioned. Could be CNI but see a...

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RE: Looking to decode this allograft biopsy 3 days ago

See attached Allosure levels Never crossed 0.2 MFI was 1800 for Cw and just below 5000 for DR ------------------------------ Sandee...

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RE: Terlipressin Use and hepatorenal syndrome–AKI 3 days ago

.Appreciate your thoughtful comments. Appreciate your comments on usage of albumin I participated on the ATTIRE trial. the pendulum swing appropr...

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RE: Looking to decode this allograft biopsy 3 days ago

Dr. Magoon, I still have a couple of questions and comments you gave us the DSA with their MFI and said that these have been consistently decrea...

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RE: Looking to decode this allograft biopsy 3 days ago

The lack of the actual histological pictures makes a possible diagnosis very uncertain. Nonetheless, I will "dare" to suggest that he has a de-novo...

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RE: Terlipressin Use and hepatorenal syndrome–AKI 3 days ago

Interesting question about rebound. It has been observed in a substantial minority of patients, perhaps as much as 20%, depending on the initial re...

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RE: Looking to decode this allograft biopsy 3 days ago

Dr Glassock albumin3.8 how do you explain this degree of hematuria. That is the puzzling part. I will see if I can get the images --------...

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RE: Looking to decode this allograft biopsy 3 days ago

This looks like FSGS secondary to ischemia or CNI toxicity. (The Venkat hypothesis) .The lack of a diffuse Podocytopathy (by EM) makes an APOL1 (do...

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RE: lupus podocytopathy 3 days ago

If the patient relapses after a CR from steroids I would not re-biopsy, but I would prefer RTX or OBI for a second remission inducing therapy, and ...

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RE: Looking to decode this allograft biopsy 3 days ago

I do not have pictures. He is on Prograf/MMF and low dose steroids ------------------------------ Sandeep Magoon MD Nephrology Associates of Tide...

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RE: Terlipressin Use and hepatorenal syndrome–AKI 3 days ago

i read this -- very good table on HRS reversal with various agents including current ones Based on the data on the appropriate patient selection ...

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RE: Terlipressin Use and hepatorenal syndrome–AKI 3 days ago

Bp was 85 systolic close to his baseline Una was less than 5 before and after 25g albumin IV for 4 doses ------------------------------ Part...

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RE: Terlipressin Use and hepatorenal syndrome–AKI 3 days ago

Systemic blood pressure went up from an average of 90 systolic to 120s systolic and sustained after stopping Terlipressin Systemic blood pressure w...

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RE: Looking to decode this allograft biopsy 3 days ago

Would it be possible to post the actual LM, IF and EM pictures? What is the ongoing IS regimen? ------------------------------ Mario Rubin, M.D....

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RE: Looking to decode this allograft biopsy 3 days ago

Patient has 50-100 RBCs inevery single specimen. with 4 g of proteinuria, the origin is kidney. There is no urological cause, it has been rolled ou...

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RE: lupus podocytopathy 3 days ago

she went into remission with steroids, never argue with success. I would use an alternate medication going forward to GET HER OFF steroids I wo...

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