RE: Sarcoid assoc Ca stones 4 hours ago

As @John Asplin said "Both what have been referred to as absorptive and renal leak hypercalciuria are treated with thiazides." Part of the point th...

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RE: Membranous nephropathy 4 hours ago

Thanks Dr. Garrick for your advice. The duodenal biopsy report is pending. I shall post it as soon as it's available. --------------------------...

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RE: Membranous nephropathy 9 hours ago

Understood Thanks Dr. Rodby. ------------------------------ Emilio Venturelli MD Scuola di specializzazione in Nefrologia, Università degli st...

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RE: Membranous nephropathy 10 hours ago

The original post had the path, but it was not deidentifed enough so we had that part removed. For what it is worth, I was convinced it was MGN. ...

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RE: Membranous nephropathy 12 hours ago

Thanks Dr. Glassock for your advice. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Membranous nephropathy 12 hours ago

Thanks Dr. Rodby for your advice. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Membranous nephropathy 12 hours ago

Dr. George, I'm not sure that the information you provided are enough to classify this patient has having membranous nephropathy, can you post a mo...

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RE: Membranous nephropathy 14 hours ago

CA 125 is a poor marker of cancer in MN. It can be positive due to hypoalbuminemia, edema, serositis, inflammation. A negative test does not rule o...

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RE: Membranous nephropathy 16 hours ago

Hi Do you have the biopsy results back from the duodenal lesion?Thinking about possibility of mantle cell lymphoma of the duodenum, which can lea...

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RE: A 19-Year-Old Male with Frank Hematuria, Proteinuria, and Weak Anti-GBM Positivity 18 hours ago

any update on the Renal Bx findings ? ------------------------------ Dr Mohamed Buhary MBBS, CCT, FRCP Consultant Nephrologist Jeddah --------...

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RE: Sarcoid assoc Ca stones 1 day ago

Dr. Slater - can you also let us know what the repeat 1,25 dihydroxy Vitamin D level showed.? ------------------------------ Richard Glassock MD,...

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RE: Membranous nephropathy 1 day ago

Steroids alone are ineffective in Primary MN, with or without antiPLA2 R antibody. The utility of serum Biomarkers ( such as CEA or CA125) for canc...

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RE: Membranous nephropathy 1 day ago

The cancer scanning was negative despite high CA125 level, I don't know how specific that level is for an occult malignancy, nor do I know if a PET...

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Membranous nephropathy 1 day ago

Requesting guidance regarding a case of a frail 72 year old lady with a history of type 2 diabetes mellitus and systemic hypertension since 2016, a...

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

Dr Venkat is spot on with the legal position, but who is actually going to go through with the "fight"? This is a problem in the US, especially in ...

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RE: Sarcoid assoc Ca stones 1 day ago

Thanks for the extra information. I agree that a 60 yo man with a creat/kg of 27 is likely an overcollection. Sorry I wasn't clear, when I referr...

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RE: Sarcoid assoc Ca stones 1 day ago

Thx for input PT is male and weighs 60 kg so perhaps not a signif overcollection and even so he has hypercalcuia even if 10-20% overcollection; al...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 2 days ago

From a US legal perspective (do not know if this will apply in the UK), I got the following from Google AI: "Court decisions generally support doc...

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RE: Sarcoid assoc Ca stones 2 days 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. 2 days 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. 2 days 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 2 days 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. 2 days 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 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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. 3 days 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. 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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. 3 days 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 3 days 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 Thursday, April 9 @ 3:59 PM

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 Thursday, April 9 @ 3:23 PM

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 Thursday, April 9 @ 3:01 PM

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 Thursday, April 9 @ 2:39 PM

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 Thursday, April 9 @ 2:01 PM

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 Thursday, April 9 @ 1:41 PM

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 Thursday, April 9 @ 1:05 PM

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 Thursday, April 9 @ 12:04 PM

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 Thursday, April 9 @ 11:55 AM

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 Thursday, April 9 @ 11:37 AM

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 Thursday, April 9 @ 11:35 AM

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 Thursday, April 9 @ 11:31 AM

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 Thursday, April 9 @ 11:25 AM

@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 Thursday, April 9 @ 11:20 AM

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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