RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 10 minutes ago

My mind is a bit slow today.. but am not sure of the diagnosis The IF is apparently full house but is being treated as a pauci immune GN with Avac...

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RE: Would you Re biopsy this IgA? 4 hours ago

AS above: The COOPERATE trial 2002 JAMA found addition of ARB to ACEi lowered proteinuria more than more ACEi alone. then in 2009 JAMA retracte...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 4 hours ago

what did EM show? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transpla...

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RE: Would you Re biopsy this IgA? 4 hours ago

diuretics do not change 24 hour urine sodium per se, when you first take them you are in a negative Na balance, but once you reach steady state, an...

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RE: Would you Re biopsy this IgA? 7 hours ago

Good morning Dr. Venkat, he did not have RBCs/casts in urine… would you still order serology? I did not add. But good point, if I am contemplating ...

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RE: Would you Re biopsy this IgA? 7 hours ago

I do not give ACEI+ ARB any more, but that's only because we now have better alternatives. OTOH, I do not believe there should be a taboo against i...

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RE: Would you Re biopsy this IgA? 7 hours ago

Just to ask another practical point, how accurate would a urine 24 hour sodium be if the patient is on a diuretic? ----------------------------...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 8 hours ago

With this much glomerulosclerosis and IFTA one would not expect much improvement in GFR with immunosuppression. Were any steroids given with.the RT...

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A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 9 hours ago

I am posting this case for a colleague, and I would appreciate the community members input on this case: The patient is a 20-year-old African Ame...

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RE: Would you Re biopsy this IgA? 15 hours ago

I too have several patients with IgAN who have done very well (in stable remission with low proteinuria ., no hematuria and unchanged eGFR) on comb...

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RE: Would you Re biopsy this IgA? 15 hours ago

A reasonable estimate of 24 hour urinary Na excretion can be obtained from a mid-day spot urine Na/creatinine ratio multiplied by estimated 24 urin...

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RE: Would you Re biopsy this IgA? 17 hours ago

I have a few patients on ARB and ACEi, a leftover from 15 years ago, they're doing great with minimal protein urea. Should I continue or stop it? ...

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RE: Would you Re biopsy this IgA? 18 hours ago

Did start on Torsemide at the clinic visit for volume, HTN and since increased Losartan. Although do recommend low Na diet [More]

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RE: Would you Re biopsy this IgA? 1 day ago

Excellent clinical point. A failure to reduce proteinuria in glomerular disease can often be attributed to excess NaCl intake. I routinely measure ...

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RE: Would you Re biopsy this IgA? 1 day ago

A detail...but worth noting because, IMO, it does not get enough emphasis. For remnant proteinuria on an ARB, particularly if K is "high normal" or...

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RE: Would you Re biopsy this IgA? 1 day ago

Was referred to Tx at last visit given egfr and younger age (but missed their three calls, he works 6 nights and sleeps during the day and when he ...

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RE: Would you Re biopsy this IgA? 1 day ago

Very happy to say that Rodby and Hirsch are not in opposition; actually, they fit together (in this particular case, and overall!), a good team, I ...

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RE: nephrotic syndrome 1 day ago

if you are waiting 4 week what about steroids in the mean time, maybe it will go away and you wont need a biopsy... granted you wont know exactly w...

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RE: nephrotic syndrome 1 day ago

Thank you Dr Rodby. We are indeed very skeptical for the renal biopsy. We will complete 4 weeks from the interruption of cabozontinib and we will...

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RE: nephrotic syndrome 1 day ago

Thank you Dr Rodby. We are indeed very skeptical for the biopsy. For the moment we are waiting for around 4 weeks after the interruption of caboz...

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RE: nephrotic syndrome 1 day ago

Thank you Dr Rodby. We are indeed very skeptical for the biopsy. For the moment we are waiting for around 4 weeks after the interruption of caboz...

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RE: nephrotic syndrome 1 day ago

I remember eons ago that RCC is rarely associated with MCD, https://link.springer.com/article/10.1007/s11255-024-04069-7 The DD is long (2 dru...

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RE: Would you Re biopsy this IgA? 1 day ago

I would focus on transplantation. sorry to be such a nihilist - a credit to my realism? Dr Hirsch is the anti nihilist - a credit to his optim...

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RE: Puzzling Case of Post-Transplant Proteinuria 1 day ago

hen's teeth are indeed rare but so is this case-would love to hear any additional explanations for NRP 20g/g, normal serum albumin, unremarkable EM...

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RE: Would you Re biopsy this IgA? 2 days ago

Thank you All. Patient believes he can get me the biopsy results from 40 years ago, had bleeding complication at the time of the biopsy. Is on...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

Alport with NRP at 20 g/g and BOTH (basically) normal EM x 2 despite P having quadrupled AND no hematuria has got to be about as rare as hen’s teet...

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RE: Would you Re biopsy this IgA? 2 days ago

I fully agree with Dr. Hirsch. The therapy for advanced CKD , obesity and diabetes should be optimized. Unfortunately , there are no non-invasive d...

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RE: Likely Active C3G before transplant 2 days ago

please give us followup on your decision if possible -thanks for posting ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST K...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

Dr. Mahmut Altindal- I think you've made an excellent point. It is possible that the deceased donor kidney in this particular case of unexplained s...

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RE: Would you Re biopsy this IgA? 2 days ago

It is hard for me to believe that after at least 38 years of disease with extensive CKD and increased echogenicity that the risk v benefit calculat...

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RE: Would you Re biopsy this IgA? 2 days ago

Dr. Kaur: If it is not certain that he had IgA nephropathy on the original biopsy and if serological tests currently are non-diagnostic, rebiopsy m...

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RE: Would you Re biopsy this IgA? 2 days ago

Hello, I routinely perform kidney biopsies myself at my hospital. For this particular patient, the main question is: is this progressio of the unde...

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RE: nephrotic syndrome 2 days ago

I thank you all for your comments. We hesitate to perform a KB because of the bleeding risk (according to the literature around 4 weeks ). The...

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RE: nephrotic syndrome 2 days ago

Recovery from proteinuria from VEGF inhibitors typically takes several weeks and may take several months. I about 40% the effects are irreversible ...

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RE: Would you Re biopsy this IgA? 2 days ago

Dr. Dastoor- good point. . The addition of Atrasentan or a conversion from RASi to Sparesentan could certainly be considered but the level of eGFR ...

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RE: nephrotic syndrome 2 days ago

if this is related to Cabozanitinib, why not waiting to see if the proteinuria will resolve after stopping it? ------------------------------ M....

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

Dr Venkat, with all due respect; carriers of COL4 mutations may have very subtle GBM changes. I could not find any other explanation to this case (...

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RE: Would you Re biopsy this IgA? 2 days ago

@Richard Glassockwould you consider ET1a antagonist at this eGFR?? --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional...

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RE: Would you Re biopsy this IgA? 2 days ago

I would not rebiopsy but would add GLP1RA, small doses of RASi, SGLT2i and, if tolerated , Finerenone. I see no indications for immunosuppression a...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

Dr. Venkat - can you find out what happened to the other kidney from this deceased donor. ? If similar proteinuria developed, this would point to a...

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RE: Would you Re biopsy this IgA? 2 days ago

Thank you Dr. Venkat. I also think so but do I need confirmation; any chance that management could change based on any other findings (I have ...

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RE: Would you Re biopsy this IgA? 2 days ago

Fluctuating proteinuria could have been due to interruptions in RAAS-blockade and SGLT2-I therapies. SAlb level trend? Kidney size/echogenicity cor...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

Dr. Lerman: After retirement, I function as an honorary teaching attending at my former hospital. I no longer have any patient management privilege...

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Would you Re biopsy this IgA? 2 days ago

57-year-old man with biopsy-proven IgA nephropathy diagnosed at age 19, lost to follow up for multiple years, now with CKD and persistent significa...

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RE: SGLT2i & renal tubular creat secretion 2 days ago

https://pubmed.ncbi.nlm.nih.gov/36736537/ --------------------------------- Oded Friedman ---------------------------------

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RE: SGLT2i & renal tubular creat secretion 2 days ago

Oded: Makes sense. Do you have a reference for this plz? ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Ass...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

When I first read this post, I thought of donor-derived RME failure, eg biallelic cubilin mutations, worsened by the ATI but then the progression a...

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RE: SGLT2i & renal tubular creat secretion 2 days ago

An increased mClcreat/mGFR ratio post-SGLT2i could reflect pseudo-chromogen effect of glycosuria on (some) Jaffe Ucreat (assays) rather than an act...

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RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

Sorry I meant the genetic testing in the donor. In Turkey, since more than 90% of kidney transplants are performed from living donors, we usually h...

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RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 3 days ago

Indefinite therapy duration with Pegcetacoplan is probably not feasible or appropriate . Incomplete penetrance and modifier genes ate going to impa...

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