RE: FSGS vs C3G and Canavan Disease 54 minutes ago

Would you consider therapy with Iptacopan or Pegcetacoplan. ? Just curious. Any opinion, Dr.Rodby? ------------------------------ Richard Glassoc...

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RE: Osteoporosis In Stage 5 Ckd 57 minutes ago

Good Question. To best of my knowledge, It inhibits new bone formation and reduces the delivery of calcium to the ECF from bone. Both bad news in A...

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RE: Osteoporosis In Stage 5 Ckd 1 hour ago

Thank you for your replys, May I enquire about the mechanism of hypocalcemia in the setting of hypoparathyroidism with consequent adymamic bone di...

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RE: FSGS vs C3G and Canavan Disease 3 hours ago

Her Creatinine just returned , it is worsening . Seems to now correlate with her biopsy I think i would be now inclined to pulse steroid her . ...

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RE: FSGS vs C3G and Canavan Disease 3 hours ago

Low C3 and C4 (if both were decreased ) suggests classical pathway activation and not compatible with a post-streptococcal IRGN. RF level may help ...

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RE: Polyuria 3 hours ago

Thank you so much Dr. Rodby for explaining this so well. Please suggest what advice to be given to the parents? For example timed voiding, limiting...

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RE: FSGS vs C3G and Canavan Disease 4 hours ago

Her Complements are low , she has not had a RF done , will request it tomorrow .. todays first meeting was a bit tense with the husband , wife and ...

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RE: FSGS vs C3G and Canavan Disease 5 hours ago

I agree with Dr. Rodby. The Canavan disease mutation is likely a red-herring. The LM has feature of MPGN and the EM will be very helpful- the diffe...

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RE: FSGS vs C3G and Canavan Disease 5 hours ago

The IF says only IgA in casts but the Comment says IgA 1+ I think there is a bit too much Igs for C3 GN? An infection related GN is always a ...

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RE: Polyuria 5 hours ago

"The serum osmolality is 288mosm/l, urine osmolality is 146 mosm/L. The serum sodium is 136. I was wondering if there is a component of partial cen...

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RE: Osteoporosis In Stage 5 Ckd 6 hours ago

I totally agree with Prof Glassock, especially with the relatively low bone alk phos and PTH, she likely has low turnover disease and Prolia, or ot...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 6 hours ago

"If plumbing is bad in the kitchen, it is bad in the bathroom too". Renal vascular disease is highly expected. The biggest risks for this patient...

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FSGS vs C3G and Canavan Disease 6 hours ago

Saw a 32 year old female for the first time . She was seen by a colleague around 2 weeks ago Was initially seen in the ER with a 3 week history o...

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RE: Polyuria 7 hours ago

Additional data: The serum osmolality report came as 288mosm/l, urine osmolality is 146 mosm/L. The serum sodium is 136. Serum Ca is 9.6mg/dl, se...

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RE: Polyuria 7 hours ago

Thanks Dr. Rodby for the opinion. She does not have salt craving. There are no symptoms of androgen excess. ------------------------------ Jaiso...

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RE: Polyuria 7 hours ago

Thank you so much Dr. Glassock. The serum osmolality is 288mosm/l, urine osmolality is 146 mosm/L. The serum sodium is 136. I was wondering if ther...

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RE: Pauci-Immune GN, Chronic, Minimally Active 8 hours ago

The proteinuria may be due to the FSGS lesions noted in the kidney biopsy. Is the patient on optimal anti-proteinuric therapy with RAS inhibitor, s...

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RE: Osteoporosis In Stage 5 Ckd 8 hours ago

I am presuming that the bone specific Alkaline Phosphatase level in this patient was 10 mcg/L not 10mg/L. Values for Bone-specific alkaline phospha...

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RE: Osteoporosis In Stage 5 Ckd 8 hours ago

I think this patient is at very high risk of developing serious hypocalcemia after Denosumab and would avoid its use . This is an opinion only. The...

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RE: Polyuria 9 hours ago

Agree with others that this most likely represents increase urine frequency . May consider looking for hypercalciuria and hyperuricosuria as can be...

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RE: Pauci-Immune GN, Chronic, Minimally Active 11 hours ago

Follow up on this case. EM: Rare mesangial and few sub epithelial electron dense deposits seen. Minimal foot process effacement. She was started ...

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RE: Osteoporosis In Stage 5 Ckd 12 hours ago

Hypocalcemia may develop even with underlying adynamic bone disease, and low low PTH level? Bone Alkaline phosphatese was 10 mg/L ( normal 6-20) -...

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RE: Osteoporosis In Stage 5 Ckd 13 hours ago

Based on the low PTH level and normal total AP, it is likely that she has Adynamic Bone Disease. Further investigation with bone turnover Biomarker...

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Osteoporosis In Stage 5 Ckd 14 hours ago

75 year old lady with diabetic nephropathy and stage 5 CKD not on dialysis( eGFR of 12 ml/min) , was referred from ortho. department for opinion. ...

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RE: Polyuria 22 hours ago

If she does not have nocturia, I really doubt this is a urinary concentration problem, also her U SG is 1.010 suggesting isosthenuria I suppos...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 23 hours ago

CAPS- serious involvement of 3 or more tissues / organs. -thrombopenia, skin necrosis and gangrene and kidney involvement (not proven because kidne...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Thank you prof . Glassock I would appreciate your guidance—given my limited experience, could you explain what key features made you lean toward ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Here's my considerations From a diagnostic standpoint: A more sensible method (serum immunofixafion) should be performed to identify a small...

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RE: Polyuria 1 day ago

This patient is exhibiting Pollakiurua , not really Polyuria. Intrinsic bladder pathology needs to be evaluated. ------------------------------ ...

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RE: Polyuria 1 day ago

Urine output about 3ml/kg/hour, which is modestly increased as is the frequency of voiding , but the urine is not of very low specific gravity. We ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Tough question. No good answers, I would slightly favor a biopsy approach,, of involved skin/muscle and bone marrow (for atheroembolic disease or c...

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Polyuria 1 day ago

Requesting opinion on this case: An 8 year old girl was brought by parents with complaints of polyuria. She was noted to have polyuria since 7 mon...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Thank you prof Dr.Glassock And Dr . Venturelli In this case of triple-positive APS with digital ischemia/ulcers and positive cryoglobulin, SPEP sh...

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RE: Postural hypotension 1 day ago

Thanks Dr. Kesavan. There is no phimosis. Will do a magnesium level and anemia workup as suggested. ------------------------------ Jaison George...

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RE: Postural hypotension 1 day ago

Thanks Dr. Campese ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Membranous Nephropathy 1 day ago

I am concerned about the progressive decline in eGFR and am inclined to biopsy now rather than waiting, but observation is OK if the eGFR trajector...

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RE: Membranous Nephropathy 1 day ago

Thanks for the replies. Correct finally PLA2R is < 4 since January and < 4 even in March. Proteinuria worse and now Cr worsening. Question is s...

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RE: Postural hypotension 1 day ago

I was not seriously considering Shy-Drager syndrome in this patient but mentioned it out of academic interest and definitely did not relate it to t...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Excellent suggestion Dr. Venturelli! This might very well be a Crystal forming variant of Type I (monoclonal ) cryoglobulinemia but this would nit ...

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RE: Membranous Nephropathy 1 day ago

If I understand this, the PLA2R is now [More]

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RE: Dialyzer reaction 1 day ago

Try the Nipro Cellentia series. We had a patient tolerated NxStage (even with 3L UF) but 15 minutes into regular HD would drop BPs to 60s systolic ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Is there a monoclonal gammopathy? Consider Crystal-cryoglobulinemia Another possibility could be atheroembolic renal disease, the more chronic an...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

"And only in January 2026 that urine acr 73.84 mg/mmol( with steroids and rituxan)" Was there already a downward trend in UAlb/Cr, UPr/Cr and SCr...

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RE: Membranous Nephropathy 1 day ago

With a worsening eGfR I do not think that use of a CNI would be a wise decision. Just an opinion. ------------------------------ Richard Glassock...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

In addition, the sFLC ratio is near to the lower limit of normal for thus degree of CKD suggesting but not proving a lambda MGUS- probably not wort...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

The anti-phospholipid assays indicate triple positivity compatible with Primary anti-Phospholipid antibody syndrome and a high risk of arterial or ...

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RE: Membranous Nephropathy 1 day ago

A repeat biopsy might be helpful to rule out superimposed FSGS. Immunological remission maybe followed by clinical remission after several months...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Antiphospholipid Antibodies * Anti-β2 glycoprotein I IgG: >100 U/mL * Anti-β2 glycoprotein I IgM: 4 U/mL * Anticardiolipin IgG: >120 GPL-U/mL * An...

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RE: Membranous Nephropathy 1 day ago

According to a LabCorp description the anti-PLA2R IgG test is an ELISA that has not been validated for monitoring. I would use the standard quantit...

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RE: Membranous Nephropathy 1 day ago

Is the PLA2R IgG the IFA assay for anti-PLA2R antibody. If so, this test is more sensitive than the ELUSA . I n this case I would pay attention to ...

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