RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 hour ago

Is there significant microscopic (or macroscopic) hematuria in this patient. I think that the IgA nephropathy is not the significant problem in thi...

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RE: Diamox causing kidney stones 2 hours ago

David: As a practical approach to the potential opposing effects of citrate on stone formation (especially with CaP04), can you compare the SS for ...

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RE: Diamox causing kidney stones 7 hours ago

"I've said it before here on several occasions: it could be that the increase in urine citrate is more important as an inhibitor of calcium stones ...

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RE: Diamox causing kidney stones 7 hours ago

Thanks everyone, will try supplementing potassium citrate. ------------------------------ Brendan] [Mielke] [MD] [Kootenai Clinic] [Coeur d Alene...

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RE: transplant cases 7 hours ago

To my knowledge, there is not specific treatment paradigm for plasma cell rich rejection and other than noting that the ACR is plasma cell rich it ...

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RE: Diamox causing kidney stones 8 hours ago

Yes I agree. There's this study showing that you can increase urine citrate in patients with hypocitraturia getting topiramate. https://pmc.ncb...

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RE: transplant cases 8 hours ago

both pathologies need treatment!!! Dear Muhammad Soobadar followup will be very helpful to this forum. Thanks for posting this fascinating case in ...

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RE: Diamox causing kidney stones 8 hours ago

Acetazolamide directly inhibit CA at the choroid plexus reducing ICP (this is the main mechanism). Correction of systemic acidosis lower the hyperv...

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RE: transplant cases 9 hours ago

Dr. Venturelli. Very good points. I can't say ,with any degree of certainty from morphological features alone, that this is IgAV or a particularly ...

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RE: transplant cases 9 hours ago

Great discussion! My apology as I misinterpreted the case as positive C4d (it was G and not PTC). With these positive portfolios of DSA which are r...

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RE: Diamox causing kidney stones 10 hours ago

agree with kcitrate,salt restriction, and fluids. my sources suggest giving alkali does not reverse CNS benefit of diamox follow 24 hr urines for...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 10 hours ago

consider IVIG ± pulse methylprednisolone for chronic active ABMR WOULD do SPEP, urine PEP, SLC for completeness, to r/o MGRS, restart ARB for PROTE...

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RE: Diamox causing kidney stones 10 hours ago

@John Asplin @David Goldfarb I know that the CA inihibtor topomax has both proximal and distal tubular CA inhibition and thus gives features...

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RE: transplant cases 11 hours ago

I agree. I think it is highly probable both things are occurring and should be treated. ------------------------------ Jonathan Zuckerman MD, Ph...

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RE: transplant cases 11 hours ago

Dr. Glassock perhaps I missed part of the patient's history What makes you say, without evidence of concurrent or historical systemic involveme...

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RE: transplant cases 12 hours ago

Thanks Dr. Zuckerman -I am not against treating the IgA vasculitis component, but remain convinced that the acute cellular rejection.1 B should als...

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RE: transplant cases 12 hours ago

I will also share case with Dr. Xin Zhou a respected renal pathologist in Dallas who has extensive experience with kidney Transplant pathology ...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 12 hours ago

Thanks - great teaching case - is creatinine/eGFR stable? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past M...

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RE: transplant cases 13 hours ago

This is a challenging and unusual case. Given the presence of a diffuse active necrotizing/crescentic GN with IgA dominant IF staining, there is cl...

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RE: Diamox causing kidney stones 13 hours ago

The mainstay of treatment is K citrate supplementation to raise the 24 hr urine citrate > 320 mg and not to increase urine PH > 7 to decrease furth...

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RE: transplant cases 1 day ago

I can't say for sure in kidney transplant recurrence, but in IgA V involving the native kidney often has a prominent tubulo-interstitial inflammati...

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RE: transplant cases 1 day ago

Thanks - look forward to his comments- we also need to appreciate clinical picture which includes a noncompliant patient with immunosuppression and...

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Diamox causing kidney stones 1 day ago

I just saw a 53 you woman who was started on diamox 500 tid for pseudotumor cerebri. The improvement in her headaches and vision has been life chan...

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RE: Crescentic ig a in transplant case 1 day ago

Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria? Agree with Dr. Lerman th...

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RE: transplant cases 1 day ago

Yes, I do think that with severe crescentic recurrent IgAV it will not be possible to discern an underlying ABMR or ACMR, based on histology alone....

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RE: transplant cases 1 day ago

Dear Dr.Glassock are you suggesting biopsy only shows IgAV without ACR 1B ?+\- ABMR? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP...

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RE: transplant cases 1 day ago

I think this is mainly recurrent IgAV in an allograft. I would consider treating with Iptacopan or RTX in addition to short course of pulse IV MP./...

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RE: transplant cases 1 day ago

Any MVI? Sound like mixed rejection and IgAN, I would increase the dose of MMF to 2 gram/day, add PLEX and IVIG. -------------------------------...

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transplant cases 1 day ago

i am posting from Transplant Forum 18M, Issues: 1) Declining kidney function - Suspected rejection: Admits to poor compliance with...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 1 day ago

Metabolic alkalosis has both generation and maintenance phases. In ectopic ACTH syndrome (EAS), generation phase is due to excess cortisol stimul...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 1 day ago

these cases are rare but so interesting I have see only one IUhave attached my publication from it. the VERY high ACTH levels associated wit...

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RE: Crescentic ig a in transplant case 1 day ago

Would treat ACR 1B with thymoglobulin 1mg/kg daily x 7-10 doses , convert Azrhioprine to MMF 2-3 gms/day. Get dd-cfDNA , rebiopsy after above treat...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

This pathology report illustrates the continuum of chronic lesions that can be seen in a biopsy. Ci =3 but ci =1, ct= 1, cg =1 and affects only 2...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

------------------------------ Vijayakumar Paramasivam MD Nephrologist Renal and Transplant Associates of the North East Springfield MA (484) 362-3...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 1 day ago

Extremely high doses of spironolactone will likely be required, with much anticipated (and unwanted ) anti-androgenic effects. Amiloride or Triamte...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 1 day ago

Send stat serum ACTH and a random/late-afternoon serum cortisol plus 24-hour urine free cortisol add aldactone or other MRA continue to replet...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

I suggest looking at this biopsy before throwing in the towel cg1b could e just 5% of capillary loops affected in the worst glomeruli cv3 could...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 1 day ago

This case cries out for the use of Metyrapone, Ketoconozole, Paseriotide, or Osilodrostat to inhibit the presumed ectopic ACTH driven hypercortisol...

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Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

54/male, second deceased-donor kidney, ~7 years out. First living-related graft (2003–2010) lost to transplant glomerulopathy/secondary FSGS, allog...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

we chose to do the low dose tacro with goal of 3-5- neuro deficits resolved. latest mri - radiology read- 8/4/26- Significant improvement compared ...

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Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 1 day ago

A 71 yr old female with a heavy 30+ yr smoking history is admitted for a month of progressively increasing weakness. On presentation, her K was 2...

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RE: ig a case is it alcohol/liver disease related. 1 day ago

C3 co-deposition in IgAN is so common in > 90% is some cohorts and not indicate alternative pathway activation. Some studies link this to future CK...

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RE: ICI induced IgAV 1 day ago

I thought of it LDH 388 slightly elevated Ferritin 1450 significantly elevated Triglyceride 1.7 normal Platelets 129 LFTs normal We do...

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RE: MPO VASCULITIS 1 day ago

Thank you Dr Aledan. The patient you referred had autoimmune hepatitis and might have been the reason for positve MPO titers ------------------...

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RE: ig a case is it alcohol/liver disease related. 2 days ago

My answer to your 2 Questions is No. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCL...

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RE: nephrotic syndrome with 2 days ago

Not necessarily. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA Laguna Woods CA (9...

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Crescentic ig a in transplant case 2 days ago

18M, Issues: 1) Declining kidney function - Suspected rejection: Admits to poor compliance with tacrolimus Previous negative DSAs July 202...

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RE: ig a case is it alcohol/liver disease related. 2 days ago

C3 and C4 levels, HBV status -ve cant find ANCA is diagnosis of abdominal pain in Ig a on kidney biopsy enought to label Ig a v . no documentatio...

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RE: nephrotic syndrome with 2 days ago

What is seum albumin? 17.6 , C3 and C4, HCV and HBV status.? all negative RF /BM/Cryo Not done @prog glassock would you not need to gi...

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RE: ICI induced IgAV 2 days ago

"I'm wondering if the levofloxacin caused a flare up! There are reports that fluoroquinolones may accentuate the immune response to Immune checkpoi...

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