RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 9 minutes ago

Thx Dr Glassock. No PET yet but will order it. All input appreciated. Young lady, elementary school teacher,etc. ------------------------------ F...

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RE: Nephrotic syndrome and VEGFR inhibitors 45 minutes ago

The Cabozantinib is a hybrid agent with both anti-VEGF and TKI properties. In the absence of TMA and with the rather abrupt onsent of NS, I favor a...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 51 minutes ago

Diffucult case. This is most likely PGNMID without an identifiable clone and a recurrence in a kidney allograft. In the abscence of therapy, a repe...

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RE: Fsgs 54 minutes ago

Thanks prof he is on 5 mg of pred already . How long would you give cyclosporin ? When would you stop pred? I reduced it to 4 mg today Not sure wi...

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RE: IgA nephropathy case in a young Caucasian female 1 hour ago

With a T2 lesion, only slight hematuria and no good evidence of inflammation, she is not a good candidate for steroids,(oral systemic or TRF Budeso...

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RE: Fsgs 1 hour ago

Three years of CsA is probably too long. He is in a partial remission with persistent hypialbuminemua and a slowly declining eGFR. The declining eG...

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RE: Fsgs 1 hour ago

He is on arb and dapa Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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Fsgs 1 hour ago

Patient presented with Aki and nephrotic syndrome . Biopsy February 23 showed fsgs . After 24 weeks of of oral steroids patient did only partially...

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IgA nephropathy case in a young Caucasian female 2 hours ago

Good afternoon. I would like some feedback on a case of advanced IgA nephropathy at presentation. I met this 33 year old female with no medical h...

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RE: FSGS and primary Hyperparathyroidism 4 hours ago

Thank you Dr.Hayder, FSGS was biopsy proven. The patient improved totally on Cyclosporine and maintained remission even after gradual withdrawal ...

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RE: Primary Hyperparathyroidism 4 hours ago

Any DEXA scan performed? How much is ionized calcium? Alkaline phosphatase or bone fraction alkaline phosphatase? ---------------------------...

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Diffuse proliferative Gn with IgG kappa deposits allograft failure 6 hours ago

In summary, this is a 34-year-old female currently on dialysis. She has a history of end stage renal disease, presumed secondary to hypertension (n...

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RE: Primary Hyperparathyroidism 13 hours ago

I tend to agree with Dr Rodby, calcium is not that impressive, and Phos is not low, may be from CKD. Unfortunately, because of the CKD, 24 hour uri...

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RE: Primary Hyperparathyroidism 14 hours ago

I was referring to lower muscle mass in general in women --> lower creatinine generation. The gender correction in eGFR formulae not always accurat...

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RE: FSGS and primary Hyperparathyroidism 14 hours ago

Does the initial diagnosis of FSGS was biopsy proven? I have exactly similar case with family history of CKD (mother underwent kidney transplant a...

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RE: Nephrotic syndrome and VEGFR inhibitors 16 hours ago

Please see following reference regarding VEGF-inhibitors and renal disease, and mechanisms by which steroids and immunosuppression may help in trea...

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RE: Nephrotic syndrome and VEGFR inhibitors 21 hours ago

Thanks ALL. ------------------------------ Hamza Shahran MD, MS Aurora BayCare Medical Center De Pere WI (832) 888-1536 ------------------------...

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RE: Nephrotic syndrome and VEGFR inhibitors 22 hours ago

I second that steroids not likely to be effective. Discussion with patient and oncologist about risk benefit is needed. When we saw this with int...

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RE: Nephrotic syndrome and VEGFR inhibitors 22 hours ago

Since I think this is a direct podocytotoxic effect of a TKI + VEGF inhibitor , not an auto-immune response, I doubt that steroids will be effectiv...

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RE: Primary Hyperparathyroidism 23 hours ago

Thanks prof rodby and venkat . Ionised calcium you mean on venous gas? Not done . I don’t have cystatin c 24hr urinary calcium normal . Female and ...

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RE: Is It LN?? 23 hours ago

@ prof rodby eurolupus is 6 pulses of cyclophosphamide any steroids ? Would you add rituximab due to patient being nephrotic ? Or no evidence and ...

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RE: Primary Hyperparathyroidism 1 day ago

Serum ionized calcium and cystatin C levels? Female patient: SCr may be overestimating GFR. Is she on a on a thiazide? Urinary calcium level? -...

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FSGS and primary Hyperparathyroidism 1 day ago

I would like to have your kind advice on this case, 40 year old male patient was diagnosed earlier to have steroid resistant primary FSGS with ne...

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RE: Nephrotic syndrome and VEGFR inhibitors 1 day ago

Any ref on TKI interfere with nepherin synthesis --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 ---------------...

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RE: Primary Hyperparathyroidism 1 day ago

Mild hypercalcemia , I think the adjusted ca overestimates hyoercalcemia. Pth while not totally suppressed is not impressive either if it were ...

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RE: GN question 1 day ago

@Richard GlassockThank you very much for the input. What was also confusing is that he developed purpuric rash on dorsum of one hand which looked l...

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Primary Hyperparathyroidism 1 day ago

63 female ckd 4 ( single functioning kidney ) , obstructive uropathy, puj - reflux nephropathy Dec 21 creatinine 1.36 eGFR 36 Adj ca 2.75(2.20-2...

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RE: Kfre 1 day ago

Thanks . And in rapidly varying creatinine ? Someone had dropped 15 ml in 2 years but low kfre and no proteinuria that’s why I asked the questions ...

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RE: Nephrotic syndrome and VEGFR inhibitors 1 day ago

TKI can also interfere with Nephrin synthesis and produce a MCD like lesion. TMA is typically seen with VEGF inhibition -------------------------...

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RE: Nephrotic syndrome and VEGFR inhibitors 1 day ago

This question was discussed recently at rush biopsy rounds on jan 16 You can visit their YouTube channel It was an excellent discussion and may he...

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RE: Nephrotic syndrome and VEGFR inhibitors 1 day ago

Urine sediment and serum lipids? Very heavy proteinuria and hypoalbunemia suggest a podocytopathy (MCD/FSGS/collapsing glomerulopathy) +/- AIN. V...

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RE: secondary IgA? 1 day ago

"His serum Na 132 meq/L, BP was 111/67 Mm Hg". Since he be has history of hypertension, this may be relative hypotension and there is hyponatremi...

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Nephrotic syndrome and VEGFR inhibitors 1 day ago

The patient is a pleasant 55-year-old male with a history of hypertension and metastatic renal cell Ca to the lung/status post lt side nephrectomy ...

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RE: secondary IgA? 1 day ago

Thank you all. His serum Na 132 meq/L, BP was 111/67 Mm Hg. Urine Na came out 71 . Urine protein/creat shows "Normal dilute" -----------------...

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RE: Re-Biopsy in LN 2 days ago

My guess is that will not have an answer to this issue question anytime in the near future. ------------------------------ Richard Glassock MD, F...

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RE: Gibbs-Donnan effect on potassium bath 2 days ago

While what you say is correct, the system is complicated because of the presence of other ions such as Na and of course more importantly Cl. Albumi...

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RE: Re-Biopsy in LN 2 days ago

A question I keep asking my colleagues is when will we move on from cyc/pred in crescentic LN? What will it take? In the modern era for ln, it seem...

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RE: secondary IgA? 2 days ago

What is the urine PCR? Because this better for assessment of proteinuria than urine dipstick which is subjected to false positive and negative res...

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Gibbs-Donnan effect on potassium bath 2 days ago

I wonder if it is possible to calculate the Gibbs-Donnan effect on dialysate potassium. For example, if a dialysis patient has normal serum albumin...

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RE: GN question 2 days ago

Good questions Dr. Venkat , as usual. IgA Vasculitis is not a histopathogical diagnosis, but the absence of capillary wall necrosis/crescents make ...

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RE: secondary IgA? 2 days ago

Very good point Dr. Venkat. What is his serum sodium and current BP values? ------------------------------ Richard Glassock MD, FASN Laguna Woods...

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RE: Re-Biopsy in LN 2 days ago

The inclination to use CYC based regimens (IV or oral) in the uncommon forms of LN with clinical RPGN and "extensive" crescents (variously defined)...

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RE: secondary IgA? 2 days ago

Dysmorphic RBCs and RBC casts, if present currently will favor GN. Decrease of proteinuria may be due to falling GFR. Maintained BP and if hypona...

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RE: GN question 2 days ago

@Richard Glassock: Does the lack of subepithelial and/or subendothelial deposits, and PMNs in glomeruli make IgA nephropathy or IgA vasculitis more...

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RE: Re-Biopsy in LN 2 days ago

There is crescentic LN with rapidly worsening renal function and crescentic GN with mild/moderate and stable renal dysfunction. One can treat the f...

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RE: secondary IgA? 2 days ago

Thank you all for your input. Appreciate it. HRS is in my differential. Checking urine Na. Type 2 is possible. His BP is stable, good urine output ...

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RE: secondary IgA? 2 days ago

I fully agree with Dr. Rodby. Thus is very likely secondary IgA deposit disease (not Primary IgAN) in a patient with advanced cirrhosis and HRS. Tr...

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RE: Membranous case 2 days ago

This is an early first relapse after successful therapy of PLA2R+ MN, not 'refractory MN.". There is no compelling reason to treat with agents like...

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RE: Membranous case 2 days ago

I know it is hard to get anti-CD38 for MN in USA, hopefully the company can get accelerated approve. When patient fails everything including Cyc, m...

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RE: secondary IgA? 2 days ago

you have to wonder if his elevated creatinine has more to do with his cirrhosis (HRS?) than his IgAN, to have that creatinine from IgAN without pro...

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