RE: High PLA2R and minimal proteinuria 9 hours ago

Data exists that in Primary MN the auto-antibody response precedes the development of overt Nephrotic Syndrome by months or even years, but there i...

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RE: High PLA2R and minimal proteinuria 9 hours ago

I am not aware of any data about prevalence of anti-PLA2R antibody titer in patients without MN (someone chime in if data exist).  Usually it order...

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RE: Allograft vein thrombosis or hyper acute rejection ? 11 hours ago

Suspect this was a vascular catastrophe rather than hyper acute rejection given absence of historical preformed antibodies and surgical finding of ...

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RE: Allograft vein thrombosis or hyper acute rejection ? 11 hours ago

Stumbled on this small transcriptomics study of early isolated C4d/DSA/microvascular inflammation-negative intimal arteritis in non-highly sensitiz...

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RE: A case of proteinuria 12 hours ago

Good point Dr. Venkat.  I usually do not perform a UACR for evaluation of possible nephrotic syndrome.  A UPCR on an aliquot of intended 24 hour ur...

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RE: A case of proteinuria 13 hours ago

"Urine  analysis showed an albumin:creatinine of 1515." Is this UAlb 1515 mg/g creatinine? If yes, makes MCD less likely. Even in severely hypoalbu...

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Allograft vein thrombosis or hyper acute rejection ? 14 hours ago

Hello, I would like to share with you a very unfortunate transplant case that occurred in our center.  A 31 yo. male, two years in hemodialysis. ...

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RE: A case of proteinuria 16 hours ago

Making a diagnosis of MCD will likely require a kidney biopsy whereas Amyloidosis, MN can be diagnosed without a kidney biopsy. This can be impor...

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RE: A case of proteinuria 19 hours ago

Yes, absolutely true..it has to be considered as well ------------------------------ Ahmed Hassan MBBS hospital ------------------------------

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RE: A case of proteinuria 19 hours ago

AL Amyloidosis (and MGRS in general ) is always in the differential of proteinuria in the Elderly, but DN, Membranous Nephropathy, MCD and perhaps ...

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RE: A case of proteinuria 19 hours ago

I have a differential diagnosis of DM nephropathy, h nephropathy, FSGS based on single kidney and HTN, Membranous as u thought to,specially with ca...

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RE: A case of proteinuria 20 hours ago

Can you also obtain a serum anti-PLA2R antibody level (By IFA) fairly quickly ? Sent from my iPad

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RE: A case of proteinuria 20 hours ago

Please provide The results of a retinal Exam, serum albumin Level along with a serum free light chain assay And serum Immunofixation. Thanks. Sent ...

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RE: Uremic vs non-uremic preicarditis 22 hours ago

Pericardial friction rubs were taught, in years past, to be the sine qua non of uremic pericarditis...usually coupled with an elevated BUN. Back in...

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A case of proteinuria 23 hours ago

72 years male patient presented with bilateral lower limbs pitting edema that is noticed over 2 -week period only. Investigations regarding heart a...

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RE: Unexplained Proteinuria 1 day ago

Just for fun, I did my own calculations, in a somewhat different way. 10 ml of normal whole blood contains about 4 ml of packed RBC and 6ml of plas...

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RE: High PLA2R and minimal proteinuria 1 day ago

Appearance of anti-PLA2R antibody in blood can precede clinical MN by a long time. Nephrotic range proteinuria develops gradually in MN. Thus, a va...

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RE: Unexplained Proteinuria 1 day ago

If the initial uPCR was done on the grossly hematuric sample whereas the other tests were run after it had settled, at a Hct of 0.4, 10 mL of blood...

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RE: High PLA2R and minimal proteinuria 1 day ago

Interesting. The anti-PLA2R Test was not indicated in the first place. I would follow proteinuria and eGFR, at 3 month intervals. And do nothing no...

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RE: Unexplained Proteinuria 1 day ago

Not with this degree of proteinuria (albuminuria). Sent from my iPad

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High PLA2R and minimal proteinuria 1 day ago

Hello  Will appreciate help to address management plan for a patient  52 yrs old Gentleman who accidentally found to have protein ++ on dipstick wo...

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RE: Post transplant immunosuppressive therapy in covid pt 1 day ago

Doubt any set guidelines- suspect many programs slowly resume MMF and/or Tac after clinical recovery and conversion to negative RT-PCR ------------...

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RE: Unexplained Proteinuria 1 day ago

Could this be hemorrhagic cystitis such as caused by adenovirus ------------------------------ [Dr Ravindra Attur] [Prabhu] [Professor HoU] [KMC Ma...

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RE: Unexplained Proteinuria 1 day ago

“UPEP Interpretation MILD PROTEINURIA IN SELECTIVE PATTERN.” Mild suggests it was done later in the course of events when proteinuria and hematuria...

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RE: Uremic vs non-uremic preicarditis 1 day ago

Agree . For patients with large effusion or tamponade .drainage is required. In mild to moderate effusion we can sometimes do with aggressive dialy...

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RE: Unexplained Proteinuria 1 day ago

"SPEP/UPEP showing moderate proteinuria in selective pattern with decreased alhpa one, alpha two, beta and gamma globulins, however, serum immunofi...

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RE: Uremic vs non-uremic preicarditis 1 day ago

A very sensible comment of Dr Rudnick,i mmediate drainage rather than a a more conservative approach of aggressive   hemodialysis, is our clinical ...

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RE: Unexplained Proteinuria 1 day ago

UPEP showed:  Albumin  82.5%  Alpha 1 Globulin,  3.1%   Alpha 2 Globulin,  6.9 %   Beta Globulin, 6.4 %   Gamma Globulin, 1.1%  UPEP Interpretation...

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RE: Unexplained Proteinuria 1 day ago

Interesting ------------------------------ Ghansham Das MD Syracuse NY ------------------------------

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RE: Unexplained Proteinuria 1 day ago

Thanks for the clarification. An episode of self-limited infection related GN super-imposed on TBMN ight be the best explanation, but the EM studie...

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RE: Uremic vs non-uremic preicarditis 1 day ago

I believe it's important to distinguish between pericardial effusions  which are a very late manifestation of uremia versus pericardial effusion's ...

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RE: Unexplained Proteinuria 1 day ago

Being an Occam-phile but able to reluctantly accept  Hickam     https://radiopaedia.org/articles/hickams-dictum?lang=us,  I suppose this patient co...

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RE: Unexplained Proteinuria 1 day ago

her albumin was 3.2g/dl on the day when her UPCR was 13.03mg/mg. ------------------------------ Ghansham Das MD Syracuse NY -----------------------...

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RE: Unexplained Proteinuria 1 day ago

Sorry it's all mg/mg ------------------------------ Ghansham Das MD Syracuse NY ------------------------------

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RE: Unexplained Proteinuria 1 day ago

If the estimation of proteinuria was done during period of gross hematuria it can be misleading. We had a similar case, gross heamturia, nephrotic ...

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RE: Unexplained Proteinuria 1 day ago

UPCR is not reported as mg/dL - please clarify the next to last sentence in your original report. What pattern of proteinuria was seen in the UPEP?...

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RE: Unexplained Proteinuria 1 day ago

I rechecked it. It's 13.03mg/mg ------------------------------ Ghansham Das MD Syracuse NY ------------------------------

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RE: Unexplained Proteinuria 1 day ago

Nephrotic range proteinuria with intact foot processes is a severe mismatch. As Dr. Rodby says- it does not compute. Sent from my iPad

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RE: Unexplained Proteinuria 1 day ago

Something is off. You reported proteinuria in mg/mg. Are you sure it wasn’t mg/g? --------------------------------- Roger Rodby MD, FASN Professor ...

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RE: Unexplained Proteinuria 1 day ago

EM showed generally intact podocytes. No significant foot process fusion. ------------------------------ Ghansham Das MD Syracuse NY --------------...

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RE: Unexplained Proteinuria 1 day ago

Explaining the high grade proteinuria and thin basement membranes on hyper filtration is a stretch (no pun intended) . The Hematuria could be TBMD ...

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RE: Converting albumin / creatinine ratio to approximate g/day 1 day ago

Thank you all for the resources / assistance, it has been much appreciated. ------------------------------ Justin Davis MBBS Nephrology Registrar T...

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Unexplained Proteinuria 1 day ago

A 69-year-old female with a past medical history of depression/anxiety, migraine, herpes zoster infection, SIADH, hypothyroidism readmitted to the ...

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RE: Converting albumin / creatinine ratio to approximate g/day 2 days ago

I agree with Dr. Venkat. There is often some useful information in examining the ratio of UACR and UPCR. Sent from my iPad

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RE: Converting albumin / creatinine ratio to approximate g/day 2 days ago

Another thing to be aware of when assuming ~ 70% albumin content of total protein in urine to convert UAlb/Cr to UPr/Cr is the possibility that in ...

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RE: Uremic vs non-uremic preicarditis 2 days ago

For what it is worth... I once had a case of tamponade (clear diastolic collapse) with hypertension! The patient was tachycardic and I suppose had ...

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RE: Converting albumin / creatinine ratio to approximate g/day 2 days ago

We recently looked at ACR in patients with AL amyloidosis.​  The correlation was extremely good.  However, it is slightly different whether the pro...

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RE: Uremic vs non-uremic preicarditis 2 days ago

In my opinion the most important issue is the pericardial effusion causing hemodynamic instability. Tamponade - are there signs of cardiogenic shoc...

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RE: Unusual case of proteinuria 2 days ago

As i promised- here is the final version of the case (attached) ------------------------------ [Amaresh] [Vanga] [MD] [Virginia Beach, VA] --------...

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RE: Need help with interesting electrolyte abnormality case 2 days ago

His calcium in rest of labs are ok and never was an issue again. on further poking, he does admit to the fact that he was having issues with freque...

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