RE: genetic testing for kidney disease - some questions 8 minutes ago

Interesting case - if mother and daughter both have the same disease (a reasonable hypothesis but not certain), then mutations in a recessive FSGS/...

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 26 minutes ago

Would you repeat serology or even biopsy before cyclophosphamide treatment Can you please attach the KI report pdf --------------------------------...

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 8 hours ago

Thanks Dr.Glossock for your input.. ------------------------------ Ajay Ganglam MD Malvern PA (443) 610-2374 ------------------------------

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 9 hours ago

I think you just should just hang in there. I like your plan thus far. --------------------------------- Roger Rodby MD, FASN Professor of Medicine...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 9 hours ago

Follow up on this patient creatinine still 3 highest creatinine one month ago was 3.8 C3 is now 85 lower limit of normal 83 Up from 41 a month ago ...

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 10 hours ago

Thanks for the additional information. The negative anti-DNA and normal C3/C4 is distinctly uncommon in patients with LN and + anti-MPO ANCA, but t...

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 11 hours ago

Thanks Dr.Aledan ------------------------------ Ajay Ganglam MD Malvern PA ------------------------------

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 11 hours ago

Thanks for response Dr. Glassock. Path - 30 glomeruli were seen on Light Microscopy. 6/30 glomeruli globally sclerosed. 0/30 Segmentally sclerosed....

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 11 hours ago

Presence of ANCA positive LN tend to have different pathomechanism than ANCA negative LN according to this KI report. https://www.kidney-internatio...

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RE: Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 13 hours ago

How many glomeruli in the kidney biopsy? How many Crescents? Fibrous, Fibrocellular, Cellular Crescents? Why did you choose MMF rather than CYC for...

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Crescentic GN/Diffuse Proliferative GN Class 4 Lupus Nephritis/Collapsing FSGS-Asymptomatic Covid/Strong +VE ANA/PR3-MPO ANCA + 13 hours ago

42 y/o Asian female presented with progressive generalized swelling over 2 weeks with painless hematuria for a month. She also had redness of her e...

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RE: Derms in HD patients 16 hours ago

Acquired Perforating Dermatosis in Patients with Chronic Renal Failure and Diabetes Mellitus (attached)  "The perforating disorders of the ...

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RE: Derms in HD patients 16 hours ago

Based on the skin biopsy findings, you might try Tacalcitol creme or ointment. ------------------------------ Richard Glassock MD, FASN Emeritus Pr...

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RE: genetic testing for kidney disease - some questions 16 hours ago

Completely agree, for NPHS1 (nephrin), it is very unlikely for a 55 yo patient.  Although very rare, NPHS2 (podocin) pathogenic variants can be fou...

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RE: Derms in HD patients 17 hours ago

The clinical utility of the skin biopsy is once again demonstrated. ------------------------------ Mario Rubin, M.D. Houston TX -------------------...

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RE: COVID 19 In Transplant Patient 17 hours ago

Thank you for nice explanation, Bp readings not so high, her systolic BP ranging 150-170. Native disease not known but suggestions of drug induce r...

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RE: genetic testing for kidney disease - some questions 17 hours ago

A Nephrin mutation causing FSGS would be exceptionally unlikely in a 55 year old patient. --------------------------------- Richard Glassock MD, FA...

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RE: Post Transplant erythrocytosis 17 hours ago

Nothing is going to really help this patient until you better understand the origins of the RCC and the erythrocytosis. I suspect a VHL mutation an...

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RE: Blood pressure via Smart Watch 18 hours ago

I’m not even certain that the wrist strap will have to do anything it may be all sensors based on pulse. There was an app that used your index fing...

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RE: C3 GN vs MPGN type I: treat or not 18 hours ago

"UPCr : 0.2" If this is not a typo, surprisingly low for a severe glomerular disease documented by biopsy. Since SCr is 1.8 to 2.0 mg and he is non...

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RE: Derms in HD patients 18 hours ago

Hello everybody I have skin biopsy results, I will transcribe itÇ SAMPLE Posterior thorax skin specimen Microscopic view Epidermis is highly ulcera...

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RE: COVID 19 In Transplant Patient 18 hours ago

What was the native kidney disease that caused ESRD requiring transplantation? Since uncontrolled hypertension is present, need to consider TMA due...

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RE: COVID 19 In Transplant Patient 19 hours ago

I had a case where the patient had the now second "classic" finding of an fsgs picture but with mild moderate tubulitis. We didn't have apol1 info ...

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RE: Kidney Transplant With Radical Nephrectomy For The Single Kidney With RCC 19 hours ago

A 9 cm tumor needs to be removed and I would also consider it unwise to perform a transplant at the same sitting. Was the patient not followed up b...

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RE: Post Transplant erythrocytosis 20 hours ago

I have found myself that losartan works better than telmisartan for this but of course this may be a clinical illusion. There is some evidence for ...

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RE: COVID 19 In Transplant Patient 20 hours ago

This is a challenging case because we still know so little about COVID19. You can take the systematic approach or the kitchen sink approach. The pr...

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RE: Derms in HD patients 20 hours ago

Agree with Dr Glassock. I see it in patients with ESRD, usually on the lower extremities, but can be anywhere, and more often in patients with Afri...

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RE: COVID 19 In Transplant Patient 20 hours ago

Unfortunately DSA not available! Regard ADAMTS 13..... Patient's platelet count is normal, and blood film normal without anemia or fragmentation. W...

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RE: genetic testing for kidney disease - some questions 21 hours ago

Regarding genetic forms of FSGS, there is sill low risk of recurrence. In patients with NPHS1 (Nephrin) pathogenic variants, anti-nephrin antibodie...

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RE: COVID 19 In Transplant Patient 21 hours ago

Get DSA as TMA can be associated with C4d negative ABMR-is any evidence for MAHA ? if so ADAMTS13 should be sent . Would dc CSA and start sirolimus...

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RE: C3 GN vs MPGN type I: treat or not 22 hours ago

Thank you! ------------------------------ Bhavika Gandhi MD Nephrology Fellow Baylor Scott and White Bhavika[LastN[CompanyName] -------------------...

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RE: Rapid correction of severe hypernatremia 22 hours ago

Also from Dr Stearns, what seems a very reasonable practical approach/summary: "Inadvertent rapid correction of hypernatremia is much less likely, ...

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RE: Post Transplant erythrocytosis 22 hours ago

No role for hydroxurea in PTE - would continue phlebotomy to maintain Hgl [More]

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RE: Post Transplant erythrocytosis 23 hours ago

Since it is 18 months since the transplant already, the PTE is likely to persist a long time or indefinitely. Interestingly, he has had bilateral p...

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RE: Post Transplant erythrocytosis 1 day ago

I would strongly suspect a mutation of the VHL gene in this patient. Genetic testing should be performed. Erythopoetin levels should be measured. A...

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RE: Rapid correction of severe hypernatremia 1 day ago

I have attached an excellent recent discussion of this topic by Rick Sterns. In this review, Dr Sterns makes the following statement : ​ There has ...

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RE: C3 GN vs MPGN type I: treat or not 1 day ago

You really have to make sure this is not an infection related GN. Blood cultures, especially bartonella,. Echo even if cultures are negative ------...

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RE: C3 GN vs MPGN type I: treat or not 1 day ago

I think the diagnosis of C3GN is consistent if you have an MPGN pattern of injury + predominance of C3 deposits + no evidence of recent infection.....

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COVID 19 In Transplant Patient 1 day ago

A 60 yrs old female who received kidney transplant 7 yrs ago (on CsA, MMF, Prednisone) , admitted 2 months ago as covid19 after 10 days in hospital...

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Post Transplant erythrocytosis 1 day ago

47 yrs old gentleman post kidney transplant 18 months: He has history of RCC (1 mass in Lt, 2 in Rt): bilateral partial nephrectomy done in 2017. K...

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C3 GN vs MPGN type I: treat or not 1 day ago

Hello everyone , I came across a rather interesting case of a 77 yo M who presented with worsening anasarca and dyspnea.  PMHx : HTN, OSA, dCHF. Wa...

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RE: Reminder: Apply by May 5 (tomorrow) to serve as a 2021 Kidney Week case report reviewer 1 day ago

Thank you for the opportunity, would be happy to volunteer as a case report reviewer. ------------------------------ Karthik Kovvuru MBBS, FASN MET...

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RE: Derms in HD patients 1 day ago

Lower limbs for Kirle's disease and limbs (upper or lower) for prurigus nodularis. We are shown the patient's back, right? We need a dermatology co...

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RE: Kidney Transplant With Radical Nephrectomy For The Single Kidney With RCC 1 day ago

Many transplant centers would not transplant a potential recipient with a RCC > 5cm without a reasonable wait time at least 2 years . Incidentally ...

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RE: Derms in HD patients 1 day ago

Or maybe Kyrles disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408719/#idm140412582041616title They look like twisted hard keratitic plugs a...

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RE: Derms in HD patients 1 day ago

It looks like prurigo nodularis - a relatively common and difficult to treat lesion in dialysis patients with severe itching. Dermatitis herpetifor...

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RE: Derms in HD patients 1 day ago

Scabies? Consider dermatologist evaluation with possible skin biopsy. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 --...

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RE: Mental health in chronic HD population 1 day ago

Thank you for your response ------------------------------ Juan C Santacruz Clínica de los Riñones Menydial Quito-Ecuador M.D Nephrologist. -------...

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Derms in HD patients 1 day ago

This is male 60 y/o patient on chronic HD, tells two months of itching and painful skin lessions on back, pain has neuropathic characteristics, no ...

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RE: Kidney Transplant With Radical Nephrectomy For The Single Kidney With RCC 1 day ago

Can you please provide the detailed pathology report of the initial RCC in the left kidney? The chances are that the recent right kidney RCC has th...

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