RE: Delayed Relapse of primary membranous with renal impairment unresponsive to Rituximab with bil. femoral AVN 51 minutes ago

We need more information. What is his cumulative CYC exposure since 2010?  Can you obtain an ELISA for anti-PLA2R levels?Making treatment decisions...

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Delayed Relapse of primary membranous with renal impairment unresponsive to Rituximab with bil. femoral AVN 1 hour ago

I would love to get some advice on a tough case..   I follow a 35 year old black male patient  who was diagnosed with membranous nephropathy on...

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RE: Primary Vs secondary MGN 2 hours ago

It was my understanding that both PLA2R and THSD7A staining of the kidney biopsy was negative in this case. In addition, The IgG subclass staining ...

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RE: Xenograft Huge Advance 2 hours ago

Robert Montgomery is a brilliant transplant physician and surgeon- had the opportunity to sit with him at a dinner presentation he gave at CEOT Mar...

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RE: Xenograft Huge Advance 2 hours ago

Someone has to go first- like the pioneering identical twin transplant performed by Joseph Murray and colleagues at the Peter Bent Brigham Hospital...

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RE: noncompliant dialysis patients 3 hours ago

What is (are) the reason (s) he gives for not coming to dialysis as prescribed? ------------------------------ Sheldon Hirsch MD Lakeside Nephrolo...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 4 hours ago

Have to put in my 2 cents: 1. urine under normal circumstances is acidic not alkaline 2. 2 main causes of alkaline Urine are Distal RTA and Ureaase...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 4 hours ago

Have to put in my 2 cents: 1. urine under normal circumstances is acidic not alkaline 2. 2 main causes of alkaline Urine are Distal RTA and Ureaase...

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RE: Xenograft Huge Advance 5 hours ago

"On the other hand, I would like to hear what the ethicists say as the brain dead patient derived no benefit from the procedure.​" I am not an eth...

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RE: noncompliant dialysis patients 6 hours ago

Thank you everyone for the responses. This particular patient comes in about thrice a month. He does get labs done after long absences , a few days...

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RE: Primary Vs secondary MGN 7 hours ago

As far as I understood, PLA2R-associated MN was excluded based on ELISA or IFT assays to measure anti-PLA2R antibodies, ie not based on biopsy anal...

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RE: noncompliant dialysis patients 7 hours ago

I've had a few such patients in over 50 years of taking care of dialysis patients.  Usually a patient who misses more than half of their 13/mo. HD ...

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RE: Xenograft Huge Advance 7 hours ago

Certainly a major milestone in transplantation! Of course, Dr. Montgomery and his team deserve our congratulations and gratitude. We should also ap...

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RE: ? interstitial nephritis 8 hours ago

Since SCr is back to baseline, don't think that kidney biopsy is indicated. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 8 hours ago

I agree with Dr. Glassock that many cases posted in the Forum are excellent for teaching purposes. I have used several of them in conferences for f...

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RE: Xenograft Huge Advance 9 hours ago

The barriers are multiple (see attached) but, as already stated, this kind of pioneer work is HUGE. Kudos to Dr. Montgomery and his team. --------...

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RE: persistent microscopic hematuria in IgA nephropathy 9 hours ago

I would think that  persistent hematuria with proteinuria would  have a worse rate of decline in eGFR  , than isolated hematuria by itself in the s...

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RE: severe hypercalcemia 10 hours ago

KDIGO guidelines do not recommend more than 2000 mg of elemental calcium per day in CKD patients . 800- 1000 mg of elemental calcium is enough to k...

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RE: Xenograft Huge Advance 10 hours ago

I agree with you both! We will need to know the Xenografts are safe and will need to interpret episodes of transplant dysfunction in a new milleau!...

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RE: noncompliant dialysis patients 10 hours ago

I agree with Dr. Hirsch's response that the perhaps the patient does not need RRT .  You didn't tell us more about the patient, but what are the re...

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RE: noncompliant dialysis patients 10 hours ago

Some of these patients come around and become more compliant as they develop symptoms of missed dialysis. Others do not and have a poor outcome. As...

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RE: Xenograft Huge Advance 10 hours ago

Genetically engineered pigs have been on the brink of creating human history for some time. It required someone of Dr Montgomery's stature to take ...

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RE: Biopsy or not ? 10 hours ago

If he has other stigmata of DM such as retinopathy or neuropathy, in this case autonomic, I would say no and treat as diabetic nephropathy. ------...

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RE: Xenograft Huge Advance 10 hours ago

Breaching the hyper-acute rejection barrier to xenotransplantation is indeed a huge step forward , if this n=1 experiment can be duplicated. But ma...

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RE: Living Kidney Donor with Normal GFR, Small Kidneys 10 hours ago

Measuring GFR will not tell you how many nephrons are present in a smallish kidney. Adaptive changes in snGFR can return WK GFR to normal or close ...

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RE: Xenograft Huge Advance 10 hours ago

Agree. This is huge ------------------------------ Arjun Sekar MD Associates in Kidney Care West Des Moines IA (515) 330-5680 --------------------...

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RE: Xenograft Huge Advance 11 hours ago

No doubt that this represents not only a major scientific leap indeed and a strong validation to all those individuals who have been involved in xe...

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RE: ? interstitial nephritis 11 hours ago

Creatinine always 0.9->1.1 so now at baseline.  Peripheral eos negative ------------------------------ Deborah Fein MD Nephrologist Pattner and Gr...

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Xenograft Huge Advance 13 hours ago

How is this not the headline of all headlines? https://www.nytimes.com/2021/10/19/health/kidney-transplant-pig-human.html What a huge step forw...

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RE: persistent microscopic hematuria in IgA nephropathy 13 hours ago

IgAN is so heterogeneous it is difficult to study targeting creatinine and proteinuria, I doubt there will ever be a trial targeting microscopic he...

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RE: persistent microscopic hematuria in IgA nephropathy 17 hours ago

Great Question.  No good answer.  There is a strong association between the persistence and magnitude  of hematuria  in IgA N and the rate of decli...

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RE: Living Kidney Donor with Normal GFR, Small Kidneys 17 hours ago

In these cases an evaluation with scintigraphy can solve your problem. Better , but difficult to assess: measurement of Gfr with exogenous substanc...

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persistent microscopic hematuria in IgA nephropathy 17 hours ago

Is persistent microscopic hematuria in IgA nephropathy an indication for corticosteroid therapy as its suppose to be a feature of active inflammato...

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RE: Osteoporosis In Hemodialysis Patient 19 hours ago

Again, Professor Glassock is right on.  Though the review is interesting and should prompt us to pursue studies, we do have to be careful as to how...

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RE: Biopsy or not ? 22 hours ago

With 16 years of poorly controlled T2DM, this is most likely Diabetic Nephropathy. i would treat him with SGLT21, MRA and RASi without axkidney bio...

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Biopsy or not ? 22 hours ago

White gentleman age 73, has albumin to creatinine ratio 4469 today compared to 2850 in June compared to 2795 in March compared to 888 in February, ...

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RE: Podocyte Infolding glomerulopathy PIG 1 day ago

I concur with Dr. Fogo’s remarks that PIG is not a discrete disease entity , but rather a “pattern of injury” indicating a severe and chronic Podoc...

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RE: Osteoporosis In Hemodialysis Patient 1 day ago

I am more persuaded by the Susan Ott , et al counter argument that the evidence for benefit over harms for use of anti-resorptive drugs in advanced...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 1 day ago

This is a new twist on leveraging the Open Forum discussions in an innovative way. We should encourage more such Group Discussions, using the cases...

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RE: noncompliant dialysis patients 1 day ago

I would endorse 100% Dr. Kelly’s elegant and humanistic response to this dilemma. Do the best we can, and do no harm. ---------------------------...

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RE: noncompliant dialysis patients 1 day ago

IMO; Beautifully said by Dr Kelly.  As a sort of ancillary point, probably not applicable to any of Dr Ahmad's patients,if a patient is only showi...

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RE: ? interstitial nephritis 1 day ago

Do you have any recent baseline SCr values for this patient prior to this episode of AKI? Since SCr has decreased already from 1.9 mg to 1.18 mg/dL...

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RE: noncompliant dialysis patients 1 day ago

Hello there. This is unfortunately a common problem in dialysis care.  No matter the patient preference to reject the good care offered, we as phys...

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RE: Osteoporosis In Hemodialysis Patient 1 day ago

There is a recent review of adynamic bone disease in CKD  in which the authors question whether low bone formation should be considered a disease a...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 1 day ago

It must have been an outstanding conference. Thank you for sharing it. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 1 day ago

This fascinating and interesting case case was discussed this morning via e-mail with the division of nephrology faculty and fellows at the Univers...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 1 day ago

I still wouldn't ruled out IgG4 related (pancreatitis) and endocrine glandular disease. I still don't understand how the hypoparathyroidism can be ...

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RE: HJypoparathyroidism , Sjogrens syndrome.. 1 day ago

Hypo-Parathyroidism +Hypothyroidism + Serology+ RTA = Auto- immune polyglandular deficiency disease secondary to Sjogren Syndrome in my book.. ---...

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RE: severe hypercalcemia 1 day ago

I agree 100%. Impaired GFR increases the risk of alimentary hypercalcemia, especially in the presence of exogenous Vitamin D. --------------------...

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RE: severe hypercalcemia 1 day ago

Reading this post late. My initial impression is that of exogenous Ca leading to hypercalcemia, azotemia, and a vicious cycle. An elevated HCO3 lev...

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