RE: MPGN-What next? 6 hours ago

Have a question If pt with ckd has free k/l ratio 3 considered in range for CKD and then develop lambda chain producing clone Ratio will be normal ...

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RE: Minimal Change Diseae 9 hours ago

PS- I assume that the IF is negative in this case. IgAN with MCD can occur in connection with Psoraisis. Sent from my iPad

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RE: Minimal Change Diseae 9 hours ago

I usually do not routinely suggest testing for CMV, EB or ZVZ antibodies in such patients and I am not sure if there is any data to answer our ques...

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Minimal Change Diseae 10 hours ago

66 year- old Caucasian man with history of hypertension, asthma, psoriasis, obesity, osteoporosis, hyperlipidemia, diagnosed 3 years ago by kidney ...

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RE: MPGN-What next? 12 hours ago

These are interesting findings -  the monotypism for IgG3 is unusual.  In PGNMID the subclass Deposition is usually IgG1/2.  No Fibrillary deposits...

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RE: MPGN-What next? 14 hours ago

Ok , I called the pathologist and they actually did that pronase digestion on the sample. it was just not reflected on initial report. here is thei...

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RE: IgA Vasculitis 15 hours ago

​Her creatinine was 0.8 in nov 2019 when she presented to hospital with HTN emergency and edema. started on lisinopril. Creatinine 2 days ago at 1....

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RE: IgA Vasculitis 15 hours ago

Initial SCr and evolution of SCr subsequently? Were complements normal, especially C3? Nature of "skin lesions" in LLE? Palpable purpura versus cel...

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RE: IgA Vasculitis 15 hours ago

That is a tough one.  Steroids can cool the lesion, but theoretically will cure.  CYC can be beneficial.  The complement activation in IgAV and IgA...

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RE: Renal Pathology Video Episodes 16 hours ago

​Hi Anna, For the last 3 years, I have been doing a flipped curriculum on hyponatremia called "the Elecrolyte Club." I started this curriculum init...

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RE: Renal Pathology Video Episodes 17 hours ago

Thx, I also piloted similar flipped classroom style videos in the med school curriculum here at Wash U for clinical skills teaching, and they were ...

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RE: Surgeon declines to place PD cath due to prolene mesh 17 hours ago

I suggest you read paper below, specifically the section headed: MYTH 5: MESH HERNIA REPAIR IN THE PERITONEAL DIALYSIS PATIENT IS ASSOCIATED WITH H...

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RE: IgA Vasculitis 18 hours ago

I use the negative Lafayette, et al RCT of RTX in IgAN (JASN, 2017; including some patients with NS and impaired GFR ) as an argument against using...

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RE: MPGN-What next? 18 hours ago

I think the K/L ratio is consistent with CKD and does not necessarily point to a Monoclonal disorder. However, only about 30% of cases of PGMID hav...

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RE: tunneled catheter removal 18 hours ago

Discussed this with our, very experienced, interventionist ,Alejandro Alvarez. He says that if the catheter cannot be easily removed a minor cut do...

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RE: IgA Vasculitis 18 hours ago

I have had a handful of similar cases. I typically use a 3 month trial of po prednisone and cytoxan. With this I have had favorable results with th...

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Surgeon declines to place PD cath due to prolene mesh 18 hours ago

Greetings all, I would like a group opinion about a VA patient whom we follow for his ESRD. He has been on maintenance HD for some time and finally...

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RE: MPGN-What next? 19 hours ago

Just to amuse me, could you have your pathologist perform pronase digestion? ------------------------------ Nelson Leung MD Mayo Clinic Rochester M...

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RE: Proteinuria 20 hours ago

To answer @Roger Rodby regarding the 8 weeks of therapy. The biggest reason for this is the lack of a hematologic marker of response. We have no id...

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RE: Membranous GN 20 hours ago

What about the S prograf level when S creatinine increases and what's now  ------------------------------ Yasir Sharba MD AL Sodre Teaching Hospita...

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Mycobacterium Abscessus in a PD Patient 20 hours ago

I have an ESRD patient on PD for 6 months. Few weeks after peritoneal dialysis catheter placement he started having some drainage from the exit sit...

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RE: Membranous GN 21 hours ago

Thanks, Dr Aledan What do you think the reason for increased albuminuria while tap off TAC? ------------------------------ Ella Koifman-Zeltzer MD ...

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RE: Renal Pathology Video Episodes 21 hours ago

Tim, Thank you for sharing! Your videos are great! I think videos like yours can be a great use for ‘flipping the classroom’. Assign the video to b...

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RE: Membranous GN 21 hours ago

I would follow serum PLA2R Ab by ELISA but negative PLA2R Ab by IF is reassuring. According to MENTOR trial RTX is superior to CNI but as you start...

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Membranous GN 22 hours ago

He is 64 y old white male; PMH of HTN treated with amlodipine; allopurinol due to a past history of kidney stones 25 y ego and hyperuricemia; BPH; ...

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RE: IgA Vasculitis 1 day ago

3 crescents out of 25 glomeruli. Thank you for all the suggestions. Once I have the full biopsy report, will post it. -----------------------------...

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RE: MPGN-What next? 1 day ago

The K/L ratio of 1.99 is expected in CKD and the ratio outside 0.37-3.1 in either direction is abnormal in CKD. --------------------------------- H...

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RE: MPGN-What next? 1 day ago

Thank you for your input. I saw this chart before Dr.Rodby thank you for sharing. it was leading me towards a polyclonal pathway and since there is...

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RE: MPGN-What next? 1 day ago

Useful for diagnosis, less so for treatment. Sent from my iPad

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RE: IgA Vasculitis 1 day ago

https://www.ncbi.nlm.nih.gov/pubmed/28638602 4 patients... and subject to reporting bias, but then again may be something.  "3 crescents" in how ma...

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RE: MPGN-What next? 1 day ago

Two algorithms for MPGN based on IF staining. ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical C...

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RE: MPGN-What next? 1 day ago

MPGN is a pattern of injury almost always secondary to a defined cause. You need to search for a cause before labeling it as “Idiopathic immune com...

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MPGN-What next? 1 day ago

​67 year old female past medical history significant for hypertension, graves disease-old history no recent flare up- chronic kidney disease with a...

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RE: IS pneumonia 1 day ago

Need more information: 1. Walking pneumonia meaning mild symptoms, no or low grade fever, no dyspnea, no hypoxia, no pleuritic pain? 2. Characteris...

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RE: IgA Vasculitis 1 day ago

In IgAV (unlike IgAN), is there not a small body of literature, albeit observational level, arguing against RTX atheism? --------------------------...

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RE: IgA Vasculitis 1 day ago

Probable IgA Vasculitis. There is no standard-of-care therapy for this condition with a presentation including Nephrotic Syndrome. Due to the Diabe...

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RE: IgA Vasculitis 1 day ago

Sorry for vague history. IF showed mainly IgA. Very week c3 deposit. Official biopsy report pending. No history of infection at all. --------------...

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RE: IgA Vasculitis 1 day ago

From the title of your query, I presume the IF showed IgA deposits. It would help to know if any infection (particularly Staph) is present. Can y...

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IgA Vasculitis 1 day ago

51 yr old white female , obese presented with nephrotic syndrome and microscopic hematuria. Also had LLE skin lesions. All serologies negative incl...

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RE: Proteinuria 1 day ago

​The issue is that if the patient responds, you won't know which agent he/she responded to. ------------------------------ Nelson Leung MD Mayo Cli...

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RE: tunneled catheter removal 1 day ago

Hello I'm new to forum but someone brought this to my attention. Great comments and discussion. To summarize, the only initial adherent area would ...

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RE: Tubule interstitial Nephritis 1 day ago

"0.9-3.4"  This was rather sub-acute or acute.  I am assuming this is not a big person, so 0.9 is probably GFR [More]

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RE: Proteinuria 2 days ago

Can we use both Rituximab and proteosome Inhibitor at the same time as sometimes in antibody mediated rejection in transplant Of course with high r...

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RE: Proteinuria 2 days ago

8 weeks of Rituxan is a lot of Rituxan given typical gn Regimens call for 4 weeks at that dose: "Rituximab has been dosed at either 375 mg/m2 per w...

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RE: tunneled catheter removal 2 days ago

@Monnie Wasse are there any published guidelines or best practices for tunelled catheter removal? --------------------------------- Roger Rodby MD,...

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RE: Tubule interstitial Nephritis 2 days ago

"Question is what is the significance of plasma cell islands in this case? Is there a concern for malignancy ? BM biopsy needed. " On immunofluores...

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RE: Tubule interstitial Nephritis 2 days ago

The PPI use may be quite significant. Recovery after stopping PPI is very slow and inconsistent. I am not sure that steroids help. She is not Mexic...

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RE: tunneled catheter removal 2 days ago

The story is older with pacemaker wires. When they are malfunctioning, fractured or replaced, they either need endovascular laser removal or open v...

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RE: Tubule interstitial Nephritis 2 days ago

Congo red stain was negative. EM was negative for any electron dense deposits. Pathologist suggest to screen for sjogrens because of higher plasma ...

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RE: Tubule interstitial Nephritis 2 days ago

Can I assume that no fibrils were seen in EM and that the Congo Red stain was negative? Is there any history of use of Herbal remedies of any kind....

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