RE: A case of Acute Kidney Injury. 22 minutes ago

The repeat kidney biopsy pretty much makes Vasculitis or Glomerulonephritis as a cause of AKI extremely unlikely, but the episodic hematuria remain...

View Discussion

RE: A case of Acute Kidney Injury. 29 minutes ago

Unfortunate that no past urinalyses are available. Proteinuria and microscopic hematuria due to another cause might have antedated the superimposit...

View Discussion

Do we need genetic testing in C3G (outside Cypriot ancestry)? 1 hour ago

In my opinion — no. Would like the community's input on this. Unlike aHUS, genotype doesn't drive diagnosis, treatment, monitoring, stopping decisi...

View Discussion

RE: A case of Acute Kidney Injury. 2 hours ago

I would echo the statements of the Dear Professor . During my fellowship several decades ago , I was taught that in case of subacute renal failure...

View Discussion

RE: A case of Acute Kidney Injury. 3 hours ago

Do you have EM on the second biopsy? What is the full extent and nature of "nodular sclerosis "?. Is the patient diabetic? Do you have serum free l...

View Discussion

RE: AA Amyloidosis of unknown origin? Idiopathic? Other ? 3 hours ago

I would postulate that this patient (and perhaps his sister ) have inherited a high -Amyloid risk variant of the NOD2 gene associated with Crohn-s....

View Discussion

RE: Iron replacement strategy in dialysis 4 hours ago

The Pivotal Trial has serious limitations and should not be used to establish "Guidelines". 1) it was open-labeled. 2) it showed an ARR of only...

View Discussion

RE: Iron replacement strategy in dialysis 4 hours ago

Teleologically, the iron level is controlled at the entry gate, which speaks of overload harm. In dialysis patients, we bypass that gate with IV ir...

View Discussion

A case of Acute Kidney Injury. 5 hours ago

76-year-old male who with medical history for long standing hypertension, Atrial fibrillation who had a mechanical fall with tibia fracture needing...

View Discussion

AA Amyloidosis of unknown origin? Idiopathic? Other ? 8 hours ago

Dear All Good day, A 32-year-old male, Parents of Arab origin from the Galilee. In 2014, he began experiencing abdominal and diarrheal symptoms...

View Discussion

RE: Resistant Rejection 22 hours ago

Look at prograf level variablity index. Also, how does patient seem, mentally and psychologically? we have had a couple of patients flat out gi...

View Discussion

RE: Iron replacement strategy in dialysis 1 day ago

I agree - guidelines are not infallible and are often (too often) touted as "evidence based" when they really are not, since the evidence is freque...

View Discussion

RE: Iron replacement strategy in dialysis 1 day ago

Dr Cook, I hardly am pretending to know much about this topic, so I asked open evidence… I am generally NOT a fan of guidelines , my former c...

View Discussion

RE: Iron replacement strategy in dialysis 1 day ago

The KDIGO recommendations are based on the PIVOTAL trial, which shows that a proactive approach targeting high TSAT and ferritin levels is more eff...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

Thank you fir this citation. I was not aware of it. It is a single research letter report from 6 years ago. . Was the finding ever independently co...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

another way that might help is to stain globally sclerosed glomerulus for IgA, if positive, IgA related GN is probably less likely. See: Kidney Int...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 2 days ago

These values make me more worried about an infection-related IgA dominant GN. Have you performed a TEE for cardiac valve vegetations? Do you have K...

View Discussion

RE: Resistant Rejection 2 days ago

A though case. I think second dose of rituximab or tocilizumab is unlikely going to work in this case. We have some experience with daratumumab in ...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Rheumatoid factor was 88 IU/mL and 77 IU/mL, two days apart (Lab reference range: 0-14 IU/mL). C3 complement was 52 mg/dL (reference: 82-167) and C...

View Discussion

RE: Iron replacement strategy in dialysis 2 days ago

Thanks Dr Rodby, I really appreciate and respect your posts in general. Even though I've never met you, I consider you one of my better educat...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 2 days ago

RItuximab in true steroid resistant Prinaryv FSGS with Nephrotic Syndrome , results in a complete or partial remission in about 20% of patients . T...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Thanks. What were the levels of RF and C3/C4. If the RF is very high, you may want to start with a low dose of RTX to avoid a passive serum sicknes...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Thank you all for the great inputs! Here are the answers to all the questions that were asked. Creatinine data - Baseline around 1 mg/dL...

View Discussion

RE: Iron replacement strategy in dialysis 2 days ago

im still not sure of the risk if clinically evident end organ damage from top From Open Evidence - "How often is iron overload by ferritin lev...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 2 days ago

Dr. Dastoor very interesting It's quite unusual for me to see response with Rituximab in (true) steroid resistant patients Do you, or other pe...

View Discussion

RE: Resistant Rejection 2 days ago

If DSA is negative, the MVI element, provided recurrent GN and Hep C infection etc is ruled out, maybe it could be due to NK Cells and warrant CD38...

View Discussion

RE: Resistant Rejection 2 days ago

What are tacrolimus trough levels during this period. The August biopsy showed intimal fibrosis and prominent arteriolar hyalinosis which is not pr...

View Discussion

RE: Iron replacement strategy in dialysis 3 days ago

Ferritin >500 μg/L is a red flag, especially if it's rising without clear inflammation. But the real signal is transferrin saturation (TSAT): once ...

View Discussion

RE: Iron replacement strategy in dialysis 3 days ago

You're right, that's probably an unrealistic target goal. But I wonder if our ferritin protocols are too generous and I also wonder if some of the ...

View Discussion

RE: Iron replacement strategy in dialysis 3 days ago

Not meaning to sound flippant but good luck keeping the ferritin 1-300. May I ask where this data comes from? Is it observational ? My guess is i...

View Discussion

RE: Resistant Rejection 3 days ago

Dr Pineda is spot on about further tissue staining for markers of PTLD. Dr Aleydan I want to clarify what does "Late Active" signify in histopatho...

View Discussion

RE: Iron replacement strategy in dialysis 3 days ago

Based on my personal experience a slightly higher ferritin target may be necessary and acceptable. Then the question becomes one of overruling th...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

I do not think that this patient would qualify for the suggestion made by KDIGO CPG to treat with a combination of CYC + Steroids. I agree that the...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

In this patient with crescentic IgA nephropathy/IgA vasculitis nephritis, routine PLEX is not recommended, as evidence for benefit in IgAV-associat...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

Dr. Gharib- you raise some important issues. We do need to know the results of C3/C4 serum levels, Rheumatidc Factor levels, Cryoglobulin Assays an...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

It seems that the major contribution of very low GFR (serum creatinine 4 mg/dl) comes from ATI from RBC casts as suggested by Dr. Rodby especially ...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

View Discussion

RE: unexplained rhabdomyolysis 3 days ago

Yes multiple times --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh Shakhbout Medical Cit...

View Discussion

Iron replacement strategy in dialysis Friday, September 25 @ 4:38 PM

Based on the most recent evidence of iron overload contributing to liver cirrhosis, I am revising my own personal goals for iron replacement in dia...

View Discussion

RE: IgA Nephropathy case Friday, September 25 @ 4:24 PM

The notion that hematuria is an independent predictor of outcome is "all the rage" and could be targeted (as what prompted your post) I think yo...

View Discussion

RE: CMNephritis Friday, September 25 @ 4:05 PM

Long term CNI may have been doing well enough but it can lead to CKD, and you have an opportunity for remission with an anti-CD 20 drug. If you ...

View Discussion

RE: CMNephritis Friday, September 25 @ 2:45 PM

Thank you for responding: Patient 1 Patient 2 S. Albumin 3.7 4.0 Creatinine 3.7 2.76 (up from 1.86) U. protein 1.44 gmn 460 mg Tacrolimu...

View Discussion

RE: unexplained rhabdomyolysis Friday, September 25 @ 2:43 PM

I'm sure someone measured his thyroid function tests as hypothyroidism does cause mild non-traumatic rhabdo. ------------------------------ Da...

View Discussion

RE: IgA Nephropathy case Friday, September 25 @ 2:20 PM

Consistently in the 70s, no change over the 6 months since I have been seeing her. ------------------------------ Ritu Vyas MD Catonsville MD (4...

View Discussion

RE: CMNephritis Friday, September 25 @ 1:50 PM

I would taper (and stop) the CNI and treat both patients with RTX or Obinutuzumab . What is the current level of proteinuria, serum albumin snd eGF...

View Discussion

RE: IgA Nephropathy case Friday, September 25 @ 1:44 PM

What is her current eGFR- she might beca candidate fir moderate dose steroids + MMF or one of the anti- April-/ April/BAFF agents. --------------...

View Discussion

IgA Nephropathy case Friday, September 25 @ 11:55 AM

Hello, I have a 48 year female who I have been following for biopsy proven IgA. She is on Lisinopril 2.5 (unable to tolerate any higher due to lo...

View Discussion

CMNephritis Friday, September 25 @ 9:48 AM

I have two patients in their 60's with biopsy proved membranous nephritis. One has elevated Eliza PLA2R and the other does not. They have been doin...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy Friday, September 25 @ 9:41 AM

Dr. Charytan- No direct comparator RCT of CYC vs RTX in IgA Vasculitus have been published- but three independent observational trials (one oroen...

View Discussion