Treatment of membranous nephropathy with microsherular substructure 1 hour ago

78 yr old Chinese woman. Preserved kidney function egfr 82 with proteinuria. 24 hr protein 0.66 albumincreatine ratio was 155mg/mmol now it's 89 mg...

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RE: AKI & Immune complex GN 2 hours ago

Thank you Dr. Lerman for your comment and agree with you but I think that response to IS therapy doesn’t completely exclude infection related GN be...

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RE: AKI & Immune complex GN 3 hours ago

Thanks Dr. Friedman- important observation- whatever name we assign to it, this glomerular lesion is still a pattern -of -injury and not a specific...

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RE: AKI & Immune complex GN 5 hours ago

May not change Rx but why isn’t this C1q nephropathy as was brought up in original post (proliferative form; based on historical criteria where co-...

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RE: AKI & Immune complex GN 10 hours ago

“AKI on the other hand is better on Prednisone 60 mg qd & Cellcept 500 mg BID sCr 2.0---->1.8--->1.6 UACR stabilized at 200 Md/d from peak 1,000 ...

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RE: AKI & Immune complex GN 22 hours ago

Nice description Dr. Glassock, I would dig more for infection, rule out other possible causes of culture negative SBE such as Coxiella, and T. whip...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 1 day ago

Thank you Dr. Venkat and Dr. Glassock for your clarifications. ------------------------------ Sinasi Salman MD, FASN Owner Northlake Nephrology, ...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 1 day ago

Not at all. The "disease " in this patient wad not accompanied by a permanent loss of nephrons ------------------------------ Richard Glassock MD...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 1 day ago

Progression of CKD in different patients even with the same underlying kidney disease is highly variable. Agree with Dr. Glassock that it is imposs...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 1 day ago

Thank you Dr.Glassock; Mid summer 2024, I was summoned to ER for this patient with creatinine 16 and supra-pubic distention. Meticulous work [over ...

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RE: DNAJB9-positive fibrillary GN with a distal acidification defect and recurrent calcium stones 1 day ago

Since Sjogren Syndrome has been associated with both Distal RTA and Typical Fibrillary GN, i think that Sjogren Syndrome is a strong candidate desp...

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RE: IgA nephropathy and MCD 1 day ago

I agree with Dr. Rodby. I would not reBiopsy but treat with Rituximab or Obinutuzumab and then slowly taper steroids. I would also stop Sparsentan ...

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RE: IgA nephropathy and MCD 1 day ago

steroid responsive NS , steroid dependent NS, I suspect the IgAN is background but I'm not sure it matters the only odd thing I see is th FPE of...

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RE: transplant cases 1 day ago

Just to clarify I agree that ATG can be given for ACR 1B my point was if Cyclophosphamide is going to be used to treat IgA i would be very careful ...

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IgA nephropathy and MCD 1 day ago

Hello, 49 year old female, african, presented in 2022 for nephrotic syndrome, nl creatinine. kidney biopsy: LM: No hypercellularity, necrosis or...

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RE: DNAJB9-positive fibrillary GN with a distal acidification defect and recurrent calcium stones 1 day ago

I'll take a shot at this QUESTIONS Has anyone seen DNAJB9-positive fibrillary GN alongside a distal acidification defect, and did a secon...

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RE: transplant cases 1 day ago

Agree with Dr. Lerman that not all Banff grade IB TCMRs respond to methylprednisolone boluses alone. If the IB TCMR is causing marked and progressi...

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RE: transplant cases 1 day ago

"MR: Treated with pulse methylprednisolone. I would hold ATG - Grade IB without vascular involvement is usually steroid-responsive"-for the record ...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

Dr. Paramasivam: Lack of hematuria further strengthens the impression that IgA nephropathy is incidental and not causal to this patient's renal pro...

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DNAJB9-positive fibrillary GN with a distal acidification defect and recurrent calcium stones 1 day ago

Posting a case where I suspect I am looking at two processes, anyone who has seen this combination? CASE Woman in her early 40s. Recurrent calc...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

trace blood seen in one sample - however no rbc seen in UA Latest Reference Range & Units 05/21/24 09:09 08/28/24 08:40 05/16/25...

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RE: AKI & Immune complex GN 2 days ago

This case can most likely be categorized as a pattern of injury lesion characterized by mesangioproliferstive ( not Membranoproliferative ) GN or L...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 2 days ago

Also, look at the variables used in the kidney failure prediction equations (Tangri et al)) ------------------------------ Richard Glassock MD, F...

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RE: Does the type of kidney injury determine the angle of the slope towards dialysis? 2 days ago

Almost an impossible question to answer. The eGFR trajectory. is so heterogeneous depending on the nature of the injury,, glomerular , tubular, vas...

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RE: transplant cases 2 days ago

Good point Dr Glassock this article was published this month https://www.sciencedirect.com/science/article/pii/S0149291826003103 -------------...

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RE: transplant cases 2 days ago

Based on very limited evidence, all observational, I prefer Steroids + Iptacopan or steroid + RTX therapy over Steroids + CYC for therapy of recurr...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

Thanks for case . To summarise Options 1 Tac / mmf as maintenance with pulse methyl pred and warning oral steroid + iv ig 6 session 2 tac / mmf...

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RE: transplant cases 2 days ago

Good morning this is a challenging case we saw a similar case 1 month ago . This is a mix picture of acute TCMR Grade IB (t2/3, i2/3, v0) wit...

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RE: AKI & Immune complex GN 2 days ago

Correct, blood cultures are negative. We had an HIV test came back negative. She just had an echo, TTE, I have to get the final report but the p...

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RE: AKI & Immune complex GN 2 days ago

Roger- thanks for digging deeper I to this issue. I stand corrected. The frequency of a positive RF depends on the duration of the SBE. The longer ...

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RE: AKI & Immune complex GN 2 days ago

you had mentioned blood cultures and an echo - they were done and negative I assume Dr Glassock mentioned that a negative RF essentially rules ou...

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Does the type of kidney injury determine the angle of the slope towards dialysis? 2 days ago

Can you tell me if proximal nephron injury [say diabetic injury] is worse than distal nephron injury [ obstructive injury?] ---------------------...

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RE: AKI & Immune complex GN 3 days ago

So Bartonella Quintana IgM >1:20 (borderline). We doubt it has any relation to this. AKI on the other hand is better on Prednisone 60 mg qd & Cellc...

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RE: transplant cases 3 days ago

On top of steroids with or without rATG for the TCM, the late AMR and, based on recent reports, the severe IgAN might respond to anti CD38 therapy ...

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RE: transplant cases 3 days ago

"Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria?" Dr. Glassock: I asked ...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 3 days ago

I think standard therapies will likely not work in this late active AMR with some chronicity. You may try daratumumab weekly four doses, then plan ...

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RE: Diamox causing kidney stones 3 days ago

In our clinical practice we do only pre and post treatment 24 hr urine electrolytes, citrate, oxalate, uric acid, PH parameters which are misleadin...

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RE: transplant cases Saturday, September 12 @ 3:07 AM

Dr. Venkat- How would you treat the severe crescentic IgAN/IgAV in this patient?-this process seems to be the major problem. --------------------...

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RE: transplant cases Friday, September 11 @ 10:52 PM

Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria? Agree with Dr. Lerman th...

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RE: Tuberous sclerosis in 34 year old Friday, September 11 @ 8:15 PM

Thank you for your input. Will contact Riley and see if they can see her. Will continue either with ckd management. --------------------------...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? Friday, September 11 @ 7:41 PM

Is there significant microscopic (or macroscopic) hematuria in this patient. I think that the IgA nephropathy is not the significant problem in thi...

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RE: Diamox causing kidney stones Friday, September 11 @ 6:54 PM

David: As a practical approach to the potential opposing effects of citrate on stone formation (especially with CaP04), can you compare the SS for ...

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RE: Diamox causing kidney stones Friday, September 11 @ 2:37 PM

"I've said it before here on several occasions: it could be that the increase in urine citrate is more important as an inhibitor of calcium stones ...

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RE: Diamox causing kidney stones Friday, September 11 @ 2:30 PM

Thanks everyone, will try supplementing potassium citrate. ------------------------------ Brendan] [Mielke] [MD] [Kootenai Clinic] [Coeur d Alene...

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RE: transplant cases Friday, September 11 @ 1:49 PM

To my knowledge, there is not specific treatment paradigm for plasma cell rich rejection and other than noting that the ACR is plasma cell rich it ...

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RE: Diamox causing kidney stones Friday, September 11 @ 1:29 PM

Yes I agree. There's this study showing that you can increase urine citrate in patients with hypocitraturia getting topiramate. https://pmc.ncb...

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RE: transplant cases Friday, September 11 @ 1:10 PM

both pathologies need treatment!!! Dear Muhammad Soobadar followup will be very helpful to this forum. Thanks for posting this fascinating case in ...

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RE: Diamox causing kidney stones Friday, September 11 @ 12:41 PM

Acetazolamide directly inhibit CA at the choroid plexus reducing ICP (this is the main mechanism). Correction of systemic acidosis lower the hyperv...

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RE: transplant cases Friday, September 11 @ 12:08 PM

Dr. Venturelli. Very good points. I can't say ,with any degree of certainty from morphological features alone, that this is IgAV or a particularly ...

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RE: transplant cases Friday, September 11 @ 11:54 AM

Great discussion! My apology as I misinterpreted the case as positive C4d (it was G and not PTC). With these positive portfolios of DSA which are r...

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