RE: Treatment /Management of MN 19 minutes ago

I completely agree with Drs. Glassock and Rodby that CNI + steroids would not be a first choice. 40 mg of prednisone for 8 weeks is a very high dos...

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RE: to do kidney biopsy or not 23 minutes ago

Lead and kidney disease: a chronic tubulointerstitial disease associated with HTN, I haven't seen a case in 40 years and I have looked for it , but...

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RE: Resistant hypertension 33 minutes ago

I like this regimen; AMLODIPINE 10 mg OD CCB TELMISARTAN 80 mg OD ARB MOXONIDINE 0.3 mg TID I had to look this one up but it seems like cloni...

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RE: Resistant hypertension 52 minutes ago

BP control improved in hospital. This suggests possible medication non-adherence as outpatient. Proteinuria is now minimal with 30-35 RBCs/HPF (p...

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RE: to do kidney biopsy or not 1 hour ago

This patient's initial urine albumin/creatinine ratio was > 3.1g/g. There was decrease in UAlb/Cr ratio with losartan. Thus, there is significant g...

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RE: to do kidney biopsy or not 1 hour ago

i think I remember 1case decadea ago. It is a rare condition nowadays, but it is so treatable and easy to diagnose with simple trsting that I would...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 2 hours ago

Neurological improvement may be due to reduction in brain edema/swelling after steroids. I am sure close clinical and imaging follow-up for the bra...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 2 hours ago

Now that CNS better - can discuss management of chronic allograft failure-if decision to not resume Belatacept ( why was it used instead of CNI in ...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 2 hours ago

Very interesting " mysteroius case" Perhaps best to avoid Bela completely and not sure if mTOR may better then r/s CNI given CNI assoc w Neuro si...

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RE: Challenging FSGS/MCD Case 3 hours ago

This case follows a common pattern for some patients with podocytopathy( MC and FSGS spectrum) ; initially steroid responsive and later secondary s...

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RE: to do kidney biopsy or not 5 hours ago

Thanks prof glassock Read it on up to date Have you seen cases of lead ckd in your practice ? Have you ever used chelation therapy ?( just curiou...

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RE: to do kidney biopsy or not 5 hours ago

Myeloma screen negative --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Resistant hypertension 6 hours ago

Thanks Dr. Leisring for the opinion ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Resistant hypertension 6 hours ago

Thanks Dr. Glassock. I managed to get the patient hospitalised and BP is under control now (perhaps compliance might be the issue). I got a 24 ho...

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RE: Atypical Anti-GMB? 8 hours ago

His GFR is below 15. He just started dialysis. I am waiting for the IgG subclasses staining. I'll let you know if we have any further news from ...

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RE: to do kidney biopsy or not 13 hours ago

Good idea, but small kidneys would be unusual for Myeloma cast Nephropahy, ------------------------------ Richard Glassock MD, FASN Emeritus Prof...

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RE: to do kidney biopsy or not 13 hours ago

Genetic tests for UMOD mutations ( Chronic interstitial Nephritis )and COL4A3/4. CKD , hypertension and Gout can all be caused by chronic lead po...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 13 hours ago

pt now showing clinical improvement of neuro deficits- few days after completion of pulse steroids. therefore brain biopsy deferred, now ADEM thoug...

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RE: to do kidney biopsy or not 14 hours ago

Did you do SPEP,SLC, and urine protein electrophoreses? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past M...

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RE: to do kidney biopsy or not 15 hours ago

And genetic test to look for collagenopathy? --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: to do kidney biopsy or not 15 hours ago

Thanks prof glassock. What made you think of lead ? I have not thought of lead so won’t be able to base the questing raised but will explore at nex...

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RE: CD19, ritux, and membranous 15 hours ago

I will give you my opinion. I do not routinely monitor peripheral CD19 +B-cells in patients with MN ( PLA2R+) as the ELISA level of anti-PLA2R anti...

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RE: Painless macroscopic hematuria 16 hours ago

Dr. Hirsch - thanks for the comment. The Urologist I worked with for many years routinely made an effort during Cystoscopy for gross hematuria to c...

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RE: Treatment /Management of MN 16 hours ago

Tacrolimus + steroid would not even make it to a third choice for this patient., in my opinion. I am not the person to ask about Tacrolimus dosing ...

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RE: Treatment /Management of MN 16 hours ago

I think most of us would treat this patient with an anti CD 20 agent, Rituximab or Obi. I think the risk of infection with an anti CD 20 agent is...

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RE: Treatment /Management of MN 16 hours ago

Thanks prof glassock Agree about efficacy of ritux obi vs Cni My colleague was worried about impact of infection on 86 year old patient given ritu...

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RE: to do kidney biopsy or not 16 hours ago

I would do genetic studies but not a kidney biopsy .Any possibility of Lead exposure. I might do a serum lead concentration . Are his gums normal. ...

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RE: Treatment /Management of MN 16 hours ago

PLA2R + MN with a low eGFR. A CNI + steroids woukd not be be m y choice. CNI therapy is inferior to RTX or OBI. The patient is not a good candidate...

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RE: Challenging FSGS/MCD Case 17 hours ago

I think this story is quite consistent with a lesion of a primary diffuse Podocytopathy , possibly due to anti-podoctye auto-antibodies . There may...

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RE: to do kidney biopsy or not 17 hours ago

i also note gout uric acid 513 in 2018 and kf relatively preseved then no baseline urine acr could this be gout and hypetensive nephropathy ...

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to do kidney biopsy or not 17 hours ago

74 m Diagnosis: CKD with the proteinuria - ? cause ( referred to clinic because of that) Hypothyroidism Gout Hypertension Seen in new patient c...

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Treatment /Management of MN 17 hours ago

86 M BG Osteoarthritis of shoulder joint - now has a right shoulder replacement  Previous amputated finger because of Dupuytren's contracture ...

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RE: Challenging FSGS/MCD Case 18 hours ago

Thanks for the response, Dr. Rodby! Albumin has been consistently in the high 1s-low 2s. We just got his labs back today. Interestingly Cr is 1...

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RE: Painless macroscopic hematuria 18 hours ago

Also need to exclude hypercalciuria which has been associated with microscopic and gross hematuria. Any family history of nephrolithiasis? ------...

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RE: Painless macroscopic hematuria 18 hours ago

I recently had a patient just like this, mine had normal electrophoresis and normal genetic screening and a normal CT angiogram/urogram. During all...

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CD19, ritux, and membranous 19 hours ago

If I remember correctly, the original studies of Rituximab in membranous did not measure CD19 levels. Yet, in discussions here, that is sometimes r...

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RE: Challenging FSGS/MCD Case 21 hours ago

wow what a story were his AKIs associated with profound hypo-albuminemia? what is his creatinine now, I'd be a bit worried about using a CNI...

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RE: NEPHROCALCINOSIS 21 hours ago

A great point again. Will need to keep in mind few points First: as you know the hyperoxalurias are a heterogeneous group of disorders that are var...

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Challenging FSGS/MCD Case 21 hours ago

Hello Everyone, I have a 22-year-old male patient that I met in early May in the hospital after he presented with volume overload. He has a histo...

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RE: NEPHROCALCINOSIS 22 hours ago

Dr. Al Masri- How do you fit a normal urinary oxalate excretion rate into your high suspicion of Primary Oxalosis in this patient.? -----------...

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RE: Painless macroscopic hematuria 22 hours ago

I agree with Drs. Rodby and Lerman . Persistent macroscopic (normomorphic ) hematuria without albuminuria would be highly unusual in an African Ame...

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RE: Painless macroscopic hematuria 22 hours ago

Agree with Dr. Rodby sickle cell trait is the first thing to rule out with the hemoglobin electrophoresis. If that is negative then genetic studies...

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RE: NEPHROCALCINOSIS 23 hours ago

Your comment makes a lot of sense. However in Middle Eastern communities it is not uncommon to encounter kindreds with multigeneration consanguinit...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 23 hours ago

"Anthony, Roger: Here is the paper that Roger tried to get. Coincidentally, it is from his institution! The authors made some very interesting obse...

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RE: Painless macroscopic hematuria 23 hours ago

i would not assume he doesnt have sickle cell trait and would rule that out first ------------------------------ Roger Rodby MD, FASN Professo...

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RE: NEPHROCALCINOSIS 1 day ago

primary Hyperoxaluria 1-2 are all autosomal recessive so I dont see how this father and 2 uncles with ESRD could fit into this, (besides teh normal...

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Painless macroscopic hematuria 1 day ago

I would appreciate the community's advice in this 28 yr old healthy African American male was referred to me for evaluation of painless macroscopic...

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RE: interpretation of renal transplant ultrasound 1 day ago

DR. Soobadar thanks for the 2 biopsy reports-nothing to suggest TG or acute rejection IMO though the most recent sample is small. if no fever or ot...

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RE: NEPHROCALCINOSIS 1 day ago

Does ormal urinary oxalate excretion in this case dissuade you from diagnosing Primary Oxalosis? Genetic studies are definitely indicated. -----...

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RE: NEPHROCALCINOSIS 1 day ago

A bit atypical case. This is primary hyperoxaluria until proven otherwise. This would be THE FIRST entity I would work hard to exclude; there is po...

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