RE: TMA Case 1 hour ago

Tough decision. It is a judgement call. The patient needs to be informed of tge risk of fatal niningiciccal Dusease in the absence of immunization ...

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RE: Hypertonic and Hypotonic Hyponatremia 3 hours ago

So this patient was started on dialysis , with a Pna of 118 and Serum osmolarity 300 Osmolar gap of 46 attributed to Mannitol She was dialysed aga...

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RE: TMA Case 6 hours ago

Thank you Dr Glassock. I did not make much of the slight MGUS with a relatively normal light chain ratio. I also though I might see an immunologic ...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 7 hours ago

Any possibility of getting sample drug "free:. The key word sf "FREE," Of course you assume all of the responsibility for the patient. On 3 attempt...

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RE: TMA Case 7 hours ago

With severe Renal limited TMA at this age with a monoclonal protein identified, would strongly suspect a MGRS presenting as a TMA. Eluluzumzb plus ...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 9 hours ago

Compassionate use is an interesting concept . We don't allow it in Abudhabi, because once the drug is approved by the FDA , we are then obliged to ...

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RE: TMA Case 13 hours ago

I should also mention, no hx of problematic htn. No features of clinical scleraderma. ------------------------------ Shaun Joshi MD North Idaho N...

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TMA Case 13 hours ago

Dear colleagues, this is the first time I am posting on the ASN blog. Greetings from North Idaho! I recently picked up the nephrology service from ...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 13 hours ago

I used to be involved with pharamcoecnomic studies with captopril and Irbesartan after those studies came out so I am a bit familiar with what is c...

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RE: Hypertonic and Hypotonic Hyponatremia 14 hours ago

" In light of her worsening renal failure , persistent Osmolar gap, I think it may be best to dialyse her , remove mannitol and allow kidneys to re...

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RE: Hypertonic and Hypotonic Hyponatremia 14 hours ago

With this UNa would be hard to call it SIADH. this seems to be hypovolemic hypoNa Would require also repeat AM cortisol and Cosytropin stim tes...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 18 hours ago

UpToDate suggests that patients receiving > 20mg daily who are HBs- and HBc+ are at risk for reactivation of HBV reactivation (including flooding s...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 18 hours ago

O see the problem Novartis in it's (non) wisdom has priced Iptacopan for IgA at the same price as PNH indication. Who is sponsoring the ongoing Ipt...

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RE: Concomitant use of Patiromer and Sod. Zirconium 19 hours ago

Agree, there are many ways to diurese him. But with severe hypoalbuminemia and thereby low oncotic pressure how can we redistribute more of his int...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 19 hours ago

Recommendations vary for kidney tranplant recipients who are HBVsAg-/cAb+ve. Uptodate recommends anti-viral prophylaxis but not duration, EASL guid...

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RE: Lupus nephritis 21 hours ago

Which one of the "Chinese Menu" if choices do you plan to use for initial therapy of this patient? ------------------------------ Richard Glassoc...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 21 hours ago

Understood- common use, not supported by data- largely based on inferences from diabetic studies. Not included as recommended therapy by UpToDate, ...

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RE: Coronary angiogram in AKI 21 hours ago

IMO, the most important practical points of the "Special Report" is that the risk of CI-AKI with IV contrast for eGFR> 30 is 0-2%, ie, nil, and, as...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

Iptacopan , has been used for PNH , and being a very rare disease has been priced at an astronomical amount . Novartis in it's (non) wisdom has pri...

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RE: Lupus nephritis 1 day ago

Would you use Trimethoprim prophylaxis with antiCD 20 agents or only with steroids --------------------------------- Dr. Hormaz Dastoor. MD, FASN...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

In absence of ET1a , we use MRA's with RASi and SGLT2i, to reduce proteinuria . Is this EBM , probably not .. but as once said , Absence of Evidenc...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

I beleive that HDV reactivation can occur with post-transplant immunosuppression. Where dud you obtain informationbsupporting your conjecture that ...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

In cases like this the following always worked (in my hands): 3x 250 mg furosemide 50 mg chlortalidone or 40 mg xipamide (all as tablets; may...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

I believe with HepB core positive prophylaxis needed only when giving Rituximab Even not long term in Tx pt unless Liver Tx Please kindly correct ...

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RE: Coronary angiogram in AKI 1 day ago

Sure Prof.,my concern related to its practical predictive utility before giving contrast, Regards ------------------------------ Ahmed Yasin, M...

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RE: Coronary angiogram in AKI 1 day ago

The Mehran Score has utility in predicting risk of developing "CI-AKi" after Coronary angiography and PCI- in my opinion , it has no proven role in...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

I am curious why you would add an MRA. The patient is non-diabetic. Maybe a GLP1RA would be better to counteract the Obesity. I do not disagree wit...

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RE: Coronary angiogram in AKI 1 day ago

What do you think regarding applicability of Mehran 2 score in that context? ------------------------------ Ahmed Yasin, MD,FASN Al Ahmady,Hospit...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

1. Steroid based regimen and MMF if concomitant hematuria 2. I would add MRA , but doubt will be effective , if Sparsentan and SGLT2i were ineffect...

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RE: Suspected Infection Related MPGN 1 day ago

Many things influence the exertion of protein in urine. My interest in this area dates back 40 years. J. W. Swanson,A. Besarab,P. P. Pomerantz, an...

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RE: Suspected Infection Related MPGN 1 day ago

Since genetic mutations are coon in the normal population , I usually do not order them given their cost and their utility in diagnosis. However if...

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RE: Suspected Infection Related MPGN 1 day ago

pre AKi alb levels before both episodes ~ 2.2 , after albumin administration 2.7--3.6 in the hospital. Agree with your point about the denominator ...

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RE: Suspected Infection Related MPGN 1 day ago

For the female pt with recurrent uti- c3 level during infection episodes 50-60. inbetween- wnl C4 levels have been wnl through out Hep C ab...

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RE: Suspected Infection Related MPGN 1 day ago

Dr. Paramasivam: Your cirrhotic patient has had 2 episodes of AKI-on-CKD. After the first episode, SCr improved to 1.7 mg. During the current episo...

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RE: Suspected Infection Related MPGN 1 day ago

The female patient with MPGN and IgG/IgM codominant glomerular deposition and high RF probably has a Type II CryoIg . Please do a HCV quantitative ...

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RE: Lupus nephritis 1 day ago

Thank you Dr. Dastoor. She is going to receive PJP prophylaxis. ------------------------------ Amit Joshi MD, FASN Cook County Health Chicago...

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RE: Lupus nephritis 1 day ago

Thank you Dr. Rodby. She was taking Azathioprine 150 mg daily. Serum albumin 3.4 g/dL. Persistently high ANA, dsDNA, C3<50, C4 8 (both very l...

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RE: Suspected Infection Related MPGN 1 day ago

yes the cirrhotic patient was receiving however the female patient with recurrent uti was not on albumin ------------------------------ Vijay...

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RE: Lupus nephritis 1 day ago

Her renal function is preserved with serum creatinine 0.7. Proteinuria about 2.5 g/g. No TMA on biopsy. Attached deidentified report. -------...

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RE: Suspected Infection Related MPGN 1 day ago

Was the patient receiving any IV albumin infusions shortly before or during the urine collection for proteinuria,? If so, this explains the very hi...

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RE: Suspected Infection Related MPGN 1 day ago

edited, yes 30gm/ gm this is the female patients biopsy- serological wu and hepatitis panel negative- except for elevated RF 40 - no cryo, ...

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RE: Suspected Infection Related MPGN 1 day ago

Considering Alternative complement pathway activation- do you see a role for complement inhibtors - esp iptacopan with its use in c3gn and igan. Ar...

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RE: Suspected Infection Related MPGN 1 day ago

I have already ordered aHUS complement panel - tests for alternative pathway complements( cincinnatti children's)- CFH, CFI, CFH auto ab, Factor B,...

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RE: Suspected Infection Related MPGN 1 day ago

thank you, he is not a candidate now. due to recent etoh use. ------------------------------ Vijayakumar Paramasivam MD LONGMEADOW MA (484) 362-...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

Thanks prof glassock. really insightful and educational . Kind regards --------------------------------- Muhammad Soobadar MBChB UK ----------...

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RE: Suspected Infection Related MPGN 1 day ago

You mean 30 gram/gm - not 30 gram/mg, I assume. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ---------...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

Of course,you can use TRF-Budesonide- but this therapy is no more or less efficacious (no direct comparisons available ) than moderate doses of ora...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

Thanks for post . @prof glassock can we not use enteric budesonide ? What is relevance of c3 staining ? And use of mmf and steroid is that to u...

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RE: Suspected Infection Related MPGN 1 day ago

This was rechecked . I have another patient with infection related MPGN - this is a female with documented Recurrent uti's with steady worsening of...

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RE: Suspected ANCA vasculitis ( Should I biopsy her? ) 1 day ago

I think that Amiodarone exposure greatly increases the likelihood that this is an ANCA Vasculitis. I would be happy with empiric RTX therapy, if a ...

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