RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 46 minutes ago

I fully agree with Drs. Rubin and Rodby. I jumped the gun on this consult. We need help from experts. ------------------------------ Richard Gla...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 hour ago

Dr. Rodby I agree but response to Rtx in MCD can be much faster than other diseases that we treat with Rtx ------------------------------ Emilio ...

View Discussion

RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 hour ago

Too many red flags here IMO, questionable genetics, renal asymmetry, Which kidney do you take anyway? I feel this is one of those donors we wi...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 hour ago

It may take a while for the Rituximab to have its effect, It looks like the patient is still n prednisone taper, that being the case I think you ca...

View Discussion

RE: IgA Nephropathy Dual Immunotherapy 1 hour ago

There are no data on the simultaneous use of sibe and nefecon and i have not combined these in my practice to date. Sibe is not yet available so it...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 2 hours ago

Dr. Liang this is compatible with minimal change disease and is probably going to be a steroid dependent phenotype given the early relapse The ad...

View Discussion

RE: Thymoglobulin Removal By Plasmapheresis 2 hours ago

Yes, like any globulin, ATG (Thymoglobulin) will be removed by PLEX. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -------...

View Discussion

RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 3 hours ago

I agree with Dr. Venkat the CT calculated kidney volume on the right is increased- this needs further evaluation with an MRI. Genetic counseling is...

View Discussion

RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 4 hours ago

Another (unrelated) issue in this donor: "Right kidney volume was 234 cc and left kidney volume 154.5 cc." Given this discrepancy in kidney volum...

View Discussion

RE: Antibiotic Prophylaxis Prior To Dental Procedures 4 hours ago

Posed your question to Google AI and got following response and reference: Top of Form "Yes, antibiotic prophylaxis is often recommended or requi...

View Discussion

Thymoglobulin Removal By Plasmapheresis 4 hours ago

Does post transplant PLEX need to be timed away from IV Thymoglobulin so it's not removed by the procedure?

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 12 hours ago

OK thanks so much for your reply! I hope it does become available next year; it would be a useful test to help guide therapy. -------------------...

View Discussion

RE: recurrent pla2r 13 hours ago

In my experience, the commonest cause of a FP ELISA for anti-PLA2R antibody is T2DM. The levels of "antibody" detected are usually in the low range...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 13 hours ago

There is no commercially available -Anti-Nephrin auto- antibody assay approved by the FDA or the ENA for clinical use. The only assays currently pe...

View Discussion

RE: IgA Nephropathy Dual Immunotherapy 13 hours ago

To my knowledge - there is no convincing evidence that Telitacicept or Ravulizumab , alone or in combination, " resurrect" dormant nephrons. (The L...

View Discussion

RE: IgA Nephropathy Dual Immunotherapy 14 hours ago

I found this chart interesting . Interesting from the perspective that Ravulizumab and Telitacicept actually reversed the decline in eGFR and incre...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 15 hours ago

Thank you so much Dr. Rubin!! ------------------------------ Kelly Liang MD, MS, FASN Kansas City KS (507) 269-7812 ------------------------------

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 15 hours ago

@Astrid Weins i have copied Dr. Weins (at the Renal Pathology Lab at Brigham) who is the right person who can guide you on how to get your patien...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 15 hours ago

Thanks! Do you know if there are any anti-nephrin Ab assays available for ordering? Do you recommend I try to order it to see if his MCD is due to ...

View Discussion

RE: recurrent pla2r 16 hours ago

@Gerard Lambeau I support your decision and have also consulted with a colleague (AI as is now known) for his/her thoughts on the subject (see...

View Discussion

Antibiotic Prophylaxis Prior To Dental Procedures 16 hours ago

We all know AHA guidelines for antibiotic prophylaxis prior to dental procedures for prevention of infective endocarditis. What are the current re...

View Discussion

RE: recurrent pla2r 16 hours ago

As Alice in Wonderland said, "it gets curiouser and curiouser". While in her original presentation, both the Elisa and the IFA were positive, this ...

View Discussion

RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 17 hours ago

@Katafan Achkar This is a very complex situation which requires the input from a geneticist and genetic counselor. I suggest to reach out to them...

View Discussion

RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 17 hours ago

Modifier genes can greatly affect rhe phenotype of patients with Pathigenic (usually non-truncating) PKD1 mutations . This might be such a case. If...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 17 hours ago

Compatible with Primary diffuse Podocytopathy - MCD of FSGS. I think it would be OK to stop the CNI when you give RTX, but I have also continued CN...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 18 hours ago

Here's the biopsy report: LIGHT MICROSCOPY REPORT: Sections of native kidney core biopsy stained by the hematoxylin and eosin, periodic acid-Schi...

View Discussion

Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 19 hours ago

I would appreciate the community input on the following case: 42-year-old white female who presented as a potential kidney donor for her mother wh...

View Discussion

RE: Vitamin K2 In Calciphylaxis 19 hours ago

Please post the reference that originated thus question so we can evaluate it and prepare a response.. ------------------------------ Richard Gl...

View Discussion

RE: macroscopic haematuria in young patient 19 hours ago

How did you come up with PNH in this case? No urinary clots expected with hemoglobinuria. ------------------------------ Richard Glassock MD, F...

View Discussion

RE: macroscopic haematuria in young patient 19 hours ago

Finding red cell casts would bias towards renal vs. non renal origin They can be occasionally happen in tubuloinsterstitial diseases but of course ...

View Discussion

RE: Vitamin K2 In Calciphylaxis 19 hours ago

@prof glassock/any colleagues would appreciate please on this question ? --------------------------------- Muhammad Soobadar MBChB UK ----------...

View Discussion

RE: macroscopic haematuria in young patient 20 hours ago

Then we can think more in paroxysmal nocturnal haemogloubinuria as main features is hematuria plus blood clots or may be renal vein thrombosi...

View Discussion

RE: macroscopic haematuria in young patient 21 hours ago

Not Alport Syndrome if the clots in the urine and L flank pain are real. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA...

View Discussion

RE: IgA Nephropathy Dual Immunotherapy 21 hours ago

Since KDIGO IgAN 2025 contains no information on Iptacopan, Atrasentan or Sibeprenlimab (all approved by the FDA in the USA) it must be considered ...

View Discussion

RE: macroscopic haematuria in young patient 21 hours ago

May be Alport syndrome --------------------------------- Hasan Abdelkader MBChB King Fahad hospital hofuf ---------------------------------

View Discussion

RE: macroscopic haematuria in young patient 21 hours ago

@prof rodby as community we need to be better at posting follow up It will be good to see a “ teased “ prof today output Many thanks everyone ...

View Discussion

RE: IgA Nephropathy Dual Immunotherapy 21 hours ago

Quote of the year: “The KDIGO 2025 guidelines for IgA are obsolete” @Richard Glassock Also from @Brad Rovin “MEST Score is not very useful” ----...

View Discussion

RE: LUPUS WITH ANCA 21 hours ago

Anti-MPO ANCA can be false + in SLE. In light of the pathology in this case, I think the Anti- PR3 is a true positive and the patient has 3 disease...

View Discussion

RE: IgA Nephropathy Dual Immunotherapy 21 hours ago

I would not recommend use of simultaneous or sequential use of Sibe and Nefecon. In my opinion, this patient needs therapy with oral systemic stero...

View Discussion

IgA Nephropathy Dual Immunotherapy 22 hours ago

Does anyone have experience with simultaneous initiation of vs sequential budesonide (Tarpeyo) and sibeprenlimab (Voyxact)? Patient with IgA nephro...

View Discussion

RE: macroscopic haematuria in young patient 22 hours ago

We have been fortunate to see 2 patients with flank pain, hematuria and nutcracker syndrome Constitutionally , these patients need to be skinny ...

View Discussion

RE: LUPUS WITH ANCA 22 hours ago

Approximately 15-20% of LN patients are ANCA positive (even in tha absence of drug-induced lupus). Eighty % of these patients are MPO +ve and only ...

View Discussion

RE: macroscopic haematuria in young patient 1 day ago

A narrowing or tortuous appearance at the UPJ on CT urogram can be considered normal or simply reflect ureteral peristalsis, especially if contrast...

View Discussion

RE: LUPUS WITH ANCA 1 day ago

@Richard Glassock@K.K. Venkat thank you. What do you make of the high positive PR3 Anca . The IF in all glomeruli , shows full house pattern of sta...

View Discussion

RE: Idiopathic fsgs csa dep 1 day ago

Thx for the feedback and suggestions- super helpful as the patient and I sort out best next steps His last flare was 15 months ago and not sure i...

View Discussion

RE: Idiopathic fsgs csa dep 1 day ago

Hi, in children we were able to discontinue CSA after maintaining remission for at least 2 years. I taper CSA over a period of 12-24 months an...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

I would use the 1gm X2 AA two week interval initially. What did the IF on the Kidney Biopsy show.. Any IgG "dusting".? --------------------------...

View Discussion

RE: LUPUS WITH ANCA 1 day ago

Challenging case of Class IV LN with superimposed ANCA + Vasculitis and a thrombophilia related To a Lupus anticoagulant . Three diseases in one pa...

View Discussion

RE: LUPUS WITH ANCA 1 day ago

Given diffuse/granular capillary wall IMF pattern may have significant class-V lupus (membranous) component in addition to class-IV explaining heav...

View Discussion

RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

? lupus podocytopathy. Agree with rituximab. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ------------------------------

View Discussion