RE: IgAN with nephrotic syndrome 10 hours ago

Very interested in your experience with treatment in IgAN. I have yet to see any treatment failure of Iptacopan in patients who have hematuria and ...

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RE: Can severe hyperglycemia cause osmotic nephropathy 10 hours ago

@Richard Glassock I stand corrected. As per my AI consultant: " as of 2025 in the United States, the most common laboratory method (70%) used in ...

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RE: Can severe hyperglycemia cause osmotic nephropathy 14 hours ago

My AI consultant says that the Jaffe reaction is still used by a majority of commercial comprehensive serum biochemistry platforms, but the enzymat...

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RE: Can severe hyperglycemia cause osmotic nephropathy 16 hours ago

@John Schwartz Thank you John for sharing this piece of interesting/fascinating history. ------------------------------ Mario Rubin, M.D. Ho...

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RE: Can severe hyperglycemia cause osmotic nephropathy 16 hours ago

@Edwin Anand To my knowledge colorimetric creatinine assay methods (The Jaffe reaction) are no longer used by most clinical laboratories. Enzymat...

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RE: Can severe hyperglycemia cause osmotic nephropathy 17 hours ago

Just for fun. When was the effect of ketoacids on creatinine measurement first described? It was a lot longer ago than you might imagine. Graham in...

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RE: Can severe hyperglycemia cause osmotic nephropathy 17 hours ago

I suspect that the "AKI" in this case can be attributed to spurious hypercrearininemia ( from hyperglycemia and ketonemia) ) and some degree of vol...

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RE: SGLT2i In Pure Tubulointerstitial Kidney Diseases 19 hours ago

This has always been the million dollar question, and it applies to RAASi as well. Renoprotection from RAAsi correlates so strongly to glomeru...

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RE: Can severe hyperglycemia cause osmotic nephropathy 19 hours ago

Even the worst case of uncontrolled diabetes does not give the glycosuria degree seen with SGLT2i (>1000 on UA when I see it it is "always" SGLT2i)...

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RE: Can severe hyperglycemia cause osmotic nephropathy 1 day ago

Thanks- Could the same type of interference cause a spurious increase in serum creatinine levels. Do you have access to an enzymatic assay for Scr ...

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RE: Can severe hyperglycemia cause osmotic nephropathy 1 day ago

Urine Na was 40. Sorry for the typo Dr. Glassock, Urine creat was indeed 751 mg/dl. As you suggest, high glucose or ketones were likely causing i...

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

Thank you for the follow up. As Dr. Balan stated: " I think this case highlights the importance of looking for an abnormal genetic variant in the p...

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

Follow up on this case Donor denies any family history of Gout, MODY, hypomagnesemia, hyperuricemia or GU malformations. The Mother genetic te...

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RE: Can severe hyperglycemia cause osmotic nephropathy 1 day ago

See attached ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------ Files Attached Docu...

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RE: Can severe hyperglycemia cause osmotic nephropathy 1 day ago

Dr. Anand. You triggered my curiosity as I was not aware of this phenomenon. I have attached my query to ChatGPT (very useful information i must sa...

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RE: Can severe hyperglycemia cause osmotic nephropathy 1 day ago

Urine creatinine "751" ? What are the units. With excessive glucose and ketones in urine (and serum) a colorimetric assay (Jaffe) for creatinine ca...

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RE: Can severe hyperglycemia cause osmotic nephropathy 1 day ago

YES. Look at table 1 of the attached article. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ----------------...

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Can severe hyperglycemia cause osmotic nephropathy 1 day ago

A 36 yr old male with no past medical history presented with lethargy and other non specific symptoms. Was found to be in DKA, blood glucose 2092, ...

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RE: SGLT2i In Pure Tubulointerstitial Kidney Diseases 1 day ago

I agree- The existing "evidence" ,such as it is, does not support a beneficial effect of SGLT2i on the trajectory of eGFR decline in chronic tubu...

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RE: SGLT2i In Pure Tubulointerstitial Kidney Diseases 1 day ago

Although SGLT2i have anti inflammatory and anti fibrotic effects that could theoretically help tubulointerstitial injury, there is no high quality ...

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RE: Hypokalemia , what is happening! 1 day ago

Because in the kidney stone world almost everyone gets a 24 hr urine, I do not deal with this issue often, so I do not have a "favorite" equation. ...

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RE: DKA with severe Hypernatremia 1 day ago

Earlier in my career when we used to actually hand write orders I would frequently use alternating solutions of varying tonicity. Rare to see a cas...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

Risk of reactivation of CMV due to Belatacept in older transplant patients with poor graft function is underestimated and not widely mentioned. ...

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SGLT2i In Pure Tubulointerstitial Kidney Diseases 1 day ago

Today we present a case of Karyomegalic interstitial nephritis in our weekly zoom meeting of Iraqi Society of Nephrology and Transplantation and th...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

I think your explanation of CG in a kidney transplant with 2 high Reiser APOL1 allekes and a "second hit" of CMV nfection is the mist provably corr...

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RE: DKA with severe Hypernatremia 1 day ago

See Dr. Mellas post above on the limited value of a low urinary Na concentration in a spot urine as indicative of volume depletion in an osmotic di...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

Update on this patient: To recap briefly, starting a few months after deceased donor kidney transplant, slowly increasing SCr and proteinuria devel...

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RE: Hypokalemia , what is happening! 1 day ago

Dr Asplin @John Asplin which equation do you utilize to estimate 24 hour Urine volume and which one is best to use. -----------------------------...

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RE: DKA with severe Hypernatremia 2 days ago

Urine Na of 12 is indicative of severe hypovolemia with appropriate ADH and renin- angiotensin-aldosterone hyperactivation. In this situation assum...

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RE: PLA2R-membranous nephropathy 2 days ago

Thanks prof glassock appreciate your input --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: PLA2R-membranous nephropathy 2 days ago

I agree that electron lucent deposits are indicative of immunologically inactive disease The fundamental goal of therapy of PLA2R induced MN is ...

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RE: PLA2R-membranous nephropathy 2 days ago

Thanks for previous reply prof glassock --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: PLA2R-membranous nephropathy 2 days ago

@ prof glassock any comments about em and deposit characterisation for acute va chronic And also your dosing regime with ritux for maintenance in ...

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RE: Primary membranous nephropathy 2 days ago

With nodular diabetic glomerulosclerosus and persistently negative serum Anti.PLA2R it seems very unlikely that RTX therapy will have any beneficia...

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RE: Primary membranous nephropathy 2 days ago

"That is a very rapid drop in GFR from 54 to [More]

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RE: Primary membranous nephropathy 2 days ago

Thanks for case . I would agree with ruling out RVT , and consideration of rituximab after discussing with patient and ruling out age appropriate s...

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RE: ANCA associated vasculitis 2 days ago

"diseases desperate grown , by desperate appliance are relieved . Or not at all." Shakespeare understood this dilemma very well. Steroids and RTX a...

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RE: ANCA associated vasculitis 2 days ago

Yes I agree , patients with DAH and eGFR less than 15 ml/min were excluded from Avacopan trials . There have been case reports of successful use o...

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RE: ANCA associated vasculitis 3 days ago

Dr.Dastoor- i agree that the benefits of PLEX on DAH in ANCA+ aGBM- disease and this therspy is not routinely recommended . In addition, I know of ...

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RE: ANCA associated vasculitis 3 days ago

@Richard Glassock what are your thoughts on the use of TPE in DAH with hypoxia . Mayo clinic studies have shown no benefit of TPE , and may increas...

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RE: Linear Glom IgG deposit , cANCA and -ve Anti-GBM 3 days ago

SCr doubled between 2023 and 2024, doubled again by 2025, and has increased further over the past year. Lot of chronicity in the biopsy. ATN and AI...

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RE: ANCA associated vasculitis 3 days ago

I think you can resume RTX without Avacopan or CYC. Just an opinion. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (94...

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RE: ANCA associated vasculitis 3 days ago

Thanks for the reply Dr Rodby and Dr Glassock. Yes this is the protocol we were following taken from this paper. He received so far 1 g RTX...

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RE: Linear Glom IgG deposit , cANCA and -ve Anti-GBM 3 days ago

What were the albumin stains by IF.? The + ELISA for anti-PR3 might be false +. No clear indication for CYC or RTX. -----------------------------...

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RE: ANCA associated vasculitis 3 days ago

I agree with Dr. Rodby. I see no reason to use Avacopan here. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-...

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RE: ANCA associated vasculitis 3 days ago

What happened to his Cr thus far, and no more DAH? If he seems to have responded I may not give more CYC. If not, since you are already essenti...

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RE: Pregnant woman with proteinuria 3 days ago

I have posted the correct reference regarding Amyloid P protein staining. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5...

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RE: Pregnant woman with proteinuria 3 days ago

I think you nailed it! You should contact Dr. Larsen at Arkana for amyloid P protein staining of the biopsy ------------------------------ ...

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RE: Pregnant woman with proteinuria 3 days ago

Wondering if this is a case of atypical membranous nephropathy with organized deposits. --------------------------------- Edgard Wehbe MD, FASN ...

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RE: Pregnant woman with proteinuria 3 days ago

13 grams proteinuria is more than what you would expect with pregnancy hyperfilteration. I would a CNI, and taper steroids. ---------------------...

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