RE: IgA Kappa PGMID and EGPA 14 hours ago

I applaud your present approach, but agree with Dr Glassock IgA LC restriction is usually lambda and typically does not represent a MGRS when pre...

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RE: IgA Kappa PGMID and EGPA 17 hours ago

Troubling case. IgA kappa PGNMID is very rare-most cases are IgA lambda . Can you stain the biopsy for gdIgA with KN55.? Can you look for IgA1 vs I...

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IgA Kappa PGMID and EGPA 19 hours ago

I have a patient with RPGN for whom trying to establish a unifying diagnosis and best treatment plan is proving challenging: 39-year-old Algerian w...

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RE: Diffuse proliferative GN 1 day ago

I agree that if the aortic regurgitation is of new onset this fact makes endocarditis a distinct possibility despite negative BC and a negative TTE...

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RE: Diffuse proliferative GN 2 days ago

Do we know aortic regurgitation is new any previous Echo How high was the rheumatoid factor because Rheumatoid factor can be positive at this age i...

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RE: Diffuse proliferative GN 2 days ago

I would still hold Endocarditis high in the DD. Other opinions welcome. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA ...

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RE: Diffuse proliferative GN 2 days ago

Update on the patients. Blood cultures, Borrelia, Bartonella and Q fever are all negative. RF is positive. Cryoglobulins are negative. They d...

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RE: Hypercalcemia in a patient with SLE/MCTD 3 days ago

Dr. Venkat. Both bisphosphonates and Calcitonin are effective in treating hypercalcemia due to Vitamin D intoxication so the benefits observed in t...

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RE: Hypercalcemia in a patient with SLE/MCTD 3 days ago

Dr Venkat, I agree. I think we will never know the exact mechanism but the case does teach us what e do not know. . ----------------------------...

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RE: Hypercalcemia in a patient with SLE/MCTD 3 days ago

When she was hospitalized with serum calcium of 13.7 mg/dL, treatment with IV calcitonin and zoledronic acid decreased serum calcium to 7.1 mg to 7...

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RE: Hypercalcemia in a patient with SLE/MCTD Friday, July 4 @ 4:27 AM

I suppose that given the circumstances and the absence of a 25 -OH Vitamin D level at the time of hypercalcemia that we cannot fully exclude the po...

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RE: Hypercalcemia in a patient with SLE/MCTD Thursday, July 3 @ 8:39 PM

Agree, a fascinating chronologic story. "Increased bone resorption due to inflammatory cytokines and/or SLE-associated Increased bone resorption du...

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RE: Hypercalcemia in a patient with SLE/MCTD Thursday, July 3 @ 7:00 PM

Fascinating, very educational experience. That fir posting the follow -up. Agree that exogenous Vitamin D intoxication seems very unlikely -----...

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RE: Hypercalcemia in a patient with SLE/MCTD Thursday, July 3 @ 6:17 PM

Update on this patient To recapitulate, this 40-year-old female with SLE/MCTD had presented with the following features: 1. Severe hypoalbuminemia ...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 4:26 PM

Thank you. I don't really have much of an option. Nothing to lose by doing the genetic studies. I had discussed this with the patient after the pla...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 4:19 PM

Thanks. The initial proteinuria is a bit out of the range typically seen with genetic FSGS and the "partial response" to steroids and CNI is seen i...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 3:41 PM

Thank you That is correct. Patient was clinically very nephrotic with significant edema, low albumin and proteinuria of more than 10g/day at the ...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Thursday, July 3 @ 11:55 AM

Possible that if you post the genotype @John Lieske can tell you based on Mayo Clinic database if it is B6 responsive. Since you won't be able to d...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Thursday, July 3 @ 11:01 AM

Unfortunately, since you're a patient who died six months after simultaneous LK transplant Apparently did not receive intensive perioperative dialy...

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RE: Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 8:19 AM

If my reading of the thread is correct, the patients has demonstrated resistance to therapy with High disease of steroids , CNI and one course of R...

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Original MCD . Repeat biopsy June 2025 Thursday, July 3 @ 7:25 AM

Good evening I re biopsied the patient whose case I presented in May. I have attched the original thread below and the biopsy report from the 2n...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Thursday, July 3 @ 3:23 AM

"What treatment for recurrent PH did your patient with SLKT receive who did not survive?" intensified HDF dialysis 10 days before transplant + B6...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Wednesday, July 2 @ 7:34 PM

Please let us know the management plan you intend to pursue for this patient. Many thanks. ------------------------------ Richard Glassock MD, F...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Wednesday, July 2 @ 9:09 AM

One should also note that Alnylam has a compassionate use program for lumasiran that you can apply for. We have just received access to lumasiran f...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 8:08 PM

"How will detection of a pyridoxine sensitive mutation alter the planned sequence of LT and KT.?" It would not IMO but in the absence of Lumisari...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 8:02 PM

What treatment for recurrent PH did your patient with SLKT receive who did not survive? ------------------------------ [Mark] [Lerman] [MD,FASN,F...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 4:11 PM

In this setting pronase IF may be helpful in evaluating the hyaline pseudothrombi deposits which were seen by LM but did not appear to be captured ...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 3:18 PM

I resonate with Dr. Venkat's analysis, but organized deposits are not typically seen in Type III cryoimmunoglobulinemia. I still would do Pronase d...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 3:13 PM

What a great discussion of a very formidable and challenging management issue, complicated greatly by the un-Availability of Lumisarin. I sense agr...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 2:16 PM

I am going to be hyperbolic (I dont think that is the right expression but you get the idea) here: Whatever you do do it soon, This is what hap...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 11:19 AM

CLKT vs kidney tx results in better kidney graft survival but similar patient survival in B6 unresponsive PH Was that B6 responsive PH for which...

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RE: Question about HDF convection volume target Tuesday, July 1 @ 11:02 AM

When you ultrafilter 23L /BSA , how accurately can yoy achve the remova;of theinterdialytic fluid accumilated which can cary form 1 to 4?:. This ma...

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RE: Question about HDF convection volume target Tuesday, July 1 @ 10:01 AM

We are implementing a convection volume target of 23 liters per 1.73 BSA in our unit but we are not sure of the best target to monitor. In the best...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 9:32 AM

Is your patients genotype B6 responsive? CLKT vs kidney tx results in better kidney graft survival but similar patient survival in B6 unresponsiv...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 9:30 AM

IgG and IgM3+ with negative IgA on immunofluorescence certainly suggests possibility of cryoglobulinemia , type III (given lack of monoclonality by...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 9:23 AM

I don't have any personal experience in this area. Rapid access to and prompt availability of oxalate blood level results will be critical since ne...

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RE: ? Cryoglobulinemic GN Tuesday, July 1 @ 9:21 AM

Thanks Dr Glassock and Dr Rodby. HCV Ab and syphilis screening was negative. ANA was 0 by CMIA and neg by IFA. Our lab does not run ENA profile i...

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RE: Question about HDF convection volume target Tuesday, July 1 @ 9:01 AM

I believe in individualization, However, calculation of BSA as our normalization factor for persons of different weight and height but same gender ...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 8:40 AM

Sequential liver followed by kidney transplant would be the better option for him at this age. One of the advantages is that the same donor (if wil...

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RE: Microscopic hematuria Tuesday, July 1 @ 8:30 AM

Was the urine microscopic organisms examination done with automated devise or manually as automated devise may miss dysmorphic or lysed RBCs -----...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 8:15 AM

Contrary to DDT, kidney and liver grafts will be obtained from different donors in LDT. So it seems appropriate to do liver transplantation followe...

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Question about HDF convection volume target Tuesday, July 1 @ 6:10 AM

We are implementing a convection volume target of 23 liters per 1.73 BSA in our unit but we are not sure of the best target to monitor. In the best...

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RE: Microscopic hematuria Tuesday, July 1 @ 2:21 AM

I think we must proceed ;in addition to follow up, for other tests like Ca/Cr ratio, urine c/s ,Hb electrophoresis, coagulation studies in additi...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Tuesday, July 1 @ 1:22 AM

unfortunately, We Don't have access to Lumisarin ------------------------------ Ahmed Emara MD, FASN Ain shams university, cairo Cairo ---------...

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RE: Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Monday, June 30 @ 11:13 PM

I do not have an answer to this question, but it may be an important one. In an era of Lumisarin and Pyridoxine therapy for Primary Type1 Hyperoxal...

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RE: minimal change disease steroid dependent Monday, June 30 @ 8:20 PM

thank you , will ask pathologist to relook again. ------------------------------ Shivangi Patel Nephrology Morristown NJ ---------------------...

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RE: minimal change disease steroid dependent Monday, June 30 @ 7:23 PM

We can also see "dusting" of IgG on podocyte cytoplasm with conventional IF in many cases suggestive of an anti-podocyte antibody (nephrin or other...

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Request for Expert Opinion on SLKT in a Case of Primary Hyperoxaluria Monday, June 30 @ 4:54 PM

I would greatly appreciate your opinion on a complex case we are currently managing. We have a 22-year-old male diagnosed with end-stage kidney dis...

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RE: Microscopic hematuria Monday, June 30 @ 4:05 PM

The pediatricians who cared for the patient til the age of 18 probably never considered genetic testing since the family history was negative. Pers...

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RE: Microscopic hematuria Monday, June 30 @ 2:58 PM

We have no indication of hereditary disease, both parents and a sibling have been examined. Means there urine I believe But believe no genetic tes...

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