RE: Post infective crescentic GN 2 hours ago

Candida pneumonia is uncommon in immunocompetent patients. Since patient had been on other antibiotics, could have had oropharyngeal candidiasis an...

View Discussion

RE: Post infective crescentic GN 2 hours ago

The evidence forc a favorable effect of immunosuppression in cases like this is very weak and inconsistent . I would likely chose further treatment...

View Discussion

One Week Left - Nephrology Quiz and Questionnaire 6 hours ago

There is only one week left to help contribute to the Nephrology Quiz and Questionnaire session at Kidney Week 2025. Please complete this 15-questi...

View Discussion

One Week Left - Nephrology Quiz and Questionnaire 6 hours ago

There is only one week left to help contribute to the Nephrology Quiz and Questionnaire session at Kidney Week 2025. Please complete this 15-questi...

View Discussion

RE: Post infective crescentic GN 6 hours ago

Seems like u have a case of Infection Related GN (IRGN) with , lack of IgG suggesting activation of alternate Complement pathway. As she has severe...

View Discussion

RE: Post infective crescentic GN 7 hours ago

Just to add the Immunoflouriscent study revealed predominenet C3 deposits. EM result is pending ------------------------------ Wael Jebur MD ...

View Discussion

Post infective crescentic GN 7 hours ago

52 year old lady presented to emergency department with fever and chills for few days with abdominal pain. Examination was unremarkable. Invest...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 9 hours ago

Whistleblower says U.S. organ transplants corrupted by greed and bias This is so disappointing. Mt personal e mail is besaraba1943@outlook.com ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 10 hours ago

The discussion we are having is likely to become Tagged as inappropriate for the Forun, so I am writing to you from my personal e-mail. I am of U...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 12 hours ago

One of the real troubling things that is happening in the Kurdish region has nothing to do with medicine or wars. The public education system is cr...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 12 hours ago

As you so state, part of the problem is the "billing" department which has a temper temprum when they cannot get the bill out in a week and throws ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 12 hours ago

Thank you for your reply. Every nation needs to determine how much and to whom it must provide health care and how to provide the necessary funding...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 16 hours ago

Dr. Weins I'll reply to a couple of comments that may be of general interest. I'll get in touch with you through email outside of the forum. I...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 17 hours ago

The stain is an H&E. We are well experienced with Fabrys. I find the H&E just as good as special stains for identifying podocyte swelling and Zebra...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 19 hours ago

Dr Basarab I,ve been in Kurdistan of Iraq 18 years since retiring in the States. In the last 10 years, the inequities in healthcare have increase...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 23 hours ago

Since kidney function has improved in association with steroid therapy, it may be best to wait and see if proteinuria resolves completely and GFR n...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

The tubular casts are strange looking in the photomicrographs. The single glomerulus has a few intercapillary zones that look expanded and Foamy. C...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

How do you keep costs down? In the statws anyone on Medicare and a supplemental [p;icy is not surprised between charges and the actual pauments mad...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

Just wanted to chime in here. Renal Pathologist from Boston. I work on podocytopathies and anti-nephrin as well. In light of everything you say, ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

At a cost of $900 we can forget that such a test as EM exists. In India we have a few centres(private labs) that do EM at a cost of ₹7000 or around...

View Discussion

RE: Kidney transplantation in a patient with monoclonal C3G 1 day ago

Just an opinion, but I think the risk of recurrent Disease in a kidney transplant is too high since his monoclonal C3G is not in full remission. In...

View Discussion

RE: Kidney transplantation in a patient with monoclonal C3G 1 day ago

thanks Current C3 level is slightly low at 0.6 g/L (n.v. 0.9-1.8) @Richard Glassock@Nelson Leung ------------------------------ Emilio Ventur...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

Retrieving EM from a paraffin block will be all right for deposits. The visceral epithelial cells do not retrieve very well, the cytoplasm deterior...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

I don't think that a rebiopsy is going to help very much . The diffuse podocytopathy of MCD can disappear fairly quickly after steroid therapy . Do...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Dr. Glassock, yes she has edema and hyperlipidemia (LDL 350 mg/dl and TC 450 mg/dl), the biopsy was done right after 3 pulse steroid therapy. Dr. ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Dr. Hughson thanks I was aware of the use of paraffin embedded tissue for EM as a "rescue" technique to look for electron dense deposits. Can it...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

MCD is now suspect. Was any edema or hyperlipidemia found at presentation? The UPCR and UACR may be wrong due to AKI. Was the biopsy done after or ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Dr Hyder We will need a new biopsy for EM. One core in formalin is fine. There was no "dusting" on the glomeruli. There was no podocytopathy b...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Dr Hyder We can do the EM, if there are enough glomeruli in the block. It will take about a week. I'll talk to Dr Alaa tomorrow. It is not done r...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

I published a study on proteinuria occurring in transplanted kidneys. Seeing that even LR kidneys had proteinuria , I wondered whether proteinuria ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Thanks all for your insightful comments. We have the opportunity to have access to do ELISA anti-nephrin antibodies and I agree it is still not st...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Also If standard US was done I would perform a Doppler US to rule out renal vein thrombosis. ------------------------------ Emilio Venturelli MD...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

I have an average of 6 dogs, and whenever they have a terminal illness , I prefer to euthanize them. Having said that I am amazed by the advances i...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

If you were to proceed to treat this as a lupus case, you can try MMF again or if there is GI introlerance try mycophenolic acid. Apparently MPA ha...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 days ago

Dr. Aledan, please clarify: 1. Was BP markedly elevated (SS-A/SS-B positive)? 2. Type of "pathological casts" in urine (mentioned under history in ...

View Discussion

RE: Lupus Case 3 days ago

I never use UACR in LN. After a Euro -Lupus CYC regimen, with a rapid PEXIVAS styled steroid taper, I would maintain on MMF (or RTX if ANCA +.). Ju...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 3 days ago

How is anti-Nephrin antibody "pending"? We do not have an FDA approved assay in the USA. Research assays cannot be used for patient care. I suspect...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 3 days ago

Anti-nephrin antibodies but no Ems? that is a new one but you have to deal with what you have. IS this SS with MCD or a podocytopahty like we ...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 3 days ago

Too bad no EM. Thus case is most likely MCD superimposed on Sjogren Syndrome . Multiple case reporters have described this association. I would thi...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Primary (presumed auto-immune) IC-MPGN is exceptional uncommon in adult Humans-I have no ideas how common it is in dogs, but standard IF for LC mon...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 3 days ago

This is of course assuming that the GFR impairment is due to severe podocyte foot process effacement and acute tubular injury and not other process...

View Discussion

RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 3 days ago

Very nice case Dr Aledan. this is my personal opinion it's unfortunate that the EM is not available. I think MCD is possible and we sometimes se...

View Discussion

Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 3 days ago

A 48 years old female patient with a history of hypertension (7-8 years duration ) and poorly controlled. Presented with decreased urine output and...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Assuming this is not a CMGRS (canine monoclonal gammopathy of renal significance) - on the list only bc of the MPGN pathology Assuming this is n...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Thanks, Dr. Torralba. Detection of anti-ds and anti-Smith antibodies have been described in dogs, but they are not commercially available tests to ...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Jd: A question for you. I have been interested in uremic toxins for years as a clinician. I know cats get renal failure not infrequently. Would you...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

ANA or RF would not give you much specificity. Would it be possible to run anti-dsDNA, anti-Smith instead? ------------------------------ Karina...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? Saturday, September 13 @ 5:48 PM

Since dogs do have and express all four IgG heavy chain subclasses, it is probably best to test for heVy chain rather than LC monotypism, if one is...

View Discussion

RE: Thoughts on immunosuppresion for canine MPGN? Saturday, September 13 @ 2:21 PM

Thanks so much for sharing your thoughts. We can definitely run an SPEP and immunofixation to look for any gammopathy that could be present. We...

View Discussion

RE: Lupus Case Saturday, September 13 @ 12:38 PM

I agree , a sister facility has used CarT for malignancies and 2 cases of lupus . Awaiting to see their results . But I think it has drawbacks , in...

View Discussion