RE: hemodialysis 41 minutes ago

Peritoneal dialysis, despite blindness, would be preferable to intermittent HD in a patient like this. Just an opinion. -------------------------...

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RE: Lupus Nephritis 45 minutes ago

Azathioprine is a concern about malignancy as it is chemical that is integrated into the DNA genome, MMF does not have the same risk as it is not i...

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RE: Lupus Nephritis 2 hours ago

Thank you to all who have responded and all the articles attached. From the patient’s perspective, she has done very well for over 5 years and gon...

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hemodialysis 2 hours ago

61 y/o DM,HTN,ESKD,AMI 2 weeks ago LVEF 22%.Any time put on dialysis becomes unresponsive, hemodynamically stable but rolls over eyes and passes ou...

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RE: Lupus Nephritis 3 hours ago

See this "Position Paper" by De Vriese, Fervenza and Sethi (KI 2025;107:198-211. ) It is very convincing, to me at least, that serological, not his...

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RE: Lupus Nephritis 4 hours ago

The hybrid report (Buenos Aires-Ohio) is thought provoking and may well become the way to go but it requires validation (see attached editorial by ...

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RE: Lupus Nephritis 4 hours ago

That is a reasonable "camp", and a logical conclusion, I just know if there data is there that improving serologic activity in a patient without pr...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 4 hours ago

Has the patient been transfused with normal RBC? this might obscure the meaning of a normal MCV. What does the peripheral smear show? What is the L...

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RE: Lupus Nephritis 4 hours ago

I am in the Mayo Clinic camp in this debate. So long as immunological activity is present (increased levels of anti-DNA antibody, low C3/C4 levels ...

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RE: Lupus Nephritis 4 hours ago

this is an excellent point, that when patietns thought to be in remission are biopsied (lupus protocol biopsies) there is often histologic activity...

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RE: Lupus Nephritis 5 hours ago

Assessing actvity on a repeat biopsy might be helpful. In a study in 2022, 21 percent patients had activity index more than 2 even with clinical re...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 6 hours ago

Dear Dr. Garrick, Dr. Thomas, and Dr. Guevara-Pineda, Thank you for these insightful considerations and your help to solve the case. The patient ...

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RE: Lupus Nephritis 10 hours ago

the million dollar question actually 2 questions 1) Do you continue maintenance therapy "forever" 2) Do you treat abnormal serology alone (ot...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 10 hours ago

Tocilizumab is not very effective and may be harmful in organ transplant patients with severe COVID (see Pereira MR, et al Am J Transplant 2022; 20...

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Severe COVID in Renal Transplant Patient - Tocilizumab? 11 hours ago

Hello to all, We have a colleague of ours, 61 yo M, with HTN, ADPKD, s/p deceased donor kidney transplant 3 years ago, hospitalized 4 days ago wi...

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RE: Anti GBM with Fibrillary GN 11 hours ago

Thank you. MPO/PR3 negative. --------------------------------- Narothama Reddy Aeddula MD, FASN Newburgh IN (774) 641-1444 -------------------...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 11 hours ago

This condition seems to be a multi-systemic disease . Although viral infections can trigger severe inflammation ,tend to be self limited . Allow me...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 11 hours ago

Hi Fascinating case. A few questions Did he received treatment for his IGA nephropathy, and if so, what did he receive?Could that possibly be ...

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RE: ANCA vasculitis with AIN 11 hours ago

PR-3 and MPO antibodies received today and negative. I will not give rituximab and have discontinued steroid. Serum creatinine remains stable at 3....

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 12 hours ago

Good day. What are his chronic medications? Would you entertain TB or viral infections other than Parvovirus 19, such as HIV or CMV? PNH can pres...

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Lupus Nephritis 12 hours ago

Looking for advice regarding a 41-year-old patient with SLE with lupus anticoagulant. She had kidney biopsy in January of 2017, which showed LN I...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 16 hours ago

Dear Dr. Venkat, Dear Dr. Glassock, Thank you for your valuable insights. Parvovirus B19 PCR is negative, making active infection unlikely. The...

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RE: Anti GBM with Fibrillary GN 20 hours ago

This assay has a false positive rate as high as 16% due to cross reactivity to other GBM auto-antigens -but this is a very high titer. Was the anti...

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RE: Anti GBM with Fibrillary GN 23 hours ago

Thank you Dr Glossock, Anti GBM levels were 263. IgG by multiplex bead. ARUP labs. --------------------------------- Narothama Reddy Aeddula MD...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

I agree with most of the comments made. A biopsy would give a more definitive diagnosis, though I am not convinced that it is necessary. What is hi...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Sorry-i meant hepatic vein , not portal vein, thrombosis. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-888...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

I also agree with Dr. Venkat that the clinical findings are compatible (including marrow aplasia, reactive arthritis and portal vein thrombosis) wi...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

What is the patients Mean corpuscular volume and peripheral blood smear, red cell morphology , and Hemoglobin electrophoreses? Could this be IgAN, ...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Isolated ineffective erythropoiesis: Have you done blood parvovirus B-19 PCR (IgM and IgG antibodies less reliable)? Parvovirus can cause liver dam...

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A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Distinguished colleagues, we seek your insight on a 38-year-old man whose clinical trajectory has recently changed in a way that we are strugglin...

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RE: Anti GBM with Fibrillary GN 1 day ago

Oral cyclophosphamide (CYC) + RTX combinations have been used to treat FGN. IV CYC is usually not used to treat Anti-GBM disease . What assay was u...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

I agree with Dr. Venkat. Clinically, this is most likely steroid-induced Osteoporosis, post kidney transplant. But a bone biopsy may be the only wa...

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RE: Anti GBM with Fibrillary GN 1 day ago

Yes. Active UA, since 07/2025. Pt was never referred to a nephrologist before. Walked into ER this past Monday with abnormal eGFR and UA follow...

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RE: Anti GBM with Fibrillary GN 2 days ago

There are rare reports of anti-GBM-ab RPGN and fibrillary GN occurring together: https://pmc.ncbi.nlm.nih.gov/articles/PMC4720204/ Wonder if anti...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 2 days ago

Pth 30 2020 now 100 --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 2 days ago

B alkaline phosphate not done. --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 2 days ago

Thanks prof venkat Alp= alkaline phosphate Kind regards --------------------------------- Muhammad Soobadar MBChB UK -------------------------...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 2 days ago

Kidney transplant 31 years ago, on prednisolone and cyclosporine since then. Both these drugs can cause osteoporosis. Intermittently high normal se...

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RE: Follow up 2 days ago

Dr. Whittier thanks so much -as I stated in my previous post one of my issues when we started letting IR do the biopsies even transplant, kidney bi...

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Anti GBM with Fibrillary GN 2 days ago

Hello all, Have an interesting case and appreciate your input. 57 year old Caucasian female with hx of rheumatoid arthritis, admitted on 3/16/20...

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RE: Follow up 2 days ago

yes, when we do the PRB, we typically do the right kidney. our protocol has been nephrology does the majority of the biopsies, but if they need CT ...

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RE: Follow up 2 days ago

Dr. Whittier- thanks so much for your input- does that mean that when you and your Colleagues, and therefore your fellows under their supervision, ...

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RE: ANCA vasculitis with AIN 2 days ago

creat gone up ------------------------------ Muhammad Soobadar MBChB UK ------------------------------

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RE: ANCA vasculitis with AIN 2 days ago

many thanks there is one artery that shows vasculitis . Creatinine has gone down rapidly. RF +ve, normal complement Blood culture negative I ...

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RE: Follow up 2 days ago

My practice plan is as follows: 1. Refer all outpatient biopsies to the university. High volume center, lower complication rate. 2. Due to the incr...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 2 days ago

adjusted calcium 2.20-2.60 mmol/l phosphate range mmol/l PTH ( 1.5-7.6 ) pmol/l thanks for input ------------------------------ Muhammad...

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RE: Follow up 2 days ago

Thank you for your valuable input. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 2 days ago

Dear colleagues appreciate input on mx of bone disease and osteoporosis in renal tx recipient Cadaveric Tx Recipient 1995 Maintained on Neoral...

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RE: Follow up 2 days ago

There are several issues regarding definitions of major complications of percutaneous renal biopsy (PRB). One of them is that they are defined by n...

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RE: Lithium Nephropathy 2 days ago

I have had a number of cases of Lithium toxicity as well as testified in medical legal caes. The initial problem of toxicity is handled as you all ...

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