RE: Applications Now Open for the 2026 Kidney TREKS Program 50 minutes ago

Dear all, As a reminder, applications for the 2026 ASN Kidney TREKS program close next Friday, January 30, 2026. To be eligible for the 2026 Kid...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 1 hour ago

Intracapillary fibrin-platelet thrombi are seen in TTP- I do not beluve that these features were present n the kidney biopsy of this case, but in l...

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RE: Hypercalcemia in tertiary hyperparathyroidism 4 hours ago

@Wael Jebur Have you performed an ultrasound of the neck looking for parathyroid enlargement? ------------------------------ Mario Rubin, M.D. ...

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simultaneous liver kidney transplant 5 hours ago

Respected faculty, We solicit your opinion on a 28 year old female patient who underwent live simultaneous liver and kidney transplant with two li...

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RE: anti gbm/mpo +ve in young female 5 hours ago

A single course of oral cyclophosphamide would usually not cause female infertility , but I would talk to the OB people about Lupron, that should f...

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RE: anti gbm/mpo +ve in young female 6 hours ago

Completely agree with Drs Glassock and Rodby. This can be a renal presentation of a (potentially) systemic disease and aggressive treatment is just...

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RE: anti gbm/mpo +ve in young female 6 hours ago

I would only add that, I recently had a similar patient, double anti-GBM ANCA positive: almost identical presentation and biopsy who developed pulm...

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RE: Hypercalcemia in tertiary hyperparathyroidism 7 hours ago

My mistake I did not realize that you reported the phos in mmol/liter so 1.5 mmol/l is not low ------------------------------ [Mark] [Lerman] [...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 9 hours ago

good point !! -although the kidney biopsy findings are not indicative if TTP. ------------------------------ Richard Glassock MD, FASN Laguna Woo...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 10 hours ago

ADAMTIS13 was not done? ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai ------------------------------

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 13 hours ago

I think I would rebiopsy. I do not see anyvrole fir RTX therapy in a patient with aHUS and these characterustics . Why nit try tobenroll the patien...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 13 hours ago

The ongoing APPELHUS Phase 3 trial of Iptacopan in aHUS may provide a rationale for Factor B inhibition in Chronic CM- TMA - the results are eagerl...

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RE: Hypercalcemia in tertiary hyperparathyroidism 16 hours ago

I think Hypophosphatemia is irrelevant as the patient is oliguric end stage kidney disease on regular HD. @K.K. Venkat The marginal drop in PTH r...

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RE: anti gbm/mpo +ve in young female 20 hours ago

Tricky case. Although the prnisis for recivery is very poor when oligo-Abpnuria and 100% crescent (0% normal glomeruli are found on kidney biopsy ,...

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RE: Thin BM 20 hours ago

Very difficult to asses GBM width on paraffin embedded material by rescue EM methids. Direct, not rescue , EM is the "gold standard" for diagnosis ...

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anti gbm/mpo +ve in young female 20 hours ago

19 female Has been unwell since 17.12 Vomitting, nausea, fatigue Kept working until 2 weeks ago - but then had to stop had bloods 16/1 - eG...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

95 x 1.3 : 10 = 12.4 - am I correct? ------------------------------ Sinasi Salman MD, FASN Owner Northlake Nephrology, PLLC Mooresville NC (704) ...

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RE: Thin BM 21 hours ago

I think genetics is the key in this case. I thought if the GBM is less then 200 nm is diagnostic of thinning of the GBM even on a paraffin embedde...

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RE: Thin BM 22 hours ago

attached ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773)...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

@Stuart Sprague I assume that this patient remains hypophosphatemia without phosphate binders. How often do you see a low serum phosphorus in a pat...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 1 day ago

I think if a repeat biopsy still shows a smoldering chronic active vs chronic fibrotic TMA , possibly CM-TMA, there is a very good case for C5 bloc...

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RE: Thin BM 1 day ago

I would be grateful if anyone on this forum would elaborate more on DFS 70 and it's utility . --------------------------------- Dr. Hormaz Dastoo...

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RE: Young male patient with IgA nepropathy 1 day ago

I was (and still am) a member of the TESTING trial so I very much agree and support the notion (expressed in the UpToDate guidelines that oral mode...

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RE: Thin BM 1 day ago

Reprocessing of paraffin embedded renal biopsy tissue for EM examination is well known to result in "substantial " thinning of BM. Thus, the Suspic...

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RE: Young male patient with IgA nepropathy 1 day ago

Dr Glassock, I recently saw an abstract from (attached) ASN that showed TESTING IgA effects lasted 6 years. While still in abstract form, this...

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RE: Thin BM 1 day ago

My understanding as mentioned by our rheumatologist was that a Positive DFS 70 , in the presence of only a Positive ANA ( negative dsDNa) rules out...

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Chronic Active Thrombotic Microangiopathy - kidney biopsy 1 day ago

Dear all, Case for Discussion A 39-year-old previously healthy man, with a history of bioprosthetic aortic valve replacement (2022), presented...

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RE: Thin BM 1 day ago

I was not sure what the DSF-70 antibodies mean https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.810639/full the conc...

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RE: Young male patient with IgA nepropathy 1 day ago

I concur again, until the FIND-CKD is published we don't have a large RCT. There are however signs of efficacy from many smaller studies and case ...

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RE: Young male patient with IgA nepropathy 1 day ago

Thanks Dr. Dastoor for your concurrence with my opinions on thus case, derived from the UpToDate guideline. I have no objections to adding non-ster...

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RE: Young male patient with IgA nepropathy 1 day ago

I concur with the eloquently put statements by Dr. Glassock As stated in Uptodate , having 3 out of 4 high risk criteria , is a strong indication...

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Thin BM 1 day ago

Dear Colleagues. I encountered a 18 year old lady , who did a preliminary screening test prior to joining college. She also complained on arthral...

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RE: Young male patient with IgA nepropathy 1 day ago

Clinical end-points of "success" are improved e GFR, reduction of proteinuria , eradication of hematuria.. ------------------------------ Richard...

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RE: Young male patient with IgA nepropathy 1 day ago

In my opinion, RAS inhibitors ( or Sparsentan ), SGLT2i inhibition (if overweight , obese or diabetic), plus moderate doses of oral systemic methyl...

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Young male patient with IgA nepropathy 1 day ago

Dear Collagues 26-year-old male with no known chronic disease. His serum creatinine was within the normal range in March 2025, then increased ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Serial PTH levels with corresponding serum calcium levels? Possible that PTH was higher and came down when hypercalcemia by a non -parathyroid caus...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

If he becomes hypocalcemic, it would increase the PTH, but if the Calcium remains high normal and elevated likely not Very difficult case, not su...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

bone excavation is in progress We need to stop the osteoclasts. This is hyper dynamic [not a-dynamic] renal osteo-dystrophy type. He might be b...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Dr. Sprague- Won't Denosumab therapy worsen the hyperparathyroidism? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

High alkaline phosphatase, low phosphorus, high calcium, high PTH = Primary vs. tertiary hyperparathyroidism. Have you done a neck ultrasound looki...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

The handful of patients I have treated with similar presentations all responded to higher dose of parsabiv, which can go to 15 mg per session. --...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

Then it is likely not adynamic bone and would proceed with either Pamidronate or Denosumab, whichever you feel more comfortable with. Would still m...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

Alkaline phosphatase is elevated at 320 IU/L (normal range 60-116) ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai --...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

At his age, I would not pursue a bone biopsy, though would check a Bone Alk Phos to see if it is relatively low. I also would not use teriparatide ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

@Stuart Sprague ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773) ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

Serum alkaline phosphatase and bone-specific alkaline phosphatase levels? Skeletal X-ray findings including hands? ------------------------------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

This high level of serum iPTH makes adynamic bone disease rather unlikely but a bone biopsy would be required to exclude it completely ----------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

PTH level of 70 pmol/l (normal range 1.6- 6.9) with hypercalcemia , is tertiary hyperparathyroidism still questionable in this context? suspecting ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

I am sorry for the typo , as ionized calcium is 7.5 mg/dl normal range (4.45 -5.29). adynamic bone disease with suppressed PTH is commonly encoun...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

In my experience Denosumab at 60 mg dose, has not led to a prolonged Hypercalcemia, but does cause severe hypocalcemia . Additional benefit , con...

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