RE: Non Lupus Full house nephropathy management 11 minutes ago

If the LM is an MPGN lesion , then then full house pattern suggests IC- MPGN In this case you would need to rule out infections , immunological an...

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RE: Lupus - Steroid free management options 44 minutes ago

She never was intentionally non complaint , it was mainly financial .. since IV infusions were covered by insurance she continued taking IV Belimum...

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RE: Lupus - Steroid free management options 3 hours ago

With a history of poor compliance to MMF ,do you plan to monitor blood levels of MPA during this therapy? ------------------------------ Richard ...

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RE: Non Lupus Full house nephropathy management 3 hours ago

I generally concur with your staremsnt . The "full house , non lupus MN" pattern of injury might be due to a chronic viral infection like HBV, but ...

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RE: Non Lupus Full house nephropathy management 4 hours ago

It is important to investigate the underlying cause of the full-house pattern on biopsy. Exclusion of an infection is essential, as well as evaluat...

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RE: Lupus - Steroid free management options 7 hours ago

Yes , we have OBI available now to us after the FDA approval. I was hoping to start her MMF and see how it influences her dsDNA titer in 3 months ...

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RE: Non Lupus Full house nephropathy management 8 hours ago

Unfortunately, there are no RCT to inform us regarding optimum therapy for "full house non-lupus MN" -a descriptive term for a "pattern of injury" ...

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Non Lupus Full house nephropathy management 9 hours ago

Hi all, I need opinion. I have a young patient who presented with proteinuria and worsening renal function now. She was seen about 8 months ago fir...

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RE: Parathyroid mass with severe hypercalcemia 9 hours ago

Eagerly awaiting update on surgical findings and post-surgery outcomes in your patient. Blood sampling and intraoperative PTH measurements on the v...

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RE: Friday : Unexplained metabolic acidosis 11 hours ago

What is under the hood? Changes in e-KF [estimated Kidney Function] may change the direction of the electrons and protons in this engine under...

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RE: Kidney transplantation in a child with C3G/DDD 12 hours ago

Would only proceed with transplant after very careful discussion with the patient and the potential donor regarding the high likelihood of recurren...

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RE: Lupus - Steroid free management options 14 hours ago

While Dr Rodby and I disagree on the definition of a remission in LN , we both agree that at a kidney biopsy is not needed and that additional anti...

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RE: Lupus - Steroid free management options 17 hours ago

I always classify my lupus GN patents in clinical and serologic remission and there can be any combination of that. Complete serologic remission ...

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RE: Lupus - Steroid free management options 18 hours ago

In my opinion , she is not in remission snd has immunologically active diseases . A repeat kidney biopsy is not needed. She is a good candidate for...

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RE: Pd Question 19 hours ago

Developed ascites post transplant Transplant . Cirrhosis on us and liver team Said cirrhosis happened post transplant( no liver disease prior) ...

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RE: Recurrence of C3 Glomerulopathy After Kidney Transplantation ? 19 hours ago

I think the question here is did the patient have IC- MPGN sec to lupus vs MPGN-C3 on the first biopsy. Here Pronase digestion would help to ru...

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RE: Pd Question 19 hours ago

As I suspected, the , no change in GFR suggest that all of the 10 ml/min is coming from the native kidneys. I agree with draining completely and in...

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Lupus - Steroid free management options 19 hours ago

Dear Colleagues , I have a 34 year of social media influencer female , dx with SLE and Lupus nephritis She also has a metallic AVR done and is...

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RE: Recurrence of C3 Glomerulopathy After Kidney Transplantation ? 20 hours ago

Curious case. Was this patient ever serologically positive for SLE (anti-dsDNA , anti Smith, anti Chromatin, anti-Nucleosome antibody)? What were t...

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Recurrence of C3 Glomerulopathy After Kidney Transplantation ? 21 hours ago

Hello, Please allow me to present the following clinical case for your consideration and discussion. Case Presentation A 36-year-old woman Medi...

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RE: Kidney transplantation in a child with C3G/DDD 23 hours ago

Hi, If an adult patient C3GP, we would discuss the high risk of disease recurrence with both the recipient and the potential living donor. It is e...

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Kidney transplantation in a child with C3G/DDD 1 day ago

we have recently a 14 y old child coming for kidney transplant with his 45 y mother as a potential donor he was diagnosed with ESKD 5 years earl...

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RE: Parathyroid mass with severe hypercalcemia 1 day ago

A very interesting and complicated case and I agree with most of the comments presented. I also agree that I would not use calcimimetic or denosuma...

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RE: AKI/CLL/Nephritic syndrome 1 day ago

Trying to figure out how a repeat biopsy will help in managing this patient. Yes, he may have a proliferstive/necrotizing/crescentic GN given clini...

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RE: AKI/CLL/Nephritic syndrome 1 day ago

Another biopsy will be needed. My bet would be on PGNMID. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885...

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RE: Pd Question 1 day ago

Thanks prof bargman --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Pd Question 1 day ago

Not if the PD is a daily or near-daily procedure. There isn't a lot to drain and indeed sometimes ascites is missed and it is assumed that the pati...

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RE: Pd Question 1 day ago

Assuming ascites is recurrent till he gets liver transplant I guess --------------------------------- Muhammad Soobadar MBChB UK --------------...

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RE: Pd Question 1 day ago

So every time we do pd have to drain ascites ( and give Human albumin solution? Does not seem practical to me ? ---------------------------------...

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RE: Pd Question 1 day ago

Hope that makes sense --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Pd Question 1 day ago

Patient had. Transplant with dgf ATN on biopsy ( never required RRT post transplant ) Efgr stuck at 10 ml/min Developed ascites post transplant T...

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RE: Pd Question 1 day ago

Thanks for asking but the clinic case is very unclear, at least to me. I presume that the transplant was a kidney transplant, but what does "ATN ac...

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RE: AKI/CLL/Nephritic syndrome 1 day ago

Here are the biopsy images and report ------------------------------ Jared Fialkow DO, FASN Hendricks Nephrology Associates Danville IN (3...

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RE: AKI/CLL/Nephritic syndrome 1 day ago

Kidneys are not enlarged. I will try to add the biopsy report and photos. ------------------------------ Jared Fialkow DO, FASN Hendricks Nephr...

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RE: AKI/CLL/Nephritic syndrome 1 day ago

I am getting repeat SPEP and IFE and K/L. I will repeat complements and check an RF. Imaging does not show any enlargement of the kidneys. ...

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RE: Transplant Question 1 day ago

I agree with Drs Venkat and Rubin. Bx done after one month might have documented degree of interstitial fibrosis and predicted whether recovery was...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

It seems that we did not reach a consensus on the pathogenesis of the worsening of metabolic acidosis (HCO3- drop from 20 to 4 meq/l with a recipro...

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RE: Pd Question 1 day ago

I agree: The criteria for a WBC count in PD is for when the patient is doing PD, it seems to be less definitive for ascitic fluid in the absence of...

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RE: Transplant Question 1 day ago

Dr. Nauman: my comment about futility of further biopsies was specifically about the posted patient since he is > 3 months post-transplant. I agr...

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RE: Pd Question 1 day ago

Two observations relevant to this patient: 1. Since PD catheter has been in for some time and not used - in this setting, when you obtain fluid for...

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RE: Pd Question 1 day ago

1) do you know if the ascites is cirrhotic or "nephrogenic" can be hard to tell fro mSAG but if this is "neprhogenic" I should expect a high monocy...

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RE: delay prog CkD in PKD 1 day ago

Excellent questions! 1) no known data on efficacy of tolvaptan for patients >66. The current definition of rapid progression and risk of progressi...

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RE: Transplant Question 2 days ago

Repeat biopsy threshold in DGF or very poorly functioning graft IMO should be low considering that other treatable causes of graft injury i.e Rejec...

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RE: Parathyroid mass with severe hypercalcemia 2 days ago

Thank you all for your replies. We did give him another dose of IV pamidronate 30 mg (just five days after the first dose after the Ca level starte...

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RE: AKI/CLL/Nephritic syndrome 2 days ago

Hi Dr. Fialkow, very interesting case. this is my personal opinion only. Are the kidneys (both) enlarged on imaging, sometimes direct infiltratio...

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RE: AKI/CLL/Nephritic syndrome 2 days ago

Given CLL/B cell lymphoma, need to consider MGRS or cryoglobulinemia with GN or infection-related GN (IRGN). Questions: 1. Serum IEP,/IF, kappa:...

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RE: Transplant Question 2 days ago

Dr. Soobadar: I listed the indications for serial biopsies during DGF in my earlier message. If your patient has one of these indications, then ser...

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AKI/CLL/Nephritic syndrome 2 days ago

I have a very pleasant 66y.o. woman with a history of CLL initially treated with steroids 3 years ago who then developed hemolytic anemia for which...

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RE: Pd Question 2 days ago

Let's break the silence: I would drain ascites [THERAPEUTIC VOLUME] and REMOVE the Tenchoff out. I would treat peritonitis; and then place a...

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RE: Transplant Question 2 days ago

Yes we have only done one Kidney biopsy no repeat one Thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------...

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