RE: minimal change disease steroid dependent 2 hours ago

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 5 hours ago

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 5 hours ago

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 7 hours ago

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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RE: ? Cryoglobulinemic GN 8 hours ago

I agree tgat a palmar rash demands a search for secondary Syphillis . ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: ? Cryoglobulinemic GN 8 hours ago

Clinical features, Low C4, slightly low C3, LM and IF findings suggest Type II mixed Cryoglobulinemia . But normal RF , organized deposits is more ...

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RE: Microscopic hematuria 8 hours ago

Urine hemoglobin 3+ positive, microscopic urine sediments negative for red blood cells = hemoglobinuria or myoglobinuria unless the urine sediment ...

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RE: Microscopic hematuria 9 hours ago

microscopic blood only since childhood but: nl BP minimal proteinuria at best nl creatinine I would not biopsy (yet) but I would get genet...

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RE: ? Cryoglobulinemic GN 9 hours ago

palmar rash better check for syphillis, pathology atypical but cant miss that... Cryo with a negative RF has to be unusual I agree, I kinda doubt...

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RE: Microscopic hematuria 10 hours ago

I agree with Dr Glassock that PNH has to be excluded Below is an abstract from a recent publication Pathogenesis of paroxysmal nocturnal hemog...

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RE: Microscopic hematuria 12 hours ago

Thanks for your input. The upper limit for UACR at our lab is 3,0. We will check both LD and CK and also a fresh urinary sediment. --------------...

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? Cryoglobulinemic GN 12 hours ago

Will appreciate community's opinion: 37 years old man referred for hematuria and proteinuria. No arthralgia, skin rash or oral ulcers. Cigaret...

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RE: C3 or IgA 13 hours ago

Going back to the initial presentation of isolated hematuria, and a sediment without elevated erythrocytes but positive test on dipstick, I would t...

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RE: Microscopic hematuria 14 hours ago

If this is l hemoglobinuria, not hematuria a search for the cause of hemolysis is in order-like paroxsysmal nocturnal hemoglobinuria. -----------...

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RE: Microscopic hematuria 14 hours ago

Interesting - so no confirmed hematuria -only hemoglobinuria /myoglobinuria. What are the units for UACR? A fresh urine sediment needs ri be examin...

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RE: Microscopic hematuria 15 hours ago

Thank you Dr Glassock for your quick answer! An ultrasound two years ago was unremarkable and so was the urinary sediment with no red blood cells, ...

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RE: Microscopic hematuria 18 hours ago

What are the morphological characteristics if the hematuria-dysmorphic or normomorphic? What are the results of UACR and CT-Urogram . Negative wh...

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Microscopic hematuria 19 hours ago

Dear Colleagues, i would like to hear your opinion concerning an 18-year old male with persistent heamaturia since early childhood. He has no pro...

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RE: C3 or IgA 19 hours ago

With no morphological or clinical findings of recurrent IgAN or C3G, I would manage him conservatively, with another transplant biopsy at 1 years. ...

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RE: C3 or IgA 20 hours ago

When labels are confusing we go back to the pathobiology of the disease. This appear to be antibody mediated disease with complement activation. Tr...

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RE: C3 or IgA 20 hours ago

Hello, just to summarize this case , as we have had a lot of suggestions and comments ... Any final thoughts or recommendations .. thanks -------...

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RE: minimal change disease steroid dependent 21 hours ago

Addendum- it appears that a confocal IF microscopy showing redistribution of nephrin and colocalization of IgG can be equivalent to a positive seru...

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RE: minimal change disease steroid dependent 1 day ago

It should be stressed that no commercial FDA-approved anti-nephrin antibody test is available on demand anywhere Just yet. ---------------------...

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RE: minimal change disease steroid dependent 1 day ago

70% is much improved over early reports this is great news, very encouraging thanks ------------------------------ Roger Rodby MD, FASN...

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RE: minimal change disease steroid dependent 1 day ago

In my opinion, we will see "MCD" evolve as a "pattern of injury", not a diagnosis, much like MN, except t evolution will be driven by serology not ...

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RE: minimal change disease steroid dependent 1 day ago

Still there are a lot of non-anti-nephrin Ab MCD cases out there. >50% I believe? I wonder if it is still a problem with sensitivity, or will th...

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RE: minimal change disease steroid dependent 2 days ago

thank you for feedback, will keep everyone posted . Sent from my iPhone

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RE: minimal change disease steroid dependent 2 days ago

I fully agree with and support the preferential use of RTX in this case. Insurance coverage can be an issue in some localities. A favorable initi...

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RE: minimal change disease steroid dependent 2 days ago

There is enough evidence of Ritux efficacy to use it as initial therapy for MCD without steroids. ritux monotherapy Ritux Monotherapy ----...

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RE: minimal change disease steroid dependent 2 days ago

rituxaan rituxan and assuming you were still in remission at 6 months I would give another 1 gram at that point I know one Mayo MD that give...

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RE: treatment for hypophosphatemia 2 days ago

In Europe, particularly France and Greece, eating during HD is permitted. The general concept that it should be avoided so that adverse events do n...

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RE: treatment for hypophosphatemia 2 days ago

When hypophosphatemia is discovered after a patient's iHD treatment has commenced, we've been known to smuggle a cola product into the unit for the...

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RE: Pt with Minimal Change Disease in Remission Planning Pregnancy 2 days ago

We have used Rituximab in the first trimester , and literature suggests you could possibly use it up to 26 weeks . That is if it is indicated . C...

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RE: Pt with Minimal Change Disease in Remission Planning Pregnancy 3 days ago

Thanks. The 12 months use of contraception recommended in the label is not evidence based and RTX is not absolutely contraindicated in Pregnancy.. ...

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RE: Pt with Minimal Change Disease in Remission Planning Pregnancy 3 days ago

Thank you for your quick response. The recommendations to avoid IV Rituximab is from the "manufacturer's guidelines"/FDA insert: "are pregnant or...

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RE: Pt with Minimal Change Disease in Remission Planning Pregnancy 3 days ago

Dr. Joshi. Thanks for the post. We get a lot of similar posts as there is so little real data to guide management in such situations . I don't unde...

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Pt with Minimal Change Disease in Remission Planning Pregnancy 3 days ago

Dear colleagues, I would like to get the ASN Communities' input on a management issue on a lovely African American of Ethiopian descent. She was ...

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RE: treatment for hypophosphatemia 3 days ago

That is interesting. Raises the concept of personalizing each dialysis run based on the directly pre-dialysis electrolyte profile. One wonders ...

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RE: minimal change disease steroid dependent 3 days ago

In this case, I think that RTX may be the best choice, but not direct head to head comparisons vs MMF or CNI have yet been conducted. Consideration...

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minimal change disease steroid dependent 3 days ago

30 yo female who i met post partum, with nephrotic proteinuria- with renal biopsy minimal change disease, gave steroids and within week- proteinuri...

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Belatcaept/Tac 3 days ago

This paper in Clinical Transplantation Longterm Outcomes Belatacept/Tac used immunosuppression discharge medications UNOS database and found superi...

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RE: Initiating Statin In Dialysis Patient Thursday, June 26 @ 5:31 PM

Many thanks units mmol/l . The lab does not give me standard reference in that particular hospital --------------------------------- Muhammad So...

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RE: C3 or IgA Thursday, June 26 @ 5:29 PM

I come late to the discussion after the dust settles. Patient has a genetic mutation increasing risk of uncontrolled activation. My guess that this...

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RE: TMA Case Thursday, June 26 @ 2:33 PM

chronic lymphocytic leukemia/small lymphocytic lymphoma representing approximately 10% of the total cellularity. So, apparently t does not take a p...

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RE: TMA Case Thursday, June 26 @ 2:12 PM

I wanted to provide some update for the community: 1) pt/family declined a trial of IV Eculizumab. 2) she was discharged and continues on outpt...

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RE: treatment for hypophosphatemia Thursday, June 26 @ 1:21 PM

In a major academic medical center, the nephrology group had an interesting policy to check phosphorus level before dialysis treatment and if phosp...

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RE: treatment for hypophosphatemia Wednesday, June 25 @ 9:25 AM

I would not r/o oncogenic induced phospahe wasting and agree that a repeat FGF23 is needed. Does she have HepB and on treatment? Some other drugs c...

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RE: treatment for hypophosphatemia Wednesday, June 25 @ 9:13 AM

Story more complicated than described initially. Crohn's (mod-severe), multiple sclerosis, RNP (+) connective tissue disease. What therapy? One...

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RE: treatment for hypophosphatemia Wednesday, June 25 @ 2:31 AM

I agree with Prof Glassock. I would also question the assay used as I would still expect it to be much higher with the elevated urine phos and hypo...

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RE: treatment for hypophosphatemia Wednesday, June 25 @ 2:06 AM

A " normal" FGF23 level in the face of hypophosphatemia is "abnormal" . It should be very low. Any features of Fanconi syndrome present? --------...

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