RE: Hyperfiltration/IgA nephropathy 3 hours ago

The variation in urine creatinine concentration in a "spot" un timed urine sample tells you virtually nothing about 24 hour urine creatinine excret...

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RE: pr3 +ve is it endocarditis ? 3 hours ago

Granulomas in PR3-+ Vasculitis can occasionally lead the hypercalcemia, which is excess 1,25 dihydroxy vitamin D driven, thus iPTH levels should be...

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RE: Hyperfiltration/IgA nephropathy 4 hours ago

Appreciate the response, Dr. Glassock! He is not obese. BMI is 30. ------------------------------ David Wilhelm DO Nephrologist Nephrology Consul...

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RE: Hyperfiltration/IgA nephropathy 4 hours ago

Albumin in February was 3.0. Current albumin is 3.3. No current edema. He did have some at the time of the initial visit but made improvement with ...

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RE: Hyperfiltration/IgA nephropathy 4 hours ago

Thanks for the response, Roger! This may sound like a stupid question, but can you give an explanation (or provide me a resource so I can read more...

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RE: pr3 +ve is it endocarditis ? 5 hours ago

Thanks prof glassock Wednesday PET . Outpatient toe requested by id team. Have contacted cardio for inpatient TOE ( hopefully this week) High cal...

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RE: pr3 +ve is it endocarditis ? 5 hours ago

The elevated Anti-PR3 is highly likely to be due to Endocarditis. When will you be doing a Trans-esophageal Echocardiograph .? ------------------...

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RE: pr3 +ve is it endocarditis ? 5 hours ago

Rf raised 79 (0-14) C3/c4 not back Hiv negative , syphilis negative --------------------------------- Muhammad Soobadar MBChB UK -------------...

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RE: Hyperfiltration/IgA nephropathy 5 hours ago

With a solitary kidney at least some of the proteinuria is due to maladaptive capillary hypertension. Too early to tell about beneficial effects of...

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RE: pr3 +ve is it endocarditis ? 5 hours ago

What is the serum Rheumatoid Factor Level and the C3 And C4 levels?Is the HIV testing negative,? ------------------------------ Richard Glassock ...

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pr3 +ve is it endocarditis ? 6 hours ago

54 MALE Constitutional symptoms ( hx of endocarditis 2023 in the context of TOF/Congenital Heart Disease) feeling unwell since Feb 26 --> 2 st...

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RE: Hyperfiltration/IgA nephropathy 8 hours ago

Serum albumin trend? Any edema? Size of right kidney/is it hypertrophied/echogenicity? ------------------------------ K.K. Venkat MD Troy MI (248...

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RE: Hyperfiltration/IgA nephropathy 8 hours ago

1) Kudos to biopsy a solitary lkidney 2) Kudos to being aggressive with APRIL inhibitor (started in April btw) 3) This is advanced disease whe...

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Hyperfiltration/IgA nephropathy 10 hours ago

I have a patient I would like to present for advice. 57 y.o. male with history of aortic dissection involving left renal artery in 2015 with resu...

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RE: young girl with Chronic TI dz 11 hours ago

THanks for mentioning us Roger and Dick! I agree with your thoughts and am interested to test! Tony ------------------------------ Anthony Bleyer...

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RE: young girl with Chronic TI dz 11 hours ago

Yes, it sounds very much like autosomal dominant tubulointerstitial kidney disease. THis is usually caused by UMOD or MUC1 mutations. UMOD can be s...

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RE: de-novo MGRS with LCDD 11 hours ago

I apologize for my contribution in advance as it regards to a formal theme, abbreviations. The first sentence already consist of 11 abbreviations a...

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RE: de-novo MGRS with LCDD 12 hours ago

UPCR can be misleading. Till tubular uptake is saturated, the UPCR can be low or even normal. Focal disease can have more nephrons saturated and th...

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RE: young girl with Chronic TI dz 13 hours ago

would FEUa be useful especially if >5%? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Ki...

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RE: young girl with Chronic TI dz 14 hours ago

The only think I have to add to this is, since this almost certainly is an ADTID, associated with hypeuricemia, I would treat that aggressively as ...

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RE: young girl with Chronic TI dz 15 hours ago

Exactly Dr. Aledan. Many thanks. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

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RE: young girl with Chronic TI dz 17 hours ago

The key point is that the negative genetic panel doesn’t rule it out. The MUC1 frameshift sits in a GC-rich (~80%) tandem repeat that short-read se...

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RE: secondary IgA Nephropathy 17 hours ago

Thanks , these findings exclude "hyper-creatininemia " from diet or drugs. The discrepancy between the biopsy andGFR remain unresolved. I suppose t...

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RE: secondary IgA Nephropathy 18 hours ago

Fasting creatinine is 2.44 ( eGFR 33 ml/min) and Cystatin C is 1.85 ( eGFR 37 ml/min). UA has 3+ blood with 15 to 20 RBC and Proteinuria 0.24 gms. ...

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RE: young girl with Chronic TI dz 1 day ago

What specific mutations were sought in the genetic testing? The case sounds very suspicious for a UMOD or a MUC 1 mutation. Please review the biops...

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young girl with Chronic TI dz 1 day ago

20 year old Indian female incidentally diagnosed with ckd : creatinine 1.4-1.6 mg/dl in 2024 and now 1.7-1.9 mg/dl in 2026 In 2024, uric acid w...

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RE: Kidney Biopsy in AL Amyloidisis 1 day ago

IgM lambda accounts for only 6-9 % of MGUS. When present it is most often a sign of Waldenstroms macroglobulinemia or AL Amyloidosis . Just a littl...

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RE: Kidney Biopsy in AL Amyloidisis 1 day ago

I apologize for late entry. This was our case from Our Rush Biopsy conference . You can watch it here https://youtu.be/HYIkZ1DZjh8 I sugges...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

any proteinuria? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transplan...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

egfr is stable, saw her in office visit post discharge, now neuro deficits resolved, pending mRI ------------------------------ Vijayakumar Para...

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RE: MGRS/Fanconis 2 days ago

Dr Shah Clone directed therapy is definitely indicated as strongly recommended by Dr Rodby Reviewed literature with AI resources Monoclonal Gammop...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

My AI consultant (Claude) makes an educated guess of about 1 in 20 cases meeting the description of this case will NOT have AL Amyloid on kidney bi...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Interesting statistic, but not relevant to this case. What % of 70 year old patients with Nephrotic Syndrome and +Congo Red Deposits in Bone Marrow...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

7.4.4 Hematologist-directed diagnosis of AL amyloidosis 7.4.4.1 Interpretation of the monoclonal protein screen In about 10% to 40% of patients wi...

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RE: MGRS/Fanconis 2 days ago

Dr. Rodby - per Dr. Shah marrow was normal. The serum free light chain ratio seems extremely high, and that could easily be followed during appropr...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Mario Rubin @Richard Glassock I agree. Fascinating case and a lot of clinical learning. ------------------------------ Satish Balan MD DM D...

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RE: MGRS/Fanconis 2 days ago

No - bc these are recent diagnoses - but I guess the crux of the question is - does myeloma therapy improve proximal tubulopathy and associated ...

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RE: MGRS/Fanconis 2 days ago

Yes, small percentage of plasma cells. The more I read the more I see that the hypophosphatemia is very unlikely to respond. Treating makes sen...

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RE: IgA-Nephropathy: to complement or not to complement? 2 days ago

The presence of Obesity makes the eGFR -Cystatin C less reliable, bu the only way to resolve the discrepancy is to obtain a measured GFR or a 24 ho...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Thank you all for this vigorous and enlightening discussion. The patient clearly has systemic Amyloidosis based on the bone marrow and fat pad biop...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Satish Balan In the case we discussed, the POST-BIOPSY fat pad and bone marrow congo red staining were both positive for amyloidosis. No further...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Mario Rubin Thanks for those pathology pearls. While I absolutely agree with those arguments, in the situation that Dr Glassock posted, assumin...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

I also wanted to share another pearl written by Dr. Fogo et al which was just sent to me by Dr. S. Korbet and briefly discussed at the Rush confere...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

I was also present at the meeting. The case, as presented, was characterized by a slight elevation of IgM lambda with normal IgG, IgM and IgA. The ...

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RE: IgA-Nephropathy: to complement or not to complement? 2 days ago

" 04/2023 creatinine-based eGFR 76, cystatin C-based 67 04/2025 creatinine-based eGFR 77, cystatin C-based 38 04/2026 creatinine-based eGFR 68,...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Richard Glassock: In the patient presented at the Rush University Kidney Biopsy Conference that you referred to, kidney biopsy must have been done...

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RE: MGRS/Fanconis 2 days ago

Have kappa and lambda levels been increasing over the years? Do you have serial DEXA scans and/or skeletal x-rays showing progressive deterioration...

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RE: MGRS/Fanconis 2 days ago

I would absolutely treat , following the k/l ratio, the tubulopathy may not improve but I think you are asking for trouble doing nothing. Just opin...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Unless it has already been mentioned that AL has been confirmed, I think we should still try to type the amyloid detected in the bone marrow biopsy...

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RE: MGRS/Fanconis 2 days ago

"SPEP = IgG Kappa, FLC ratio = 315." what is IgGK,IgGLambda levels? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCO...

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