RE: Intradialytic hypertension 3 hours ago

always a tough problem Running to holiday party but will Attache a couple reviews on the topic I'd start with the most recent ...

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RE: IgA Nephropathy 3 hours ago

Sounds very advanced yet kidneys normal sized tough call but with proliferation, maybe worth a try as you pointed out There are so many new...

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IgA Nephropathy 6 hours ago

26 YO caucasian seen him first time as an inpatient consult yesterday and did the biopsy for proteinuria, RBC casts and elevated creatinine and the...

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Intradialytic hypertension 8 hours ago

Have a 35 year old male who has recently started IHD 2x/ week . He passes around 1 liter of urine per day. His current dry weight is 73 kg and he i...

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RE: IgA Nephropathy Dual Immunotherapy 10 hours ago

Agree with Dr. Rubin. The label for Sparsentan requires that ARB or ACEi be stopped when Sparsentan is prescribed. ------------------------------...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 12 hours ago

No Lasix was given ------------------------------ Katafan Achkar MD, FASN Houston Methodist Hospital and CLS Health Webster TX (832) 469-1166 ---...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 13 hours ago

Just curious. Was this a lasix-MAG 3? We need to remember that MAG3 reflects effective renal plasma flow, not GFR (unlike DTPA). A 60/40 split is c...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 13 hours ago

I think this case highlights the importance of looking for an abnormal genetic variant in the proband. This has already been mentioned in the previ...

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RE: IgA Nephropathy Dual Immunotherapy 13 hours ago

What is the rationale of using DEARA and losartan? ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 14 hours ago

We did MAG3 Split function, RT kidney 60%, left kidney 40% Also, I attached an image of both kidneys ------------------------------ Kata...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 14 hours ago

Thank you Dr Achkar. If the CT was enhanced with contrast then it is comparable to MRI, so if done with contrast then no need to obtain MRI. Both w...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 14 hours ago

Thank you Dr. Chebib and everyone for your input. The donor does not have any hepatic and pancreatic cysts. The CT report of the mother states: Liv...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 14 hours ago

Thank you Dr. Glassock. The left kidney volume seems normal (average 140ml and physiologically 5-10% larger than right) . The right kidney volume i...

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RE: IgA Nephropathy Dual Immunotherapy 15 hours ago

Quite a favorable response to Iptacopan. The persistence of proteinuria of 1.5gns/ day, resistant to Sparsentan is a concern but in all likelihood ...

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RE: IgA Nephropathy Dual Immunotherapy 18 hours ago

Yes, pt on sparsentan, SGLT2i, Losartan Hematuria resolved after adding Fabhalta --------------------------------- Ashraf Mohammed MD, MBBS Las...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 18 hours ago

Thanks Dr. Chebib for elegant elegant analysis of a complex case. I wonder how you would interpret the high degree of asymmetry in kidney volume in...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 22 hours ago

Interesting case. Thanks for sharing. I would hold off on allowing kidney donation until the case is resolved. The potential donor does not ha...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

Dr. Venturelli - Yes, VEXAS was excluded by genetic testing after that initial biopsy. Thanks for the advice about the 24-h urine testing; I did in...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

Thank you so much Dr. Rodby!! Very useful references. ------------------------------ Kelly Liang MD, MS, FASN Kansas City KS (507) 269-7812 ----...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

I recently looked into response time with rituximab (granted rituximab alone, firstline) for recurrent podocytopathy. What is reported in resp...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 day ago

Here, several things do not fit: The mother doesn't have ADPKD, since her kidneys are not enlarged. In ADPKD kidney volume correlates with rapid ...

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RE: Antibiotic Prophylaxis Prior To Dental Procedures 1 day ago

I would add patients with polycystic kidney disease to that list. Cyst infection after procedures commonly associated with bacteremia have been rep...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 day ago

We screen if donor is first degree and test both donor and recipient which helps to interpret the results. Her parents should undergo testing if th...

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RE: IgA Nephropathy Dual Immunotherapy 1 day ago

No studies of combining Iptacopan with Sibeprenlimab and none planned as far as I know. What happened to hematuria on Iptacopan. With 1.5gm/d of pr...

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RE: IgA Nephropathy Dual Immunotherapy 1 day ago

Speaking of combination therapy, Any benefits of combining Fabhalta and Voyxact? My IgA pt did not respond to Nefecon. Decent response to Fabhalta...

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RE: IgA Nephropathy Dual Immunotherapy 1 day ago

@Brad Rovin recently we had a patient with what is classified as Active disease e, with 2 grams proteinuria , E1, M1 , C1 lesions . We suggested a ...

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RE: IgA Nephropathy Dual Immunotherapy 1 day ago

I respectfully disagree that the KDIGO IgAN Guidelines are "obsolete". While it is true that the current guidelines do not discuss the most newly a...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 day ago

I fully agree with Drs. Rubin and Rodby. I jumped the gun on this consult. We need help from experts. ------------------------------ Richard Gla...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

Dr. Rodby I agree but response to Rtx in MCD can be much faster than other diseases that we treat with Rtx Edit: in my experience and supported ...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 day ago

Too many red flags here IMO, questionable genetics, renal asymmetry, Which kidney do you take anyway? I feel this is one of those donors we wi...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

It may take a while for the Rituximab to have its effect, It looks like the patient is still n prednisone taper, that being the case I think you ca...

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RE: IgA Nephropathy Dual Immunotherapy 1 day ago

There are no data on the simultaneous use of sibe and nefecon and i have not combined these in my practice to date. Sibe is not yet available so it...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

Dr. Liang this is compatible with minimal change disease and is probably going to be a steroid dependent phenotype given the early relapse The ad...

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RE: Thymoglobulin Removal By Plasmapheresis 1 day ago

Yes, like any globulin, ATG (Thymoglobulin) will be removed by PLEX. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -------...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 day ago

I agree with Dr. Venkat the CT calculated kidney volume on the right is increased- this needs further evaluation with an MRI. Genetic counseling is...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 1 day ago

Another (unrelated) issue in this donor: "Right kidney volume was 234 cc and left kidney volume 154.5 cc." Given this discrepancy in kidney volum...

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RE: Antibiotic Prophylaxis Prior To Dental Procedures 1 day ago

Posed your question to Google AI and got following response and reference: Top of Form "Yes, antibiotic prophylaxis is often recommended or requi...

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Thymoglobulin Removal By Plasmapheresis 1 day ago

Does post transplant PLEX need to be timed away from IV Thymoglobulin so it's not removed by the procedure?

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

OK thanks so much for your reply! I hope it does become available next year; it would be a useful test to help guide therapy. -------------------...

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RE: recurrent pla2r 1 day ago

In my experience, the commonest cause of a FP ELISA for anti-PLA2R antibody is T2DM. The levels of "antibody" detected are usually in the low range...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 1 day ago

There is no commercially available -Anti-Nephrin auto- antibody assay approved by the FDA or the ENA for clinical use. The only assays currently pe...

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RE: IgA Nephropathy Dual Immunotherapy 2 days ago

To my knowledge - there is no convincing evidence that Telitacicept or Ravulizumab , alone or in combination, " resurrect" dormant nephrons. (The L...

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RE: IgA Nephropathy Dual Immunotherapy 2 days ago

I found this chart interesting . Interesting from the perspective that Ravulizumab and Telitacicept actually reversed the decline in eGFR and incre...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 2 days ago

Thank you so much Dr. Rubin!! ------------------------------ Kelly Liang MD, MS, FASN Kansas City KS (507) 269-7812 ------------------------------

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 2 days ago

@Astrid Weins i have copied Dr. Weins (at the Renal Pathology Lab at Brigham) who is the right person who can guide you on how to get your patien...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 2 days ago

Thanks! Do you know if there are any anti-nephrin Ab assays available for ordering? Do you recommend I try to order it to see if his MCD is due to ...

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RE: recurrent pla2r 2 days ago

@Gerard Lambeau I support your decision and have also consulted with a colleague (AI as is now known) for his/her thoughts on the subject (see...

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Antibiotic Prophylaxis Prior To Dental Procedures 2 days ago

We all know AHA guidelines for antibiotic prophylaxis prior to dental procedures for prevention of infective endocarditis. What are the current re...

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RE: recurrent pla2r 2 days ago

As Alice in Wonderland said, "it gets curiouser and curiouser". While in her original presentation, both the Elisa and the IFA were positive, this ...

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RE: Potential kidney donor older than 40, likely pathogenic PKD1 mutation and no cysts on CT scan of the abdomen 2 days ago

@Katafan Achkar This is a very complex situation which requires the input from a geneticist and genetic counselor. I suggest to reach out to them...

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