RE: ANCA with full house IF (?) 2 hours ago

Thank you Dr Glassock - I totally agree(!). I failed to mention the entire clinical picture: BC neg x2 , TEE neg for vegetation, ESR 0, no feve...

View Discussion

RE: ANCA with full house IF (?) 2 hours ago

This patient with Anti-PR 3 ANCA , low C 4, high RF , cardiac valve disease , colonic disease and a kidney biopsy with crescentic GN and ICGN must ...

View Discussion

ANCA with full house IF (?) 3 hours ago

58 y.o. male with a PMH significant for, colorectal cancer s/p resection and radiation, iron deficiency anemia, severe Mitral regurgitation and HTN...

View Discussion

RE: Challenging Case C3GN 5 hours ago

Sorry- We need the full report, not just a summary. It can be quite difficult to separate IRGN and C3GN on morphology . C3GN is a "pattern of inj...

View Discussion

RE: Challenging Case C3GN 8 hours ago

"Currently, the patient has 2+ proteinuria on dipstick and an increase in the urine albumin to creatinine ratio from 145 to 255 mg/g." Did he als...

View Discussion

RE: Challenging Case C3GN 8 hours ago

Thank you all for the prompt response. This is so appreciated. Below is the de-identified biopsy. Yes, I think monitoring off I/S will be the best ...

View Discussion

RE: Challenging Case C3GN 8 hours ago

The depressed C3 level seen in PIGN can be very short and therefore it is easily missed, unless serial levels are obtained weekly for at least 8-10...

View Discussion

RE: Challenging case 8 hours ago

A normal Rheurmatod factor level makes the possibility of Infective Endocarditis with kidney involvement in infection-related GN quite unlikely (th...

View Discussion

RE: Challenging case 8 hours ago

Wow! This is an open depiction and first time starting discussion from bottom ::::> the origin; instead of from the top downward : : : : >. from ...

View Discussion

RE: Challenging case 12 hours ago

Thank you Dr. Glassock and Dr. Rodby, I'll keep you updated. Dr. Abdalla I must admit with IgM predominant immune deposits endocarditis was high ...

View Discussion

RE: Challenging case 12 hours ago

Has the possibility of infective endocarditis been ruled out? --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ----...

View Discussion

RE: Challenging Case C3GN 12 hours ago

forgot to attach ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Ch...

View Discussion

RE: Challenging Case C3GN 12 hours ago

My favorite article to attach these days echoes Dr Glassock's point C3G v PIGN can be difficult to tell apart. And yet I wonder that a normal c...

View Discussion

RE: Challenging Case C3GN 12 hours ago

Would it be possible to post the original kidney biopsy (, including LM, IF and EM, de-identified , of course)? . How can you be sure that thus is ...

View Discussion

RE: Challenging case 12 hours ago

I was aware of the concept but did not know that ASIA syndrome was it's name tattoos? https://onlinelibrary.wiley.com/doi/10.1002/978111985843...

View Discussion

Challenging Case C3GN 12 hours ago

Colleagues, I have a 20-year-old male with a diagnosis C3 glomerulonephritis in 2019 following an upper respiratory infection. At that time, the ...

View Discussion

RE: Challenging case 13 hours ago

Obviously , this must be Female Tattoo Disease (FTD). Just kidding. I have no idea what name to assign to this unusual constellation of findings. A...

View Discussion

Challenging case 19 hours ago

Dear colleagues, I'd like to receive your insight on this case. A woman in her 40s with history of abdominal pain, weight loss (now weighting abo...

View Discussion

RE: lupus proteinuria 22 hours ago

Prof.Ritchard, CNIs-voclosporin if affordable, tacrolimus otherwise-are first-line in isolated class V LN for three reasons. 1. Strong RCT signal: ...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

IL-6 is the only cytokine that I know of associated with hypercalcemia. IL-6 is produced together with parathyroid hormone-related protein (PTH-rP)...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

To summarize previous notes commentss. This is a case of a 45 y /o female carrying a diagnosis of SLE/MCTD for past 9 yrs .Rxment with hydroxychl...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

These results raise question. about compliance with the vitamin D prescription. For poorly understood reasons patients with SLE often have Vitamin ...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

@Richard Glassock: This patient's first visit one year ago at our institution was in the ophthalmology clinic to check for eye toxicity from hydrox...

View Discussion

RE: lupus proteinuria 1 day ago

Why is a CNI ( Voclosporin first Choice) the preferred approach to "pure" Lupus Membranous Nephropathy . Is this based on expert opinion or evidenc...

View Discussion

RE: lupus proteinuria 1 day ago

Hello,the safest approach is still to *do* the biopsy. Bridge warfarin with therapeutic LMWH for 3–5 days (CHEST 2022 peri‑op antithrombotic guidan...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

Thanks- How long had she been taking 50,000 IU of Vitamin D per week when the 25 Hydroxy Vitamin D leveks was measured. Are you sure she did n...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

@Awais Nauman: I share your impression that her generalized lymphadenopathy with increased FDG uptake in the lymph nodes, spleen and bone marrow (+...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

I agree with Dr. Glassock that sarcopenia by decreasing urinary creatinine, may significantly overestimate 24 hour urinary albumin or u Rd binary a...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

But HCQ blocks conversion of 25 hydroxy Vitamin D conversion ro 1,25 dihydroxy Vitamin D ------------------------------ Richard Glassock MD, FASN...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

Thanks for sharing the case Dr Venkat. Do you think Lupus is the cause of lymphadenopathy and FDG avid spleen and bone marrow and does it merit t...

View Discussion

RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

Dr Foster: Your comments intrigued me although I have been doing dialysis for over 40 yrs...here is the paper you referred to by Dr Johnson -----...

View Discussion

RE: lupus proteinuria 1 day ago

Has the patient been evaluated for antiphospholipid antibody syndrome and renal vein thrombosis beside with class 5 lupus nephritis? ------------...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 1 day ago

The marked discrepancy between UACR and UPCR is noted and suggest TI disease, as pointed out by Dr. Venkat but because of the high probability of l...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

Truly a mystery. I agree that her low muscle mass and hypoalbuminemia are likely from her chronic inflammation. Some years ago when I was your coll...

View Discussion

RE: Acidosis vs proteinuria 2 days ago

So far as I know, whatever albuminuria might be induced by alkali administration. , whether it is glomerular or tubular in origin is completely unk...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

Normal or even low serum phosphorous levels may be more common in Vitamin D intoxication than suggested in textbooks. 50,000 units per week is a hi...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

@Richard Glassock, @Anatole Besarab: Thanks for your responses and suggestions.During her initial visit with us a year ago, her serum calcium (unco...

View Discussion

RE: Acidosis vs proteinuria 2 days ago

Not to my knowledge, but this would be a good study! ------------------------------ Hunter Huston MD, FASN NASHVILLE TN ------------------------...

View Discussion

Kidney biopsy needles- Bard Monopty 2 days ago

I'm being told that the Bard Monopty 16 gauge needles are being discontinued. Is anyone else having this issue? Are there other 16 gauge kidney bio...

View Discussion

Glomcon RADIANT program 2 days ago

Hello All, Please encourage your fellows to apply to new Rare Disease and Nephrology Research Training Program. The program is intended to teach...

View Discussion

RE: lupus proteinuria 2 days ago

I think you have an excellent grasp of your case. Agree that a Class V lupus MGN is by far the most likely. Of course a biopsy would really hel...

View Discussion

RE: Acidosis vs proteinuria 2 days ago

Dr. Huston. Thanjs for the post. Does anyone know what happens to urinary albumin excretion rates fin these these healthy non-acidotic athletes whe...

View Discussion

lupus proteinuria 2 days ago

38 y.o. Hispanic F referred to office on 4/22/2025 for proteinuria in the setting of active SLE. - Initially diagnosed SLE in 2014 on MM, tapering ...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

I missed the ionized values. Yes , when Calcium exceeded 12mg/dL , ionized Ca exceeded the upper limits of normal. I think the excess vit D being t...

View Discussion

RE: Are KDIGO 2025 TSAT and Ferritin Targets (TSAT ≤40%, Ferritin ≤700 ng/mL) for Dialysis Anemia Management Evidence-Based? 2 days ago

The controversy goes beyond just the original PIVOTAL Study and the restriction placed by geographic and ethnic factors. I frankly disagree that ...

View Discussion

RE: Acidosis vs proteinuria 2 days ago

There is some data to back this up. What is unknown is whether in this situation it translates into clinical consequences -----------------------...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

The ionized calcium was elevetad on several determinations. As far as I can tell, 25-OH vitamin D leveks were never measures. Hypervitaminosis D is...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

Agree that this is a fascinating case. I would only mention a couple of aspects. The hypercalcemia was noted while she was taking 50K of vitam...

View Discussion

RE: Acidosis vs proteinuria 2 days ago

Dr Glassock, it's interesting the point about NaCl vs Bicarbonate. I do quite a lot of work in the sports performance arena and both of these point...

View Discussion

RE: Hypercalcemia in a patient with SLE/MCTD 2 days ago

A lymph node biopsy showed non granulomatous inflammation, making Sarcoidosis unlikely. The 1,25 dihydroxy Vitamin D level was normal during hyperc...

View Discussion