RE: Hypercalcemia in a patient with SLE/MCTD 3 hours ago

I am thoroughly confused. Comes under your care and supposedly taking 50,000IU vit D and taking HCQ. Ca is on the low side and 25-OH vitD level [Mo...

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Positive genetic test for CFH gene 4 hours ago

How do you manage a 70 yr old female with stable renal function with serum creatinine at 1.12 with positive heterozygous CFH complement factor H de...

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RE: Hypercalcemia in a patient with SLE/MCTD 6 hours ago

@Anatole Besarab: In fact, as previously posted, only 1-25 dihydroxy vitamin D level was checked during hypercalcemia work-up and it was normal at ...

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RE: Hypercalcemia in a patient with SLE/MCTD 6 hours ago

Strange discrepancy between UACR/UPCR ratio.no explanation obvious With hypoalbuminemia and nephrotic range total urine protein excretion and negat...

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RE: Hypercalcemia in a patient with SLE/MCTD 7 hours ago

We have reached the point where we still do not understand the complex nature of her disease. We have left the issue of the hypercalcemia and as Dr...

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RE: Alport syndrome 7 hours ago

Dear Professor Richard Glossack, Thank you for your valuable suggestion. Under microscopy, the urine RBC deformation rate exceeds 80%. While persis...

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RE: Hypercalcemia in a patient with SLE/MCTD 8 hours ago

Update: Kidney biopsy results are shown below. To reiterate, her renal parameters preceding biopsy: 1. Urinalysis 1+ protein, no blood, no RBC or c...

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RE: Alport syndrome 12 hours ago

I assume that no clots are seen and that lower unitary tract bleeding is not suspected . The nut cracker syndrome is a confounder here. Has cystosc...

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RE: ANCA with full house IF (?) 15 hours ago

Thank you so much for the input on this case. I'll be updating this conversation once I get the results. I'm looking forward to get results. ...

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RE: ANCA with full house IF (?) 15 hours ago

Thanks- if a Type III cryo is present thus would be compatible with Infective Endocarditis but not ANCA Vasculitis. If s Type II cryo is found then...

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Alport syndrome 16 hours ago

‌Patient Demographics‌ ‌Gender‌: Female ‌Date of Birth‌: December 4, 2015 ‌Clinical Timeline & Key Findings‌ ‌December 14, 2017‌ ‌Chief Comp...

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RE: ANCA with full house IF (?) 16 hours ago

Thank you again Dr Glassock, No hydralazine or any other known drugs that can cause ANCA Cryoglobulin still pending. C3 levels 101mg/dl ---...

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RE: ANCA with full house IF (?) 23 hours ago

Thanks for the additional information. Does the patient take hydralazine.? Can you expedite the serology for the organisms mentioned. My suspicion ...

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RE: ANCA with full house IF (?) 1 day 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...

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RE: ANCA with full house IF (?) 1 day 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 ...

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ANCA with full house IF (?) 1 day 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...

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RE: Challenging Case C3GN 1 day 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...

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RE: Challenging Case C3GN 1 day 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...

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RE: Challenging Case C3GN 1 day 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 ...

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RE: Challenging Case C3GN 1 day 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...

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RE: Challenging case 1 day ago

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

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RE: Challenging case 1 day ago

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

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RE: Challenging case 1 day 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 ...

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RE: Challenging case 1 day ago

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

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RE: Challenging Case C3GN 1 day ago

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

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RE: Challenging Case C3GN 1 day 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...

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RE: Challenging Case C3GN 1 day 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 ...

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RE: Challenging case 1 day 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...

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Challenging Case C3GN 1 day 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 ...

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RE: Challenging case 1 day 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...

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Challenging case 1 day 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...

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RE: lupus proteinuria 1 day ago

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

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

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

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

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

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

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RE: lupus proteinuria 2 days ago

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

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RE: lupus proteinuria 2 days 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...

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

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

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

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

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

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

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

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

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days 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 -----...

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RE: lupus proteinuria 2 days ago

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

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

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RE: Hypercalcemia in a patient with SLE/MCTD 3 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...

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RE: Acidosis vs proteinuria 3 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...

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RE: Hypercalcemia in a patient with SLE/MCTD 3 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...

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RE: Hypercalcemia in a patient with SLE/MCTD 3 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...

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