RE: GN with Bartonella endocarditis 7 hours ago

At least we now have one RCT as a guide . It says to avoid steroids. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949...

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RE: GN with Bartonella endocarditis 8 hours ago

@David Goldfarb I just read the attached article which may shed some light with your therapeutic dilemma.​ ------------------------------ M...

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RE: fibrillary nephropathy and MDS disease 10 hours ago

MDS is like kidney disease. Some are really bad and some are not so bad. Some can be treated with high dose ESA. Others are pre AML. If it is the l...

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RE: GN with Bartonella endocarditis 10 hours ago

Looks like he is taking really potent drugs but probably not what you prescribed him. That is not predicting a positive outcome. T

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RE: GN with Bartonella endocarditis 10 hours ago

Really appreciated. Dr. Nadasdy, thanks for your thoughts as well. In fact as he returned today after escaping the hospital for a respite, with cre...

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RE: Peripheral B lymphocyte or CD 19 cell count 11 hours ago

There is no reason to check CD19+ cells in PB as he is in a CR with negative ELISA for anti-PLA2R antibody. There is no need to follow ELISA and IF...

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Peripheral B lymphocyte or CD 19 cell count 13 hours ago

Hi All I have a patient with membranous nephropathy which I treated 2 doses of rituximab patient responded very well and his UPC ratio is less than...

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RE: IgA Nephropathy with collapsing FSGS 17 hours ago

Agree with Dr. Glassok. One of the toughest decisions we make is to say we should not treat. We are trained to do things, but sometime, doing nothi...

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RE: osteoporosis in Dialysis pt 1 day ago

You cannot make a diagnosis of osteoporosis in advanced/ESRD, as described by Dr Venkat. In fact, DEXA does not predict fractures in advanced kidne...

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RE: IgA Nephropathy with collapsing FSGS 1 day ago

From your description this is either IgAV (without peripheral signs) or IgAN - C1 with superimposed collapsing FSGS. Either way, with this much IFT...

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RE: IgA Nephropathy with collapsing FSGS 1 day ago

Thanks. HIV negative, no COVID. Hispanic Hard to post full report, but here is the relevant Info I gathered: Bx shows: - 19% (4/21) active c...

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RE: IgA Nephropathy with collapsing FSGS 1 day ago

History of alcohol abuse. Does he have any evidence of cirrhosis. Glomerular IgA deposition may be related to chronic liver disease. "Collapsing...

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IgA Nephropathy with collapsing FSGS 1 day ago

Hi everyone, Would like some input on management of a case. Have a patient in his 30's admitted to an outside hospital 4 months ago with alcoholi...

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RE: fibrillary nephropathy and MDS disease 1 day ago

Thank you very much, really I don't have light chain monotypism and DNAJB9 stains! Randa ------------------------------ Randa Farah MD Amma...

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RE: fibrillary nephropathy and MDS disease 1 day ago

Fibrillary GN is such a rare finding in MDS that it's therapy is unknown at this time. (See Schwotzer N et al KI Reports, 2921; 6: 746. Do you have...

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RE: renal tubular acidosis 1 day ago

Sent from my iPhone

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fibrillary nephropathy and MDS disease 1 day ago

47 year old man , previously medically free , presented with severe Anemia and found to have nephrotic syndrome his kidney biopsy showed fibrillar...

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RE: renal tubular acidosis 1 day ago

This doesn't sound like proximal RTA, is there any sign of a renal Fanconi syndrome? Distal RTA is more likely; does she have a history of stones...

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RE: fe urea 1 day ago

The auther name is Bruce Molitoris ------------------------------ [V] [Melnikov] [MD, FASN ] NW Kaizer Nephrology Salem, OR (547) 768-6930 -------...

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RE: Nephrogenic diabetes insipidus 2 days ago

thanks! I get the point now (I am several decades removed from didactic Genetics!). Lyonization, being limited to the X-chromosomes, should not i...

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RE: Nephrogenic diabetes insipidus 2 days ago

In an autosomal recessive disease all cells are affected equally. In a female with a heterozygous X-linked disorder only some cells are randomly af...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

I agree with with Dr. Nadasdy's very germane comments. RF is often elevated in infection-related GN. ------------------------------ Richard Glasso...

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RE: renal tubular acidosis 2 days ago

Mutations in Several genes be associated with Distal Renal Tubular acidosis (which is what the patient likely has) inherited as autosomal dominant ...

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RE: osteoporosis in Dialysis pt 2 days ago

I think that Dr. Venkat has summarized the issue of Osteoporosis scanning by DEXA scans in dialysis treated ESKD patients very nicely. Using Denosu...

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renal tubular acidosis 2 days ago

I would like to comment on a case of a 29-year-old woman who presented to the emergency department of our institution with hypokalaemia approximate...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

Crescentic GN with C3 and IgG: consider infection before you start heavy immunosuppression. The normal C3 and negative blood cultures do not exclud...

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RE: fe urea 2 days ago

An article about the revised classification and definition of hepatorenal syndrome: News in Pathophysiology, Definition and Classification of Hepa...

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RE: fe urea 2 days ago

Nicely stated and concur. Whatever we call it one still has the task of determining the pathophysiolgy which is the true art of nephrology. ------...

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RE: osteoporosis in Dialysis pt 2 days ago

The problem with bone density measurement in ESKD patients is the following - low bone density in this population is not proof of osteoporosis of t...

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RE: fe urea 2 days ago

Leading to....For a terrific meticulous updated discussion of what we've historically called pre renal failure...see Dr Molinaris, https://cjasn.a...

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RE: Nephrogenic diabetes insipidus 2 days ago

“.. If she has the X-linked form of the disease, and is an obligate heterozygote, Lyonization of the X- chromosome will mean than some nephrons wil...

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RE: Hypercalcemia In Hemodialysis Patient 2 days ago

Calcium of 18 mg/dL seems a little too high for hyperparathyroifism (tertiary more likely than primary). Given age of 70, malignancy has to be kept...

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c3 GN 3 days ago

62-year-old male with history of hypertension, diabetes and hyperlipidemia who presented to the ER in May 2022 with left-sided numbness. His blood ...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 3 days ago

We don't have EM yet. Takes around a week to get EM. ------------------------------ Imtiyaz Hakeem MD Baylor Scott & White Health/Texas A&M COM-HS...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 3 days ago

Blood Cx negative. Complement normal ------------------------------ Imtiyaz Hakeem MD Baylor Scott & White Health/Texas A&M COM-HSC Temple TX ----...

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RE: fe urea 3 days ago

This is obviously a super controversial topic. My 2c is that, in the hands of an experienced nephrologist (e.g., most of the people on this pos...

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RE: osteoporosis in Dialysis pt 3 days ago

No, No, Yes. Please see the extensive prior discussions on the Open Forum regarding this topic. ------------------------------ Richard Glassock MD...

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RE: Hypercalcemia In Hemodialysis Patient 3 days ago

Serum calcium of 18 mg/dL seems too high for hyperparathyroidism (tertiary much more likely in this patient than primary HPT). Failure to suppress ...

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osteoporosis in Dialysis pt 3 days ago

Is there a role for doing bone density test on ESRD pts. and if osteoporosis noted on bone density test then is there evidence that prolia provid...

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RE: gross hematuria in an 18 year old man 3 days ago

This is an 18 year old, short of nephrectomy I cannot think of a test I would not do if there were any chance of a diagnosis, Agree that an angio s...

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RE: fe urea 3 days ago

Dr. Rodby: Dr. Ali's initial post in this thread was regarding AKI-on-CKD. Preexisting CKD may confound interpretation of UNa/FENa and FEurea. Goo...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 3 days ago

Good point. Also a RF might help. Do we have the EM results yet. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 38...

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RE: Hypercalcemia In Hemodialysis Patient 3 days ago

Dear Jebur What is the level of alkaline phosphatase? If alkaline phosphatase is high, I very strongly feel this hypercalcemia is due to hyperparat...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 3 days ago

We're blood cultures sent and what are her serum complement levels? ------------------------------ Daniel Kniaz MD, FASN Associates in Nephrology,...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 3 days ago

None of those. ------------------------------ Imtiyaz Hakeem MD Baylor Scott & White Health/Texas A&M COM-HSC Temple TX --------------------------...

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RE: fe urea Saturday, September 24 @ 4:28 PM

Yes, the question one needs to answer is the physiology behind inadequate renal perfusion. In the the case of excessive vasodilation the patient ne...

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RE: Hypercalcemia In Hemodialysis Patient Saturday, September 24 @ 3:48 PM

How many years your patient on dialysis? What is the result of sestamibi scan? VIT D level? I would say the patient most probably has 3ry hyperpara...

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RE: gross hematuria in an 18 year old man Saturday, September 24 @ 3:44 PM

If the bleeding was coming from the R ureter only and he had R sided colicky pain, this may have been due to clot formation. I think he needs a R s...

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RE: fe urea Saturday, September 24 @ 3:27 PM

"My personal favorite is the patient with HFpEF, on vasodilators, presents with AKI, edema, and PVC." Dr. Mellas: can't a low UNa/FENa or FEurea in...

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RE: fe urea Saturday, September 24 @ 1:35 PM

We agree on the physiology and our names are Robert Robey and Roger Rodby Am I your nom de plume? Are you mine? ;) --------------------...

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