RE: Thin BM 59 minutes ago

attached ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773)...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 hours ago

@Stuart Sprague I assume that this patient remains hypophosphatemia without phosphate binders. How often do you see a low serum phosphorus in a pat...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 2 hours ago

I think if a repeat biopsy still shows a smoldering chronic active vs chronic fibrotic TMA , possibly CM-TMA, there is a very good case for C5 bloc...

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RE: Thin BM 4 hours ago

I would be grateful if anyone on this forum would elaborate more on DFS 70 and it's utility . --------------------------------- Dr. Hormaz Dastoo...

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RE: Young male patient with IgA nepropathy 5 hours ago

I was (and still am) a member of the TESTING trial so I very much agree and support the notion (expressed in the UpToDate guidelines that oral mode...

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RE: Thin BM 5 hours ago

Reprocessing of paraffin embedded renal biopsy tissue for EM examination is well known to result in "substantial " thinning of BM. Thus, the Suspic...

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RE: Young male patient with IgA nepropathy 5 hours ago

Dr Glassock, I recently saw an abstract from (attached) ASN that showed TESTING IgA effects lasted 6 years. While still in abstract form, this...

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RE: Thin BM 5 hours ago

My understanding as mentioned by our rheumatologist was that a Positive DFS 70 , in the presence of only a Positive ANA ( negative dsDNa) rules out...

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Chronic Active Thrombotic Microangiopathy - kidney biopsy 5 hours ago

Dear all, Case for Discussion A 39-year-old previously healthy man, with a history of bioprosthetic aortic valve replacement (2022), presented...

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RE: Thin BM 5 hours ago

I was not sure what the DSF-70 antibodies mean https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.810639/full the conc...

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RE: Young male patient with IgA nepropathy 6 hours ago

I concur again, until the FIND-CKD is published we don't have a large RCT. There are however signs of efficacy from many smaller studies and case ...

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RE: Young male patient with IgA nepropathy 6 hours ago

Thanks Dr. Dastoor for your concurrence with my opinions on thus case, derived from the UpToDate guideline. I have no objections to adding non-ster...

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RE: Young male patient with IgA nepropathy 7 hours ago

I concur with the eloquently put statements by Dr. Glassock As stated in Uptodate , having 3 out of 4 high risk criteria , is a strong indication...

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Thin BM 7 hours ago

Dear Colleagues. I encountered a 18 year old lady , who did a preliminary screening test prior to joining college. She also complained on arthral...

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RE: Young male patient with IgA nepropathy 9 hours ago

Clinical end-points of "success" are improved e GFR, reduction of proteinuria , eradication of hematuria.. ------------------------------ Richard...

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RE: Young male patient with IgA nepropathy 9 hours ago

In my opinion, RAS inhibitors ( or Sparsentan ), SGLT2i inhibition (if overweight , obese or diabetic), plus moderate doses of oral systemic methyl...

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Young male patient with IgA nepropathy 13 hours ago

Dear Collagues 26-year-old male with no known chronic disease. His serum creatinine was within the normal range in March 2025, then increased ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 20 hours ago

Serial PTH levels with corresponding serum calcium levels? Possible that PTH was higher and came down when hypercalcemia by a non -parathyroid caus...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

If he becomes hypocalcemic, it would increase the PTH, but if the Calcium remains high normal and elevated likely not Very difficult case, not su...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

bone excavation is in progress We need to stop the osteoclasts. This is hyper dynamic [not a-dynamic] renal osteo-dystrophy type. He might be b...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

Dr. Sprague- Won't Denosumab therapy worsen the hyperparathyroidism? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

High alkaline phosphatase, low phosphorus, high calcium, high PTH = Primary vs. tertiary hyperparathyroidism. Have you done a neck ultrasound looki...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

The handful of patients I have treated with similar presentations all responded to higher dose of parsabiv, which can go to 15 mg per session. --...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Then it is likely not adynamic bone and would proceed with either Pamidronate or Denosumab, whichever you feel more comfortable with. Would still m...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Alkaline phosphatase is elevated at 320 IU/L (normal range 60-116) ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai --...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

At his age, I would not pursue a bone biopsy, though would check a Bone Alk Phos to see if it is relatively low. I also would not use teriparatide ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

@Stuart Sprague ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773) ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Serum alkaline phosphatase and bone-specific alkaline phosphatase levels? Skeletal X-ray findings including hands? ------------------------------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

This high level of serum iPTH makes adynamic bone disease rather unlikely but a bone biopsy would be required to exclude it completely ----------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

PTH level of 70 pmol/l (normal range 1.6- 6.9) with hypercalcemia , is tertiary hyperparathyroidism still questionable in this context? suspecting ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I am sorry for the typo , as ionized calcium is 7.5 mg/dl normal range (4.45 -5.29). adynamic bone disease with suppressed PTH is commonly encoun...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

In my experience Denosumab at 60 mg dose, has not led to a prolonged Hypercalcemia, but does cause severe hypocalcemia . Additional benefit , con...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Non-lateralizing back pain in a female with gross hematuria. . Not likely to be Nutcracker Syndrome. Pelvic pain or “heaviness” or Dyspareunua is m...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Hi, did she have a CTa or MRa? Would check the aortomesenteric angle to assess for nutcracker syndrome. Is she very thin? -----------------------...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

If hematuria dysmorphic (with acanthocytes) no need to evaluate fir Renal TB. If UACR normal and persistent dysmorphic hematuria present biopsy is ...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Not a bad idea but genetic testing has little no value in diagnosing IgAN, at the present time. No increase in UACR -no kidney biopsy, as a general...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I would avoid Bisphosphonates if adynamic bone disease is suspected., especially If the patient is on activex Vitamin D alalogure ( alphacalcidiol)...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Have --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

If this patient patient was to face adynamic bone disease bone biopsy what would pamidronate do? Thanks --------------------------------- Muhamma...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

There is no rush here. I usually do genetic testing before any kidney biopsy. Results in less than 2 weeks now. ------------------------------ ...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

If Dysmorphic rbc and no proteinuria would you biopsy prog glassock Should we check for urinary tb? Thanks --------------------------------- Mu...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Microscopic Haematuria persists She had ct scan --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

No clots , non colicky , non lateralising , no fh of renal disease, white British Urinary acr normal --------------------------------- Muhamma...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Did she have a nob-cintrast CT. Is the pain colicky or lateralizing ? Any clots with gross hematuria . what is her ancestry and family history ? Wh...

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Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

26 female , active in sports , fit and well September 25 starred with macroscopic haematuria and back pain ( while Lowe back ) and microscopic Ha...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

I dont know why, but PTH never seems to be totally suppressed in ESRD, you said the "He was found to have hypercalcemia with serum ionized calci...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

Dr. Rodby thank you for your advise. Hypercalcemia of immobility could it be in this range 7.5 mmol/l.? if its not tertiary hyperpara. why PTH ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

dialysate calcium 1.25. this the least we have. ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai ---------------------...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 2 days ago

My understanding is that a renal phosphate leak is commonly found in hypercalciuric renal stone formers, not due to excess FGF23. My questions ar...

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RE: Hypercalcemia in tertiary hyperparathyroidism 2 days ago

I agree with Dr. Rodby Denosumab should not be used. What is the dialysate Calcium level. Should (or can) it be reduced. ------------------------...

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