RE: 25-year-old male with PLA2R-positive membranous nephropathy, persistent nephrotic-range proteinuria, and CKD stage 3 - seeking management guidance 2 hours ago

If this patient has been treated with appropriates doses of RTX and followed with serial measurements of anti-PLA2R this would be a decidedly decid...

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RE: 25-year-old male with PLA2R-positive membranous nephropathy, persistent nephrotic-range proteinuria, and CKD stage 3 - seeking management guidance 4 hours ago

Also, serial kidney ultrasound results -size/echogenicity/cortical thickness? SCr/eGFR trends over past few years? Serum albumin and lipid levels? ...

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RE: 25-year-old male with PLA2R-positive membranous nephropathy, persistent nephrotic-range proteinuria, and CKD stage 3 - seeking management guidance 6 hours ago

You state he is on Immunosuppressive therapy, what specific medications(s) and for how long has he received it/them? what is his entire anti PLA2...

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25-year-old male with PLA2R-positive membranous nephropathy, persistent nephrotic-range proteinuria, and CKD stage 3 - seeking management guidance 6 hours ago

I would like expert input regarding a 25-year-old male medical student with biopsy-proven primary membranous nephropathy (PLA2R-positive) who has b...

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RE: Lupus nephritis class IV and V 6 hours ago

On the LM 9 out of 12 glomeruli are globally sclerosed , 2 of the 3 viable glomeruli have segmental sclerosis and 1 has wire loop lesion. The pro...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 7 hours ago

@Roger Rodby thanks for sharing these images , especially leonine facies .. until now I didn't pay attention to this clinical description of my pat...

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RE: Data Leakage from AI in Kidney Care?-- Enterprise Data Protection in AI: What It Really Means? 8 hours ago

Really clear explanation... thanks for laying it out so well. It would be amazing for trainees/fellows to have enterprise access in the future so t...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 10 hours ago

"at exam leonine facies, wheelchair bound (severe myopathy), multiple fractures in the past most recent femoral fracture few months ago, lower extr...

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RE: Lupus nephritis class IV and V 10 hours ago

While the pathology is mostly mesangial and membranous lupus, with a single glomerulus showing endocapillary hypercellularity and a wire loop I thi...

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RE: Lupus nephritis class IV and V 11 hours ago

Agree with Dr Venkat that the initial Bx shows a lot of irreversible changes (9 of 12 glomeruli sclerodes) and significant tiubular fibrosis. This ...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 11 hours ago

Agree with all of your recommendations. .Bone specific Alk Phos is not widely available and while at HFHs was a send out. I studies a number of pat...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 12 hours ago

reviewed no use of biotin ------------------------------ Radu Raducu MD MD Sanford Hospital BIsmarck ND (203) 606-7322 -------------------------...

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RE: Lupus nephritis class IV and V 13 hours ago

C3, C4, anti-ds-DNA antibody levels/trend? ESR, CRP levels? Seems to have lot of irreversible chronic damage in the biopsy. -------------------...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 21 hours ago

Biotin blood test results can be significantly skewed, leading to falsely high or low values that may cause misdiagnosis. High doses of biotin, oft...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 21 hours ago

Make sure pt not on high dose Biotin High levels of biotin can interfere with parathyroid hormone (PTH) tests, leading to inaccurate results. Biot...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Good point. This is a heterozygous VUS- at COLIVa3 so pathogenicity is uncertain without other studies. Two consecutive EM studies failed to show a...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Could secondary FSGS due to COL4A3 renalsight result which does not suggest gentic cause for FSGS but does mention VUS in the COL4A3 Thanks -----...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Very interesting case indeed. I agree with most of the comments. With normal calcium and phos without binders is also interesting and suggests the ...

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RE: Data Leakage from AI in Kidney Care?-- Enterprise Data Protection in AI: What It Really Means? 1 day ago

Thanks for sharing this @Wisit Cheungpasitporn - it's a really important discussion. I wish to emphasize that "enterprise data protection" and "en...

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RE: Lupus nephritis class IV and V 1 day ago

Thank you Dr. Glassock. She has been prescribed hydroxycloroquin and ARB. I will give pulse doses of steroid. Still waiting for UPCR results. --...

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RE: Lupus nephritis class IV and V 1 day ago

There is no universally agreed upon optimal therapy for LN of this category of LN (Class IV + V ; a + c). My suggestion would be for "Triple Therap...

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Lupus nephritis class IV and V 1 day ago

Dear colleague, I have 38 y/o AA female with previously diagnoses lupus nephritis 12 years ago. She has lost to follow-up for the past 9 years an...

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RE: Onconeph case 1 day ago

Thanks ------------------------------ Emilio Venturelli MD Scuola di specializzazione in Nefrologia, Università degli studi di Genova Genova ---...

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RE: Onconeph case 1 day ago

Dr. Venturelli. For sure it is difficult to assign a possible nephron injury as caused by only oneof two potentially nephrotoxic agents, base on cl...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Dr Nauman, That's a very good point and I think you are correct that G1 and G2 in cis has not been reported. They are mutations in different l...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

In my opinion, it is not possible to interpret diffuse podocyte effacement as a "diagnostic" sign of Primary FSGS lpm when features of Diabetic Nep...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Dear Dr Abra This patient has G1/G2 risk alleles. I was under the impression that G1 and G2 cannot exist together on same allele and therefore ...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Great. Thank you Dr. Abra ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

If the two APOL1 mutations are on the same chromosome (in cis) then the other chromosome has a normal APOL1 gene and there is no increased kidney r...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Appreciate the input and I also find it curious thecthe second bx just 6 months later shows the perihilar sclerosis which is suggestive of 2ry FSGS...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

@Graham Abra Can you please explain and provide references on the clinical value of determining a luminal (cis) vs. cytoplasmic (trans) orientati...

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RE: Onconeph case 1 day ago

Urine can be sometimes bland in interstitial nephritis If interstitial nephritis due to ICI will need steroid Dr Glassock don’t you think Bx is ne...

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Data Leakage from AI in Kidney Care?-- Enterprise Data Protection in AI: What It Really Means? 1 day ago

🔒 Enterprise Data Protection in AI: What It Really Means As AI becomes woven into clinical, research, and operational workflows, Enterprise Data P...

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RE: Onconeph case 1 day ago

Dr. Glassock don't you think Nivolumab, more than Cabozantinib, might be the culprit in this case given the absence of proteinuria and the presence...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Dr. slater in my opinion the second biopsy with perihilar focal segmental sclerosis provide additional support that this is secondary (most likely ...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Thanks for the additional information. I am not convinced that this is Primary FSGS. Diabetic Nephropathy + Obesity related Glomerulopathy is most ...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Apellis is recruiting patients for Phase 3 trial on Primary FSGS with Pegcetacoplan. Perhaps that would be an option. ---------------------------...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Can we have the bone imaging findings and the bone turnover studies? The explanation for normal PO4 levels without binders might be the use of more...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Yes the bx was from his native kidney and it was mislabelled further digging I found he has h/o pre diabetes at time of 1st bx HbA1C 6.2...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Very interesting case! I agree with your thought that the two APOL1 gene mutations are likely in cis given the lack of proteinuria though certain...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Very interesting case, and thank you for the references Drs Besarab and Raduca. Our Endocrine Surgeons do a reasonable number of subtotal parathy...

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RE: Steroid Resistant FSGS treatment with Obi ? 1 day ago

Thanks- this is labeled as an allograft biopsy. Is this an error? There are significant changes for Diabetic Nephropathy.. Is the patient Diabetic ...

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RE: Steroid Resistant FSGS treatment with Obi ? 2 days ago

Salb range 2.5 to 4 dependent on UPCR now Salb 4.0 w UPCR 3 gm ------------------------------ Jonathan Slater MD Renal & Transpla...

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RE: Steroid Resistant FSGS treatment with Obi ? 2 days ago

Did the EM of the original biopsy show diffuse FP effacement? What was the serum albumin when he presented with proteinuria? Has genetic testing fo...

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Steroid Resistant FSGS treatment with Obi ? 2 days ago

Appreciate others thoughts regarding 64 y/o M I inherited with primary FSGS Apol1neg kidney bx 2020 with all IS regiments w/o any benefit, in...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 2 days ago

Although I sent the references, my own experience has not been one of ever having to do an inter-operative dialysis during a subtotal or total para...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 2 days ago

Another factor that has been implicated in perioperative hyperkalemia in patients with impaired renal function is prolonged preoperative withholdin...

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RE: Onconeph case 2 days ago

Single kidney, no hematuria or proteinuria and a falling eGFR that is unexplained. The Cabozantinb has to be the main suspect, based on information...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 2 days ago

I have never encountered this phenomenon either. Intra-operative hyperkalemia has been reported when succinylcholine is used as an anesthetic (part...

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RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 2 days ago

I must admit that in my limited experience with management of patients with ESKD on dialysis following subtotal parathyroidectomy (not total PTX) I...

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