RE: Subacute rise in creatinine should I biopsy 19 minutes ago

Biopsy decision will rest fresh urine sediment microscopic exam and serology. Until these are available I am reluctant to say yes or no to the biop...

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RE: Subacute rise in creatinine should I biopsy 58 minutes ago

TYPE 1 DM, BP was uncontrolled UACR 6000mg/gm, very nephrotic Creatinine 3.8 mg/dl to 8 in 8 months seems a bit fast but I doubt I would b...

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RE: Subacute rise in creatinine should I biopsy 1 hour ago

Unfortunately he dont have full records Urine out put 1 liter per day on torsemide 20 mg po I already asked for C3 and C4 urine analysis all s...

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RE: Subacute rise in creatinine should I biopsy 3 hours ago

Urine sediment findings? Daily urine output volume just before he was started on dialysis? Was SCr stable or increasing daily before dialysis was s...

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Subacute rise in creatinine should I biopsy 4 hours ago

Dear colleague I hope you help me for a acase of 30 years old who is a known case of T1DM since childhood with history of PDR on Insulin. He was fi...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 4 hours ago

I also think this is a renal limited B cell lymphoma. Are the cells monoclonal? Immunohistochemistry should help. An extensive hematology evaluatio...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 13 hours ago

Addendum- why was a Bone Marrow biopsy not none? Was a PET/CT scan done? Was a cyto-genetic analysis of the Bcell infiltrates performed? --------...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 15 hours ago

Strangel case. The advanced Disbetic Nephropathy seen in the biopsy accounts for the proteinuria and orogrssive loss of GFR. This might be a highly...

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Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 15 hours ago

Dear Colleagues I would like to get your opinion about the management of an interesting case 65 years old hispanic male with PMH of DM II, HTN...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 15 hours ago

Dr Ali For clarification, could you please post the initial UACR (in mg/gm) and the UPCR (in mg/gm). There may be some confusion as you did not s...

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RE: Double positive ANCA MPO and GBM rapid progressive renal failure 17 hours ago

What is the current Anti-MPO ELISA, and anti-GBM.? If both negative I might opt fir monitoring rather than maintenance therapy (with RTX every 4 mo...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 23 hours ago

Biopsy might identifying renal disease related to MM which justify treatment. We have seen light chain tubulopathy with minimal or no proteinuria. ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 23 hours ago

It would be unusual for such as slow progression. ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 208-1459 --------...

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RE: Double positive ANCA MPO and GBM rapid progressive renal failure 23 hours ago

Dear all, I will like to ask your help with this patient. She is still in remission only with induction treatment that i previous described. The...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

I agree fully with Dr. Rodby and Dr. Rubin on the importance of "team management" in this complex case. The patients desires and wishes for future ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 1 day ago

Dr. Leung. Thanks . Just curious. Why would you not consider this case as having Light Chain Cast Nephropathy secondary to a light chain MM? ----...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

@Roger Rodby Thank you for asking my opinion. This is clearly a complex case which requires expertise and team effort. It cannot and should not b...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

"Actually with active cancer now, he's not a candidate for future Transplant anymore and we will be managing him most likely in future" I would s...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 1 day ago

Thanks @Richard Glassock. It depends a lot on whether this patient is a good candidate for chemotherapy. With little albuminuria, I would probably ...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

With a creatinine of 5 his urine ratios are unlikely to be reliable. However he does have hypoalbuminemia. I would not be keen on further immunosup...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

Actually with active cancer now, he's not a candidate for future Transplant anymore and we will be managing him most likely in future -----------...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

With all due respect to the sincere attention you are giving him, Why are you trying to manage this, shouldn't his transplant center team take c...

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management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

African-American gentleman. Age 77, got kidney transplant in April, 2017 because of probable hepatitis C virus associated glomerulonephritis and ty...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 2 days ago

This thread began with a question about possible contraindications for kidney biopsy in the presence of asymptomatic bacteruria and pyuria. In my o...

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RE: Nephrotic range proteinuria associated with cGVHD 2 days ago

Hello everybody. I apologize for answering after such a long time. To answer the questions that you asked me, the patient did receive Tacrolimu...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 2 days ago

I agree with the comments about myeloma and biopsy reiterate that from what I think we've been told the protein in the urine is albumin suspe...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

Thanks Dr. Leung. If you think this is a LC MGUS, with a serum creatinine at the 3 level, but with little albumin in urine would you still do a kid...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

In general the relation between CFHR deletions and complement mediated HUS is through the production of anti CFH antibodies. I am not aware of any ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

As Dr. Rodby and others have said, if this multiple myeloma, a biopsy is probably not going to change the management unless it is amyloidosis which...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

What was the initial serum kappa free light chain level? If over 500mg/L the diagnosis of Myeloma Cast Nephropathy is very likely. This patient nee...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

If a diagnosis of MM is made I do not see a reason for a kidney biopsy bc the treatment is for MM, not the pattern of renal involvement. Havin...

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RE: AKI, urinary K Wasting and uncontrolled HTN 3 days ago

You can continue spironolactone and even escalate the dose to 50 mg /day as far as serum K [More]

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Although her A1C is 5.8, however, her OGTT is within normal limits and has no evidence of increased risk for diabetes as evidenced by calculated an...

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RE: AKI, urinary K Wasting and uncontrolled HTN 3 days ago

This elderly patient presents with recent worsening kidney function, accelerated hypertension with spontaneous hypokalemia suggesting possibly seco...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

I strongly recommend biopsy in this case if he can safely be taken off of his anti-platelet agents for the following reasons: The diagnosis of m...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

The most recent KDIGO guidelines recommend using a risk calculator to assess the donor's risk and having a cut-off acceptable to the individual cen...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

My answer is only pertaining to genotype of the donor. Birth weight and nephron number aside, she should not be excluded. Risk for the recipient is...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Thanks very much for the incredibly prompt responseCheersShlomo -- Shlomo Cohney FASN PhD FRACP MRCP MBBS Physician/Nephrologist/Transplant Immu...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Her BMI is 29.97, had 2 pregnancies but no gestational Diabetes. We did OGTT since she had HbA1c 5.8, her Fasting was 90 mg/dl and two hours glucos...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

Presumably he has IHD and AF (clopidogrel & apixaban) He is on a lot of pills ! Yet he is not on any RAAS blockade He likely has significant reno...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Thus is eGFR -by the EKFC equation, not mGFR, but these values should be pretty close to mGFR. (see Astley, M, et al Kidney Int, 2025) ...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Many of us (in Australia) are hesitant/reluctant when considering younger donors and especially in a child to parent situation If as I understand ...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

The median eGFR for 40-45 year old healthy female is 100ml/min/173m2. An eGFR of 80ml/min /1.73m2 is at the lower limit of "normal" . I agree wit...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Average GFR in age 40-49 is 80-100 ml/min-1.73-so 80 is lower limit for normal but many LKD programs prefer > 90 in donors with potential longer li...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Sunday, March 30 @ 3:37 PM

I have to find out what was her birth weight. However, my understanding from reviewing literature evaluating normal GFR in general population, is t...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Sunday, March 30 @ 2:50 PM

In addition to the genetic concerns mentioned above, a 44 year-old donor with a GFR is 81 ml/min/1.73. Would cause me to recommend against acceptan...

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RE: AKI, urinary K Wasting and uncontrolled HTN Sunday, March 30 @ 10:21 AM

He was started on spironolactone 25 mg daily on 26 March and since then, creatinine has rose from 3.5 to 4.1, a 17% rise, BUN has rose from 41 to 5...

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RE: AKI, urinary K Wasting and uncontrolled HTN Sunday, March 30 @ 6:45 AM

13,6grams /d of total urine protein excretion , yet only 3.5milligrams/ d of albumin. Something is wrong here. What is the urinary Immunofixation o...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? Sunday, March 30 @ 3:56 AM

This is highly suggestive of LCCN based on high sFLC > 500 mg/l and predominantly non-albumin proteinuria plus kappa light chains predominance. I w...

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RE: AKI, urinary K Wasting and uncontrolled HTN Sunday, March 30 @ 3:34 AM

Thanks for additional informations. Blood gas with knowing of blood PH is important in interpretation of acid-base disorders. Because if we have on...

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