Kidney Stone Management in patients who cannot come off Topamax 3 hours ago

Any thoughts on how to treat a patient with recurrent kidney stones who cannot stop Topamax? Most recent Litholink results were normal aside f...

View Discussion

RE: Possible Case Of TIN 3 hours ago

Urine output 1.5-2l always --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Possible Case Of TIN 3 hours ago

Never oliguric --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Possible Case Of TIN 3 hours ago

96 mg /mmol Pyuria you mean Wcc? Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Possible Case Of TIN 4 hours ago

I assume 96 is 96 mg/g? If not can you give the units and what is considered normal? If it is in mg/g, this does not seem like enough protein for...

View Discussion

RE: Anticoagulation and kidney biopsy 4 hours ago

Thanks for the article, but from my experience, @Jonathan Foster knows more about dog GN than about anyone. The "problem" with the article is tha...

View Discussion

RE: Transplant Question 4 hours ago

Many thanks 71 male Renal tx April /23 Metastatic prostate cancer diagnosed in April 2024 high psa 66.9 . Bone scan showed sclerotic area left pu...

View Discussion

RE: Possible Case Of TIN 4 hours ago

No fever no skin rash. Eosinophil normal Urine pcr 96 .Rbc non lysed . 737 (0-43) ( this is new hospital I am used to traditional dipstick stuck in...

View Discussion

RE: Anticoagulation and kidney biopsy 5 hours ago

Looks like ICGN is associated with lower albumin and proteinuria vs non-ICGN although histologically amyloidosis( is this common in dogs ) MN and M...

View Discussion

RE: Anticoagulation and kidney biopsy 8 hours ago

Jonathan - found this article regarding veterinary renal pathology with nephrotic Syndrome . I think it is an excellent article for those of us tha...

View Discussion

RE: Possible Case Of TIN 9 hours ago

Seems like slow recovery for ATN and AIN is a possibility but Diabetic with osteo says IgA dominant infection related gn, but her urine should be a...

View Discussion

RE: Possible Case Of TIN 20 hours ago

Urine analysis and urine sediment findings? UPr/Cr and UAlb/Cr? Skin rash, fever, arthralgias, fever, +/- eosinophilia? Tempo of worsening of eGFR ...

View Discussion

Possible Case Of TIN 1 day ago

Dear all., 56 female increased bmi admitted with right 3rd toe osteomyelitis . Egfr 90 dec 24 on admission went to 10 then had amputation . Admitte...

View Discussion

RE: Mpgn 1 day ago

He has Age related macular degeneration and there are some cases of genetic linked c3gn associated with this . Will speak to national complement ce...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

No good data to answer your question- but most physicians I know always try steroids first. IgA V cannot be definitively diagnosed by kidney biopsy...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Just for my learning, what is the difference between igA vasculitis with kidney involvement and igA nephropathy? I called the pathologist and he sa...

View Discussion

RE: Anticoagulation and kidney biopsy 1 day ago

Hematuria? Do you do serologic tests tgat we do in humans, eg Ana, complements etc? What is your pre biopsy top 3 diagnoses in a miniature golden d...

View Discussion

RE: Anticoagulation and kidney biopsy 1 day ago

Just some thoughts. In humans as already pointed out, we would definitely try a course of steroids. I wouldn't do a biopsy on clopidogrel and rivar...

View Discussion

RE: C3 GN with Vasculitic picture 1 day ago

Dr Glassock, you are the expert. I don't know the answer of which drug would be preferred it alternate pathway defect is involved in this particula...

View Discussion

RE: PKD and SGLT2inhibitors 1 day ago

Two points: As was already mentioned, published clinical experience is very small and limited, and controversial as well. (Morioka F et al, J of...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Thanks Dr Glassock, I will go ahead with rituximab for this patient while tapering steroids. Maybe iptacopan can get attempted if there is no impr...

View Discussion

RE: tip variant fsgs relapse in pregnancy 1 day ago

I do understand. ------------------------------ Dr V Lachman Nephrologist South Africa ------------------------------

View Discussion

RE: Anticoagulation and kidney biopsy 1 day ago

PLA2R has been characterized in canine podocytes (Expression of phospholipase A2 receptor in primary cultured podocytes derived from dog kidneys - ...

View Discussion

RE: Anticoagulation and kidney biopsy 1 day ago

If human with same clinical picture - would agree with Dr. Glassock and give empiric steroids without biopsy as risk of holding anticoagulation wit...

View Discussion

RE: C3 GN with Vasculitic picture 1 day ago

Extensive complement testing (except for genetic testing) do not point to alternate complement pathway. I think it is quite clear that her underlyi...

View Discussion

RE: Anticoagulation and kidney biopsy 1 day ago

Empiric steroids is an option. Minimal change disease is quite uncommon in our patients. Only 7.4% of proteinuric dogs were found to have this lesi...

View Discussion

RE: Mpgn 1 day ago

I agree with hematology consult that the Kappa/lambda FLC ratio is within normal limits when the patients eGFR is taken into consideration. The ser...

View Discussion

RE: Mpgn 1 day ago

Em will be done by Thursday. Not sure if urine has been done but will chase it. New hospital new it system still figuring things out Bw -------...

View Discussion

RE: Mpgn 1 day ago

Thanks so much C3 1.16(0.9-1.8 ) C4 0.24 ( 0.1-0.4) Serum kappa 65.1 (3.3-19.4) Serum lambda 27.6 (5.7-26.3) Serum k/l 2.4 (0.26-1.65) Serum ele...

View Discussion

RE: C3 GN with Vasculitic picture 1 day ago

If such studies were done and they showed convincing evidence of alternative C pathway activation, which of the following drugs would you choose fo...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

There are no pathognomonic findings on kidney biopsy for IgAV- it is always a clinical + pathological diagnosis . The 1000 ng X 2 regimen for RTX h...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Dr Glassock, I see your point. Now that I recall, she had a recurrence of a mild vasculitic rash on her abdomen even when on high dose steroids. Sh...

View Discussion

RE: C3 GN with Vasculitic picture 1 day ago

Regarding using Eculizumab, I think it is reasonable to screen for alternate pathway activation by complement testing/genetic studies. ---------...

View Discussion

RE: Mpgn 1 day ago

Agree with Pronase digestion and Paraffin IF for monoclonal LC. What are the absolute levels of serum Kappa and Lambda LC by FLC assay.? What are t...

View Discussion

RE: Anticoagulation and kidney biopsy 1 day ago

Why not try a course of oral prednisone without a biopsy under the assumption that it is NS due to MCD like lesion.? ---------------------------...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

If this is IgA Vasculitis, and I think the evidence points in this direction, then the next treatment of choice is RTX, not Sparsentan, Iptacopan ,...

View Discussion

Mpgn 1 day ago

80 male cognitively intact good et 27/12/24 admitted with haematuria for 2 weeks and kidney function drop . Hb drop 133/116 Cystoscopy and and non ...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 2 days ago

Thank you Dr Glassock and Dr Rodby for your input Complements and ANCA were negative For immunosuppressive component of her treatment - I was c...

View Discussion

Anticoagulation and kidney biopsy 2 days ago

Hi everyone, We were wondering what approach would be taken for a human with a similar scenario,. We have 7 year old miniature golden doodle wi...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 2 days ago

IO think the easiest question is the last one " Could this be secondary IgA from underlying possible cirrhosis? " which is pretty much a no. Ha...

View Discussion

RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 2 days ago

Complex case . This is not likely IgA Nephropathy . The IgA deposits might be related to Cirrhosis . What are the C3/C4 levels, HBV and HCV serolog...

View Discussion

RE: rituxan sensitivity test ( cd 20) 2 days ago

thank you ------------------------------ Usha Peri MD North Texas Kidney Disease Association lewisville TX (214) 356-3428 -----------------------...

View Discussion

RE: rituxan sensitivity test ( cd 20) 2 days ago

Dr. Peri- Please see the long-term follow up of the Mainritsan trials (referenced in my earlier post). For Vasculitis these findings seen to cont...

View Discussion

IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 2 days ago

Esteemed colleagues, would really appreciate help with this case. 59 yo with h/o DM well controlled, referred to me for an acute rise in creatin...

View Discussion

RE: rituxan sensitivity test ( cd 20) 2 days ago

Thanks, Dr Glassock ------------------------------ Ella Koifman-Zeltzer MD Tel-Aviv ------------------------------

View Discussion

RE: rituxan sensitivity test ( cd 20) 2 days ago

Thanks, Dr Glassock ------------------------------ Ella Koifman-Zeltzer MD Tel-Aviv ------------------------------

View Discussion

RE: rituxan sensitivity test ( cd 20) 2 days ago

Great question- no hard data to proved a firm answer. I usually recommend that a BL IgG level be obtained at initiation of RTX therapy and the IgG ...

View Discussion

RE: PKD and SGLT2inhibitors 2 days ago

I tend to agree with Dr. Rodby and would NOT use SGLT2i in ADPKD, unless there is another indication - e.g. T2DM with preserved Kidney Function or ...

View Discussion

RE: PKD and SGLT2inhibitors 2 days ago

I shared the skepticims that SGLT2i might help ADPKD for those same reasons, but here is a good review which illustrates the complexity of effects ...

View Discussion

RE: rituxan sensitivity test ( cd 20) 2 days ago

Dr Rodby, Dr Glassock What is your approach to monitor IGG levels during B cell depleting therapies? To the best of my knowledge, Kdigo 2024 do...

View Discussion