RE: IgA nephropthy 1 hour ago

@Richard Glassock thanks for your responses . His BP is very well controlled . His office BP is 125/80 this morning He is not obese , and curr...

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RE: IgA nephropthy 5 hours ago

I wonder if measurement of serum gdIgA1 (by lectin not KM55 method) would have any value for therapy decision making in patients like this. No defi...

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RE: IgA nephropthy 6 hours ago

Tough case (as usual for IgAN) - the findings you describe suggest a chronic scar rather than active disease so I would use supportive therapy. Is ...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 6 hours ago

Great question. Not an evidence based suggestion. Just an opinion. I have more experience with Iptacopan - easier to administer. Some concerns abou...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 8 hours ago

@Richard GlassockI noticed u pointedly mentioned Factor B inhibitor and excluded C3 blockers . Is that personal experience or some reservations . ...

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IgA nephropthy 9 hours ago

40 year old male from Bangladesh , diagnosed with IgA nephroapthy with M1 E1 S1 lesions Was treated with TESTING course of steroids His eGFR w...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 10 hours ago

Thanks. This excludes a PGNMID. He has C3 GN with slow but steady loss of nephrons - for me this is active disease. I would treat with Iptacopan in...

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RE: Urine Sodium In Hyponatremia 10 hours ago

The Fe uric acid was 18% --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh Shakhbout Medic...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 14 hours ago

Hi, Dr. El-Meanawy, I just wanted to update the paraffin IF result. Per clinician request, paraffin immunofluorescence (PIF) was performed at x...

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RE: Proteinuria 14 hours ago

Thanks for your reply. She is short and her kidney size was similar at the donation time. She didn't have any proteiuria or haematuria prior to thi...

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RE: A difficult case of IgAN 15 hours ago

It would be a lot cheaper and convenient to carry out a Pronase digestion of paraffin embedded material with staining for LC and Ig locally The add...

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RE: Urine Sodium In Hyponatremia 15 hours ago

Also- If the ithe tube feedings contained protein, the additional urea load might have contributed to improvement of the hyponatremia of SIADH by...

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RE: Urine Sodium In Hyponatremia 15 hours ago

Dr. Dastoor: What was the FEuric? I still find it difficult to reconcile the low BUN/SCr/serum uric acid values with a volume depleted state. ---...

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RE: A difficult case of IgAN 16 hours ago

Also out of curiosity would Dr. Sethi agree to perform MS/LD if requested and is there a charge associated with this testing . Any idea on the esti...

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RE: Urine Sodium In Hyponatremia 16 hours ago

It is a interesting concept but one that I find somewhat confusing. HTS and HTS with free water deliver an identical amount of Na. In the latter ...

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RE: finerinoneh 16 hours ago

You would probably get more proteinuira reduction with dose increase , at the expense of higher risk of Hyperkalemia. Worth a try as long as you ca...

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RE: A difficult case of IgAN 17 hours ago

Not without a confirmatory Pronase digestion, just an opinion, ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffe...

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RE: A difficult case of IgAN 17 hours ago

@Richard Glassockthere is an MPGN pattern of injury on LM and IF shows Kappa restriction. Wouldn't that be enough to consider a diagnosis of PGNMID...

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RE: Urine Sodium In Hyponatremia 17 hours ago

I agree , the drop in Na with normal saline is typical of SIADH, since Uosm is typically greater than the osmolality of the infused fluid , free wa...

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RE: Urine Sodium In Hyponatremia 19 hours ago

A few comments; I concur with Dr Fenves that dehydration is not the appropriate term in this case since this implies a lack of free water. This w...

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RE: Urine Sodium In Hyponatremia 19 hours ago

Thanks Dr. Dastoor. The evidence for volume depletion and inappropriate renal salt wasting was weak and the solutions you administered were are ver...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 20 hours ago

Just a follow up on this case over the last 96 hours Patient given Obinutuzumab last thursday and planned for second dose after 2 weeks Last w...

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RE: Urine Sodium In Hyponatremia 21 hours ago

Just to give you a synopsis of the case as we treated him over the last 72 hours This patient was clinically dehydrated , Hyponatermic , and ext...

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RE: A difficult case of IgAN 1 day ago

Thanks for all your suggestions, Dr Glassock. Will try to organise whatever we can get done! ------------------------------ Tanuj Lamech Clinical...

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RE: finerinoneh 1 day ago

In a diabetic with SBP of 120 mmHg in the sitting position I would check BP during orthostasis. Orthostatic hypotension in these patients could gen...

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RE: A difficult case of IgAN 1 day ago

You can also send paraffin tissue to Dr. Sethi at the Mayo Clinic for Laser dissection /Mass spectrometry, which should give definitive answers to ...

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RE: ?Mitochondrial disorder 1 day ago

Thank you. ------------------------------ M Kaisar Nephrologist Brisbane ------------------------------

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RE: ?Mitochondrial disorder 1 day ago

I had a MELAS syndrome long ago that was very severe and present when not under stress, but asking this "mitochondrial mutation that causes lactic ...

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RE: ?Mitochondrial disorder 1 day ago

I agree that with this history and repeated episodes of HAGMA and hypokalemia a genetic mitochondrial cytopathy they should be considered. (See the...

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RE: A difficult case of IgAN 1 day ago

Unfortunately I dont think we have access to those stains, Dr Glassock. But I will check with our pathologist if any of that is possible --------...

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RE: A difficult case of IgAN 1 day ago

Thanks. I better understand your choice of CYC, it hard to say that this is RPGZN with inky C1 crescents. Any chance you can study the biopsies for...

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RE: A difficult case of IgAN 1 day ago

Thank you, Dr Glassock! I did notice the absence of light chains, but didnt think a paraprotein-mediated aetiology was likely at his age, so didn't...

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?Mitochondrial disorder 1 day ago

I would appreciate any input for the case below.. Thank you. Recent reviewed a young lady whom previously had been diagnosed with type 1 RTA t...

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RE: finerinoneh 1 day ago

Thank you. As you mentioned data from https://pmc.ncbi.nlm.nih.gov/articles/PMC10278789/#s3 Mainly black females were the ones with stage 4 CKD i...

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RE: finerinoneh 1 day ago

Thank you for your reply. The patient BP is around 120+ systolic. He is diabetic again well controlled. ------------------------------ M...

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RE: finerinoneh 1 day ago

Thank you for your reply. Only data I could find was indirect : https://jamanetwork.com/journals/jama/fullarticle/2432163 and subgroup analysi...

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RE: A difficult case of IgAN 1 day ago

This is a very atypical presentation and pathology for classical IgAN.. The lack of light chain deposits and the MPGN features features make me thi...

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A difficult case of IgAN 1 day ago

We recently had a patient with IgAN who has been particularly difficult to treat. Would be grateful for advice on what to do next: 19/M, who pres...

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RE: finerinoneh 2 days ago

To reframe your question is that you use Finerenone per trials for CKD patient with an entry eGFR > 25 ml/min but now the eGFR is drift below 25 ml...

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RE: finerinoneh 2 days ago

The FIDELIO DKD trial included diabetic patients with rGFR down to 25 mL/min/1.73 m², but did not establish efficacy below that threshold. Your p...

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RE: are foamy cells in kidney biopsy synonymous with fabry disease? 2 days ago

Thanks prof glassock. Very helpful as usual . Proposed donor excluded. Albumin in donor 33 slightly below normal ( not sure of genetic fsgs can ...

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RE: Proteinuria 2 days ago

How tall is she? 9.5 cm kidney could be small for tall person. Zoledronic might be innocent by stander. If she has FSGS, which is expected, will be...

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RE: Urine Sodium In Hyponatremia 2 days ago

"My main question is that if we assume any patient , is volume depleted , will his Urine Na reflect his volume depleted status ie low Una or will h...

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RE: Proteinuria 2 days ago

Thank you very much for your advice. ------------------------------ Soroush Shojai MD Associate Professor University of Alberta Edmonton AB 0044...

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RE: Proteinuria 2 days ago

Thank you for your advice. We haven't repeated her US recently but her kidney was 9.5 Cm on the latest US. I am not aware of her birth eight but ...

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RE: Proteinuria 2 days ago

The other symptoms reported are consistent with zoledronic acid induced systemic inflammation, a well reported phenomenon, and I wouldn't necessari...

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RE: Proteinuria 2 days ago

Yes her serum Albumin is normal and she doesn't have any oedema. Thank you very much for your advice. ------------------------------ Soroush S...

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RE: Proteinuria 2 days ago

Thank you for your advice. I agree ATIN is a possibility and it was discussed among our team. However, the consensus was even if the biopsy shows A...

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RE: Proteinuria 2 days ago

Hi Thank you for your reply. She doesn't have any glycosuria. ------------------------------ Soroush Shojai MD Associate Professor University ...

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RE: Proteinuria 2 days ago

Reviewed labs - could follow for now on present meds- reserve biopsy if eGFR decreases or becomes nephrotic ( serum albumin normal if read table co...

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