RE: Nephrotic syndrome with massive bilateral PE 32 minutes ago

Agree with Dr. Glassock that steroids are not my first choice due to morbid obesity and possible steroids AEs she may have. Proteinuria reduction ...

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RE: MPO VASCULITIS 1 hour ago

No hydralazine therapy is reassuring. With platelets of 100,000 ,off Apixaban and normal INR a kidney biopsy would likely be reasonably safe. unusu...

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RE: Nephrotic syndrome with massive bilateral PE 1 hour ago

The average time to CR for RatX monotherapy of MCD is about 25 days, and can be as short as 12 days. I am not sure that Prednisone is any quicker a...

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RE: Nephrotic syndrome with massive bilateral PE 4 hours ago

There is really no evidence on triple therapy. I'm just adding Tac to limit steroids exposure, and this is as a bridge to rituximab until it takes ...

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RE: Nephrotic syndrome with massive bilateral PE 4 hours ago

Thanks Dr Glassock. So you would just give Rituximab alone? Are steroids contraindicated during acute PE? I mean do they have prothrombotic ef...

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RE: MPO VASCULITIS 4 hours ago

Thanks Dr Glassock. Platelets: 101000 101 L x 10^9/L Hb 8g/dl; INR 1.3 , Urine: No red cell casts or acanthocytes, HBV, HCV: Non-reacti...

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RE: ig a case is it alcohol/liver disease related. 5 hours ago

This might be IgA Vasculitis complicating chonic alcoholic liver disease explaining the biopsy findings and the abdominal pain. (Visceralvasculitis...

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RE: nephrotic syndrome with 9 hours ago

What is seum albumin, C3 and C4, HCV and HBV status.? Is he receiving anticoagulants. Prostatic cancer will not be a contraindication to chemothera...

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RE: MPO VASCULITIS 9 hours ago

What is the level of platelets. What are his current medications? Does the urine show. RBC casts or acanthocytes. Vwhat is his HBV and HCV status a...

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RE: Nephrotic syndrome with massive bilateral PE 9 hours ago

I do not think that a rebiopsy is indicated in the setting. She needs continual anticoagulation with full dose warfarin monitored carefully by freq...

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MPO VASCULITIS 10 hours ago

Dear all 74 year old cacusian with the following comorbidities Hypertension Cirrhosis liver biopsy proven Jan 2025. No ascites no oesophag...

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nephrotic syndrome with 11 hours ago

BG 76 male DIAGNOSES:  Left atrial appendage occlusion January 2024 (22mm Amulet device)  Permanent atrial fibrillation  Previous haemorrh...

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ig a case is it alcohol/liver disease related. 11 hours ago

46Y M- GP referral with worsening abdominal pain and cramps PmHx; COPD CLD ETOH access IVDU Opioid type drug dependence - under turning p...

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RE: Nephrotic syndrome with massive bilateral PE 13 hours ago

Is there added benefit of using pulse methyl pred compared to oral pred in DP? --------------------------------- Muhammad Soobadar MBChB UK ---...

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RE: Nephrotic syndrome with massive bilateral PE 13 hours ago

I guess you are not planning to do kidney biopsy in this setting due to need to omit therapeutic anticoagulation in context of new life threatening...

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Nephrotic syndrome with massive bilateral PE 14 hours ago

Dear colleagues, I would appreciate your input on this 16 year old morbidly obese (wt 127kg) female patient with hx of childhood onset nephrotic ...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 15 hours ago

Prof Glassock’s recommendations dated 9/6/26 seems most appropriate, meaningful, logical and excellent holding psoriasis MAB agents and addressing ...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Have you questioned the? mother regarding over the counter preparations containing Methyl Salicylate (oil of wintergreen) ? ---------------------...

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RE: Latent TB and Membranous Nephropathy 1 day ago

With CKD stage 4 the use of enoxaparin or warfarin are very tricky. This is a judgement decision that can only be made by the treating physician af...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

Good points Dr. Kesavan, but still would be more comfortable with stopping the Sekakinumab while steroids are being are being given for IgAN. Just ...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

Thank you Drs. Glassock, Rodby and Kesavan for your thoughts. These are all very helpful. There was no renal work up in April 2025. The initial ren...

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RE: Latent TB and Membranous Nephropathy 1 day ago

Thanks prof glassock hepatitis b /c negative Appreciate help Patient on treatment dose enoxparin with peak And trough level monitoring Have asked...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

Was any renal work up including biopsy done in April 2025 when he had worsening renal function and on set of UACR 1600 mg per gm creatinine -----...

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RE: Anti-gap positive metabolic acidosis 1 day ago

@Michael Emmett any thoughts ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Panc...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

Dr. Rodby' points are all well taken. I would agree that supportive care should consist of an ACEi or an ARB plus an Endothelin antagonist (Atrasen...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Sorry, I wasn't clear about the Tylenol. The mother only gives Tylenol and not aspirin, but he has not had any Tylenol for several months. Sent fro...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

Primary or secondary I'm not sure really matters at this point. This degree of ckd portends a bad long term renal prognosis. There is nothing wrong...

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RE: IgA nephropathy in the setting of psoriasis/psoriatic arthritis 1 day ago

This case illustrates the aphoristic situation of "being between a rock and a hard place" The IgAN is most likely an association with Psoriasis , b...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Since pt got Tylenol it could have brought out an inherited glutathione deficiency? 5-oxoproline toxicity (also known as pyroglutamic acidosi...

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IgA nephropathy in the setting of psoriasis/psoriatic arthritis 2 days ago

Dear all, can I please get your thoughts with my patient. 48-year-old male with psoriatic arthritis and hypertension presents with worsening kidn...

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RE: Anti-gap positive metabolic acidosis 2 days ago

I agree venous pH is important just a little more difficult in a two year-old that I was consulted on the phone for a " curbside" consult .He was a...

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RE: Anti-gap positive metabolic acidosis 2 days ago

I'm an adult nephrologist. Blood work is just harder to get on little kids but working on it. Sent from my iPhone On Sep 5, 2026, at 06:56, James H...

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RE: Anti-gap positive metabolic acidosis 2 days ago

You're not critical, but there are some logistical issues. I was curbside consulted on the phone about this case. A pediatric nephrologist saw the ...

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RE: Anti-gap positive metabolic acidosis 2 days ago

Yes I was thinking of hunting zebras. The child is nearly 3 and at the 50th percentile in both height and weight with normal intellectual function ...

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RE: Anti-gap positive metabolic acidosis 2 days ago

Child voided in the laboratory and the mother reports the lab results were ready in less than an hour. Child hasnever received aspirin only acetami...

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RE: Hyponatremia 2 days ago

Drs. Hirsch and Rodby - thank you. I think we largely agree clinically; my remaining points concern the limits of individual measurements. Dr. Hir...

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RE: Anti-gap positive metabolic acidosis 2 days ago

Mother denies salicylate ingestion, and she is quite reliable person Sent from my iPhone

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RE: Anti-gap positive metabolic acidosis 2 days ago

Please forgive me if I'm being critical, but Venus blood gases are so important in the initial evaluation of the serum electrolytes and anion gap. ...

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RE: Anti-gap positive metabolic acidosis 2 days ago

Agree if previous recommended studied unraveling and VBG consistent with MA and osmolar gap are unrevealing Then plasma amino acids, acylcarniti...

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RE: Anti-gap positive metabolic acidosis 2 days ago

The abdominal pain may be a non specific symptom of the acidosis. The elevated U Na suggests the unmeasured anion is being excreted in the urine. A...

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RE: Hyponatremia 2 days ago

Thank you, Dr Liu, very nice. > However, in SIADH, the urine is concentrated (or at least not maximally dilute), so you will not have a vast u...

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RE: Latent TB and Membranous Nephropathy 2 days ago

Be sure to screen for any HBV before giving RTX or OBI ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School ...

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RE: Anti-gap positive metabolic acidosis 3 days ago

Also intense thirst and polyuria are often seen in the early phases of salicylate intoxication. The blood salicylate levels should prove to be inte...

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RE: Anti-gap positive metabolic acidosis 3 days ago

Venus, blood gas is ordered, but not yet obtained. Ultrasound of abdomen is normal. Minimal to no abdominal tenderness.I forgot the blood sugar ear...

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RE: Anti-gap positive metabolic acidosis 3 days ago

The alkaline urine and HAGMA suggests salicylate intoxication. However, if the urine pH was not tested immediately after voiding , it could be a sp...

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RE: Anti-gap positive metabolic acidosis 3 days ago

venous BG? ketones? BG? acetylsalicylic acid level? B-hydroxybutyrate ?, BP? imaging for abdominal tenderness? assume no glucose or ketones in urin...

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RE: Latent TB and Membranous Nephropathy 3 days ago

With a Hemoglobin of 10.8 there is no rush to give EPO. The severe Hypoalbuminemia can be an indication for Warfarin prophylaxis of VTE but the GI ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 3 days ago

The therapy of polygenic LN is the same as with no famiky members involved. I do not know if Mendelian LN should be treat differently -too rare, no...

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RE: Latent TB and Membranous Nephropathy 3 days ago

Any one can help me with questions? Appreciate it --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 3 days ago

If genetic lupus proven does that change management ? And if say children of patient were to have microscopic Haematuria and positive dna would w...

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