RE: anti gbm serology postive with fever and raised inflammatory markers 56 minutes ago

attached is biopsy report Native renal core biopsies. . CLINICAL DETAILS: Hypertension. eGFR, 56. Presented with severe acute kidney injury, me...

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RE: anti gbm serology postive with fever and raised inflammatory markers 1 hour ago

Dear team, I have handed over the patient this week to colleague He has finished 7th session of plex on Monday 17/08 2nd anti GBM after 2 or 3rd p...

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RE: pr3 +ve is it endocarditis ? 1 hour ago

Dear Colleagues, congenital heart disease have said that treatment of endocarditis would involve possibly open heart surgery they wanted to be cle...

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RE: Light chain proximal tubulopathy 4 hours ago

I find Dr. Leung comments both compelling and constructive. Many Thanks . We need to know the Bone Marrow findings, serum calcium, bone survey and ...

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RE: SLN in Pregnant woman 7 hours ago

Not a bad idea, but how will a positive result therapy at this time. Nephrotic syndrome may have been the cause of a DVT. Just an opinion. ------...

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RE: SLN in Pregnant woman 8 hours ago

With her DVT history.. has she had antiphospholipid antibodies checked? --------------------------------- Alaa Nabih Abdalla nephrology fellow Eg...

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RE: is it APS nephropathy 12 hours ago

Pretty typical aPL antibody syndrome , especially with migraine and thrombosis. Life long Warfatin is the key therapy. I see no reason to perform a...

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RE: MPGN pattern in a 43-year-old woman with a JAK2-positive hematologic disorder, portal hypertension, and a serum IgA-λ monoclonal protein 13 hours ago

By the way, did the marrow showed where the monoclonal IgA lambda was coming from? In POEMS patients, the monoclonal protein can be coming from a p...

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RE: MPGN pattern in a 43-year-old woman with a JAK2-positive hematologic disorder, portal hypertension, and a serum IgA-λ monoclonal protein 13 hours ago

With the absence of immune complexes, I agree this is most likely a chronic TMA. The presence of a monoclonal gammopathy raises the possibility of ...

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RE: SLN in Pregnant woman 15 hours ago

She clearly has immunologically active LN and needs immunosuppressive therapy. I think the choice of AZA, CNI and steroids is a very reasonable str...

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SLN in Pregnant woman 15 hours ago

I have a 26yo with SLN Class 3/4 on 2020 biopsy. Hx of Nephrotic Syndrome and DVT. She had a total of 5 pregnancies and 3 healthy kids. I saw her l...

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RE: Light chain proximal tubulopathy 18 hours ago

I am still not certain that he has LCPT, and even if he does, it could be stable for years without therapy. More concerning is the high serum FLC a...

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is it APS nephropathy 19 hours ago

26 M APL triple positive with low level haematuria and proteinuria has flank pain and i did MRA renal arteries normal ( no coarctation of aort...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 19 hours ago

agree in pd patients with VP SHUNTS PERITONITIS usually does not ascend to cause CNS infection ------------------------------ [Mark] [Lerman] [MD...

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RE: Light chain proximal tubulopathy 21 hours ago

No prominent lysosomes or crystals on EM. We don't t know the significance of occasional Congophilic cast without light chain restriction. -----...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 23 hours ago

A VP shunt is not an absolute contrainducation to peritoneal dialysis. Need other opinions. Dr. Bargman.Dr Rodby ------------------------------ ...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

HD can cause increase in intracranial pressure so should use CVVHD or other continuous RRT first after shunt can do Hd Parsons AD, Sanscrainte C...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

No thrombosis blood pressure controlled If this patient for VP shunt. She can do transplant in future What about peritoneal dialysis. She can do ...

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RE: Light chain proximal tubulopathy 1 day ago

With this degree of a serum free light chain kappa Monoclonal gammopathy. A diagnosis of Multiple Myeloma might be possible using the IMWG-SLIM -CR...

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RE: Light chain proximal tubulopathy 1 day ago

Why is the patient being treated with a SGLT2i.? I cannot see any indication for this medication. ------------------------------ Richard Glassock...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

If malignant hypertension is not present. Cerebral venous sinus stenting has been successful in controlling severe intracranial hypertension associ...

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RE: Light chain proximal tubulopathy 1 day ago

Tagging @Shree Sharma with Arkana who did a wonderful job analyzing the kidney biopsy. --------------------------------- Gary Singer MD, FASN Par...

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RE: Light chain proximal tubulopathy 1 day ago

Thank you for the great discussion about this challenging case. Over the past 5 months, kidney function has been stable - SCr 1.3-1.5 mg/dL (eGFR 4...

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RE: Light chain proximal tubulopathy 1 day ago

apologies for a typo it should be: Interestingly the LAMBDA LCPT appears to be predominantly noncrystalline while kappa restricted LCPT appear...

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RE: Light chain proximal tubulopathy 1 day ago

Dear Colleagues - how about LCPR-US? Years ago, Dr. Leung and colleagues introduced the term MGRS in order to facilitate progress in studying and...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

Agree with Dr.Glassock Ai consultant recommends frequent LP, avoid acetazolamide, use Toprimate (reduced dose) instead, consider ONSF vs venous s...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

What is the patients systemic arterial BP? What is the current anti-hypertensive regimen.. Any features suggesting a concomitant TMA.? ----------...

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RE: maintenance for PR3 ab AAV? 1 day ago

I have seen several patients with GPA and persistence of + anti-PR3 ANCA experience severe life endangering relapses after many years (20 years in ...

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RE: maintenance for PR3 ab AAV? 1 day ago

Thank you Dr Rodby. Any other thoughts? ------------------------------ Sumeyye Calp Inal MD Duluth GA (347) 237-8759 ------------------------------

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management of a patient with CKD stage 5 and severe intracranial hypertension. 1 day ago

The patient has: * CKD stage 5; creatinine 736 µmol/L * Urea 22 mmol/L * K 4.4 mmol/L * HCO₃⁻ 23 mmol/L * Papilledema * MRI brain showing increase...

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RE: Light chain proximal tubulopathy 1 day ago

Interesting case. We know the patient has a kappa monoclonal gammopathy but what is happening in the kidney. The EM description does not report any...

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RE: Light chain proximal tubulopathy 1 day ago

I think that investigation for MGRS is warranted. It has been almost 20 years since the non-crystalline LCPT was reported for the first time by us ...

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RE: Rapidly progressive glomerulonephritis 2 days ago

RTX can be very effective in IgAV but not in IgAN, for poorly understood reasons. No RCT data (yet) . I would have tried it. If no contraindication...

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RE: Full House/Non Lupus nephropathy 2 days ago

" GFR stable ".... Could you elaborate a bit on the actual GFR ... is it low for age or normal ... --------------------------------- Dr. Hormaz D...

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RE: Rapidly progressive glomerulonephritis 2 days ago

Just to update the community. No definitive infection identified Shortly after the start of prednisone he developed edema. MMF 1g bid was added ...

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RE: Light chain proximal tubulopathy 2 days ago

I believe Dr. Glassock is right on the money. The toxicity of LC in PCT can happen in the absence of crystals or clear deposits. Mis-trafficked and...

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RE: Light chain proximal tubulopathy 2 days ago

In my opinion, this is pathological trafficking , not physiological trafficking, and a bone marrow examination in needed to identify a clone, not t...

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RE: Light chain proximal tubulopathy 2 days ago

I am not sure. Given that is was sufficiently focal to be below diagnostic threshold for LCCN, I am not sure there would even be enough material to...

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RE: Light chain proximal tubulopathy 2 days ago

Does mass spectrometry of the congophilic casts is helpful in this case for better clarification? --------------------------------- Hayder Aledan ...

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RE: Light chain proximal tubulopathy 2 days ago

An interesting paper exploring this concept: Maike Büttner-Herold 1,*, Nathalie Krieglstein 1, Teresa Chuva 2, Kaija Minuth 1, Frederick Pfister...

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RE: Light chain proximal tubulopathy 2 days ago

Although kappa light chain (monomers ) are filtered more readily than lambda light chain (dimers) these values are not compatible with physiologica...

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RE: Light chain proximal tubulopathy 2 days ago

The congophilic casts are bit concerning to me as that is an extremely unusual non-specific finding in most renal biopsies (at least in our lab). B...

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RE: Light chain proximal tubulopathy 2 days ago

Last SPEP showed free kappa LC and no M-spike. BM biopsy yesterday (pending). ------------------------------ Gary Singer MD, FASN Partner Midwe...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

Thank you for sharing. Seems like quite a bit of chronicity >50% GG, 60-65% IFTA, and severe arteriosclerosis and arteriolar hyalinosis. It is stil...

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RE: Light chain proximal tubulopathy 2 days ago

LM: 19 glomeruli, 6 globally sclerotic. The intact glomeruli appear unremarkable, with no mesangial expansion, endocapillary hypercellularity, fibr...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

In view of the now known severe IFTA and the paucity of data regarding the benefits of immunosuppressive therapy for either TG or chronic active AB...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

LM: Up to 24 glomeruli are identified, 13 of which are globally sclerotic. Intact glomeruli show diffuse mesangial matrix expansion and mild mesang...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

IF: The sections are stained for IgG, IgM, IgA, C3, C4d, C1q, albumin, fibrinogen, and kappa and lambda light chains. There is granular capillary w...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

my understanding from reading Dr.Zuckerman's comments which seems consistent with DR. Rubin and mine-IGAN+CABMR. proteinuria IMO could be either or...

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RE: Light chain proximal tubulopathy 2 days ago

perhaps a bone marrow biopsy might help differentiate between physiological trafficking versus a true light chain tubulopathy? ------------------...

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