RE: treatment for hypophosphatemia 12 hours ago

I would not r/o oncogenic induced phospahe wasting and agree that a repeat FGF23 is needed. Does she have HepB and on treatment? Some other drugs c...

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RE: treatment for hypophosphatemia 12 hours ago

Story more complicated than described initially. Crohn's (mod-severe), multiple sclerosis, RNP (+) connective tissue disease. What therapy? One...

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RE: treatment for hypophosphatemia 19 hours ago

I agree with Prof Glassock. I would also question the assay used as I would still expect it to be much higher with the elevated urine phos and hypo...

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RE: treatment for hypophosphatemia 19 hours ago

A " normal" FGF23 level in the face of hypophosphatemia is "abnormal" . It should be very low. Any features of Fanconi syndrome present? --------...

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RE: treatment for hypophosphatemia 1 day ago

pt is caucasian Good evening, pt received 1 dose of 750 mg injectafer on may 17th and has not had any more doses since. It was prescribed for...

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RE: treatment for hypophosphatemia 1 day ago

Good evening, pt received 1 dose of 750 mg injectafer on may 17th and has not had any more doses since. It was prescribed for a ferritin level ...

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RE: treatment for hypophosphatemia 1 day ago

Good evening, pt received 1 dose of 750 mg injectafer on may 17th and has not had any more doses since. It was prescribed for a ferritin level ...

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RE: Diffuse proliferative GN 1 day ago

Cryos are still pending. RF is now pending as are blood cultures and bartonella titers (Ordered after the initial work up so will be a few days to ...

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RE: Diffuse proliferative GN 1 day ago

Thank you for the response. Somehow we did not get blood cultures or RF. I will rectify this and add the borrelia, bartonella and Q fever labs. ...

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RE: Diffuse proliferative GN 1 day ago

echoing above: Few questions Cryoglobulins? Rheumatoid factor? Use of hydralazine ro Allopurinol Blood cultures Barteonella titers? ...

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RE: Diffuse proliferative GN 1 day ago

Any medications that could be associated with autoantibodies and GN, such as hydralazine? ------------------------------ K.K. Venkat MD Troy MI (...

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RE: Diffuse proliferative GN 1 day ago

These features are consistent with Infection/Related GN (? Bacterial Endocarditis). What is the Rheumatoid Factor level and TEE. If blood cultures ...

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Diffuse proliferative GN 1 day ago

I have a delightful 74y.o. dentist with a history of HTN and HLD who developed a viral illness in March (malaise, fatigue and weakness) that he gra...

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RE: C3 or IgA 1 day ago

IgAN looks like it is splitting into multiple entities in the footsteps of FSGS. The O-glycosylation deficiency seemed to be giving IgA some cohere...

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RE: treatment for hypophosphatemia 1 day ago

I also agree with Dr Rodby, although I would check a 24 hour urine for Phos, Ca, Na and Creatinine to make she has inappropriate hyperphosphaturia ...

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RE: C3 or IgA 2 days ago

Thanks Dr. Hughson for your comment. I may have been too enthusiastic about the potential utility of KN 55 staining to help sort out the conundrums...

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RE: treatment for hypophosphatemia 2 days ago

Sorry for my typing errors. Yes her age and ethnicity are also importan; ferritins and TSATs run much lower in China, Korea, and Japan and in most ...

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RE: treatment for hypophosphatemia 2 days ago

Could you please specify what do you mean by iron exposure and why was the patient "exposed" to iron. If the patient received IV iron, was this fe...

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RE: treatment for hypophosphatemia 2 days ago

I presume IV iron has been dicontinued and which IV iron as used? What are ger current iron parameters and Hb? ------------------------------ Ana...

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RE: treatment for hypophosphatemia 3 days ago

I agree 100% with Dr. Rodby's assessment and recommendations. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) ...

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RE: treatment for hypophosphatemia 3 days ago

This seems like a board question , almost too good, so depending on the IV iron it may stimulate FGF 23 (set attached) I would get a FGF 23 l...

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treatment for hypophosphatemia 3 days ago

Good afternoon, A pt with h/o IV iron exposure has developed hypophosphatemia. Is currently on 200 mg elemental phosphorus/day PO and iv kphos...

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RE: C3 or IgA 3 days ago

This exercise is generating a lot of misinformation. At least it has been decided that CFHR variants have a positive association with IgAN, not the...

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RE: C3 or IgA Saturday, June 21 @ 12:23 PM

KN 55 staining has high specificity but lower sensitivity for identifying Primary IgAN (or IgAV) so only positive staining would have pathogenic si...

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RE: C3 or IgA Saturday, June 21 @ 11:22 AM

I think it may be available at Arkana by request,. Both of these cases were outside the USA. ------------------------------ Richard Glassock MD, ...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF Saturday, June 21 @ 11:20 AM

I discussed with hematologist, he is of the view to err on the side of caution in view of the HBV serology and closely watch HBV serology gor 6 mon...

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RE: C3 or IgA Saturday, June 21 @ 11:03 AM

How available is KM55 in the US? Most reports are from China, Japan and India. Thanks. Mario ------------------------------ Mario Rubin, M.D. Hou...

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RE: C3 or IgA Saturday, June 21 @ 10:33 AM

Thanks for allowing me to get a little more sleep. One way to better understand the two cases would be to stain the kidney biopsy with IgA deposits...

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RE: C3 or IgA Saturday, June 21 @ 10:28 AM

With a CFHR5 mutation, the patient could have presented with C3 or IgA . I would have expected Pegcetacoplan to have the pathways leading to expres...

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RE: C3 or IgA Saturday, June 21 @ 9:56 AM

I don't think we can have a proper answer to that. There are case reports of CFH mutations with C3GN becoming HUS after kidney transplant. These ar...

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RE: C3 or IgA Saturday, June 21 @ 9:26 AM

Thank you, but am still waiting for an explanation on how he went from C3 deposits , to IgA deposits after treatment with C3 inhibitors .. no point...

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RE: C3 or IgA Saturday, June 21 @ 9:13 AM

Centogene has reported it as a VUS. I think you should get this published to add to the literature on this variant. ClinVar has reported this as be...

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RE: C3 or IgA Saturday, June 21 @ 7:21 AM

Centrogene- from Germany has reported on it .. please see attachment --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Co...

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RE: C3 or IgA Saturday, June 21 @ 4:57 AM

Thanks for the genetic update. CFHR5 486dup is described as a variant of uncertain significance. There are also reports stating that it is benign. ...

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RE: C3 or IgA Saturday, June 21 @ 4:37 AM

Thanks .. let's wait for the Professor to wake up and give a response ... I bet he is thinking over the possibilities while he lays in bed . ----...

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RE: C3 or IgA Saturday, June 21 @ 4:17 AM

Both hypothyses i.e, complement mutations confering susceptibility to IgA as well as C3GN and IgA-Antidrug antibodies make intuitive sense. My case...

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RE: C3 or IgA Saturday, June 21 @ 2:41 AM

Ok, great ... So to summarize this case , with his CFHR5 mutation he is at risk for C3G and IgAN. Prior to Pegcetacoplan he manifested as C3G, and ...

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RE: C3 or IgA Saturday, June 21 @ 1:49 AM

It is very clear that CFHR5 mutations are associated with an INCREASED risk of both C3GN and IgAN. ------------------------------ Richard Glassoc...

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RE: C3 or IgA Saturday, June 21 @ 1:47 AM

He had a biopsy at 3 months and 6 months post transplant . He also got 1 dose Eculizumab, 1 week prior to the transplant and a second dose 2 weeks ...

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RE: C3 or IgA Saturday, June 21 @ 1:41 AM

Thanks for the follow-up. How long following kidney transplantation is follow up available. I would judge that there is a high risk of recurrence o...

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RE: C3 or IgA Saturday, June 21 @ 1:34 AM

I was under the same assumption as Dr. Balan. That is the generic mutations causing aHUS/C3 , were protective against IgA . These mutations are ver...

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RE: C3 or IgA Saturday, June 21 @ 1:20 AM

This patient had a successful kidney transplant . His post transplant biopsy is pristine , no IgA or C3 . On a regimen on Tac and MMF ------------...

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RE: C3 or IgA Saturday, June 21 @ 12:14 AM

Addendum- I Would probably stop the Pegacetocoplan and start MMF and moderate does of steroids or even Iptacopan. But who really knows how to treat...

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RE: C3 or IgA Friday, June 20 @ 11:49 PM

This provides the Answer to your question. This mutation (CFHR5) is associated with an increased risk of BOTH C3GN and IgAN!!! Why the Pegacetocopl...

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RE: C3 or IgA Friday, June 20 @ 10:56 PM

See attachments --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidney Care. Nephrology Consulta...

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RE: Renal phosphate wasting Friday, June 20 @ 9:42 PM

Another suggestion. If you are thinking of Albers Schonberg disease, (and which seems likely here), then please screen other family members as this...

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RE: C3 or IgA Friday, June 20 @ 9:28 PM

What was the genetic variant in this patient? To add to the complexity, CHFR variants are known to protect against IgA nephropathy -------------...

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RE: C3 or IgA Friday, June 20 @ 1:53 PM

I also suppose that in such counter-intuitive outcomes, a technical error needs to be given serious consideration. Time will tell. -------------...

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RE: C3 or IgA Friday, June 20 @ 1:41 PM

Btw... The first 2 biopsies were done in the Kingdom of Bahrain, I did try to contact them but was unsuccessful . I could make another push though ...

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RE: C3 or IgA Friday, June 20 @ 1:34 PM

Agree this is a strange and counter-intuitive outcome. All the more reason to pursue the cause with greater intensity and depth. Nature may be tryi...

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