Gibbs-Donnan effect on potassium bath 1 hour ago

I wonder if it is possible to calculate the Gibbs-Donnan effect on dialysate potassium. For example, if a dialysis patient has normal serum albumin...

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RE: GN question 2 hours ago

Good questions Dr. Venkat , as usual. IgA Vasculitis is not a histopathogical diagnosis, but the absence of capillary wall necrosis/crescents make ...

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RE: secondary IgA? 3 hours ago

Very good point Dr. Venkat. What is his serum sodium and current BP values? ------------------------------ Richard Glassock MD, FASN Laguna Woods...

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RE: Re-Biopsy in LN 3 hours ago

The inclination to use CYC based regimens (IV or oral) in the uncommon forms of LN with clinical RPGN and "extensive" crescents (variously defined)...

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RE: secondary IgA? 5 hours ago

Dysmorphic RBCs and RBC casts, if present currently will favor GN. Decrease of proteinuria may be due to falling GFR. Maintained BP and if hypona...

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RE: GN question 6 hours ago

@Richard Glassock: Does the lack of subepithelial and/or subendothelial deposits, and PMNs in glomeruli make IgA nephropathy or IgA vasculitis more...

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RE: Re-Biopsy in LN 6 hours ago

There is crescentic LN with rapidly worsening renal function and crescentic GN with mild/moderate and stable renal dysfunction. One can treat the f...

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RE: secondary IgA? 6 hours ago

Thank you all for your input. Appreciate it. HRS is in my differential. Checking urine Na. Type 2 is possible. His BP is stable, good urine output ...

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RE: secondary IgA? 7 hours ago

I fully agree with Dr. Rodby. Thus is very likely secondary IgA deposit disease (not Primary IgAN) in a patient with advanced cirrhosis and HRS. Tr...

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RE: Membranous case 7 hours ago

This is an early first relapse after successful therapy of PLA2R+ MN, not 'refractory MN.". There is no compelling reason to treat with agents like...

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RE: Membranous case 9 hours ago

I know it is hard to get anti-CD38 for MN in USA, hopefully the company can get accelerated approve. When patient fails everything including Cyc, m...

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RE: secondary IgA? 9 hours ago

you have to wonder if his elevated creatinine has more to do with his cirrhosis (HRS?) than his IgAN, to have that creatinine from IgAN without pro...

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RE: Membranous case 11 hours ago

Dara in SLE papers attached ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associate...

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RE: Membranous case 11 hours ago

" would try an anti-CD38 both Daratumumab and Isatuximab are approved in Europe." wow, although I have no idea why just bc something is hard to g...

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RE: Re-Biopsy in LN 11 hours ago

The ALMS trial that found MMF to be equal to CYC, was no powered for RPGN with crescentic lupus nephritis. I would be inclined to use CYC in this...

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RE: Membranous case 12 hours ago

IF Obinutuzumab not available, would try an anti-CD38 both Daratumumab and Isatuximab are approved in Europe. Felzartamab likely to come soon with ...

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RE: secondary IgA? 13 hours ago

You can ask to stain the biopsy with KM55, positive and high intensity suggestive of primary IgAN and negative of weak staining suggestive of other...

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RE: Re-Biopsy in LN 14 hours ago

Agrew with Dr. Venkat that when have LN/RPGN presentations, most of the time, the biopsy will lot change the treatment plan (pulse MPD plus either ...

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secondary IgA? 15 hours ago

Dear all, need your help in treatment decision making I have a 53 y/o male with HTN and alcoholic liver cirrhosis started raising creatinine sin...

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RE: Re-Biopsy in LN 18 hours ago

That was Dr Edmund Lewis' approach, (For those of you that dont know, Ed literally wrote the book on lupus nephritis and was the editor of htt...

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RE: Re-Biopsy in LN 1 day ago

While I generally agree with Dr. Rodby that management of LN is an art influence by science, the great heterogeneity of LN demands a very personali...

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RE: inexplained highly positive CEA antigen 1 day ago

Thank you for your remarks. Concerning ascites, it was transudate. We are now starting the diagnostic procedure for the possibility of chronic lymp...

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RE: Membranous case 1 day ago

obi for refractory MGN has good results. see attached; but obi is not that readily available and certainly perhaps not in Portugal? The patie...

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RE: Re-Biopsy in LN 1 day ago

@K.K. Venkat I ask myself this question all the time. It used to be that to justify cyclophosphamide (CYC) you really needed the histology. Thing...

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RE: GN question 1 day ago

first biopsy "and only mild tubulointerstitial scarring (TO). " second biopsy "There is mild interstitial fibrosis and tubular atrophy invo...

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RE: GN question 1 day ago

Thank you very much for the response. There are mesangial deposits. On the first biopsy there was focal interstitial inflammation composed pre...

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RE: GN question 1 day ago

Thank you very much for your input. Complement levels are within normal range. From first biopsy the findings were Microscopic Description:...

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RE: GN question 1 day ago

As others have said, this is not IgA nephropathy. Was this biopsy read by a renal pathologist? moat people are calling this "staphylococcus-assoc...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Seeing Dr. Hirsch's comment made me smile. One of my first dialysis nurses was a savant at dialyzing really sick ICU patients. 'Chuck' could dialyz...

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RE: inexplained highly positive CEA antigen 1 day ago

@Richard Glassock, the CEA in this patient is higher than expected for CKD alone but given very extensive negative work up assuming Ascites has bee...

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RE: inexplained highly positive CEA antigen 2 days ago

I did not realize that CKD alone could produce serum CEA levels > 500ng/ml. In the quoted paper the elevation in CEA was quite modest, not approach...

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RE: Re-Biopsy in LN 2 days ago

Dr. Venkat - thanks for your excellent question-ones that have been asked, but not answered for over 50 years. We lack the RCT that examines the ou...

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RE: Re-Biopsy in LN 2 days ago

I believe that following are the scenarios wherein initial or repeat kidney biopsy is most useful in LN patients: 1. Slowly increasing SCr, slowly ...

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RE: Re-Biopsy in LN 2 days ago

@Richard Glassock @Roger Rodby: in a patient presenting with acute nephritic or RPGN features (+/- nephrotic range proteinuria), normal sized kidne...

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RE: GN question 2 days ago

PMNs in the glomeruli? Subepithelial deposits on EM? If present, IgA-dominant IRGN , more likely. Almost 3 months of dialysis-dependent oliguric ...

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RE: Membranous case 2 days ago

I would treat with obinutuzumab. If this is not available, I would treat with a. combination of oral CYC (1.5mg/kg/d X 8 weeks with With wbc monito...

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RE: GN question 2 days ago

What were the EM findings and serum complement levels. This is highly likely IgA dominant infection related GN. Steroids are not of proven benefit ...

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RE: Kfre 2 days ago

Yes. But it is an estimate valid for only up to 5 years and the patient must have at least Stage 3 CKD. ------------------------------ Richard Gl...

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Kfre 2 days ago

Is kfre valid in non proteinuric kidney disease ?

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RE: Re-Biopsy in LN 2 days ago

I do agree with them in general. Immunological remission for class III/IV +- V should be the goal. Rebiopsy may not be necessary, certainly in the ...

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GN question 2 days ago

Would appreciate input regarding a dialysis dependent AKI patient managed by our group 72 yo M with PMH of DM2, HTN, Aortic stenosis s/p replacem...

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Membranous case 2 days ago

A 63-year-old Caucasian male presented withnephrotic syndrome in April-May 2019, characterizedby peripheral edema, proteinuria (22 g/day), hypoalbu...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 2 days ago

i my experience a double insulin/glucose drip with frequent monitoring of K and glucose will most of the time allow us to buy time (sometimes days)...

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RE: inexplained highly positive CEA antigen 2 days ago

Elevation of CEA can be associated with decrease GFR . The extensive negative work up and decreased GFR in this patient suggest false positive part...

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RE: Re-Biopsy in LN 2 days ago

In general I agree with the authors, and it fits my current practice. REBIOLUP will be a nice reference for us to help make decisions too. But it's...

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RE: inexplained highly positive CEA antigen 2 days ago

Professor Glassock, thank you very much for your valuable suggestions. His CRP values are around 100 mg/l, and serum calcitonin is elevated adequat...

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Re-Biopsy in LN 3 days ago

See the fresh thinking on this topic by de Vriese , Sethi and Fervenza in the February issue of Kidney Int. Is the achievement of a complete immuno...

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RE: inexplained highly positive CEA antigen 3 days ago

Heparin and glycosoaminoglycaNS can falsely increase CEA assay results. Were heparinized tubes used for the preparation of blood plasma for the tes...

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RE: inexplained highly positive CEA antigen 3 days ago

I suppose that we also cannot exclude a problem with positive assay interference by something (prescription drugs or over-the -counter ) being take...

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RE: inexplained highly positive CEA antigen 3 days ago

At this level of CEA a false positive test is exceedingly rare. But the rise could be due to systemic inflammation secondary to chronic rejection a...

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