RE: Paucimmune GN with Low Complements In Young Patient 2 hours ago

Dr. Venkat, unfortunately no EM was done. --------------------------------- Hayder Aledan MD, FASN Assistant Professor Basra Nephrology and Transp...

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RE: Renal Function in 55 yo male 3 hours ago

Thank you Professor Glassock No history of low endowement. I will check the urine concentrating capacity. Regards Omar Kaisar ---------...

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RE: Renal Function in 55 yo male 3 hours ago

Thank you Dr Rodby. The gentleman is lean and fit. I have attached the urine result below. We had discussed genetic testing. We havent pursued it y...

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RE: Renal Function in 55 yo male 3 hours ago

Dear Dr Venkat Thank you so much. The cystatin C level was done close to the time of the creatinine level. Previous cystatin level was done at...

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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 3 hours ago

Can someone please explain to me why one would target therapy to correct the elevated plasma bicarbonate in Bartter Syndrome? What are the expected...

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RE: Paucimmune GN with Low Complements In Young Patient 4 hours ago

Dr Venkat But there is no C3 or c1q staining on IF Surprising serum levels very low Any explanation for that Perhaps repeat levels Thanks ----...

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RE: Transplant Question 12 hours ago

s: CDC crossmatch is less sensitive than the flow cytometry crossmatch. A positive CDC crossmatch indicates a higher level of donor-specific antibo...

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RE: Fibrillary GN 1 day ago

Thank you Dr. Glassock and Dr. Rodby for a prompt response. Hep C negative. Age appropriate Cancer screening is negative. SPEP/UPEP -unremarkable -...

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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 1 day ago

Also as I read the pharmacologic concentration of Sando tablet, each tablet contain 600 mg KCl and 400 mg KHCO3 giving a total of 12 mmol K salts s...

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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 1 day ago

NSAIDs use address the pathophysiology of Bartter syndrome as those patients have high PGE2 resulting from uncoupled tubuloglomerular feedback as C...

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RE: Primary hyperaldosteronism 1 day ago

Thank you ASN forum members for all the responses. So screening for Pheo Latest Reference Range & Units 02/12/24 09:18 03/07/24 1...

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RE: Fibrillary GN 1 day ago

I would seriously consider enrolling this patient in the Obinutuzumab For Fibrillary GN being conducted at the Mayo Clinic (under direction of Lada...

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RE: Post TX TMA 1 day ago

De novo PT-TMA is more common than recurrent PT-TMA so I agree with Dr. Lerman that after rule out CMV infection and ABMR, this TMA may be due to C...

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RE: Post TX TMA 1 day ago

Since you did several changes Plex/ dc Tac/ start rapamune hard to know which is responsible for clinical improvement. -----------------------...

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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 1 day ago

NSAID therapy will be long life I don not now is it safe? --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH Egypt 00965 5...

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RE: management of PLA2R negative membranous nephropathy 1 day ago

Hi, Dr. Aledan, Thank you so much for your suggestions. will try to see if can get the serum antibodies first. I will need to discuss with pathol...

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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 1 day ago

Isn't NSAID therapy indicated in this patient? SCr (130 micromol/L) is not very high. ------------------------------ K.K. Venkat MD Troy MI (248)...

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RE: Primary hyperaldosteronism 1 day ago

Dr Duch, What a nice analysis and explanations and very important questions. Looking at t his thread however, especially Dr Duch's response, ...

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RE: Primary hyperaldosteronism 1 day ago

Interesting case with some confounding variables that make accurate interpretation somewhat challenging. Adrenal vein sampling (AVS) is designed to...

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RE: A Case Of GN In Hepatitis C Positive Patient 1 day ago

PS: Don't forget fibrillary GN associated with hepatitis C! (This case is not fibrillary GN according to the description/diagnosis but fibrillary G...

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RE: Fibrillary GN 1 day ago

Was the biopsy confirmed Fib GN with DNSJb9 staining? I will assume it was as done in 2019. Did you check for Hep C, is associated and if positi...

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RE: Fibrillary GN 1 day ago

I presume you have confirmed the diagnosis of Fibrillary GN with aDNAJB9 IHC study. Also what are the HCV serology results. With a course of wors...

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Transplant Question 1 day ago

In HLA-incompatible transplant why is graft loss higher at 5 years for patient who are cdc +ve but flow cytometry negative compared to cdc -be but ...

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RE: Primary hyperaldosteronism 1 day ago

It may make sense to screen such patients for any MEN syndromes, especially with the suggestion of symptomatic hypertension, and the probability of...

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RE: Paucimmune GN with Low Complements In Young Patient 1 day ago

Noted endocapillary proliferation and neutrophils segmentally in some glomeruli. Was EM done on biopsy? If electron dense deposits are noted (despi...

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RE: Primary hyperaldosteronism 1 day ago

In this case, the adrenal vein samplings do not support the diagnosis of unilateral adrenal disease. The selectivity index was 15 on the left and ...

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RE: Primary hyperaldosteronism 1 day ago

Suggest checking catecholamine pheo w/u consider ganglioma /paraganglioma ------------------------------ Conjeevaram Kesavan MD, MBBS, FASN Du...

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RE: Primary hyperaldosteronism 1 day ago

Interestingly, even salt-loading (Na 270 mmol in 24hr urine) did not suppress renin concentration in this patient. With non-suppressed renin and el...

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Fibrillary GN 1 day ago

66 y/o Caucasian gentleman with HTN, HLD, Gout, OSA-CPAP, CKD stage IIIa [SCr 1.4 -1.6mg/dl]. Noted to have mild proteinuria in 2000 when examined ...

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RE: Post TX TMA 1 day ago

"Do you think testing of genetic complement mutation would be of value at the moment" if genetic testing reveals a mutation significantly associa...

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RE: Post TX TMA 1 day ago

More details of the pathology may help assess if the biopsy was also performed in the resolving phase of the disease. In that case the thrombi ma...

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RE: Post TX TMA 1 day ago

Thank you for your explanation Do you think testing of genetic complement mutation would be of value at the moment ? ---------------------------...

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RE: Binder 2 days ago

This is obviously a tough ? and agree with many of the points above. If it is acute feedings, not sure I would worry about it too much. For chronic...

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RE: management of PLA2R negative membranous nephropathy 2 days ago

Agree for conservative approach and I advise to send for serum THSD7A antibodies and stain the biopsy for THSD7A Ag as 5-10% of PLA2R Ab negative M...

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RE: Post TX TMA 2 days ago

"So for the CNI induced TMA to develop, we should have a another hit" Dr. Emara: Let me clarify regarding the above statement. It has been sugges...

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RE: management of PLA2R negative membranous nephropathy 2 days ago

Dear Dr. El-Meanawy, Thanks for the suggestions. I will check anti-PLA2R antibody which I have not done. 24 hour urine protein and UPCR are d...

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RE: Post TX TMA 2 days ago

Thank you. For sharing this case let's summarize primary disease unknown LRDKT and was uneventful tacrolimus trough level acceptable fo...

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RE: management of PLA2R negative membranous nephropathy 2 days ago

Dear Dr. Glassock, Thank you for much for the suggestions. Yes, there was no LC monotypism seen in the IF. IF stained Glomerular capillary wall...

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Primary hyperaldosteronism 2 days ago

Apologies in advance for a lengthy presentation 51 y.o. female. Comes in for follow up after recent hospitalisation 2/6/2024-2/14/2024 for hypokal...

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RE: Post TX TMA 2 days ago

TAC trough levels are low for this 6 month posttransplant and this may explain borderline TCMR. I don’t thick there is specific features for CNI in...

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RE: Paucimmune GN with Low Complements In Young Patient 2 days ago

Many thanks Dr. Glassock for your nice comments. C3 0.3 g/l (0.9-1.8) and C4 0.06 g/l (0.2-0.4). --------------------------------- Hayder Aledan...

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RE: management of PLA2R negative membranous nephropathy 2 days ago

I agree with Dr. Glassock that negative PLA2R staining does not rule out PLA2R-Ab mediated MN. Based on 24 protein and UPCR, she is only producin...

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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 2 days ago

Amiloride not tried yet --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH Egypt 00965 51377736 -----------------------...

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Apixaban In hd Patient 2 days ago

Hypothetical scenario - HD pt with left sided av fistula. Patient has new arm swelling right side . Found to be new DVT. We decide to use apixaban...

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RE: Post TX TMA 2 days ago

I got your point So for the CNI induced TMA to develop, we should have a another hit May be an ischemic event happened during operation and not ...

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RE: Post TX TMA 2 days ago

The donor was the mother 55 y Mismatch 3/6 PRA : 0% NO technical problem (ischemia time 50 mins) with 1ry graft function and adequate UOP Creat ...

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RE: Hypertension in pregnant patient 2 days ago

The levels of PRA in pregnancy are not so high and in the average around 4-5 and not much higher with pre-eclampsia. For the moment, I would cont...

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RE: Post TX TMA 2 days ago

Dr. Amara: What was the degree of HLA-match between donor and recipient? Can you please post a deidentified biopsy report? What was the pretranspla...

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RE: Hypertension in pregnant patient 2 days ago

The high PRA could be the result of the two vasodilators given together. The combination of hydralazine and nifedipine makes no sense. I would use ...

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RE: Hypertension in pregnant patient 2 days ago

Neither chronic administration of nifedipine or Labetolol would likely explain the elevated Plasma renin activity, so increased progesterone conseq...

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