RE: AL amyloidosis 52 minutes ago

Not detected on SPEP, SIFE, and UPEP --------------------------------- [Sheng] [Kuo] MD, FASN ---------------------------------

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RE: AL amyloidosis 3 hours ago

what about her monoclonal IgM lambda. is that still positive? ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 208-1...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 5 hours ago

Agree with Prof Rodby. Too much reliance on serum creatinine and eGFR. Definitely pt has chronic renal ischemic damage and considering his age pro...

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RE: AL amyloidosis 22 hours ago

I have been holding off on this re-biopsy, as I didn’t believe it will yield another diagnosis. However, it’s been 3 years and hematology was so co...

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RE: AL amyloidosis 22 hours ago

Her initial bone marrow biopsy showed 10-15% plasma cell myeloma, lambda monotypic without amyloid (Congo Red negative). Most recent lambda free L...

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RE: AL amyloidosis 1 day ago

what is The lambda free light chain and kappa lambda ratio? IgM AL amyloidosis cases are harder to treat then non IgM cases. what did the original ...

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RE: AL amyloidosis 1 day ago

An update since last post in 2023 and hoping for additional guidance. Chinese female with history of HBV and hyperlipidemia initially presented w...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Thanks Dr. Kuniyil. This is very helpful information , Dobyou have any data on Brain MRI or Lumbar puncture for CSF JC virus by PCR that you can sh...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

GABA-B receptor antibody – Negative NMDA receptor (Anti-NR1) antibody – Negative CASPR2 antibody – Negative LGI1 antibody – Negative AMPA-1 rec...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Great ,thanks 🙏 ------------------------------ Ramshad Kuniyil MD Hmc Doha 0097433154100 ------------------------------ [More]

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Thank you ------------------------------ Ramshad Kuniyil MD Hmc Doha 0097433154100 ------------------------------

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Thank you, Professor Glassock. The patient received rituximab approximately 8 years ago for biopsy-proven C3 glomerulopathy. At that time, the tr...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Was JC virus PCR performed on CSF fluid obtained by spinal tap in this case? Temporary improvement after PLEX as well as Parkinsonism features and ...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Can you share with Brain MRI findings in this case.? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

How long ago was the patient treated with Rituximab.? ,This off label regimen is not standard of care, but has been used to treat anti-Factor auto-...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

"Could the patient's C3 glomerulopathy (or underlying complement-mediated immune dysregulation) and neurological syndrome be linked by a common imm...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

Was anti-LGI1 included in the auto-antibody panel?, the neurological findings are very reminiscent of this auto-immune encephalopathy, but I do not...

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RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 1 day ago

No personal experience with a similar case. I posted your case on Google AI and it responded as follows (only part of response copied below): "The...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Drs. Venkat, Rodby, and Campese your point is well taken in using RAAS blockade in hypertensive patients especially without significant proteinuria...

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RE: Iptacopan --- Does it work ????????? 1 day ago

Just for the record, yesterday (July16 ) the US FDA gave full approval to Fabhalta (Iptacopan, Novartis ) for prevention of progression in IgAN . (...

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RE: Iptacopan --- Does it work ????????? 2 days ago

I think response could be gauged by 1. Reduction in proteinuria 2. Slowing the rate of decline in eGFR In both cases , uPCR is at baseline after ...

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RE: Iptacopan --- Does it work ????????? 2 days ago

Thank you for the post. You raise an important point that we should be very critical high-cost drugs with no or minimal response. Patient selecti...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 2 days ago

Totally agree with Dr. Rogby. unfortunately, many nephrologists believe that RAS inhibitors are a panacea for all hypertensive patients with kidn...

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RE: Painless macroscopic hematuria 2 days ago

per Dr. Anand- "I reviewed his cystoscopy. It showed blood emanating from the right ureteric orifice alone. Hence they did a ureteroscopic exam. It...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 2 days ago

"Besides lack of significant proteinuria, another reason to avoid RAAS-blockade is widespread intrarenal small vessel disease mimicking hemodynamic...

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Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 2 days ago

I would appreciate the opinions of colleagues regarding a challenging case. A patient known to me has biopsy-proven C3 glomerulopathy, previously...

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RE: Bile Cast Nephropathy causing Unresolved ATI 2 days ago

It is likely that it is bile acids not bilirubin pet se that cause AKI- i would not get too fixated on bilirubin levels for diagnosis. ----------...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 2 days ago

Although a drug related elevation of Scr seems unlikely in this case, measurement of an eGFR Cystatin C might be revealing. --------------------...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 2 days ago

Besides lack of significant proteinuria, another reason to avoid RAAS-blockade is widespread intrarenal small vessel disease mimicking hemodynamics...

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RE: IgAN - Management Question 3 days ago

With the marked signs of inflammation , and progressive loss of nephrons , I would start with a very short course of pulse IV MP. Just an opinion. ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Richard, You may want to add here the editorial on goal BP I emailed to you a few months ago. If you don’t have it any longer, I could send you a c...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

First, I would determine if this patient has hypertension and/or orthostatic hypotension. Often, in these patients orthostatic hypotension is asymp...

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RE: IgAN - Management Question 3 days ago

EM is currently not available , but i assume she has podocytopahty with low serum albumin. She is on ARB, SGLT2 and ns-MRA , not on ET1a , as she...

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Iptacopan --- Does it work ????????? 3 days ago

So , we have been using Iptacopan for nearly a year . In IC- MPGN - No response , perhaps it works great in C3G - but we prefer to use C3 Blocker...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Dr. Campese, Given the severe non-glomerular vascular disease on kidney biopsy, the absence of proteinuria or CHF and an undescribed "neuropathy" w...

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RE: IgAN - Management Question 3 days ago

Great questions? no good evidence to select the "best choice" . In my opinion , I would use oral steroids and MMF , with an initial IV pulse of IVM...

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IgAN - Management Question 3 days ago

Have a 35 year old SE Asian Female eGFR is 49 ml/min Urinalysis : Hematuria uPCR : 7.2 g/g Biopsy : M1 E1 S1 T1 C1 Question : St...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

""Why do I hate eGFR values so much and just prefer a serum creatinine? That is rhetorical but also editorial. " @Roger Rodby -and the answer is?" ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

"Why do I hate eGFR values so much and just prefer a serum creatinine? That is rhetorical but also editorial. " @Roger Rodby -and the answer is? ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Can you provide the levels of BP and HR standing and sitting? does she have any clinical features of autonomic dysfunction? The biopsy is su...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Dr. Rodby. I agree. Even if the APOL1 high risk alleles are found, it would not bring us any closer to an effective treatment regimen for this pati...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

In PLA2R MGN we have an antibody to treat and an early marker and we can "head it off at the pass" In PLA2R negative MGN it is not so easy and w...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Why do I hate eGFR values so much and just prefer a serum creatinine? That is rhetorical but also editorial. I think APLO1 would explain this, b...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

"Renal US : Right 9.2 cm, Left 10 cm" The left kidney is generally longer than the right. This discrepancy of ~ 0.8 cm may not be significant by ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

I also agree with Dr. Lerman's concerns over the use of high dose Ketamine in this case. Ketamine abuse can cause sterile pyuria, ulcerative cystit...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Dr. Lerman - you raise a very important point. APOL1 risk allekes are commonly linked to a Podocytopathy and proteinuric CKD. A lesser known and ap...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

Agree with high risk APOL1 testing as high risk testing has even without proteinuria APLOL 1 high risk variants in African-Americans can cause acce...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 3 days ago

The degree of global glomeruloscleroisis and IFTA is quite compatible with the patients chronological age. The Absence of abnormal. Proteinuria mak...

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RE: PLA2R negative Membranous Nephropathy- Management Q Wednesday, July 15 @ 4:12 PM

Hi Dr. Soobadar, Thank you, No discrepancy in urine protein/cr and albumin/cr. From Jan 2026 attached (faint spike, BM was done before - negative)....

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RE: Treatment /Management of MN Wednesday, July 15 @ 4:00 PM

Thanks for discussion appreciate it --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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