RE: AKI & Immune complex GN 9 hours ago

So Bartonella Quintana IgM >1:20 (borderline). We doubt it has any relation to this. AKI on the other hand is better on Prednisone 60 mg qd & Cellc...

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RE: transplant cases 12 hours ago

On top of steroids with or without rATG for the TCM, the late AMR and, based on recent reports, the severe IgAN might respond to anti CD38 therapy ...

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RE: transplant cases 13 hours ago

"Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria?" Dr. Glassock: I asked ...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 16 hours ago

I think standard therapies will likely not work in this late active AMR with some chronicity. You may try daratumumab weekly four doses, then plan ...

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RE: Diamox causing kidney stones 17 hours ago

In our clinical practice we do only pre and post treatment 24 hr urine electrolytes, citrate, oxalate, uric acid, PH parameters which are misleadin...

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RE: transplant cases 19 hours ago

Dr. Venkat- How would you treat the severe crescentic IgAN/IgAV in this patient?-this process seems to be the major problem. --------------------...

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RE: transplant cases 23 hours ago

Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria? Agree with Dr. Lerman th...

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RE: Tuberous sclerosis in 34 year old 1 day ago

Thank you for your input. Will contact Riley and see if they can see her. Will continue either with ckd management. --------------------------...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

Is there significant microscopic (or macroscopic) hematuria in this patient. I think that the IgA nephropathy is not the significant problem in thi...

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RE: Diamox causing kidney stones 1 day ago

David: As a practical approach to the potential opposing effects of citrate on stone formation (especially with CaP04), can you compare the SS for ...

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RE: Diamox causing kidney stones 1 day ago

"I've said it before here on several occasions: it could be that the increase in urine citrate is more important as an inhibitor of calcium stones ...

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RE: Diamox causing kidney stones 1 day ago

Thanks everyone, will try supplementing potassium citrate. ------------------------------ Brendan] [Mielke] [MD] [Kootenai Clinic] [Coeur d Alene...

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RE: transplant cases 1 day ago

To my knowledge, there is not specific treatment paradigm for plasma cell rich rejection and other than noting that the ACR is plasma cell rich it ...

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RE: Diamox causing kidney stones 1 day ago

Yes I agree. There's this study showing that you can increase urine citrate in patients with hypocitraturia getting topiramate. https://pmc.ncb...

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RE: transplant cases 1 day ago

both pathologies need treatment!!! Dear Muhammad Soobadar followup will be very helpful to this forum. Thanks for posting this fascinating case in ...

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RE: Diamox causing kidney stones 1 day ago

Acetazolamide directly inhibit CA at the choroid plexus reducing ICP (this is the main mechanism). Correction of systemic acidosis lower the hyperv...

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RE: transplant cases 1 day ago

Dr. Venturelli. Very good points. I can't say ,with any degree of certainty from morphological features alone, that this is IgAV or a particularly ...

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RE: transplant cases 1 day ago

Great discussion! My apology as I misinterpreted the case as positive C4d (it was G and not PTC). With these positive portfolios of DSA which are r...

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RE: Diamox causing kidney stones 1 day ago

agree with kcitrate,salt restriction, and fluids. my sources suggest giving alkali does not reverse CNS benefit of diamox follow 24 hr urines for...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 1 day ago

consider IVIG ± pulse methylprednisolone for chronic active ABMR WOULD do SPEP, urine PEP, SLC for completeness, to r/o MGRS, restart ARB for PROTE...

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RE: Diamox causing kidney stones 1 day ago

@John Asplin @David Goldfarb I know that the CA inihibtor topomax has both proximal and distal tubular CA inhibition and thus gives features...

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RE: transplant cases 1 day ago

I agree. I think it is highly probable both things are occurring and should be treated. ------------------------------ Jonathan Zuckerman MD, Ph...

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RE: transplant cases 1 day ago

Dr. Glassock perhaps I missed part of the patient's history What makes you say, without evidence of concurrent or historical systemic involveme...

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RE: transplant cases 1 day ago

Thanks Dr. Zuckerman -I am not against treating the IgA vasculitis component, but remain convinced that the acute cellular rejection.1 B should als...

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RE: transplant cases 1 day ago

I will also share case with Dr. Xin Zhou a respected renal pathologist in Dallas who has extensive experience with kidney Transplant pathology ...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

Thanks - great teaching case - is creatinine/eGFR stable? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past M...

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RE: transplant cases 1 day ago

This is a challenging and unusual case. Given the presence of a diffuse active necrotizing/crescentic GN with IgA dominant IF staining, there is cl...

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RE: Diamox causing kidney stones 1 day ago

The mainstay of treatment is K citrate supplementation to raise the 24 hr urine citrate > 320 mg and not to increase urine PH > 7 to decrease furth...

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RE: transplant cases 2 days ago

I can't say for sure in kidney transplant recurrence, but in IgA V involving the native kidney often has a prominent tubulo-interstitial inflammati...

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RE: transplant cases 2 days ago

Thanks - look forward to his comments- we also need to appreciate clinical picture which includes a noncompliant patient with immunosuppression and...

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Diamox causing kidney stones 2 days ago

I just saw a 53 you woman who was started on diamox 500 tid for pseudotumor cerebri. The improvement in her headaches and vision has been life chan...

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RE: Crescentic ig a in transplant case 2 days ago

Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria? Agree with Dr. Lerman th...

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RE: transplant cases 2 days ago

Yes, I do think that with severe crescentic recurrent IgAV it will not be possible to discern an underlying ABMR or ACMR, based on histology alone....

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RE: transplant cases 2 days ago

Dear Dr.Glassock are you suggesting biopsy only shows IgAV without ACR 1B ?+\- ABMR? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP...

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RE: transplant cases 2 days ago

I think this is mainly recurrent IgAV in an allograft. I would consider treating with Iptacopan or RTX in addition to short course of pulse IV MP./...

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RE: transplant cases 2 days ago

Any MVI? Sound like mixed rejection and IgAN, I would increase the dose of MMF to 2 gram/day, add PLEX and IVIG. -------------------------------...

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transplant cases 2 days ago

i am posting from Transplant Forum 18M, Issues: 1) Declining kidney function - Suspected rejection: Admits to poor compliance with...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 2 days ago

Metabolic alkalosis has both generation and maintenance phases. In ectopic ACTH syndrome (EAS), generation phase is due to excess cortisol stimul...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 2 days ago

these cases are rare but so interesting I have see only one IUhave attached my publication from it. the VERY high ACTH levels associated wit...

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RE: Crescentic ig a in transplant case 2 days ago

Would treat ACR 1B with thymoglobulin 1mg/kg daily x 7-10 doses , convert Azrhioprine to MMF 2-3 gms/day. Get dd-cfDNA , rebiopsy after above treat...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

This pathology report illustrates the continuum of chronic lesions that can be seen in a biopsy. Ci =3 but ci =1, ct= 1, cg =1 and affects only 2...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

------------------------------ Vijayakumar Paramasivam MD Nephrologist Renal and Transplant Associates of the North East Springfield MA (484) 362-3...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 2 days ago

Extremely high doses of spironolactone will likely be required, with much anticipated (and unwanted ) anti-androgenic effects. Amiloride or Triamte...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 2 days ago

Send stat serum ACTH and a random/late-afternoon serum cortisol plus 24-hour urine free cortisol add aldactone or other MRA continue to replet...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

I suggest looking at this biopsy before throwing in the towel cg1b could e just 5% of capillary loops affected in the worst glomeruli cv3 could...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 2 days ago

This case cries out for the use of Metyrapone, Ketoconozole, Paseriotide, or Osilodrostat to inhibit the presumed ectopic ACTH driven hypercortisol...

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Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 2 days ago

54/male, second deceased-donor kidney, ~7 years out. First living-related graft (2003–2010) lost to transplant glomerulopathy/secondary FSGS, allog...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 2 days ago

we chose to do the low dose tacro with goal of 3-5- neuro deficits resolved. latest mri - radiology read- 8/4/26- Significant improvement compared ...

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Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 2 days ago

A 71 yr old female with a heavy 30+ yr smoking history is admitted for a month of progressively increasing weakness. On presentation, her K was 2...

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RE: ig a case is it alcohol/liver disease related. 2 days ago

C3 co-deposition in IgAN is so common in > 90% is some cohorts and not indicate alternative pathway activation. Some studies link this to future CK...

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