RE: AL amyloidosis 3 hours ago

@Richard Glassock, no, the current ISA criteria does not require a bone marrow for a complete response assessment. However, we are borrowing from m...

View Discussion

RE: secondary IgA Nephropathy 3 hours ago

I agree with @Mark Lerman "Biopsy does not explain AKI, when did creatinine rise from baseline ? if creatinine does not improve may need to consi...

View Discussion

RE: secondary IgA Nephropathy 4 hours ago

for those who are skeptical regarding this patient's creatinine level-I would attempt to measure GFR directly. We in Dallas rely on Glofil-125 (...

View Discussion

RE: secondary IgA Nephropathy 4 hours ago

SGLTi I started just 10 days ago. Ozempic , he started in 2024 and had lost 60 lbs. his creatinine after weight loss was 1.2-1.3 in May 2025. He ...

View Discussion

RE: secondary IgA Nephropathy 4 hours ago

Thank you for Reply. That was my first thought before biopsy. Humira last dose was in November. Unfortunately no creatinine checked from May 2025 t...

View Discussion

RE: Please help with renal biopsy results - vascular insult - etiology unclear 5 hours 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?" ...

View Discussion

RE: secondary IgA Nephropathy 6 hours ago

There are reports of Humira-associated AKI due to acute interstitial nephritis, secondary IGA nephropathy, etc. Noted that Humira was stopped in Ja...

View Discussion

RE: secondary IgA Nephropathy 7 hours ago

Thanks -thus is very helpful. Can you also clarify the timing of the prescription of SGLT2i and GLP1RA and the observed ruse in serum creatinine. W...

View Discussion

RE: secondary IgA Nephropathy 9 hours ago

His BMI is 31-32. No RBC casts in tubules. No evidence of AIN or ATN in biopsy. ------------------------------ Radhika Thalla MD Physician...

View Discussion

RE: secondary IgA Nephropathy 12 hours ago

The very sparse clinical literature suggests (but does not prove) that patients with IBD can "hyperabsorb" creatinine, from such sources as dietary...

View Discussion

RE: secondary IgA Nephropathy 12 hours ago

With active Crohn's disease , I would expect this patient to be malnourished, hence a creatinine of 2.2 mg/dl , may potentially suggest a more seve...

View Discussion

RE: secondary IgA Nephropathy 12 hours ago

One additional measure that might be appropriate is to measure Serum creatinine after fasting. ------------------------------ Richard Glassock M...

View Discussion

RE: secondary IgA Nephropathy 19 hours ago

This is certainly very mild IgAN. With such minimal proteinuria there is no clear indication for SGLT2i or RASi. How obese is the patient?. Any RBC...

View Discussion

RE: secondary IgA Nephropathy 19 hours ago

Thank you for reply. Creatinine is increased in February. Previous creatinine was 1.2 ( in May 2025 with his physical)s. Biopsy is done in June. ...

View Discussion

RE: secondary IgA Nephropathy 19 hours ago

Thank you for the reply. Kidney biopsy showed LM : a total of 15 glomeruli, of which is 1 is globally sclerosed. Mild mesangial cell proliferatio...

View Discussion

RE: secondary IgA Nephropathy 20 hours ago

agree no indication for Budesonide, but cautious use of ARB, and SGLT2 might be considered. Biopsy does not explain AKI, when did creatinine rise f...

View Discussion

RE: secondary IgA Nephropathy 21 hours ago

With such minimal proteinuria and the lack of any inflammation or crescents in a kidney biopsy I would suspect a spurious elevation of serum creati...

View Discussion

secondary IgA Nephropathy 22 hours ago

43 yr old with PMH of Ulcerative colitis with AKI creatinine increased to 2.4 ( baseline 1.2) and hematuria. Proteinuria of 0.2 gms. BP is usally i...

View Discussion

RE: AL amyloidosis 22 hours ago

Is a repeat bone marrow biopsy with cytogenetic analysis required for determination of a complete response in AL Amyloid treated with autologous SC...

View Discussion

RE: AL amyloidosis 1 day ago

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

View Discussion

RE: AL amyloidosis 1 day ago

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

View Discussion

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

View Discussion

RE: AL amyloidosis 1 day 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...

View Discussion

RE: AL amyloidosis 1 day ago

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

View Discussion

RE: AL amyloidosis 2 days 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 ...

View Discussion

RE: AL amyloidosis 2 days ago

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

View Discussion

RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 2 days 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...

View Discussion

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

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

View Discussion

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

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

View Discussion

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

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

View Discussion

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

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

View Discussion

RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 2 days 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 ...

View Discussion

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

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

View Discussion

RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 2 days 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-...

View Discussion

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

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

View Discussion

RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 2 days 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...

View Discussion

RE: Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 2 days 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...

View Discussion

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

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

View Discussion

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

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

View Discussion

RE: Iptacopan --- Does it work ????????? 3 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 ...

View Discussion

RE: Iptacopan --- Does it work ????????? 3 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...

View Discussion

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

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

View Discussion

RE: Painless macroscopic hematuria 3 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...

View Discussion

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

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

View Discussion

Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 3 days ago

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

View Discussion

RE: Bile Cast Nephropathy causing Unresolved ATI 3 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. ----------...

View Discussion

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

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

View Discussion

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

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

View Discussion

RE: IgAN - Management Question Thursday, July 16 @ 3:10 PM

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. ...

View Discussion

RE: Please help with renal biopsy results - vascular insult - etiology unclear Thursday, July 16 @ 2:57 PM

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...

View Discussion