RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 5 hours ago

The label and literature suggests that Guselkumsb and a Rituximab should not be administered because of a risk of profound impairment of Tvcell and...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 5 hours ago

I am not sure that a kidney biopsy will be all that helpful. I think that so long as he is fully responsive I think RItuximab (or Obinutuzumab ) is...

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Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 5 hours ago

Would appreciate thoughts on a difficult adolescent case. I’m managing a 16-year-old boy with autism and longstanding psoriasis who has now presen...

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RE: IgA nephropathy with crescents 5 hours ago

I fully realize that a more nuanced definition if RPGN might be used for justification for CYC use in this case , but the KDIGO definition of RPGN ...

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RE: IgA nephropathy with crescents 7 hours ago

I would point out that CYC and steroids are only recommended by KDIGO for RPGN and extensive crescents in IgAN While this patient does not have RPG...

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RE: IgA nephropathy with crescents 7 hours ago

All serologies including ANCA were negative. ------------------------------ Amita Vasudeva MBBS University of Missouri-Kansas City Stilwell KS (...

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RE: IgA nephropathy with crescents 8 hours ago

Thank you Dr. Rodby. The crescents and drop in gfr were precisely why I went with cytoxan and steroids. My patient had no signs or symptoms of Ig...

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RE: Tumoral calcinosis in a PD patient 8 hours ago

What is his phosphorus. I would avoid aluminum at this time as I would be concerned as suggested by Prof Glassock that he has low turnover bone and...

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RE: IgA nephropathy with crescents 8 hours ago

Dr Glassock's advice is based on KDIGO Guidelines and experts (UpToDate), what is he thinking? :) 17% crescents, eGFR dropping, I believe this is...

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RE: IgA nephropathy with crescents 10 hours ago

I would use the UpToDate suggested regimen in thus case and seriously consider Iptacopan as well. I personally would not use Nefecon in this patien...

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RE: IgA nephropathy with crescents 12 hours ago

Thank you for response Dr. Glassock. He has already one dose of Cytoxan. Will it be okay to switch him to Nefecon only at this time and other suppo...

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RE: IgA nephropathy with crescents 14 hours ago

This patient has features of typical IgA N with crescents (MEST-C score of C1) without the syndrome of RPGN. IgA Vasculitis is always possible, so ...

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IgA nephropathy with crescents 15 hours ago

I need advice/ thoughts on a patient. I really appreciate this community. I have a 44 year old caucasian male who presented with microscopic hem...

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RE: Pd Patient And Lipid Lowering Agent 22 hours ago

Dr. Soobadar- Are you using Fish Oils in these doses in your HD patients. If so , what kind of side effects are the patients experiencing? Just c...

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RE: Pd Patient And Lipid Lowering Agent 22 hours ago

The Fish oil dosing regimen is described in the NEJM paper . It is 4.0 gms of Fish daily containing 1.6 gm of EPA and 0.8 gm of DHA. Give itca try....

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RE: Pd Patient And Lipid Lowering Agent 1 day ago

Richter scale: >7 Wow, this is big. Thank you Dr Glassock. Can you also please help us about the amount of fish oil to reach these goals? ----...

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RE: AKI - 3 weeks post normal vaginal delivery 1 day ago

Thank you Dr. Mohammed. ANA panel negative, complements negative. MPO/PR3 negative. Cryo pending. ADAMTS13 pending. patient has transferr...

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RE: AKI - 3 weeks post normal vaginal delivery 1 day ago

Thank you for sharing this case for discussion. While TMA renal limited is possible, it is not classical. Postpartum is one of the important trigge...

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RE: High output HF from AVF? 1 day ago

Thank you for sharing this case. What is the cardiology team's opinion on the assessment for high-output heart failure? Is there any evidence of pu...

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RE: Tumoral calcinosis in a PD patient 1 day ago

Would it be time to consider Aluminum binders? After a few months check levels Anyone checking calcidiol levels and supplementing? Would hemodiafil...

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RE: Tumoral calcinosis in a PD patient 2 days ago

I would definitely avoid bisphosphonates in this situation. What is the current serum PO4?Do you feel comfortable decreasing or stopping the calcit...

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RE: Tumoral calcinosis in a PD patient 2 days ago

His Pth is 230. Ionized calcium is actually 1.0, lower than normal so I have been avoiding sensipar and even bispgospanate for the time being and s...

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RE: AKI - 3 weeks post normal vaginal delivery 2 days ago

Dr, Mellas raises an important question. My impression from the littersaturec is that the elevation in serum LDH is very much related to the durati...

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RE: AKI - 3 weeks post normal vaginal delivery 2 days ago

Thanks Dr. Mellas, LDH was hovering normal upper, today in 400s. Patient left last night to be at her transplant center for higher level of ca...

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RE: AKI - 3 weeks post normal vaginal delivery 2 days ago

A few questions to Dr Kaur. If the patient has renal cortical necrosis why is LDH not higher? Why can you not give gadolinium if Group II or II...

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RE: AKI - 3 weeks post normal vaginal delivery 2 days ago

Thank you Dr. Glassock! Renal biopsy done. Renal function worsening. ------------------------------ T. Kaur, MD FACP Nephrologist/HTN/Kidney Sto...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

I shall. I agree with you. Hematopathology has become an integral part of onco-nephrology. For educational purposes, I was underscoring the phenoty...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Thank you! Please let me know of any typos so I can correct them for the final version! 😀 Regarding CLL diagnosis, we should consult with hemato...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Got your paper Lynn. Now, I have a lovely weekend reading material! KUDOS! I guess, looking for CD5 expression will aid in the diagnosis of CLL. Ma...

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RE: transplant recurrent FSGS 2 days ago

Thank you Dr. Cravedi. Very helpful information. I guess the final chapter remains to be written. Best. Mario ------------------------------ M...

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RE: transplant recurrent FSGS 2 days ago

Thank you, Dr. Rubin, for the kind words. Yes, together with Dr. Angeletti in Genoa, Italy, we have accumulated some experience with this approach...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Thank you, Jonathan! I still have to correct the proofs... but the final version when available is supposed to be open access too so everyone can...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Also good time to highlight Dr. Cornell's tour de force review on all things tubulointerstitial forthcoming in KI: https://www.kidney-international...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Came here to point out the same thing- although unlikely, you don't want to miss CLL as a cause of granulomatous interstitial nephritis. The CLL ca...

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RE: transplant recurrent FSGS 2 days ago

Thank you for sharing this interesting paper. The authors make several key points but 2 of them called my attention: 1. Circulating levels of ant...

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RE: transplant recurrent FSGS 2 days ago

There is a very elegant study by Angiletti and Cravedi exploring the hypothesis that autoreactive IgM plays a pathogenic role in nephrotic syndrome...

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RE: transplant recurrent FSGS 2 days ago

@Paolo Cravedi Paolo Cravedi (a superb immunologist) is, most likely behind this idea of combining anti B cell- Plasma cell therapy and I am wond...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

About 20-30% of patients with Sarcoidosis present in a renal limited fashion- so this case is somewhat atypical but by no means rare. Early steroid...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Thank you all for the invaluable insights and guidance on this case. To update the panel, the patient's ANA 23-profile (including anti-SSA and ant...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Assuming that the patient is not taking any drugs known to produce granulomatous interstitial nephritis, my AI consults - (Expert AI (UpToDate ) an...

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RE: Tumoral calcinosis in a PD patient 2 days ago

Tumoral calcinosis is poorly understood, but as this is progressive I would treat this as calciphylaxis with HD, sodium thiosulfate (STS) avoid Ca ...

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RE: transplant recurrent FSGS 2 days ago

I have attached the article referred to by Dr Venturelli I find it interesting that they would use BOTH anti-CD 20 and anti-CD 38 since anti CD 3...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

I agree with everyone and everything above, and Dr Glassock's additional suggested work-up, and yet when you are done you will start steroids for S...

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RE: transplant recurrent FSGS 2 days ago

Dr. Hirsch I cannot say anything about pre transplant treatment and I acknowledge but working with our pediatric colleagues we have seen responses ...

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RE: Radioiodine treatment in Patient with CKD stage 4 2 days ago

https://community.asn-online.org/communities/community-home/digestviewer/viewthread?MessageKey=b916ea5e-55bd-49cf-a2d4-0ba62a9d1e3e&CommunityKey=a6...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Other rare ddx for GIN also include inflammatory bowel disease, BCG therapy, the CLL. ------------------------------ Jonathan Zuckerman MD, PhD ...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Dr. Duong this is probably a very obvious point but consider that in TINU uveitis can occur several months after interstitial nephritis --------...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Interesting question. I am not aware of any studies have evaluated such findings to that degree of granularity (if anyone know any, please share). ...

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Tumoral calcinosis in a PD patient 2 days ago

I have this 47 TO male patient with ESRD due to DM, HTN, PVD, high phosphorous in past who developed painful gluteal masses and imaging and finally...

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RE: Non-necrotizing granulomatous interstitial nephritis 2 days ago

Dr. Zuckerman - Dr. Zuckerman -thanks for your review and interpretation of the digital renal pathology in this case. How do you define "exube...

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