RE: pr3 +ve is it endocarditis ? 16 minutes ago

I have used it once to detect a Bartonella endocarditis. A phenomenonal test. Virtually no false positives and false negatives seem to be uncommon....

View Discussion

RE: pr3 +ve is it endocarditis ? 18 minutes ago

Dr Venkat, I was going to reference this test but I couldn't think of it... But it is an amazing too or so I have read! -------------------...

View Discussion

RE: pr3 +ve is it endocarditis ? 1 hour ago

The Karius cell-free microbial DNA test is claimed to detect ~ 1000 microbial DNAs in blood sample. We had a recent case in which our infectious di...

View Discussion

RE: pr3 +ve is it endocarditis ? 1 hour ago

I agree with Dr. Rodby 100%.!!! ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA Lag...

View Discussion

RE: pr3 +ve is it endocarditis ? 2 hours ago

Besides blood cultures I would get titers for various organisms such as Bartonella, Coxiella, Gamella, and any other rare culture negative SBE orga...

View Discussion

RE: Hyperfiltration/IgA nephropathy 2 hours ago

@David Wilhelm "Thanks for the response, Roger! This may sound like a stupid question, but can you give an explanation (or provide me a resour...

View Discussion

RE: Hyperfiltration/IgA nephropathy 3 hours ago

Am I missing something? "UPCR showed total protein 347 mg/dL and Cr 81 mg/dL (ratio 4.27). Initial UPCR showed total protein 128 mg/dL and Cr 19 mg...

View Discussion

RE: pr3 +ve is it endocarditis ? 4 hours ago

Dr. Soobadar: What is the SCr trend? Is the patient on antibiotics for presumed endocarditis? If SCr is improving on antibiotics, infection-related...

View Discussion

RE: Hyperfiltration/IgA nephropathy 5 hours ago

"Kudos to biopsy a solitary kidney" thanks DR. Rodby for stimulating me to ask ( remember I have done hundreds of transplant kidney biopsies (solit...

View Discussion

RE: Hyperfiltration/IgA nephropathy 6 hours ago

I am not "against" use of sibeprenlimab (or atacicept) in this case, But this is relatively advanced disease and a T2 lesion would gave excluded th...

View Discussion

RE: Hyperfiltration/IgA nephropathy 6 hours ago

Check serum Gd-IgA1 and APRIL levels if possible to confirm sibeprenlimab pharmacodynamic activity. Check serum IgA, IgG, IgM levels - these ...

View Discussion

RE: Hyperfiltration/IgA nephropathy 6 hours ago

My recommendation is based on personal experience . Ideally you should have seen a response in terms of uPCR reduction by 3 months . In the studie...

View Discussion

RE: pr3 +ve is it endocarditis ? 7 hours ago

Back in the days when PTH assay was in its infancy, biomarkers for PTH excess were in vogue. A nice paper by Palmer in 1974 Annals of Internal Medi...

View Discussion

RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 7 hours ago

Please clarify PCR ? ACR ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas...

View Discussion

RE: Hyperfiltration/IgA nephropathy 7 hours ago

Thanks for the response! Is your preference for steroids just based on experience alone or are you not yet wanting to use the BAFF/APRIL inhibitors...

View Discussion

RE: Hyperfiltration/IgA nephropathy 11 hours ago

Given my personal experience, I would have preferred to start with oral steroids , unless there are strong contraindications. However , after 3 mo...

View Discussion

RE: Hyperfiltration/IgA nephropathy 18 hours ago

The variation in urine creatinine concentration in a "spot" un timed urine sample tells you virtually nothing about 24 hour urine creatinine excret...

View Discussion

RE: pr3 +ve is it endocarditis ? 18 hours ago

Granulomas in PR3-+ Vasculitis can occasionally lead the hypercalcemia, which is excess 1,25 dihydroxy vitamin D driven, thus iPTH levels should be...

View Discussion

RE: Hyperfiltration/IgA nephropathy 20 hours ago

Appreciate the response, Dr. Glassock! He is not obese. BMI is 30. ------------------------------ David Wilhelm DO Nephrologist Nephrology Consul...

View Discussion

RE: Hyperfiltration/IgA nephropathy 20 hours ago

Albumin in February was 3.0. Current albumin is 3.3. No current edema. He did have some at the time of the initial visit but made improvement with ...

View Discussion

RE: Hyperfiltration/IgA nephropathy 20 hours ago

Thanks for the response, Roger! This may sound like a stupid question, but can you give an explanation (or provide me a resource so I can read more...

View Discussion

RE: pr3 +ve is it endocarditis ? 20 hours ago

Thanks prof glassock Wednesday PET . Outpatient toe requested by id team. Have contacted cardio for inpatient TOE ( hopefully this week) High cal...

View Discussion

RE: pr3 +ve is it endocarditis ? 20 hours ago

The elevated Anti-PR3 is highly likely to be due to Endocarditis. When will you be doing a Trans-esophageal Echocardiograph .? ------------------...

View Discussion

RE: pr3 +ve is it endocarditis ? 20 hours ago

Rf raised 79 (0-14) C3/c4 not back Hiv negative , syphilis negative --------------------------------- Muhammad Soobadar MBChB UK -------------...

View Discussion

RE: Hyperfiltration/IgA nephropathy 20 hours ago

With a solitary kidney at least some of the proteinuria is due to maladaptive capillary hypertension. Too early to tell about beneficial effects of...

View Discussion

RE: pr3 +ve is it endocarditis ? 21 hours ago

What is the serum Rheumatoid Factor Level and the C3 And C4 levels?Is the HIV testing negative,? ------------------------------ Richard Glassock ...

View Discussion

pr3 +ve is it endocarditis ? 21 hours ago

54 MALE Constitutional symptoms ( hx of endocarditis 2023 in the context of TOF/Congenital Heart Disease) feeling unwell since Feb 26 --> 2 st...

View Discussion

RE: Hyperfiltration/IgA nephropathy 23 hours ago

Serum albumin trend? Any edema? Size of right kidney/is it hypertrophied/echogenicity? ------------------------------ K.K. Venkat MD Troy MI (248...

View Discussion

RE: Hyperfiltration/IgA nephropathy 1 day ago

1) Kudos to biopsy a solitary lkidney 2) Kudos to being aggressive with APRIL inhibitor (started in April btw) 3) This is advanced disease whe...

View Discussion

Hyperfiltration/IgA nephropathy 1 day ago

I have a patient I would like to present for advice. 57 y.o. male with history of aortic dissection involving left renal artery in 2015 with resu...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

THanks for mentioning us Roger and Dick! I agree with your thoughts and am interested to test! Tony ------------------------------ Anthony Bleyer...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

Yes, it sounds very much like autosomal dominant tubulointerstitial kidney disease. THis is usually caused by UMOD or MUC1 mutations. UMOD can be s...

View Discussion

RE: de-novo MGRS with LCDD 1 day ago

I apologize for my contribution in advance as it regards to a formal theme, abbreviations. The first sentence already consist of 11 abbreviations a...

View Discussion

RE: de-novo MGRS with LCDD 1 day ago

UPCR can be misleading. Till tubular uptake is saturated, the UPCR can be low or even normal. Focal disease can have more nephrons saturated and th...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

would FEUa be useful especially if >5%? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Ki...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

The only think I have to add to this is, since this almost certainly is an ADTID, associated with hypeuricemia, I would treat that aggressively as ...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

Exactly Dr. Aledan. Many thanks. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

The key point is that the negative genetic panel doesn’t rule it out. The MUC1 frameshift sits in a GC-rich (~80%) tandem repeat that short-read se...

View Discussion

RE: secondary IgA Nephropathy 1 day ago

Thanks , these findings exclude "hyper-creatininemia " from diet or drugs. The discrepancy between the biopsy andGFR remain unresolved. I suppose t...

View Discussion

RE: secondary IgA Nephropathy 1 day ago

Fasting creatinine is 2.44 ( eGFR 33 ml/min) and Cystatin C is 1.85 ( eGFR 37 ml/min). UA has 3+ blood with 15 to 20 RBC and Proteinuria 0.24 gms. ...

View Discussion

RE: young girl with Chronic TI dz 1 day ago

What specific mutations were sought in the genetic testing? The case sounds very suspicious for a UMOD or a MUC 1 mutation. Please review the biops...

View Discussion

young girl with Chronic TI dz 1 day ago

20 year old Indian female incidentally diagnosed with ckd : creatinine 1.4-1.6 mg/dl in 2024 and now 1.7-1.9 mg/dl in 2026 In 2024, uric acid w...

View Discussion

RE: Kidney Biopsy in AL Amyloidisis 1 day ago

IgM lambda accounts for only 6-9 % of MGUS. When present it is most often a sign of Waldenstroms macroglobulinemia or AL Amyloidosis . Just a littl...

View Discussion

RE: Kidney Biopsy in AL Amyloidisis 2 days ago

I apologize for late entry. This was our case from Our Rush Biopsy conference . You can watch it here https://youtu.be/HYIkZ1DZjh8 I sugges...

View Discussion

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

any proteinuria? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transplan...

View Discussion

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

egfr is stable, saw her in office visit post discharge, now neuro deficits resolved, pending mRI ------------------------------ Vijayakumar Para...

View Discussion

RE: MGRS/Fanconis 2 days ago

Dr Shah Clone directed therapy is definitely indicated as strongly recommended by Dr Rodby Reviewed literature with AI resources Monoclonal Gammop...

View Discussion

RE: Kidney Biopsy in AL Amyloidisis 2 days ago

My AI consultant (Claude) makes an educated guess of about 1 in 20 cases meeting the description of this case will NOT have AL Amyloid on kidney bi...

View Discussion

RE: Kidney Biopsy in AL Amyloidisis 3 days ago

Interesting statistic, but not relevant to this case. What % of 70 year old patients with Nephrotic Syndrome and +Congo Red Deposits in Bone Marrow...

View Discussion

RE: Kidney Biopsy in AL Amyloidisis 3 days ago

7.4.4 Hematologist-directed diagnosis of AL amyloidosis 7.4.4.1 Interpretation of the monoclonal protein screen In about 10% to 40% of patients wi...

View Discussion