Managing severe hypertension in outpatient settings 1 hour ago

Hi everyone, We have been recently encountering several cases of patients with BP higher than 180/100 but otherwise asymptomatic. Since recent A...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 hours ago

Thank you for sharing the case. Would it be possible to share the genetic testing results redacted? Also sharing few representative images of both ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 hours ago

Great discussions. Can you please provide more details on the genetic findings? Which exon / amino acid position is involved? If the truncation i...

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RE: Pseudohypertension or true uncontrolled HTN 4 hours ago

No LVH by ECHO or EKG. Osler phenomenon present. Do we call this isolated systolic hypertension or pseudo-hypertension? I want to see a non-invasiv...

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RE: Pseudohypertension or true uncontrolled HTN 6 hours ago

Thank you all for your thoughtful responses. I reviewed his EKG and echo, both done within the past 3 months The QRS voltage is normal in the p...

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RE: Pseudohypertension or true uncontrolled HTN 6 hours ago

I would bet he certainly has HTN, if not he would feel awful being already on metoprolol and lisinopril 40. The question is "to what level if any...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 6 hours ago

If the Military has prescribed medical conditions that make this just too complicated independent of what he really has, then perhaps he should see...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 8 hours ago

If he plans to be deployed to the Middle East,where there over a 100 US bases, and high probability he will be , I would recommend against it . In ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 13 hours ago

Thanks, the waiver process does involve physicians expert advice, so under a waiver request, the question does assume clinical relevance. In this c...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 13 hours ago

Dr: Glassock: Part of the AI response (which I didn't include) describes the waiver application process. It will involve obtaining medical clearanc...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 21 hours ago

Thanks Dr. Venkat for this illuminating response (AI supported). The question asked was somewhat different. "Would you give him permission to enter...

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RE: Pseudohypertension or true uncontrolled HTN 21 hours ago

Good point. What were the Cardiac ECHO and EKG findings in this case? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 21 hours ago

Dr.Achkar - thank you for this interesting suggestion concerning use of Neonatal Fc R antagonism to treat APLAS . Theoretically thus is an attracti...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

Since this is a triple positive APLA-associated TMA, I suggest the use of neonatal FC receptor antagonists, if the APLA antibodies are of the IgG t...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

I think the presenve of LVH on echo study would be consistent with hypertension rather than pseudohypertension, a differentisting point !! -------...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Asked Google's AI tool to comment on this patient and got the following response: "Based on the medical data provided and current U.S. Department...

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RE: Please help with a case of IGA nephropathy 1 day ago

Thanks for the new information. Due to sampling issues for what is a focal process, it is very difficult to say that 4% is really different from 13...

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RE: Please help with a case of IGA nephropathy 1 day ago

Just for more clarification. Initial biopsy in 2024 showed-3 out of 23 glomerulus with cellular crescents. 2 additional glomerulus with fibrous cre...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

If the triple positivity for APLA persists beyond 6-12 weeks, this patient is at high risk for a thrombotic event and I think should be placed on W...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

The low C4 and normal C3 suggests activation of the classic pathway probably by anti phospholipid antibodies !!! In that case there could be a rol...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

The problem here is nothing has been shown to have a great effect on progressive CKD from APA syndrome, Rituximab, MMF, even anticoagulation. ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

His mother for sure has PKD but at 41 has nl GFR and relatively unimpressive CT scan genetically this is PKD 1 but seems to be acting more like P...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Is this a career decision or a-time limited engagement. ? So long as the military staff are aware of his condition and accept responsibility for hi...

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20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

I have a 20 year old male asking me if he can join the Military in the USA. He has a family history of PKD. His EGFr is 127, Normal UA. His ren...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

Does anyone know of any ongoing trials of Inebilizumab (anti-CD19 MoAB) or Felzartamab (anti-CD38 MoAB) in APLAS? -----------------------------...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

My enthusiasm for use of RTX or OBI in this case has been dampened by this (and other) study - but I acknowledge that it was primarily in Non Lupus...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

Thanks Dr Rodby and Dr Glassock and Dr Venkat - LDH 280 - Heptoglobins and ADAMTS pending at this time. But normal Hb of 15 on multiple CBC T...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

If MMF, steroids and Warfarin are not effective, C- inhibition (Pegcetacoplan or Ravulizumab) might be next choices, Is it possible to obtain a ser...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

the low amount of proteinuria makes me think that the Cr increase is more APAbs (TMA) than proliferative lupus GN. Bet there is evidence of sube...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

SLE with anti-phospholipid syndrome (triple positive) and TMA. Management,-probably Steroids, MMF and long term Warfarin. I would hold PLEX, IVIg i...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

Findings certainly suggest SLE-related TMA.?Slight decrease in SCr from its peak level and slight increase in platelet count are reassuring. LDH ,...

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RE: Full house with negative serolgy 3 days ago

Thanks so much Dr Glassock for the variable responses ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Full house with negative serolgy 3 days ago

Thank you so much Dr Zuckerman that was very insightful. ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Full house with negative serolgy 3 days ago

Dr. Zuckerman- great response. A good reason for discussants to be cautious regarding interpretation of kidney biopsy reports submitted as part of ...

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RE: Full house with negative serolgy 3 days ago

I don't have any direct experience with IHC for day to day clinical biopsies. These sorts of issues are also lab depended. So if weak C1q staining ...

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RE: Full house with negative serolgy 3 days ago

Based on the description of the report only it is difficult for me to come to a specific diagnosis as there may be other features in the biopsy not...

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RE: Please help with a case of IGA nephropathy 3 days ago

I agree with you 100% , I am not sure if AI condenses and presents all the available literature , or is making it's own biased assumptions . -...

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RE: Please help with a case of IGA nephropathy 3 days ago

Very interesting AI consult. Did your electronic consultant take into account the findings if the TESTING trial (with respect to biopsy lesions? If...

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RE: Full house with negative serolgy 3 days ago

Thanks Dr Zuckerman, I just want to say that this is on immunohistochemistry and not immunofluorescence, would it is still be as sensitive in detec...

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RE: Full house with negative serolgy 3 days ago

Thanks Dr Glassock. I will ask the pathologist is this is possible ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Interesting GN case 3 days ago

Dr.Dastoor- look at the description of the patient eligibility for the PEXIVAS trial (NEJM)- the largest trial ever conducted concerning treatment ...

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RE: Full house with negative serolgy 3 days ago

Thanks Dr. Zuckerman. Based on the findings described in the Pathology Report, is sufficient evidence available to make a "diagnosis" rather than a...

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RE: Interesting GN case 3 days ago

Is a positive ANCA enough to diagnose the patient as an ANCA vasculitis of the kidney ( MPO MPA Anca vasculitis) The biopsy seems more like FSGS......

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RE: Please help with a case of IGA nephropathy 3 days ago

@Richard Glassock yes you are right about the low Kappa for E lesions . However these lesions are the earliest responders to therapy as well. It wo...

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RE: Full house with negative serolgy 3 days ago

yes, I think KM55 staining here would be helpful, a strong positive staining would favor IgAN. However, there are report of LN cases with KM55 posi...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 3 days ago

The major known risk with using complement inhibitors is for encapsulated bacteria. So vaccination is recommended against meningococcal, pneumococc...

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RE: Please help with a case of IGA nephropathy 3 days ago

The E lesion has the worst inter observer reproducibility among the MEST-C scores (Kappa about O.45) so i would not attach too much significance to...

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RE: Please help with a case of IGA nephropathy 3 days ago

She has C1 on both biopsy. I think its significantly indicative of active IgA nephropathy, particularly where E was 0 in the second biopsy. Dose th...

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RE: Interesting GN case 3 days ago

Interesting points. I think this patient would have met the entry criteria for the PEXIVAS trial of ANCA vasculitis without a kidney biopsy. ----...

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RE: Please help with a case of IGA nephropathy 3 days ago

I agree ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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