RE: Light chain proximal tubulopathy 1 hour ago

Why is the patient being treated with a SGLT2i.? I cannot see any indication for this medication. ------------------------------ Richard Glassock...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 1 hour ago

If malignant hypertension is not present. Cerebral venous sinus stenting has been successful in controlling severe intracranial hypertension associ...

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RE: Light chain proximal tubulopathy 1 hour ago

Tagging @Shree Sharma with Arkana who did a wonderful job analyzing the kidney biopsy. --------------------------------- Gary Singer MD, FASN Par...

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RE: Light chain proximal tubulopathy 1 hour ago

Thank you for the great discussion about this challenging case. Over the past 5 months, kidney function has been stable - SCr 1.3-1.5 mg/dL (eGFR 4...

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RE: Light chain proximal tubulopathy 1 hour ago

apologies for a typo it should be: Interestingly the LAMBDA LCPT appears to be predominantly noncrystalline while kappa restricted LCPT appear...

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RE: Light chain proximal tubulopathy 2 hours ago

Dear Colleagues - how about LCPR-US? Years ago, Dr. Leung and colleagues introduced the term MGRS in order to facilitate progress in studying and...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 2 hours ago

Agree with Dr.Glassock Ai consultant recommends frequent LP, avoid acetazolamide, use Toprimate (reduced dose) instead, consider ONSF vs venous s...

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RE: management of a patient with CKD stage 5 and severe intracranial hypertension. 4 hours ago

What is the patients systemic arterial BP? What is the current anti-hypertensive regimen.. Any features suggesting a concomitant TMA.? ----------...

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RE: maintenance for PR3 ab AAV? 4 hours ago

I have seen several patients with GPA and persistence of + anti-PR3 ANCA experience severe life endangering relapses after many years (20 years in ...

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RE: maintenance for PR3 ab AAV? 5 hours ago

Thank you Dr Rodby. Any other thoughts? ------------------------------ Sumeyye Calp Inal MD Duluth GA (347) 237-8759 ------------------------------

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management of a patient with CKD stage 5 and severe intracranial hypertension. 5 hours ago

The patient has: * CKD stage 5; creatinine 736 µmol/L * Urea 22 mmol/L * K 4.4 mmol/L * HCO₃⁻ 23 mmol/L * Papilledema * MRI brain showing increase...

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RE: Light chain proximal tubulopathy 7 hours ago

Interesting case. We know the patient has a kappa monoclonal gammopathy but what is happening in the kidney. The EM description does not report any...

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RE: Light chain proximal tubulopathy 13 hours ago

I think that investigation for MGRS is warranted. It has been almost 20 years since the non-crystalline LCPT was reported for the first time by us ...

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RE: Rapidly progressive glomerulonephritis 14 hours ago

RTX can be very effective in IgAV but not in IgAN, for poorly understood reasons. No RCT data (yet) . I would have tried it. If no contraindication...

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RE: Full House/Non Lupus nephropathy 15 hours ago

" GFR stable ".... Could you elaborate a bit on the actual GFR ... is it low for age or normal ... --------------------------------- Dr. Hormaz D...

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RE: Rapidly progressive glomerulonephritis 17 hours ago

Just to update the community. No definitive infection identified Shortly after the start of prednisone he developed edema. MMF 1g bid was added ...

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RE: Light chain proximal tubulopathy 21 hours ago

I believe Dr. Glassock is right on the money. The toxicity of LC in PCT can happen in the absence of crystals or clear deposits. Mis-trafficked and...

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RE: Light chain proximal tubulopathy 23 hours ago

In my opinion, this is pathological trafficking , not physiological trafficking, and a bone marrow examination in needed to identify a clone, not t...

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RE: Light chain proximal tubulopathy 1 day ago

I am not sure. Given that is was sufficiently focal to be below diagnostic threshold for LCCN, I am not sure there would even be enough material to...

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RE: Light chain proximal tubulopathy 1 day ago

Does mass spectrometry of the congophilic casts is helpful in this case for better clarification? --------------------------------- Hayder Aledan ...

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RE: Light chain proximal tubulopathy 1 day ago

An interesting paper exploring this concept: Maike Büttner-Herold 1,*, Nathalie Krieglstein 1, Teresa Chuva 2, Kaija Minuth 1, Frederick Pfister...

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RE: Light chain proximal tubulopathy 1 day ago

Although kappa light chain (monomers ) are filtered more readily than lambda light chain (dimers) these values are not compatible with physiologica...

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RE: Light chain proximal tubulopathy 1 day ago

The congophilic casts are bit concerning to me as that is an extremely unusual non-specific finding in most renal biopsies (at least in our lab). B...

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RE: Light chain proximal tubulopathy 1 day ago

Last SPEP showed free kappa LC and no M-spike. BM biopsy yesterday (pending). ------------------------------ Gary Singer MD, FASN Partner Midwe...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

Thank you for sharing. Seems like quite a bit of chronicity >50% GG, 60-65% IFTA, and severe arteriosclerosis and arteriolar hyalinosis. It is stil...

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RE: Light chain proximal tubulopathy 1 day ago

LM: 19 glomeruli, 6 globally sclerotic. The intact glomeruli appear unremarkable, with no mesangial expansion, endocapillary hypercellularity, fibr...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

In view of the now known severe IFTA and the paucity of data regarding the benefits of immunosuppressive therapy for either TG or chronic active AB...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

LM: Up to 24 glomeruli are identified, 13 of which are globally sclerotic. Intact glomeruli show diffuse mesangial matrix expansion and mild mesang...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

IF: The sections are stained for IgG, IgM, IgA, C3, C4d, C1q, albumin, fibrinogen, and kappa and lambda light chains. There is granular capillary w...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

my understanding from reading Dr.Zuckerman's comments which seems consistent with DR. Rubin and mine-IGAN+CABMR. proteinuria IMO could be either or...

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RE: Light chain proximal tubulopathy 1 day ago

perhaps a bone marrow biopsy might help differentiate between physiological trafficking versus a true light chain tubulopathy? ------------------...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

Thank you Dr. Zuckerman. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: MPGN pattern in a 43-year-old woman with a JAK2-positive hematologic disorder, portal hypertension, and a serum IgA-λ monoclonal protein 1 day ago

Following is from AI: Patients with JAK2 mutation-associated myeloproliferative neoplasms (MPN) such as essential thrombocythemia (ET) or polycyth...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

I didn't see the full annonymized biopsy report (but may have missed it in the response chain). So my opinion on these findings is tentative as I d...

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RE: Light chain proximal tubulopathy 1 day ago

Really need EM to interpret this finding. If crystals are present this is crystalline LCPT. If crystals are not present it is a more nuanced interp...

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RE: Light chain proximal tubulopathy 1 day ago

Go back to tissue for EM if not done and possible AG retrieval by paraffin section. Any proximal tubular dysfunction signs? Complete the hematolo...

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RE: Full House/Non Lupus nephropathy 1 day ago

This is a good article. Thanks ------------------------------ Sandeep Magoon MD Nephrology Associates of Tidewater, LTD and Eastern Virginia Medi...

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RE: Full House/Non Lupus nephropathy 1 day ago

Still trying to figure out. She has been treated with steroids all along. GFR stable has 2 gms proteinuria ------------------------------ Sandeep...

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RE: Light chain proximal tubulopathy 1 day ago

Suppose no fanconi --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology, Inc. Cincinnati OH (513) 841-0222 --------------...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

It was not a question,just an observation from a large (n=64) study of patients with IgA deposition in a renal allograft. (Ganesh et al 2024) 18/64...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

Dr. Glassock, I do not understand your question. Please clarify it. The paper you cited (attached) just reinforces the ongoing discussion: " the po...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

For the Transplant Nephrologists here is an interesting study of "incidental" IgA deposition in long term allografts with chronic allograft Nephrop...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

No personal experience with anti-CD38 therapy in AMR. I have found that late-onset AMR (> 6-12 months post-transplant), especially with transplant...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

Thank you for sharing this case Want to know if this patient had previous rejection ? Whats his averrage tacrolimus trough level ? Any recent ...

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RE: Proteinuria and hematuria in 2 siblings 2 days ago

@Michelle Rheault thank you for your comments. We discussed these 2 cases at our case conference today and 2 geneticists from Natera were there. ...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

agree there is mesangial proliferation with mesangial IgA deposits-significant chronic changes. so combination IGAN (whether recurrent vs de novo ?...

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RE: Light chain proximal tubulopathy 2 days ago

Can we see the deidentified kidney biopsy report. Physiologic protein reabsorption droplets should not be monoclonal. What is the UACR, UPCR and a ...

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RE: is it SIADH 2 days ago

See also Feldman BJ et al NEJM 2005 ;352:1884-1890 for a description of the infantile X-linked form of NSIAD. Could certain drugs, like Sertraline,...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

What about the IF staining looks like strong postive for IgA In this longstanding kidney transplant would you consider this denovo IgA or second...

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RE: is it SIADH 2 days ago

as promised see post very interesting IMO ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Unive...

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