Hyperfiltration/IgA nephropathy 1 hour 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...

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RE: young girl with Chronic TI dz 2 hours ago

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

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RE: young girl with Chronic TI dz 2 hours 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...

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RE: de-novo MGRS with LCDD 2 hours 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...

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RE: de-novo MGRS with LCDD 3 hours 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...

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RE: young girl with Chronic TI dz 4 hours ago

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

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RE: young girl with Chronic TI dz 5 hours 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 ...

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RE: young girl with Chronic TI dz 6 hours ago

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

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RE: young girl with Chronic TI dz 8 hours 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...

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RE: secondary IgA Nephropathy 8 hours ago

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

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RE: secondary IgA Nephropathy 9 hours 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. ...

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RE: young girl with Chronic TI dz 16 hours 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...

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young girl with Chronic TI dz 17 hours 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...

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RE: Kidney Biopsy in AL Amyloidisis 18 hours 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...

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RE: Kidney Biopsy in AL Amyloidisis 1 day 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...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

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

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

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

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RE: MGRS/Fanconis 1 day ago

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

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RE: Kidney Biopsy in AL Amyloidisis 1 day 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...

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RE: Kidney Biopsy in AL Amyloidisis 2 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...

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RE: Kidney Biopsy in AL Amyloidisis 2 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...

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RE: MGRS/Fanconis 2 days ago

Dr. Rodby - per Dr. Shah marrow was normal. The serum free light chain ratio seems extremely high, and that could easily be followed during appropr...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Mario Rubin @Richard Glassock I agree. Fascinating case and a lot of clinical learning. ------------------------------ Satish Balan MD DM D...

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RE: MGRS/Fanconis 2 days ago

No - bc these are recent diagnoses - but I guess the crux of the question is - does myeloma therapy improve proximal tubulopathy and associated ...

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RE: MGRS/Fanconis 2 days ago

Yes, small percentage of plasma cells. The more I read the more I see that the hypophosphatemia is very unlikely to respond. Treating makes sen...

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RE: IgA-Nephropathy: to complement or not to complement? 2 days ago

The presence of Obesity makes the eGFR -Cystatin C less reliable, bu the only way to resolve the discrepancy is to obtain a measured GFR or a 24 ho...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Thank you all for this vigorous and enlightening discussion. The patient clearly has systemic Amyloidosis based on the bone marrow and fat pad biop...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Satish Balan In the case we discussed, the POST-BIOPSY fat pad and bone marrow congo red staining were both positive for amyloidosis. No further...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Mario Rubin Thanks for those pathology pearls. While I absolutely agree with those arguments, in the situation that Dr Glassock posted, assumin...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

I also wanted to share another pearl written by Dr. Fogo et al which was just sent to me by Dr. S. Korbet and briefly discussed at the Rush confere...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

I was also present at the meeting. The case, as presented, was characterized by a slight elevation of IgM lambda with normal IgG, IgM and IgA. The ...

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RE: IgA-Nephropathy: to complement or not to complement? 2 days ago

" 04/2023 creatinine-based eGFR 76, cystatin C-based 67 04/2025 creatinine-based eGFR 77, cystatin C-based 38 04/2026 creatinine-based eGFR 68,...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

@Richard Glassock: In the patient presented at the Rush University Kidney Biopsy Conference that you referred to, kidney biopsy must have been done...

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RE: MGRS/Fanconis 2 days ago

Have kappa and lambda levels been increasing over the years? Do you have serial DEXA scans and/or skeletal x-rays showing progressive deterioration...

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RE: MGRS/Fanconis 2 days ago

I would absolutely treat , following the k/l ratio, the tubulopathy may not improve but I think you are asking for trouble doing nothing. Just opin...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Unless it has already been mentioned that AL has been confirmed, I think we should still try to type the amyloid detected in the bone marrow biopsy...

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RE: MGRS/Fanconis 2 days ago

"SPEP = IgG Kappa, FLC ratio = 315." what is IgGK,IgGLambda levels? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCO...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

I think the question here is whether we are sure of the diagnosis and how far we should go to establish that. It is important to get to the source ...

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RE: MGRS/Fanconis 2 days ago

Not my speciality , though it seems there is a clone causing tubular damage with hypoPO4 . He is 57 years old and probably could live another 20-25...

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RE: IgA-Nephropathy: to complement or not to complement? 2 days ago

I am not sure if there is a need to measure both creatinine based eGFR and Cystatin C eGFr in this patient . Regarding compliance issues , glucos...

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RE: IgA-Nephropathy: to complement or not to complement? 2 days ago

@K.K. Venkat: I have to admit that we have not performed a kidney ultrasound for quite some time. I will make sure that he has one at his next vi...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

In the absence of a bleeding tendency (Factor X deficiency) there is little evidence to suggest that renal Amyloidosis confers any additional risk ...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Dr. Venkat - thanks-important information. My AI consultant (Claude) agrees, so long as the tissue contains Congo Red birefringent deposits of Amyl...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

My AI consultant says that both IMF for light chain-restriction and LMD-MS can be done on bone marrow and abdominal fat pad biopsies positive for a...

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MGRS/Fanconis 2 days ago

Hello, I have a 57M patient with MGRS manifesting as very stable CKD (bland U/A with no blood, ACR is 5 mg/mmol) and Fanconi's syndrome (very mil...

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RE: Kidney Biopsy in AL Amyloidisis 2 days ago

Thanks-Dr. Abdalla- I think that mass spectrometry (MS) would require a kidney biopsy. Do we need MS if we "presume" the circulating IgM lambda m...

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RE: Kidney Biopsy in AL Amyloidisis 3 days ago

AL amyloidosis is diagnosed via two distinct non-renal sites (fat pad pad biopsy + bone marrow . ​renal biopsy is unnecessary and carries high blee...

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RE: IgA-Nephropathy: to complement or not to complement? 3 days ago

"His current creatinine-based eGFR is 68, cystatin C-based eGFR is 35." Tough question, Dr. Glassock! Requires evaluation of patient for muscle m...

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Kidney Biopsy in AL Amyloidisis 3 days ago

Here is a question for the Open Forum participants, stimulated by an actual case (discussed recently on the Rush University Kidney Biopsy Conferenc...

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RE: IgA-Nephropathy: to complement or not to complement? 3 days ago

Dr. Venkat- which eGFR (Creatinine or Cystatin C) most likely represents mGFR in this patient? ------------------------------ Richard Glassock MD...

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