RE: IgA nephropathy with crescents 3 hours ago

Cyclophosphamide is great for severe LN and ANCA vasculitis but this may not translate to crescentic IgAN (C1) without RPGN. The only RCT of CYC th...

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RE: Pd Patient And Lipid Lowering Agent 5 hours ago

@prof bargman what is your approach to lipid management in your cohort ? Many thanks --------------------------------- Muhammad Soobadar MBChB ...

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RE: IgA nephropathy with crescents 5 hours ago

Thanks I would agree with prof glassock and dr dastoor . The conundrum in this case is if use Sparsentan first and proteinuria drops after 4 weeks...

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RE: yeast peritonitis and return to PD. 5 hours ago

Thanks really helpful Bw Belal --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: yeast peritonitis and return to PD. 5 hours ago

All except the patient with the pessary and repeat yeast peritonitis. You can look up the absolute numbers in our paper that I attached. Get Outl...

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RE: low phosphate and smoldering myeloma 5 hours ago

Hi dr dastoor, Interested to know how you get the figure of 40 mmol of phosphate in urine daily? And what is the expected range for potasssium and...

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RE: yeast peritonitis and return to PD. 5 hours ago

Thanks dr Mariam @ prof bargman. What number of patients restarted pd after yeast peritonitis and what number managed to maintain on it ( expect 2 ...

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RE: Pd Patient And Lipid Lowering Agent 5 hours ago

Thanks prof glassock I was not aware of lipid oil but from the trial Seems promising . I will discuss with colleagues in my unit and consider imp...

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RE: SIADH conundrum 5 hours ago

Vasopressin Storm - Vasopressin Surge - Vasopressin Spray Here I propose a name change to SIADH. "Vasopressin Storm!" We no longer call this wa...

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RE: SIADH conundrum 10 hours ago

in regard to potential nephrotoxicity of iv acyclovir, i assume baseline renal function was normal? how fast is acyclovir being infused and at what...

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RE: SIADH conundrum 11 hours ago

The Uosm is high , which can mean 2 things 1. The patient is volume depleted , or 2. The patient has an inappropriate ADH excretion in the face o...

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RE: C3 or MGRS 11 hours ago

No , this is another case . The previous case had a bone marrow and no evidence of a monoclonal disorder . This case also has a gamma spike on SPEP...

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SIADH conundrum 12 hours ago

Hello everyone, I have an interesting case of SIADH management in the hospital. 69 y.o. female with altered mental status found to have encepha...

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RE: C3 or MGRS 12 hours ago

Was this the case you were going to do the IgG3 on?? ------------------------------ Michael Hughson MD Univeristy of Mississippi Medical Center (...

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RE: IgA nephropathy with crescents 15 hours ago

Thank you all for your input. I read in the supplementary material of Applause trial that patients who received any immunosuppression within 90 day...

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RE: C3 or MGRS 21 hours ago

Thanks Dr. Dastoor. The fact that she was treated with immunosuppression and did not develop any clinically apparent infection makes IRGN unlikely....

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

I can only see partial notes from the outside system. It still says "ATN resolving preliminary results". No mention of glomeruli. But does not se...

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

Did the biopsy show patchy cortical necrosis is or acute tubular necrosis?. ------------------------------ Richard Glassock MD, FASN Emeritus Pr...

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

What did the kidney biopsy show? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

Does your patient have diarrhea or aType 1 DM? Has the skin lesion been biopsied? Is it Psoriasis or Eczema.?I am thinking of IPEX syndrome - a ver...

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RE: C3 or MGRS 1 day ago

I agree that this might be a C3GN pattern of injury due to a PGNMID. Temporary therapy with Pegcetacoplan might be effective, but for the long term...

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RE: IgA nephropathy with crescents 1 day ago

I agree with Dr.Dastoor, but I would use MMF as well. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School o...

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RE: C3 or MGRS 1 day ago

Thank you. As of now there has been no infections detected . She has been on high dose steroids and MMF and that would have activated an occult inf...

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RE: C3 or MGRS 1 day ago

Hi Dr. Dastoor, this is my opinion only I think there's definitely too much IgM to call it C3G and that this patients should be carefully evalua...

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C3 or MGRS 1 day ago

I would like to reintroduce the case presented here 4 weeks ago . 39 year old female , who presented with sudden onset of nephrotic syndrome. He...

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RE: IgA nephropathy with crescents 1 day ago

Pulse steroids , followed by a course of 2. oral steroids and 3. Iptacopan , if insurance permits . Hit hard and hit fast , would be the way to go....

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RE: Tumoral calcinosis in a PD patient 1 day ago

Sounds like the phos is getting under control, how high was it. Not sure you need to add tenepanor, though it may be helpful. would definitely chec...

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RE: Tumoral calcinosis in a PD patient 1 day ago

Thank you all for the excellent comments, especially regarding the adynamic bone possibility and due precautions: avoiding bisphosphonate and alumi...

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RE: Tumoral calcinosis in a PD patient 1 day ago

Is a pth of 230 really a concern for adynamic bone disease? I would however stop the vit D for that reason and also especially in the setting of tu...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

i think the psoriasis treatment can wait until the nephrotic syndrome is in remission, even if by chance rituximab exacerbates it (?). As frequen...

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RE: High output HF from AVF? 1 day ago

"Cardiology did not comment as "high output failure", I believe they were not involved other than reading the TTE," I find that there are cardiol...

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Fellows - Your Input Is Needed: 2026 ASN Fellow Survey 1 day ago

Dear Fellows, 😀 A quick reminder to please complete the 2026 ASN Nephrology Fellow / Transplant Nephrology Fellow Survey if you have not already ...

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RE: High output HF from AVF? 1 day ago

And he did have a permcath placed in 2022 when his initial LAVF failed, but no signs of central vein stenosis. ------------------------------ Esr...

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RE: High output HF from AVF? 1 day ago

Cardiology did not comment as "high output failure", I believe they were not involved other than reading the TTE, which, this time doesn't show PHT...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 2 days ago

I have done a little more research (with the help of AI) and the story gets more complicated. A connection between Rituximab therapy an d worsening...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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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