RE: Puzzling Case of Post-Transplant Proteinuria 4 minutes ago

Sorry I meant the genetic testing in the donor. In Turkey, since more than 90% of kidney transplants are performed from living donors, we usually h...

View Discussion

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 hours ago

Indefinite therapy duration with Pegcetacoplan is probably not feasible or appropriate . Incomplete penetrance and modifier genes ate going to impa...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 4 hours ago

dear Dr. Venkat- did you post this unexplained case of post transplant significant proteinuria for a colleague or do you have direct management ? I...

View Discussion

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 5 hours ago

While pegcetacoplan works broadly across the cohort, the Valiant trial doesn't define the optimal duration of therapy. In patients with a proven, l...

View Discussion

RE: SGLT2i & renal tubular creat secretion 5 hours ago

Thank you Dr Glassock> Yes, I was aware of the initial hemodynamic effect. My qstn had to do more with a longer duration of observation, like a chr...

View Discussion

RE: SGLT2i & renal tubular creat secretion 5 hours ago

So far as I know there are no established effects of SGLT2 inhibitors on tubular secretion of creatinine. The rise of serum creatinine after initia...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 5 hours ago

You must mean genetic test in the donor not the recipient- to evaluate donor derived dieease. ------------------------------ Richard Glassock MD,...

View Discussion

SGLT2i & renal tubular creat secretion 6 hours ago

Hello Folks: Is anyone aware of a publication (human or animal study) that has directly examined this qstn ? Much appreciated. AI sites do not seem...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 6 hours ago

We had a couple of cases with post-transplant early proteinuria like this which unexpectedly came up to have COL4A mutation. Dr Venkat, I think it ...

View Discussion

RE: nephrotic syndrome 7 hours ago

If you think you need to biopsy a solitary kidney in order to manage this patient, I see no reason for a delay. You will have to stop all anticoagu...

View Discussion

RE: nephrotic syndrome 8 hours ago

Although FSGS lesion due to Cabozantinib much more likely, another differential could be RCC causing AA Amyloid? Especially with massive protienuri...

View Discussion

RE: Biopsy or not 19 hours ago

Thank you, everyone, for the very helpful insights and discussion. To answer some of the questions raised, her UA showed trace hematuria with 5 R...

View Discussion

RE: Biopsy or not 20 hours ago

Dr. Hirsch- thanks for your well framed words- a delight to read them- they validate a long life filled with curiousty. All my best to you!! ----...

View Discussion

RE: Biopsy or not 23 hours ago

Dr. Lee's post mentions "trace" hematuria. It will be helpful to know how many RBCs/HPF, if they were dysmorphic and any casts were seen. Not convi...

View Discussion

RE: Biopsy or not 23 hours ago

Microscopic hematuria has been described in "10-35%" of patients with proven DM nephropathy so I doubt that this alone (without RBC casts, and with...

View Discussion

RE: Biopsy or not 1 day ago

Great response Dr.Dastoor- maybe shared decision making is the answer. How will having a precise diagnosis help the patient. --------------------...

View Discussion

RE: Biopsy or not 1 day ago

I agree that with untreated diabetes and uncontrolled HTN there is a rapid decline . In fact it was suggested that the average egFr decline correla...

View Discussion

RE: nephrotic syndrome 1 day ago

Looking at the literature, there are cases of severe proteinuria with cabozantinib. We were impressed by the 23 grams. We hesitated to perform a ...

View Discussion

RE: Biopsy or not 1 day ago

I agree with Dr Glassock: In the modern era of aggressive DM treatment and great success we sometimes forget that the natural history of poorly tre...

View Discussion

RE: nephrotic syndrome 1 day ago

Thank you both for your comments. IgG 560 mg/dl ------------------------------ Ioannis Giatras MD N. Erythrea 2106771540 ------------------...

View Discussion

RE: nephrotic syndrome 1 day ago

"IgG low" How low is the IgG level? This may influence choice of rituximab vs steroids for treatment of podocytopathy. ------------------------...

View Discussion

RE: Biopsy or not 1 day ago

May repeat kidney ultrasound. With diabetic nephropathy and amyloid, kidneys may not become smaller. However, marked increase in echogenicity compa...

View Discussion

RE: Biopsy or not 1 day ago

It won't modify management at this stage , but perhaps help in diagnosis , if the patient is inclined.. risks of bleeding also increase with lower ...

View Discussion

RE: nephrotic syndrome 1 day ago

I meant to say MCD/FSGS (a diffuse podocytopathy ) from cabozinitib (a VEGFR inhibitor) ------------------------------ Richard Glassock MD, FAS...

View Discussion

RE: nephrotic syndrome 1 day ago

The clinical features suggest MCD as a complication from ICI (nivolumab) . You could treat empirically with steroids or RTX if you are concerned ab...

View Discussion

RE: Biopsy or not 1 day ago

According to my experience and the available literature the rate if decline of eGFR expected in DN is quite broad- between 2 and 20 ml/min/1.73M2/ ...

View Discussion

nephrotic syndrome 1 day ago

I would appreciate your input on the following case: Male 53 years old, no previous history August 2022: iliac bone biopsy metastatic RCC (...

View Discussion

RE: Biopsy or not 1 day ago

Dr. Dastoor. Do you think that a kidney biopsy has a chance of modifying management.? If so, what is your estimate of the likelihood of such an out...

View Discussion

RE: Biopsy or not 1 day ago

DM nephropathy - eye exam Amyloid as was suggested Genetic FSGS - any family hx IgA -??? Renal limited TMA ( hx of preeclampsia) Could be sever...

View Discussion

RE: Biopsy or not 1 day ago

Your patient has many of the hallmarks of Diabetic Nephropathy and it is highly unlikely that a kidney biopsy will change management in any signifi...

View Discussion

Biopsy or not 1 day ago

Hello everyone, I wanted to discuss about my case of 41 y.o. Caucasian female with history of uncontrolled type 2 DM, hypertension, rheumatoid...

View Discussion

RE: Likely Active C3G before transplant 2 days ago

Living related. His potential kidney donor is his mother (47 y) --------------------------------- Ahmed Emara MD, FASN Ain Shams University CA...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

I'm surprised how cheap sparsentan is in UAE, but assuming that reflects the unique characteristics of the US healthcare system! But for full trans...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

Agree with Dr. Hirsch and Rodby about their comments. Because at UPCR of 05-0.7 g/g, there are still residual risk and the younger the patients, th...

View Discussion

RE: Likely Active C3G before transplant 2 days ago

from AI consultant- KDIGO 2020 recommends NOT excluding C3G candidates from transplantation (1B), because 5-year allograft survival exceeds 5...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

Thanks for the response , I am surprised that ET1 blocker costs USD 27k a month . The prices of drugs in Abudhabi, mirror that of the US . 30 day p...

View Discussion

RE: Likely Active C3G before transplant 2 days ago

Persistently low c3 means the alternative pathway is continuously activated at fluid phase which makes future graft involvement high. Better to def...

View Discussion

RE: Likely Active C3G before transplant 2 days ago

As noted, C3G has a high risk of recurrence. If you have access to Iptacopan or pegcetacoplan, I would have no qualms about proceeding. I would cou...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

I appreciate this thoughtful discussion on a complex and nuanced topic of treating IgA nephrophathy with the proliferating class of newer drugs. ...

View Discussion

RE: A case of Acute Kidney Injury. 2 days ago

Dr Glassock- Albumin is 2.2. First Biopsy was mostly medullary. Dr Friedman- Thanks for the comment. Interesting! Dr Lerman- Anticoagulation i...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

The clinical reasoning of Drs. Hirsch and Rodby is quite fair and sensible. The dictum is that the "lower the proteinuria the better", especially w...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 2 days ago

I am partial to Dr Rodby's thinking here. I have given Sparsentan recently to several IgA patients in the 500-1000 mg range. It is based on extrapo...

View Discussion

RE: A case of Acute Kidney Injury. 2 days ago

The discrepancies between the first and second kidney biopsy specimens is striking.. any explanations for this phenomenon. Is it all sampling error...

View Discussion

RE: Likely Active C3G before transplant 2 days ago

C3GN is not an absolute contraindication for renal transplant though high risk for recurrence. IMO low C3 does not necessarily increase risks for r...

View Discussion

RE: Likely Active C3G before transplant 2 days ago

is expected transplant living related, unrelated, or DD? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Me...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 3 days ago

Yes, but in post-hoc analyses like this we need to be cautious in interpreting an association as proof of causation. ----------------------------...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 3 days ago

this article seems to suggest that lowering proteinuria to less than 0.3 g/g is significantly renoprotective --------------------...

View Discussion

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 3 days ago

Makes sense. Thank you. ------------------------------ B. Andre' Weinstock, PhD Scientist & Alport syndrome-COL4A5 patient Somerville, MA USA ---...

View Discussion

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 3 days ago

In my opinion , genetic testing has limited value in Family planning for C3GN- genetics determines susceptibility, not destiny . Variable penetranc...

View Discussion

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 3 days ago

Given incomplete and variable penetrance, except for CFHR5 nephropathy ,,a positive result can't give a child-specific risk estimate - most carrier...

View Discussion