RE: Pseudohypertension or true uncontrolled HTN 7 hours ago

Would a non - invasive estimation of Central Aortic Pressure (wave form of peripheral pulse ) be a better option than an arterial line.? Just Cur...

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RE: Generic FSGS 7 hours ago

Yes, a small post-Hoc analysis of the DUPLEX trial of Sparsentan in genetic forms of FSGS lesions did show benefits of this agent .( See Yee et al ...

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RE: Interesting GN case 8 hours ago

MPGN Type III is no-longer used as a diagnostic term in kidney pathology- this an ICGN pattern if injury lesion. I do not see any description if do...

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RE: Interesting GN case 8 hours ago

Staining for K/L came positive for both, 3+, not monoclonal. ------------------------------ Daniele Rios Leite MD University of Florida Jacksonv...

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RE: Interesting GN case 9 hours ago

Final path report has dramatically changed. "Left native kidney biopsy: Membranoproliferative nephritis, type III, see comment Moderate chr...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 10 hours ago

Dr. Vishnapolsky is correct. Per DODI6130.03 (V1) (Medical Standards for Military Service: Appointment, Enlistment, or Induction) Chapter 6.15(m), ...

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RE: Pseudohypertension or true uncontrolled HTN 10 hours ago

@Raymond Townsend @Matthew Weir @Agarwal Rajiv Would any of you go directly to arterial line BP assessment in this patient? Or would you pref...

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RE: Generic FSGS 10 hours ago

These cases do NOT appear to be "Primary FSGS" an acquired disease of podocytes thought to be related to a circulating factor that often responds t...

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RE: Managing severe hypertension in outpatient settings 10 hours ago

One of the biggest changes in my medical years is the approach to HTN not as the number but a symptom. HTN emergency v urgency etc. This was t...

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Generic FSGS 11 hours ago

I saw 2 of 10 siblings today, 6 male and 4 female . They are the offspring of two first degree cousins . All 10 of the siblings have been diagnose...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 11 hours ago

Well that may settle this medical and philosophical debate, thank you Dr Vishnepolsky. I understand that the military cannot look at the nuances ...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 11 hours ago

APAbs are antibodies, why is it that decreasing production of antibodies has had such variable clinical results? One report sounds encouragin...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 14 hours ago

In APS /aPL positive patients with HTN and CKD, renal artery stenosis is very prevalent and maybe it could be interesting to perform a Doppler US. ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 19 hours ago

A history of polycystic kidneys is a disqualifying condition by US military medical standards regardless of Mayo class. If he already knows this in...

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RE: Managing severe hypertension in outpatient settings 1 day ago

Dr. Abid+ if you have access to the UpToDate chapter on " Management of severe asymptomatic hypertension in Adults" by Varin and Elliott (last re...

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

Dr. Chebib- thanks for your excellent and well calibrated response. We are in a new era of medicine and need to adapt in a non-paternalistic, evide...

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

Thank you Dr. Glassock. We, and others, are working on such models/tools. In our hands, AI-empowered tools reporting the various imaging metrics ...

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

Dr. Chebib- Thanks for your very informative post. The subtleties of the genetic architecture of ADPKD are difficult to remember. Is there an AI ...

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Managing severe hypertension in outpatient settings 1 day 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. 1 day 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. 1 day 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 1 day 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 1 day 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 1 day 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. 1 day 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. 1 day 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. 1 day 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. 1 day 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. 2 days 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 2 days 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. 2 days 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. 2 days 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 2 days 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. 2 days 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 2 days 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 2 days 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. 2 days 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. 2 days 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. 2 days 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. 2 days 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. 2 days 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. 2 days 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. 3 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. 3 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. 3 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. 3 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. 3 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. 3 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. 3 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 Sunday, February 8 @ 2:50 PM

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

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