RE: MPGN Pattern 4 hours ago

I agree with Dr. Song- the IC-MPGN pattern-of-injury is most often thec result of an underlying disease, especially in older adults , - auto-immune...

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Hyponatremia 6 hours ago

As a non-academic Nephrologist, it is obvious that the confusion in diagnosing and management of Hypontremia persists. I would have treated him as...

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RE: MPGN Pattern 6 hours ago

Also request for serum DNAJB9 and stain the paraffin immunohistochemistry for DNAJB9 for FGN. Given the IgG4 positive IF and possible history of m...

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RE: Latent TB and Membranous Nephropathy 7 hours ago

would colleagues use EPO or wait for biopsy or stomach polyp in case cancer? i would start EPO small dose and unlikely for polyp to be malignant ...

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RE: Latent TB and Membranous Nephropathy 7 hours ago

update OGD- 1mm polyp in antrum biopsied Colonoscopy- Left Sided Diverticulosis PET scan No evidence of occult FDG avid malignancy. Ig G...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 8 hours ago

Dr. Al-Saegh: Over the past few days, what has been the further trends in urine output, serum creatinine, hematological values and hemolysis marker...

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RE: MPGN Pattern 8 hours ago

Thank you for sharing this case. My read: IgG-dominant immune-complex MPGN with crescents; low C3 with normal C4 suggests alternative pathway activ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 11 hours ago

Why isn’t this class II (not I or V)? ‘Mesangial hypercellularity (of any degree) or mesangial matrix expansion…a few isolated subEPI (or subENDO) ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 12 hours ago

Thanks Dr. Saja , I am usually not using CNI unless nephrotic and nowadays have been switching to OBI for neohrotics and Belimumbab for non nephrot...

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MPGN Pattern 12 hours ago

Dear colleague May I consult you regarding this 58 years old patient with no known medical desease smoker refered to us due creatinine 1.67 no ...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 12 hours ago

I am wondering given the progression of her TBM disease to early onset failure and the phenotypic appearance of MG perhaps this phenotypic appearan...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 13 hours ago

Fine job - would have loved to know what the urine sodium was when the serum sodium corrected ------------------------------ [Mark] [Lerman] [M...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 14 hours ago

Dear prof Dastoor Autosomal recessive familial SLE with identified targeted gene have been identified among omani cohort Target gene mut...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 14 hours ago

Good morning This presentation is much more suggestive of early post-transplant TMA than ATG-induced hemolysis. Although ATG can certainly cause...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 15 hours ago

I wanted to thank Prem Chandran MD who actually uploaded the report of response of myasthenia gravis to dialysis. I agree with Dr. Rodby that ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 23 hours ago

Back to baseline. Some things take time.. ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 31453...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

No, he did not receive tolvaptan. It is not readily available in the hospitals I consult (cost of procurement is still high I’m told) -----------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

He never received Tolvaptan, correct? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UC...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Dr. Lerman, in his case, the Na corrected gradually-123 this past Friday, 127 on Sat, 131 Sunday and 135 yesterday and today and he was discharged ...

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RE: Obstructing Urinary Stone 1 day ago

Thanks- the obstructing stone was uneventfully removed via ureteroscopy last week . The patient is now home without any symptoms , I am awaiting ne...

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RE: Obstructing Urinary Stone 1 day ago

So sorry; I know no one may be interested in this thread anymore; but I did talk to a few of our endourologists about this. In my experience, the...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Thanks , have attached the final report from Thailand for review. --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisio...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

I agree with Dr. Rodby. This is not Class I LN . The subepithelial depidits inducted an early Class V +II lesion. I would treat with MMF + low dose...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

subepithelial and mesangial deposits on EM I suspect this is an early lupus membranous (V) responsible for the proteinuria, at 1 gram, I thin...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

If the transplant biopsy reveals TMA, I would definitely evaluate complement activity and perform genetic analyses. -----------------------------...

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RE: Sarcoidosis? 1 day ago

I do not but I think anything approaching 2 I think I would avoid. Epocrates says CrCl (eGFR) 10-50 usual dose by 50%, [More]

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Re tolvaptan: Dr Hirsch: "Something like...I give 7.5 mg in the AM and check the Na later that day. If it is increasing at an acceptable rate, ju...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 1 day ago

Thanks for the follow-up! You should report this. Case reports are case reports but when you have a case like this, it feels like a seminal event. ...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 1 day ago

Dear Colleagues: Thank you all for your great responses, and i will let you know what happened. To recap, the patietn developed kidney failure of u...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Dr. Anand-how quickly did serum sodium rise in relation to iv Bumex , have you repeated urine sodium. I want to discuss the risk if any regarding C...

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RE: AKI & Immune complex GN 1 day ago

Her serologies including lupus, and compliments were normal at the beginning of the workup, and were not repeated. She's coming back next week. I ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Thank you, Drs. Lerman and Venkat. I am glad the Page-kidney report was helpful. Professor Glassock, I agree that an allograft biopsy, once the pl...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Ok, the test done in Thailand shows 2.9 grams of proteinuria . Am questioning the reliability of the test Examined her and she has no edema She ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Interesting case. About 60% of SLE is due to hereditable polygenic factors including genetic variation of HLA, Complement (C2 and C4), Fc gamma rec...

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Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

19 year old female seen with rheumatology. She had 1.5 grams proteinuria and no hematuria in June 2026 Ana 1: 640 , ds DNa titer 60 sm RNP positiv...

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RE: AKI & Immune complex GN 1 day ago

Any follow up on thus , especially SLE serology and current status would be much appreciated.. ------------------------------ Richard Glassock M...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Dr. Al-Saegh- Do you plan to perform a transplant kidney biopsy when the platelet count exceeds 50K? . The very slow return of kidney function, t...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Dr. Lerman -I agree that Hepatic Vein Doppler US can give important clues to the presence of Portal Hypertension in Chronic Liver Disease but the "...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Thank you all for your responses, I learnt so many things from this post. My patient's Na finally budged-135 this morning. His BP is stable in t...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

@Edwin Anand-just FYI-Hepatic vein doppler might help to distinguish etiology of low EABV( HYPONATREMIA) in this case from significant TR ----...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

thanks Dr. Liu for the article which drives home all the important points -increased RI, reversal in diastolic flow, perinephric usually sub capsul...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Thank you very much, Professor Lerman. Her younger brother developed ESKD at nearly the same age and underwent a successful kidney transplant seven...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Dr. Lerman: I can recall 2 cases of Page Kidney following kidney transplantation, in the setting of implantation biopsy + early post-transplant sta...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Thank you very much, Professor Glassock. We agree that ATG-associated thrombocytopenia/hemolysis is currently the leading explanation; ATG was stop...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Here is one article for Page kidney after kidney transplant. ------------------------------ Song Liu MD Assistant professor New Mexico University...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Post transplant "Page Kidney" excellent point but never seen it happen in my Transplant Nephrology career . Per literature presents with sudden dec...

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RE: Sarcoidosis? 2 days ago

Dr. Rodby- do you have a threshold of Scr in Sarcoidosis above which you do not use MTX for therapy. Just curious!! ----------------------------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

I have customarily avoided Tolvaptan in patients hospitalized with hyponatremia due to chronic liver , especially if the latter is clinically worse...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

I like the simplicity and the prudent use of laboratory testing!!! Thanks ------------------------------ Richard Glassock MD, FASN Emeritus Prof...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Something like...I give 7.5 mg in the AM and check the Na later that day. If it is increasing at an acceptable rate, just redose 7.5 QAM until the ...

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