RE: Likely Active C3G before transplant 2 hours 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 hours 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 hours 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 4 hours 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 4 hours 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 6 hours 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 7 hours 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 7 hours 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. 7 hours 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 17 hours 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 19 hours 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. 19 hours 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 20 hours 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 20 hours 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 1 day 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 1 day 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)? 1 day 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)? 1 day 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)? 1 day 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

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 1 day ago

If readily available, genetic testing might be considered to aid in family-planning decision making of a diagnosed parent and partner. ----------...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 1 day ago

The value of adding an ET Blocker (Atrasentan) or switching to a DEARA (Sparsentan) in such patients with IgAN to get the proteinuria below 0.3gms ...

View Discussion

RE: Do we need genetic testing in C3G (outside Cypriot ancestry)? 1 day ago

i agree- genetic testing in C3 GN is primarily of research interest- at least for now. ------------------------------ Richard Glassock MD, FASN E...

View Discussion

RE: Pre-conception Strategy in CKD 3 with Proteinuria (Preserved Albumin)re: Biopsy Timing, Genetic Panel, and Pregnancy Monitoring 1 day ago

I agree with Dr. Rodby, except I would do genetic testing first as the results may make kidney biopsy unnecessary. This will be a very high risk pr...

View Discussion

RE: Role Of endothelin blockers In igA Nephropathy 1 day ago

"However from an economic standpoint does it make sense to introduce these drugs , considering studies on ET1a was mainly in patients with more tha...

View Discussion

Likely Active C3G before transplant 1 day ago

Hello everyone we have 22y guy, ESKD on dialysis (twice weekly since august 2026). He has a long history of chronic GN with last biospy in 202...

View Discussion

RE: A case of Acute Kidney Injury. 1 day ago

I assume the sensitivity of intratubular RBCs/RBC casts decays over time in ARN. And from the dates reports were printed, it would seem at least 1 ...

View Discussion

Role Of endothelin blockers In igA Nephropathy 1 day ago

We have a couple of patients with IgA Nephroapthy, who have been treated in the past with IS therapy , some without IS therapy. But all of them on...

View Discussion

RE: Pre-conception Strategy in CKD 3 with Proteinuria (Preserved Albumin)re: Biopsy Timing, Genetic Panel, and Pregnancy Monitoring 1 day ago

I would push for a biopsy after a Natera full screen (assuming negative) I suspect she has a secondary FSGS of some sort. PCR seems a bit high fo...

View Discussion

Do we need genetic testing in C3G (outside Cypriot ancestry)? 1 day ago

In my opinion — no. Would like the community's input on this. Unlike aHUS, genotype doesn't drive diagnosis, treatment, monitoring, stopping decisi...

View Discussion

RE: A case of Acute Kidney Injury. 1 day ago

What was the patients serum albumin level when he presenterd with AKI and marked proteinuria? ------------------------------ Richard Glassock MD,...

View Discussion

RE: A case of Acute Kidney Injury. 1 day ago

"As far as anticoagulation is concerned, he had a stroke off anticoagulation 2 years ago, so he is still on it as of now. Ongoing discussion with c...

View Discussion

RE: A case of Acute Kidney Injury. 1 day ago

Dr Lerman and Dr Glassock for your valuable input. Also all others who contributed their time and expertise. I already started tapering steroi...

View Discussion

RE: A case of Acute Kidney Injury. 1 day ago

Thanks, unless I'm missing something I don't see any convincing evidence for tubular obstruction from red blood cells that would explain or suggest...

View Discussion

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

The biopsy report shows no evidence of nodular glomeruloscleroisis . No increase GBM thickness . No IgA deposits. The frequency of intratubular RBC...

View Discussion

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

This is the second biopsy. As far as the concern for two embolic lesions, raising concern for some amorphic material used during first biopsy is ...

View Discussion

RE: Resistant Rejection 2 days ago

Many thanks to all for the informative and helpful inputs. Dr. Lerman, the donor is not available now and the transplant was done at other city i...

View Discussion

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

Thanks can you post 2nd unidentified biopsy ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Direc...

View Discussion

Pre-conception Strategy in CKD 3 with Proteinuria (Preserved Albumin)re: Biopsy Timing, Genetic Panel, and Pregnancy Monitoring 2 days ago

Hello colleagues I am seeking advice about a complicated pre-conception eval and CKD 39 year old female of recent West African ancestry with CKD ...

View Discussion

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

I have attached the first biopsy report. Dr Lerman- I did ask the pathologist to check for hemosiderin in tubular epithelium. Thank you. ---...

View Discussion

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

ASK pathologist re-examine both specimens specifically for intratubular RBC casts, RBCs in Bowman's space, acute tubular injury, and hemosiderin (P...

View Discussion

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

Tubules did shows significant RBC. No glomerular hemorrhage though. I was hoping it to be AKI from contrast as well with subsequent recovery h...

View Discussion

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

contrast induced AKI CAUSING aki severe enough to require RRT with baseline creatinine normal would be a huge stretch IMO. could we see the unident...

View Discussion

Do we need genetic testing in C3G (outside Cypriot ancestry)? 2 days ago

In my opinion — no. Would like the community's input on this. Unlike aHUS, genotype doesn't drive diagnosis, treatment, monitoring, stopping decisi...

View Discussion

RE: Iron replacement strategy in dialysis 2 days ago

I tend to agree with Dr. Rodby's position and would like to pose the question regarding the trade-off between higher ferritin tolerance vs. need fo...

View Discussion

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

Did the kidney biopsy show extensive RBC in the tubules- if not, it will be hard to invoke "anticoagulant nephropathy " as the cause of the AKI- i ...

View Discussion

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

He is on Apixaban. Immunofloresence showed mild IgA deposits. Once again not enough to explain his AKI. No ATN. Given RBCs with no evidence...

View Discussion

RE: AA Amyloidosis of unknown origin? Idiopathic? Other ? 2 days ago

Thank you for tour valuable input. WR Zaher ------------------------------ Zaher Armaly MD Nazareth Hospital -EMMS Nazareth 97246028829 ----...

View Discussion

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

He has AF (presumably on a DOAC or warfarin), and an episode of gross hematuria, which is a classic setup. Look for RBC casts, tubular obstruction ...

View Discussion

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

Agree that non-diabetic nodular glomerulosclerosis cannot explain the AKI. It only accounts for the proteinuria. As I had speculated earlier, anoth...

View Discussion

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

That's true. But how to explain such quick deterioration in GFR. ------------------------------ [Saifullah] [Kazi] [MD] [Consultant Nephrologist...

View Discussion