RE: A case of Acute Kidney Injury. 12 minutes 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. 14 minutes 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. 57 minutes 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 59 minutes 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 hours 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 4 hours 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. 5 hours 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. 6 hours 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. 6 hours 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. 7 hours 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)? 8 hours 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 8 hours 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. 8 hours 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. 8 hours 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 ? 13 hours 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. 16 hours 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. 18 hours 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. 21 hours ago

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

View Discussion

RE: A case of Acute Kidney Injury. 23 hours ago

Cigarette smoker? Non-diabetic nodular glomerulosclerosis more common in smokers. ------------------------------ K.K. Venkat MD Troy MI (248) 42...

View Discussion

RE: A case of Acute Kidney Injury. 23 hours ago

Yes diffuse foot process effacement. I don't have AUCR. Worth a check I guess? no dysmorphic RBC or casts. ------------------------------ [Saif...

View Discussion

RE: A case of Acute Kidney Injury. 23 hours ago

Thanks. Very helpful. The UPEP is not likely be normal with 3gms of proteinuria. . Do you have a uACR and uPCR?. The thickened GBM and nodular Glom...

View Discussion

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

Free light chains normal, SPEP and UPEP are negative, including cryo. no h/o diabetes EM- open capillary loops, thickened basement membrane, p...

View Discussion

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

The repeat kidney biopsy pretty much makes Vasculitis or Glomerulonephritis as a cause of AKI extremely unlikely, but the episodic hematuria remain...

View Discussion

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

Unfortunate that no past urinalyses are available. Proteinuria and microscopic hematuria due to another cause might have antedated the superimposit...

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

I would echo the statements of the Dear Professor . During my fellowship several decades ago , I was taught that in case of subacute renal failure...

View Discussion

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

Do you have EM on the second biopsy? What is the full extent and nature of "nodular sclerosis "?. Is the patient diabetic? Do you have serum free l...

View Discussion

RE: AA Amyloidosis of unknown origin? Idiopathic? Other ? 1 day ago

I would postulate that this patient (and perhaps his sister ) have inherited a high -Amyloid risk variant of the NOD2 gene associated with Crohn-s....

View Discussion

RE: Iron replacement strategy in dialysis 1 day ago

The Pivotal Trial has serious limitations and should not be used to establish "Guidelines". 1) it was open-labeled. 2) it showed an ARR of only...

View Discussion

RE: Iron replacement strategy in dialysis 1 day ago

Teleologically, the iron level is controlled at the entry gate, which speaks of overload harm. In dialysis patients, we bypass that gate with IV ir...

View Discussion

A case of Acute Kidney Injury. 1 day ago

76-year-old male who with medical history for long standing hypertension, Atrial fibrillation who had a mechanical fall with tibia fracture needing...

View Discussion

AA Amyloidosis of unknown origin? Idiopathic? Other ? 1 day ago

Dear All Good day, A 32-year-old male, Parents of Arab origin from the Galilee. In 2014, he began experiencing abdominal and diarrheal symptoms...

View Discussion

RE: Resistant Rejection 1 day ago

Look at prograf level variablity index. Also, how does patient seem, mentally and psychologically? we have had a couple of patients flat out gi...

View Discussion

RE: Iron replacement strategy in dialysis 2 days ago

I agree - guidelines are not infallible and are often (too often) touted as "evidence based" when they really are not, since the evidence is freque...

View Discussion

RE: Iron replacement strategy in dialysis 2 days ago

Dr Cook, I hardly am pretending to know much about this topic, so I asked open evidence… I am generally NOT a fan of guidelines , my former c...

View Discussion

RE: Iron replacement strategy in dialysis 2 days ago

The KDIGO recommendations are based on the PIVOTAL trial, which shows that a proactive approach targeting high TSAT and ferritin levels is more eff...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Thank you fir this citation. I was not aware of it. It is a single research letter report from 6 years ago. . Was the finding ever independently co...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 2 days ago

another way that might help is to stain globally sclerosed glomerulus for IgA, if positive, IgA related GN is probably less likely. See: Kidney Int...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

These values make me more worried about an infection-related IgA dominant GN. Have you performed a TEE for cardiac valve vegetations? Do you have K...

View Discussion

RE: Resistant Rejection 3 days ago

A though case. I think second dose of rituximab or tocilizumab is unlikely going to work in this case. We have some experience with daratumumab in ...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

Rheumatoid factor was 88 IU/mL and 77 IU/mL, two days apart (Lab reference range: 0-14 IU/mL). C3 complement was 52 mg/dL (reference: 82-167) and C...

View Discussion

RE: Iron replacement strategy in dialysis 3 days ago

Thanks Dr Rodby, I really appreciate and respect your posts in general. Even though I've never met you, I consider you one of my better educat...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

RItuximab in true steroid resistant Prinaryv FSGS with Nephrotic Syndrome , results in a complete or partial remission in about 20% of patients . T...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

Thanks. What were the levels of RF and C3/C4. If the RF is very high, you may want to start with a low dose of RTX to avoid a passive serum sicknes...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 3 days ago

Thank you all for the great inputs! Here are the answers to all the questions that were asked. Creatinine data - Baseline around 1 mg/dL...

View Discussion

RE: Iron replacement strategy in dialysis 3 days ago

im still not sure of the risk if clinically evident end organ damage from top From Open Evidence - "How often is iron overload by ferritin lev...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

Dr. Dastoor very interesting It's quite unusual for me to see response with Rituximab in (true) steroid resistant patients Do you, or other pe...

View Discussion

RE: Resistant Rejection 3 days ago

If DSA is negative, the MVI element, provided recurrent GN and Hep C infection etc is ruled out, maybe it could be due to NK Cells and warrant CD38...

View Discussion

RE: Resistant Rejection 3 days ago

What are tacrolimus trough levels during this period. The August biopsy showed intimal fibrosis and prominent arteriolar hyalinosis which is not pr...

View Discussion

RE: Iron replacement strategy in dialysis Saturday, September 26 @ 2:45 PM

Ferritin >500 μg/L is a red flag, especially if it's rising without clear inflammation. But the real signal is transferrin saturation (TSAT): once ...

View Discussion