C3GN in the setting of melanoma 8 hours ago

Dear Colleagues, I'd like to seek your professional opinion about the management of a patient I follow in the hospital. A 79-year-old man with a h...

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RE: Iptacopan in IgA 13 hours ago

Dr. Dastoor. Thanks for this interesting post . The main reasons for discrepancies between trial data and real world experience with oral agents,...

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RE: Iptacopan in IgA 14 hours ago

What is the trend of microscopic hematuria on iptacopan in these 2 patients? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798...

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RE: 28-year-old male with repaired Tetralogy of Fallot presenting with RPGN vs infective endocarditis-associated GN - immunosuppression dilemma 14 hours ago

Would start broad spectrum antibiotics pending TEE and blood culture results. The decision to discontinue steroids should be made if the patient ha...

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DEADLINE EXTENDED TO MAY 11: Case Report Reviewers for Kidney Week 2026 15 hours ago

ASN invites ASN Fellows-in-Training members to serve as reviewers for case reports submitted by trainees for Kidney Week 2026. The reviewing/gradin...

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DEADLINE EXTENDED TO MAY 11: Encourage fellows to volunteer as case report reviewers for Kidney Week 2026! 15 hours ago

ASN invites ASN Fellows-in-Training members to serve as reviewers for case reports submitted by trainees for Kidney Week 2026. The reviewing/gradin...

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Iptacopan in IgA 15 hours ago

i wanted to share the responses of 2 patients with IgA with Iptacopan Patient 1 : 42 year old male : eGFR 66 ml/min, Hematuria , uPCR > 1gram on ...

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RE: 28-year-old male with repaired Tetralogy of Fallot presenting with RPGN vs infective endocarditis-associated GN - immunosuppression dilemma 18 hours ago

The "evidence" for an overall beneficial effect of adjunctive Immunosuppression in Proven Infection Related RPGN with crescents is very weak and co...

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RE: AKI/ANCA Vasculitis 18 hours ago

1. Part of the confusion/complication was the infection and +anca. Unusual to have both. Infection has resolved and bladder is clear per urology. ...

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RE: Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 19 hours ago

Thank you all for your replies Dr Reen ECA normal , non lymph nodes on CT , will see with pathologist if he can do Pronase digestion , but lambd...

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RE: 28-year-old male with repaired Tetralogy of Fallot presenting with RPGN vs infective endocarditis-associated GN - immunosuppression dilemma 19 hours ago

Thank you just report release Updated serology: * ANA negative * Anti-dsDNA negative * PR3/c-ANCA negative * MPO/p-ANCA negative * Anti-GBM nega...

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RE: AKI/ANCA Vasculitis 19 hours ago

I spoke with his pulmonologist who agreed that cyclophosphamide was appropriate. Repeat MPO titers came back much higher. He will have overlap...

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RE: 28-year-old male with repaired Tetralogy of Fallot presenting with RPGN vs infective endocarditis-associated GN - immunosuppression dilemma 19 hours ago

I woul measure Rheumatoid Factor and ANCA/Anti-GBM and pursue IRGN with a TEE and blood cultures on an urgent basis. Whether a kidney biopsy is nee...

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RE: Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 19 hours ago

Dr. Beggah, please post de-identified biopsy results and images. Not all labs are created equal, location/country might give us an idea about abili...

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RE: IgA Nephropathy 20 hours ago

I would worry about using systemic steroids due to Mental disorders, which might get worse, and obesity. Targeted steroids like Tarpeyo, might be o...

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28-year-old male with repaired Tetralogy of Fallot presenting with RPGN vs infective endocarditis-associated GN — immunosuppression dilemma 20 hours ago

28-year-old male with repaired Tetralogy of Fallot in childhood, baseline creatinine normal (~70 µmol/L three months ago), now presented with AKI a...

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RE: Fit To Fly In Ckd 5 Patient 20 hours ago

If his BP is normal, SaO2 are normal, lungs are clear to auscultation .. don't see any issues here --------------------------------- Dr. Hormaz Da...

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RE: Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 20 hours ago

IgG2 plus igG1 co-dominance would highly increase the risk of a malignancy and would consider a PET scan . However here with IgG2 dominance , norm...

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RE: Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 21 hours ago

Do pronase digestion to unmask hidden clone if positive consider bone marrow If negative consider pcsk6 stain Also r /o sarcoidosis Looks like mal...

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RE: Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 22 hours ago

Thank you Dr Glassock for your prompt response There was no monotypism in Lambda kappa staining The proteinuria has slightly improved from 9g/g t...

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RE: Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 23 hours ago

The best way to approach the diagnosis in this case woukd be to refer the paraffin blocks to a center capable of performing Laser Dissection / /Mas...

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Persistent Nephrotic Syndrome (IgG2-dominant MGN) , PLA2R negative 1 day ago

I would appreciate community input in this case 76-year-old female. history of Diabetes, Hypertension and CKD. stage 3 Clinical Presentation :...

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RE: Fit To Fly In Ckd 5 Patient 1 day ago

What is the hemoglobin level ? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

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RE: Lupus nephritis 1 day ago

I'm not sure thatI would have recommended PLEx in this case -any opinions on indications for this procedure in cases like this with massive intrava...

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RE: Lupus nephritis 1 day ago

Drug toxicity can definitely cause this picture and should be excluded, especially calcineurin inhibitor toxicity. This looks more consistent with...

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Fit To Fly In Ckd 5 Patient 1 day ago

Pt with eGFR 7 for past year ( will have pd tube at some point ) Wants to fly out of uk to Thailand Feels well. Still working. No Uraemic sympto...

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RE: Lupus nephritis 1 day ago

The one case that I saw with this grade of hemoglobinemia and the plasma removed by PLEX was literally black was a man in his 70s that turned out t...

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RE: Lupus nephritis 1 day ago

Thanks Dr. Rodby, serum haptoglobin was not done in house so had to be outsourced the turnaround time was high so not sent. Also other signs like r...

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RE: Lupus nephritis 1 day ago

"Thanks Dr. Rodby. The plasma (attached as image)removed by PLEX was dark brown, shall look for heme pigment as advised. She is on dialysis for the...

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RE: Lupus nephritis 1 day ago

Thanks Dr. Glassock, She had schistocytes in peripheral smear with raised LDH, so was thinking in the lines of Lupus induced TMA, hence decided to ...

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RE: Lupus nephritis 1 day ago

Curious findings of marked liver and pancreatic enzyme elevation with a lactic acid level of 15 mmol/L suggests shock, possibly transient, R/O medi...

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RE: Lupus nephritis 1 day ago

Just curious- why are you using PLEX for this patient ? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School...

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RE: Lupus nephritis 1 day ago

Thanks Dr. Glassock. LDH iso enzyme testing is not available at the hospital, however I shall check if it can be done as an outsourced test. ----...

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RE: Lupus nephritis 1 day ago

Thanks Dr. Rodby. The plasma (attached as image)removed by PLEX was dark brown, shall look for heme pigment as advised. She is on dialysis for the ...

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RE: Lupus nephritis 1 day ago

Thanks Dr. Hormaz. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Lupus nephritis 1 day ago

Thanks Dr. Glassock. I shall test the plasma for hemoglobin today.Direct Coomb's tests is negative. Complement levels are low (just got the reports...

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RE: Lupus nephritis 1 day ago

Update: Her direct Coombs tests is negative, Her LDH dropped to 6840 (from 13969) after 1 session of PLEX. C3 is 44 (range is 90-180), C4 is 6.9 (r...

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RE: Lupus nephritis 2 days ago

Can you measure iso -enzymes of LDH. LDH 1and 2 woukd be exclusively elevated in Hemolysix, not in Hepatic Necrosis ----------------------------...

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RE: IgA Nephropathy 2 days ago

The data on efficacy of RTX in IgAV , which is wholly observational , is very impressive. I would give moderate doses of oral steroids (short term ...

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RE: Lupus nephritis 2 days ago

I wonder if the enzymatic assay levels are "false" positives due to the overwhelmingly severe intravascular hemolysis (and hemoglobinemia) . What w...

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RE: Lupus nephritis 2 days ago

Physical state of the patient : The patient is conscious, oriented and has high BP requiring NTG infusion. No fever. ---------------------------...

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RE: Lupus nephritis 2 days ago

With AST and ALT 3-5000, and a severe lactic acidosis, this (and the high LDH) appears like acute hepatic necrosis from an exposure or possibly sho...

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RE: IgA Nephropathy 2 days ago

I'm not convinced that IgAN and IgA vasculitis are completely separate entities, but more of a spectrum. Is there evidence that IgA vasculitis do...

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RE: IgA Nephropathy 2 days ago

Thank you. Do I need to use Prednisone with MMF? Or Tarpeyo with MMF? ------------------------------ Ibrahim Katerji MD Elmira NY -------------...

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RE: Lupus nephritis 2 days ago

This kind of hemolysis can ocurr in HD patients from a variety of issues- chloramine contamination , improper dialysate preparation, crimped vascul...

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RE: Lupus nephritis 2 days ago

I would get a hematology consult first --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh ...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

in my opinion, although this article does not specifically say that it should not be done. It also does not recommend that it be done. As we see wi...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

I gather from these guidelines that routine genetic testing of an unrelated (altruistic) live donor without any family history of kidney disease wo...

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RE: Lupus nephritis 2 days ago

My guess is that this is mainly severe intravascular hemolysis with false positive Lipase, amylase and troponin due to measurement positive interfe...

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Lupus nephritis 2 days ago

A 53 year old lady on twice weekly maintenance hemodialysis presented with chest discomfort to the casuaity. ECG shows non specific ST-T changes. A...

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