RE: Please help with renal biopsy results - vascular insult - etiology unclear 35 minutes ago

Drs. Venkat, Rodby, and Campese your point is well taken in using RAAS blockade in hypertensive patients especially without significant proteinuria...

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RE: Iptacopan --- Does it work ????????? 35 minutes ago

Just for the record, yesterday (July16 ) the US FDA gave full approval to Fabhalta (Iptacopan, Novartis ) for prevention of progression in IgAN . (...

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RE: Iptacopan --- Does it work ????????? 2 hours ago

I think response could be gauged by 1. Reduction in proteinuria 2. Slowing the rate of decline in eGFR In both cases , uPCR is at baseline after ...

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RE: Iptacopan --- Does it work ????????? 3 hours ago

Thank you for the post. You raise an important point that we should be very critical high-cost drugs with no or minimal response. Patient selecti...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 4 hours ago

Totally agree with Dr. Rogby. unfortunately, many nephrologists believe that RAS inhibitors are a panacea for all hypertensive patients with kidn...

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RE: Painless macroscopic hematuria 4 hours ago

per Dr. Anand- "I reviewed his cystoscopy. It showed blood emanating from the right ureteric orifice alone. Hence they did a ureteroscopic exam. It...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 5 hours ago

"Besides lack of significant proteinuria, another reason to avoid RAAS-blockade is widespread intrarenal small vessel disease mimicking hemodynamic...

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Nephrology Discussion – C3 Glomerulopathy, Immune-Mediated Encephalopathy & Rituximab 5 hours ago

I would appreciate the opinions of colleagues regarding a challenging case. A patient known to me has biopsy-proven C3 glomerulopathy, previously...

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RE: Bile Cast Nephropathy causing Unresolved ATI 9 hours ago

It is likely that it is bile acids not bilirubin pet se that cause AKI- i would not get too fixated on bilirubin levels for diagnosis. ----------...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 22 hours ago

Although a drug related elevation of Scr seems unlikely in this case, measurement of an eGFR Cystatin C might be revealing. --------------------...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 23 hours ago

Besides lack of significant proteinuria, another reason to avoid RAAS-blockade is widespread intrarenal small vessel disease mimicking hemodynamics...

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RE: IgAN - Management Question 1 day ago

With the marked signs of inflammation , and progressive loss of nephrons , I would start with a very short course of pulse IV MP. Just an opinion. ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Richard, You may want to add here the editorial on goal BP I emailed to you a few months ago. If you don’t have it any longer, I could send you a c...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

First, I would determine if this patient has hypertension and/or orthostatic hypotension. Often, in these patients orthostatic hypotension is asymp...

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RE: IgAN - Management Question 1 day ago

EM is currently not available , but i assume she has podocytopahty with low serum albumin. She is on ARB, SGLT2 and ns-MRA , not on ET1a , as she...

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Iptacopan --- Does it work ????????? 1 day ago

So , we have been using Iptacopan for nearly a year . In IC- MPGN - No response , perhaps it works great in C3G - but we prefer to use C3 Blocker...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Dr. Campese, Given the severe non-glomerular vascular disease on kidney biopsy, the absence of proteinuria or CHF and an undescribed "neuropathy" w...

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RE: IgAN - Management Question 1 day ago

Great questions? no good evidence to select the "best choice" . In my opinion , I would use oral steroids and MMF , with an initial IV pulse of IVM...

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IgAN - Management Question 1 day ago

Have a 35 year old SE Asian Female eGFR is 49 ml/min Urinalysis : Hematuria uPCR : 7.2 g/g Biopsy : M1 E1 S1 T1 C1 Question : St...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

""Why do I hate eGFR values so much and just prefer a serum creatinine? That is rhetorical but also editorial. " @Roger Rodby -and the answer is?" ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

"Why do I hate eGFR values so much and just prefer a serum creatinine? That is rhetorical but also editorial. " @Roger Rodby -and the answer is? ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Can you provide the levels of BP and HR standing and sitting? does she have any clinical features of autonomic dysfunction? The biopsy is su...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Dr. Rodby. I agree. Even if the APOL1 high risk alleles are found, it would not bring us any closer to an effective treatment regimen for this pati...

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RE: PLA2R negative Membranous Nephropathy- Management Q 1 day ago

In PLA2R MGN we have an antibody to treat and an early marker and we can "head it off at the pass" In PLA2R negative MGN it is not so easy and w...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Why do I hate eGFR values so much and just prefer a serum creatinine? That is rhetorical but also editorial. I think APLO1 would explain this, b...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

"Renal US : Right 9.2 cm, Left 10 cm" The left kidney is generally longer than the right. This discrepancy of ~ 0.8 cm may not be significant by ...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

I also agree with Dr. Lerman's concerns over the use of high dose Ketamine in this case. Ketamine abuse can cause sterile pyuria, ulcerative cystit...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Dr. Lerman - you raise a very important point. APOL1 risk allekes are commonly linked to a Podocytopathy and proteinuric CKD. A lesser known and ap...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

Agree with high risk APOL1 testing as high risk testing has even without proteinuria APLOL 1 high risk variants in African-Americans can cause acce...

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RE: Please help with renal biopsy results - vascular insult - etiology unclear 1 day ago

The degree of global glomeruloscleroisis and IFTA is quite compatible with the patients chronological age. The Absence of abnormal. Proteinuria mak...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Hi Dr. Soobadar, Thank you, No discrepancy in urine protein/cr and albumin/cr. From Jan 2026 attached (faint spike, BM was done before - negative)....

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RE: Treatment /Management of MN 2 days ago

Thanks for discussion appreciate it --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: to do kidney biopsy or not 2 days ago

Thanks everyone for help --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Thanks for case I would wait couple of weeks and review with blood and urine acr . What about mgus? Any change in serum free light chain ratio or...

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Please help with renal biopsy results - vascular insult - etiology unclear 2 days ago

67 year old african american female with PMH of Hypertension, Fibromyalgia, Hypothyroidism, Vitamin D Def, Neuropathy, Sjogren disease, Depression,...

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RE: Seeking Input for an NSF I-Corps Dialysis Initiative 2 days ago

Hi all, in effort to make sure we're exhausting the opportunity to connect within this network I wanted to follow-up on this thread. If you don't ...

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RE: Bile Cast Nephropathy causing Unresolved ATI 2 days ago

Thanks for your input. Usually, the reported bilirubin in bile cast nephropathy is 25, with it never being reported below 15. The peak bilirubin ...

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RE: Bile Cast Nephropathy causing Unresolved ATI 2 days ago

According to AI: "Plasmapheresis is rarely effective if started 4 weeks after established acute kidney injury (AKI) from bile cast nephropathy. The...

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Bile Cast Nephropathy causing Unresolved ATI 2 days ago

Would like the community's input regarding a difficult case. 38 year old male history of homeopathic medication intake for three years for body...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Dr. Kaur -thanks for the very helpful additional information. Yes, you patient might be on the cusp of a major relapse. I woukd be inclined to trea...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Thank you Dr. Glassock. April 2023 renal biopsy. Proteinuria upto 11 gms. July 2023: Rituximab x 2 doses = resolution of nephrotic syndrome,...

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RE: Painless macroscopic hematuria 2 days ago

This patient most likely has an AVM till proven otherwise. A selective renal angiogram will be my next step (already mentioned by Dr. Glassock). ...

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RE: Painless macroscopic hematuria 2 days ago

A clot in the R renal pelvis and unilateral gross hematuria (same side as the clot) makes Glomerular Disease, acquired or hereditary , very unlikel...

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RE: Painless macroscopic hematuria 2 days ago

forgive me Dr. Glassock (for being stubborn) but @Edwin Anand did your urologist check blood from urine from contralateral ureter for microhematuri...

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RE: Painless macroscopic hematuria 3 days ago

This important finding rules out Nutcracker syndrome , IgA Nephropathy, Alport Syndrome or other glomerular diseases but not SSTrait, a small renal...

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RE: CD19, ritux, and membranous 3 days ago

Thanks Dr. Hirsch for initiating this very informative and in depth discussion of a contemporary topic of the ever- changing management of MN. We n...

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RE: CD19, ritux, and membranous 3 days ago

In the not too distant future, I strongly suspect that OBI will replace RTX as the preferred initial approach to treatment of MN , and that assessm...

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RE: Painless macroscopic hematuria 3 days ago

A follow up- I reviewed his cystoscopy. It showed blood emanating from the right ureteric orifice alone. Hence they did a ureteroscopic exam. It ...

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RE: CD19, ritux, and membranous 3 days ago

@Sheldon Hirsch "Roger, with that sort of thinking in mind...I have a patient who is now four months p the initial ritux rx, with an unchanged PL...

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RE: CD19, ritux, and membranous 3 days ago

If your patient without any change in anti-PLA2R antibody 4 months after an initial dose of RTX was found not to be peripherally depleted in CD19 B...

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