Iron replacement strategy in dialysis 32 minutes ago

Based on the most recent evidence of iron overload contributing to liver cirrhosis, I am revising my own personal goals for iron replacement in dia...

View Discussion

RE: IgA Nephropathy case 46 minutes ago

The notion that hematuria is an independent predictor of outcome is "all the rage" and could be targeted (as what prompted your post) I think yo...

View Discussion

RE: CMNephritis 1 hour ago

Long term CNI may have been doing well enough but it can lead to CKD, and you have an opportunity for remission with an anti-CD 20 drug. If you ...

View Discussion

RE: CMNephritis 2 hours ago

Thank you for responding: Patient 1 Patient 2 S. Albumin 3.7 4.0 Creatinine 3.7 2.76 (up from 1.86) U. protein 1.44 gmn 460 mg Tacrolimu...

View Discussion

RE: unexplained rhabdomyolysis 2 hours ago

I'm sure someone measured his thyroid function tests as hypothyroidism does cause mild non-traumatic rhabdo. ------------------------------ Da...

View Discussion

RE: IgA Nephropathy case 2 hours ago

Consistently in the 70s, no change over the 6 months since I have been seeing her. ------------------------------ Ritu Vyas MD Catonsville MD (4...

View Discussion

RE: CMNephritis 3 hours ago

I would taper (and stop) the CNI and treat both patients with RTX or Obinutuzumab . What is the current level of proteinuria, serum albumin snd eGF...

View Discussion

RE: IgA Nephropathy case 3 hours ago

What is her current eGFR- she might beca candidate fir moderate dose steroids + MMF or one of the anti- April-/ April/BAFF agents. --------------...

View Discussion

IgA Nephropathy case 5 hours ago

Hello, I have a 48 year female who I have been following for biopsy proven IgA. She is on Lisinopril 2.5 (unable to tolerate any higher due to lo...

View Discussion

CMNephritis 7 hours ago

I have two patients in their 60's with biopsy proved membranous nephritis. One has elevated Eliza PLA2R and the other does not. They have been doin...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 7 hours ago

Dr. Charytan- No direct comparator RCT of CYC vs RTX in IgA Vasculitus have been published- but three independent observational trials (one oroen...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 8 hours ago

For me, it is more about this degree of crescentic IgAN not warranting CYC. This is based on the assumption that CYC is a superior drug for bad vas...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 8 hours ago

There is no evidence-based indication for PLEX in IgA vasculitis or infection-related IgA-dominant vasculitis." ------------------------------ Sa...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 8 hours ago

Im curios about the evidence behind your recommendation that ritux is likely better than cytoxan here- can you summarize evidence --------------...

View Discussion

RE: Somewhat suppressed aldo, Primary aldosteronism or not? 9 hours ago

Thanks for your extensive research - tell Claude I would like to meet him😂😂 ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] ...

View Discussion

RE: unexplained rhabdomyolysis 9 hours ago

I’m sure you can come up with other unifying narratives but here’s one, (sero-ve) SjD: - chronic lymphocyte-predom TIN - distal tubulopathy (with ...

View Discussion

RE: Somewhat suppressed aldo, Primary aldosteronism or not? 15 hours ago

@Mark Lerman sorry I am on a plane , but was able to get Claude to research and answer ...and I think he/she has summarized it pretty well. The mai...

View Discussion

RE: Somewhat suppressed aldo, Primary aldosteronism or not? 22 hours ago

if Renin is low - is it suppressed is the question-some articles suggest it is normal or high. if it is suppressed then how would you distinguish t...

View Discussion

RE: Somewhat suppressed aldo, Primary aldosteronism or not? 23 hours ago

@Hormaz Dastoor-please see below regarding Obesity related Hypertension Clin Kidney J . 2025 Jul 9;18(8):sfaf218. doi: 10.1093/ckj/sfaf218 ...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

Thanks Dr. Dastoor for tgis clarification. I agree. Of late, I use less steroids and more Anti-CD20 MoAB for therapy of presumed MCD/FSGS . -----...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

The biopsy report suggested possible MCD of FSGS or perhaps just an podocytopathy. I don't think we are sure of the best treatment , but if the pa...

View Discussion

RE: unexplained rhabdomyolysis 1 day ago

Yes ordered a whole panel beyond complement --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sh...

View Discussion

RE: unexplained rhabdomyolysis 1 day ago

Have you done genetic testing for conditions beyond complement disorders? ------------------------------ Roger Rodby MD, FASN Professor of ...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

I am really moving toward rituximab alone as a primary therapy for a podocytopathy. The only issue is it may take some time to get approval. In tha...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

Dr.Dastoor- add or switch to RTX? What is the evidence that RTX + steroids is any better than RTX alone in Primary MCD ? I prefer monotherapy with ...

View Discussion

RE: Somewhat suppressed aldo, Primary aldosteronism or not? 1 day ago

@Mark Lerman I think obesity in relation to hypertension is defined as a hyperaldo state characterized high sodium retention , volume expansion, LO...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

The bottom line is that this is not IgA Nephropathy and guidelines from IgA Nephropathy literature does not apply to this patient. This is either a...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

While reading the case my mind veered towards IgA Dominant infection related GN , but a lot of the features were absent 1. Often diabetic - No 2. ...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

Start steroids , if MCD lesion should respond quickly with steroids . If no response would add Rituximab . A couple of similar cases we had respon...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

Since IgA-dominant infection-related GN is in the differential diagnosis, what were C3 and C4 complement levels? ------------------------------...

View Discussion

RE: unexplained rhabdomyolysis 1 day ago

He has both muscles and tubular affection ..what causes this are ..1.toxic like lead or cadmium and needs work up 24 urine ,,and uric acid level .....

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

Got it, Thankyou for your kind response Dr Rodby --------------------------------- Umer Hassan Resident Shaikh Zayed Hospital Lahore Labore 0336...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

I think I would give oral steroids now, there is no guarantee that reevaluation of the biopsy will get you any closer to a diagnosis. I would ant...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

you have given evidence for Crescentic GN but not RPGN which depends on AKI and we have no creatinine data. 3/15 gloms with crescents is not that b...

View Discussion

RE: PLEX in Crescentic IgA Nephropathy 1 day ago

This is an extremely difficult and challenging case. Is this infection related IgA dominant Glomerulonephritis or IgA Vasculitis (formerly Henoch S...

View Discussion

PLEX in Crescentic IgA Nephropathy 1 day ago

Greetings! I hope this message finds you well. I am taking care of a 55 year old female with RPGN due to crescentic IgAN with IgA vasculitis and ...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 1 day ago

Dr. Venkat, with such high uncertainty concerning the cause of proteinuria in this case, what is your plan of management.? ----------------------...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

Thanks for your response, Worthy Colleagues Currently, follow up after 1 week with 24 hours urinary proteins and re reporting of biopsy is planned...

View Discussion

RE: another ANCA case 1 day ago

Dr. Soobadar - What evidence can you cite to support your suggestions of IV CYC + RTX + PLEX in this patient? -------------------------...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 1 day ago

given age would be sure routine cancer surveillance is uptodate ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 1 day ago

why not try , see no reason for additional IS given stable creatinine and normal serum albumin and unremarkable histopathology. my curiosity begs f...

View Discussion

RE: another ANCA case 1 day ago

Thank you, Dr. Soobadar for your valuable suggestions. ------------------------------ Amit Joshi Chicago IL ------------------------------

View Discussion

RE: another ANCA case 2 days ago

If b cell deplete then either 2 cyclo with obi or just obi --------------------------------- Muhammad Soobadar MBChB UK -----------------------...

View Discussion

RE: another ANCA case 2 days ago

I would combine 2 pulses in cyclo with ritux with weaning ateroids Check cd19 counts Ensure crp coming down with steroids ( if not concurrent se...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 2 days ago

The absence of EM is unfortunate. But unless you feel very strongly about having EM confirmation of a diffuse Podocytopathy, I would treate empiric...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

No, she is not on ARB, ACE-I, SGLT2-I or other anti-proteinuric measures. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 --...

View Discussion

unexplained rhabdomyolysis 2 days ago

I saw a 42 year old gentleman , who is an ex- army vet . He had been on several rotations in Yemen in 2014/2015 ( exposure to metals/ chemicals /...

View Discussion

RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 2 days ago

How sudden/abrupt/explosive was the onset of nephrotic edema? How much weight gain over what period of time? The more abrupt the onset, a podocytop...

View Discussion

RE: Puzzling Case of Post-Transplant Proteinuria 2 days ago

given stable serum creatinine and normal albumin- forgive me if I missed this but is treatment with ARB,SGLT2 being used and if so any decrease in ...

View Discussion

CLOSING TODAY! - Nephrology Quiz and Questionnaire 2 days ago

Calling all nephrology fellows and program directors-we need your help with the Nephrology Quiz and Questionnaire. Take the quiz today! Each year...

View Discussion