RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 17 minutes ago

Puzzling case. There are very rare case reports of ICGN from insulin therapy in Type I DM ((anti-insulin Antibody, not with recombinant Insulin . )...

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RE: uTi In Anuric Hd Patients 55 minutes ago

Cystitis in ESRD can happen and is very challenging to treat. If you can get few CCs of urine and culture, do. If not use a 3rd gen cephalosporin w...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 hour ago

Here is the Litholink from 1/2026 ------------------------------ Emily Petersen MD, FASN Kootenai Clinic Nephrology Coeur D Alene ID (208)...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 hour ago

Regarding the cystinuria genotype. Heterozygous SLC7A9 mutations, like this patient, and not SLC3A1 mutations, can cause an increase in cystine exc...

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RE: uTi In Anuric Hd Patients 2 hours ago

I do not routinely examine dialysis patient's bladder or do post-void scans. These steps + obtaining catheterized specimen from bladder should be c...

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RE: Biopsy dilemma in setting of severe refractory ITP 3 hours ago

I think rituximab is a good plan. It could treat both so if the kidney function does not improve, at least the ITP could be in remission. However, ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 3 hours ago

Thank you both Drs. Venkat and Dr. Rodby. Our pathologist mentioned just a trace of C3 deposition. I will check RF as well. ----------------...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 3 hours ago

Q1. What is the known duration of type-1 diabetes? -> She was diagnosed with T1DM ~ 20 years ago. Q2. Does she have diabetic retinopathy? ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 3 hours ago

Dr Venkat's point of : "Personally, not impressed with severity of IC-GN findings in the biopsy as explanation for wosening proteinuria" is well ...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 3 hours ago

@John Asplin "Urinary aklalinization with K citrate can aggravate stone formation" My probable oversimplified understanding of Medullary ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 3 hours ago

Questions: 1. What is the known duration of type-1 diabetes? 2. Does she have diabetic retinopathy? 3. SAlb trend? 4. Were the random/spot urine sa...

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RE: Approach to flank pain ( my case series) 4 hours ago

Allow me to opine If clots can be seen from gross hematuria in severe glomerular disease such as IgAN, it must be extremely rare. Why wou...

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Nephrotic range proteinuria with IC-mediated glomerulopathy 5 hours ago

Good morning/afternoon/evening, everyone! I have a 31-year-old female patient with type 1 diabetes mellitus who developed sub-nephrotic range prot...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 5 hours ago

Thanks Dr. Asplin . I was impressed with the medullary sponge kidney, the family history and the stone composition results. The existence of an aut...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 5 hours ago

Yes I will try to do that later today ------------------------------ Emily Petersen MD, FASN Kootenai Clinic Nephrology Coeur D Alene ID (208) 2...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 5 hours ago

I should have mentioned that the genetic test indicated that inheritance could be autosomal dominant or recessive ------------------------------ ...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 6 hours ago

Dr Petersen, This is a very interesting case. Would you be able to scan a deidentified copy of her 24 hr urine so we can look at all the numbers....

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 11 hours ago

This case would benefit from advice from Drs. Goldfarb and Asplin. Medulkary Sponge Kidney is associated with Calcium Phosphate stones and can have...

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RE: uTi In Anuric Hd Patients 19 hours ago

That’s helpful Do we routinely examine dialysis patient bladder / do post void scan ? How anuric is anuric ? 24 hr volume is not often measured i...

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Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 19 hours ago

44 yo female patient with recurrent kidney stones, approximately 5 symptomatic stones per year for many years, off and on, and has had obstructing ...

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RE: Pd Question 21 hours ago

Thanks prof venkatShe is in her 50 Active on tx list ( now suspended ) Gram -ve bacilli on cyst fluid and blood cultures urine culture pending Not...

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RE: Lupus nephritis III/IV 21 hours ago

Thanks dr Marwan. Not sure about this one . Feels risky to stop everything and have a flare in pregnancy But if stops and patient stable serologi...

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RE: Lupus nephritis III/IV 21 hours ago

Thanks prof rodby @ prof glassock how long would you wait after switching to aza assuming serological remission and no active urine sediment ( one...

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RE: Lupus nephritis III/IV 21 hours ago

thank you all for your input. I actually have this same scenario a lady who is planning pregnancy who has been on remission for >5 years, serologie...

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RE: Lupus nephritis III/IV 21 hours ago

"Drs. Hirsch and Rodby- what would you do if your 25 year old patient with Class IV LN in a complete clinical remission for 1 year on MMF 2.0 gms p...

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RE: Lupus nephritis III/IV 21 hours ago

Conversion from MMF to AZA would be acceptable practice if she is in a complete clinical and immunological remission (normal protin excretion, eGzf...

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RE: Approach to flank pain ( my case series) 22 hours ago

Thanks-Dr. it has been a long time since I first read this seminal paper which was one of the first to draw attention to the close connection...

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RE: Approach to flank pain ( my case series) 23 hours ago

Upon further reading and searching, urine clots, although described in IgA vasculitis (see attached) are quite rare in IgA but, according to Chat G...

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RE: Lupus nephritis III/IV 23 hours ago

@ prof glassock ( question not addressed to me) I would switch to aza and steroids and monitor lupus markers ( complement , ds dna, urine for blood...

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RE: Approach to flank pain ( my case series) 1 day ago

Gross hematuria/clots have been described in association with IgA . See attached. ------------------------------ Mario Rubin, M.D. Houston TX (...

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RE: Pd Question 1 day ago

Dr. Soobadar: How old is your patient? If she is a candidate for kidney transplantation, given the severity of her cyst infection, nephrectomy (as ...

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RE: uTi In Anuric Hd Patients 1 day ago

I can think of several situations wherein UTI may occur in an anuric ESKD/dialysis patient: 1. As already pointed out by Dr. Rodby, some "anuric" p...

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RE: uTi In Anuric Hd Patients 1 day ago

UTIs are often related to stasis and that is certainly something you will see in an ESRD patient, Yes I have seen what I thought to be cystitis in ...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

"Pan diuresis" (polypharmacy of all diuretics known to mankind given all at once) is in my experience a good segway to severe azotemia and ESRD." ...

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RE: Approach to flank pain ( my case series) 1 day ago

I have 'Never" seen gross hematuria with "clots" in IgAN. If the history is reliable In doubt that the hematuria is due to igAN without any LM abno...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Her BP is starting to rise! I have switched her to UF only for the past 24 hours and will continue for the next day or so as electrolytes are the s...

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RE: Approach to flank pain ( my case series) 1 day ago

@ prof glassock how do explain case 3 biopsy ? Do you think its ig a ? Kr --------------------------------- Muhammad Soobadar MBChB UK ----------...

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RE: Approach to flank pain ( my case series) 1 day ago

Thanks really helpful. Will mention it to urologist Kind regards and thanks for help --------------------------------- Muhammad Soobadar MBChB ...

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RE: Approach to flank pain ( my case series) 1 day ago

See my edits to correct spelling errors . Deitl's crises are flank /abdominal pain episodes associated with UPJ obstruction. --------------------...

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RE: Pd Question 1 day ago

Thanks prof glassock --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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uTi In Anuric Hd Patients 1 day ago

I was just wondering if colleagues have ever diagnosed UTI in anuric dialysis patients and if so how as no urine to test ? Kind regards

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RE: Pd Question 2 days ago

Understood. Boots on the ground are better than arm chair philosophy when dealing with a life-threatening condition.I hope things go well with your...

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RE: Approach to flank pain ( my case series) 2 days ago

Thanks prof glassock What do you mean “Probsbly Deitl's cresisex. Needs a retrograde pyelonephritis. “ by? Thanks so much for prompt reply KR ...

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RE: Approach to flank pain ( my case series) 2 days ago

Just a few opinions. Case #1- bilateral UPJ obstruction of onkniwn cause, does alcohol make flank pair appear. Probably no Deitl's crises . Needs...

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RE: Pd Question 2 days ago

Appreciate and grateful for such promptly advise by experts to give care to patient in different continent 🙏🏼🙏🏼🙏🏼 -------------------------...

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RE: Pd Question 2 days ago

They have advise IR drain --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Pd Question 2 days ago

Thanks prof glassock my humble reading is this is a cyst infection and that has led to pyelonephritis . Source control should be drain . But I thin...

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RE: Pd Question 2 days ago

Dr. Soobadar. Thanks. I only raised the question about nephrectomy as I was taught (many years ago by a first class urologist ) that gas in the kid...

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Approach to flank pain ( my case series) 2 days ago

case 1( RPF and Nutcracker syndrome rule out on imaging) is it loin pain haematuria syndrome with complex urological history Gyane do not feel it...

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RE: Pd Question 2 days ago

Yes it’s amazing that I get answer so promptly helping in managing complex case with best evidence Very grateful @ prof glassock if she improves...

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