RE: Generic FSGS 1 hour ago

Nephrin mutations have been associated with "recurrences" (really de novo disease like aGBM ) in Alport's. ------------------------------ Richar...

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RE: Iptacopan in IgA - A very Impressive response 3 hours ago

I have had patients approved (and receiving) for Tarpeyo, Sibeprenilamab, Atrasentan, and colleagues that have had Spasentan and iptacopan approved...

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RE: Iptacopan in IgA - A very Impressive response 3 hours ago

I have been hearing the cost of Sibeprenilamab is $400,000 per year , that could push the price of Iptacopan lower . Yes these drugs are expensiv...

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RE: Generic FSGS 3 hours ago

This is a very weird story. A clearly genetic cause should have only very rare recurrences, as Dr. Nauman explained. Another option to explore migh...

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RE: Iptacopan in IgA - A very Impressive response 3 hours ago

that is the million dollar (literally) question. 1) How longe do we treat our patients with these newer, very effective but expensive agents, and...

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RE: Iptacopan in IgA - A very Impressive response 5 hours ago

In 2012 and 2019 she had a course of steroids in Yemen and the UAE respectively . The last biopsy showed significant C3 deposits . She was reluct...

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RE: Iptacopan in IgA - A very Impressive response 5 hours ago

I agree- very impressive response to Iptacopan!! What features in this case led you to use Iptacopan for initial therapy rather than steroids and M...

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Iptacopan in IgA - A very Impressive response 5 hours ago

I just wanted to share some impressive results of Iptacopan for our patient 30 year old female , with IgA Nephroapthy - M1 E0 S1 T1 C0 ( 3+ igA/...

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RE: Interesting GN case 6 hours ago

The description of the biopsy above seems like some type of immune-complex mediated GN with polytypic IgG dominant staining. I agree the biopsy des...

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RE: IgAN With Crescents 7 hours ago

To quote Uptodate chapter on Treatment of IgA and when to start IS therapy Having 3 of 4 criteria is an indication These include 1. Low for age...

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RE: Fibrillary glomerulonephritis recurrence in a kidney transplant 9 hours ago

The apparent monotypism of LC (lambda dominant ) is probably masked polyclonal deposition , not a MGRS. I would carry out Pronase digestion and res...

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RE: Fibrillary glomerulonephritis recurrence in a kidney transplant 12 hours ago

Idiopathic FGN doesn't respond well to IS, this patient didn't response earlier and I guess is that he won't now either. Ah and aah lesions are com...

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RE: Generic FSGS 12 hours ago

Only genetic NS to recur in Kidney Tx that I know of is in those with large deletions of NPHS1. Recipient has not developed tolerance to Nephrin an...

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RE: Generic FSGS 13 hours ago

Thank you both for your expert input . I will try to access Atrasentan for these patients . Just a bit of information , especially in regards to ...

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Fibrillary glomerulonephritis recurrence in a kidney transplant 13 hours ago

A 56-year-old man first presented in 2014 with nephrotic syndrome. Kidney biopsy at that time showed a fibrillary glomerulonephritis. A work-up, in...

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RE: IgAN With Crescents 14 hours ago

Thank You so much for your valuable insights Dr.Glassock ! MRI is not done yet . Will update with results and genetic testing. Will make the sugges...

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RE: IgAN With Crescents 15 hours ago

Clearly she needs Immunosuppression /Antiinflammatory therapy,, but chronic liver disease will limit choices. I would hold off from using Iptacopan...

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RE: IgAN With Crescents 19 hours ago

Fascinating case . Do you have a liver MRI of liver for iron excess. I think I would do a HFE genetic test for Hemochromatosis. Glomerular IgA depo...

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IgAN With Crescents 20 hours ago

40 y Hispanic female with hx of anxiety ,Elevated LFTs,Presented with gross hematuria ,No URT +family hx of liver disease in mother -unknown Has 6...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

Would a non - invasive estimation of Central Aortic Pressure (wave form of peripheral pulse ) be a better option than an arterial line.? Just Cur...

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RE: Generic FSGS 1 day ago

Yes, a small post-Hoc analysis of the DUPLEX trial of Sparsentan in genetic forms of FSGS lesions did show benefits of this agent .( See Yee et al ...

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RE: Interesting GN case 1 day ago

MPGN Type III is no-longer used as a diagnostic term in kidney pathology- this an ICGN pattern if injury lesion. I do not see any description if do...

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RE: Interesting GN case 1 day ago

Staining for K/L came positive for both, 3+, not monoclonal. ------------------------------ Daniele Rios Leite MD University of Florida Jacksonv...

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RE: Interesting GN case 1 day ago

Final path report has dramatically changed. "Left native kidney biopsy: Membranoproliferative nephritis, type III, see comment Moderate chr...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Dr. Vishnapolsky is correct. Per DODI6130.03 (V1) (Medical Standards for Military Service: Appointment, Enlistment, or Induction) Chapter 6.15(m), ...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

@Raymond Townsend @Matthew Weir @Agarwal Rajiv Would any of you go directly to arterial line BP assessment in this patient? Or would you pref...

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RE: Generic FSGS 1 day ago

These cases do NOT appear to be "Primary FSGS" an acquired disease of podocytes thought to be related to a circulating factor that often responds t...

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RE: Managing severe hypertension in outpatient settings 1 day ago

One of the biggest changes in my medical years is the approach to HTN not as the number but a symptom. HTN emergency v urgency etc. This was t...

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Generic FSGS 1 day ago

I saw 2 of 10 siblings today, 6 male and 4 female . They are the offspring of two first degree cousins . All 10 of the siblings have been diagnose...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Well that may settle this medical and philosophical debate, thank you Dr Vishnepolsky. I understand that the military cannot look at the nuances ...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

APAbs are antibodies, why is it that decreasing production of antibodies has had such variable clinical results? One report sounds encouragin...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

In APS /aPL positive patients with HTN and CKD, renal artery stenosis is very prevalent and maybe it could be interesting to perform a Doppler US. ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

A history of polycystic kidneys is a disqualifying condition by US military medical standards regardless of Mayo class. If he already knows this in...

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RE: Managing severe hypertension in outpatient settings 1 day ago

Dr. Abid+ if you have access to the UpToDate chapter on " Management of severe asymptomatic hypertension in Adults" by Varin and Elliott (last re...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Dr. Chebib- thanks for your excellent and well calibrated response. We are in a new era of medicine and need to adapt in a non-paternalistic, evide...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Thank you Dr. Glassock. We, and others, are working on such models/tools. In our hands, AI-empowered tools reporting the various imaging metrics ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 day ago

Dr. Chebib- Thanks for your very informative post. The subtleties of the genetic architecture of ADPKD are difficult to remember. Is there an AI ...

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Managing severe hypertension in outpatient settings 2 days ago

Hi everyone, We have been recently encountering several cases of patients with BP higher than 180/100 but otherwise asymptomatic. Since recent A...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

Thank you for sharing the case. Would it be possible to share the genetic testing results redacted? Also sharing few representative images of both ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

Great discussions. Can you please provide more details on the genetic findings? Which exon / amino acid position is involved? If the truncation i...

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RE: Pseudohypertension or true uncontrolled HTN 2 days ago

No LVH by ECHO or EKG. Osler phenomenon present. Do we call this isolated systolic hypertension or pseudo-hypertension? I want to see a non-invasiv...

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RE: Pseudohypertension or true uncontrolled HTN 2 days ago

Thank you all for your thoughtful responses. I reviewed his EKG and echo, both done within the past 3 months The QRS voltage is normal in the p...

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RE: Pseudohypertension or true uncontrolled HTN 2 days ago

I would bet he certainly has HTN, if not he would feel awful being already on metoprolol and lisinopril 40. The question is "to what level if any...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

If the Military has prescribed medical conditions that make this just too complicated independent of what he really has, then perhaps he should see...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

If he plans to be deployed to the Middle East,where there over a 100 US bases, and high probability he will be , I would recommend against it . In ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

Thanks, the waiver process does involve physicians expert advice, so under a waiver request, the question does assume clinical relevance. In this c...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

Dr: Glassock: Part of the AI response (which I didn't include) describes the waiver application process. It will involve obtaining medical clearanc...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 2 days ago

Thanks Dr. Venkat for this illuminating response (AI supported). The question asked was somewhat different. "Would you give him permission to enter...

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RE: Pseudohypertension or true uncontrolled HTN 2 days ago

Good point. What were the Cardiac ECHO and EKG findings in this case? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

Dr.Achkar - thank you for this interesting suggestion concerning use of Neonatal Fc R antagonism to treat APLAS . Theoretically thus is an attracti...

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