RE: Light chain proximal tubulopathy 1 hour ago

Interesting case. We know the patient has a kappa monoclonal gammopathy but what is happening in the kidney. The EM description does not report any...

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RE: Light chain proximal tubulopathy 7 hours ago

I think that investigation for MGRS is warranted. It has been almost 20 years since the non-crystalline LCPT was reported for the first time by us ...

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RE: Rapidly progressive glomerulonephritis 8 hours ago

RTX can be very effective in IgAV but not in IgAN, for poorly understood reasons. No RCT data (yet) . I would have tried it. If no contraindication...

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RE: Full House/Non Lupus nephropathy 9 hours ago

" GFR stable ".... Could you elaborate a bit on the actual GFR ... is it low for age or normal ... --------------------------------- Dr. Hormaz D...

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RE: Rapidly progressive glomerulonephritis 11 hours ago

Just to update the community. No definitive infection identified Shortly after the start of prednisone he developed edema. MMF 1g bid was added ...

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RE: Light chain proximal tubulopathy 15 hours ago

I believe Dr. Glassock is right on the money. The toxicity of LC in PCT can happen in the absence of crystals or clear deposits. Mis-trafficked and...

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RE: Light chain proximal tubulopathy 17 hours ago

In my opinion, this is pathological trafficking , not physiological trafficking, and a bone marrow examination in needed to identify a clone, not t...

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RE: Light chain proximal tubulopathy 20 hours ago

I am not sure. Given that is was sufficiently focal to be below diagnostic threshold for LCCN, I am not sure there would even be enough material to...

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RE: Light chain proximal tubulopathy 22 hours ago

Does mass spectrometry of the congophilic casts is helpful in this case for better clarification? --------------------------------- Hayder Aledan ...

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RE: Light chain proximal tubulopathy 22 hours ago

An interesting paper exploring this concept: Maike Büttner-Herold 1,*, Nathalie Krieglstein 1, Teresa Chuva 2, Kaija Minuth 1, Frederick Pfister...

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RE: Light chain proximal tubulopathy 22 hours ago

Although kappa light chain (monomers ) are filtered more readily than lambda light chain (dimers) these values are not compatible with physiologica...

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RE: Light chain proximal tubulopathy 23 hours ago

The congophilic casts are bit concerning to me as that is an extremely unusual non-specific finding in most renal biopsies (at least in our lab). B...

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RE: Light chain proximal tubulopathy 23 hours ago

Last SPEP showed free kappa LC and no M-spike. BM biopsy yesterday (pending). ------------------------------ Gary Singer MD, FASN Partner Midwe...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 23 hours ago

Thank you for sharing. Seems like quite a bit of chronicity >50% GG, 60-65% IFTA, and severe arteriosclerosis and arteriolar hyalinosis. It is stil...

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RE: Light chain proximal tubulopathy 23 hours ago

LM: 19 glomeruli, 6 globally sclerotic. The intact glomeruli appear unremarkable, with no mesangial expansion, endocapillary hypercellularity, fibr...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 23 hours ago

In view of the now known severe IFTA and the paucity of data regarding the benefits of immunosuppressive therapy for either TG or chronic active AB...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 23 hours ago

LM: Up to 24 glomeruli are identified, 13 of which are globally sclerotic. Intact glomeruli show diffuse mesangial matrix expansion and mild mesang...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 23 hours ago

IF: The sections are stained for IgG, IgM, IgA, C3, C4d, C1q, albumin, fibrinogen, and kappa and lambda light chains. There is granular capillary w...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

my understanding from reading Dr.Zuckerman's comments which seems consistent with DR. Rubin and mine-IGAN+CABMR. proteinuria IMO could be either or...

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RE: Light chain proximal tubulopathy 1 day ago

perhaps a bone marrow biopsy might help differentiate between physiological trafficking versus a true light chain tubulopathy? ------------------...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

Thank you Dr. Zuckerman. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: MPGN pattern in a 43-year-old woman with a JAK2-positive hematologic disorder, portal hypertension, and a serum IgA-λ monoclonal protein 1 day ago

Following is from AI: Patients with JAK2 mutation-associated myeloproliferative neoplasms (MPN) such as essential thrombocythemia (ET) or polycyth...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

I didn't see the full annonymized biopsy report (but may have missed it in the response chain). So my opinion on these findings is tentative as I d...

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RE: Light chain proximal tubulopathy 1 day ago

Really need EM to interpret this finding. If crystals are present this is crystalline LCPT. If crystals are not present it is a more nuanced interp...

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RE: Light chain proximal tubulopathy 1 day ago

Go back to tissue for EM if not done and possible AG retrieval by paraffin section. Any proximal tubular dysfunction signs? Complete the hematolo...

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RE: Full House/Non Lupus nephropathy 1 day ago

This is a good article. Thanks ------------------------------ Sandeep Magoon MD Nephrology Associates of Tidewater, LTD and Eastern Virginia Medi...

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RE: Full House/Non Lupus nephropathy 1 day ago

Still trying to figure out. She has been treated with steroids all along. GFR stable has 2 gms proteinuria ------------------------------ Sandeep...

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RE: Light chain proximal tubulopathy 1 day ago

Suppose no fanconi --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology, Inc. Cincinnati OH (513) 841-0222 --------------...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

It was not a question,just an observation from a large (n=64) study of patients with IgA deposition in a renal allograft. (Ganesh et al 2024) 18/64...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

Dr. Glassock, I do not understand your question. Please clarify it. The paper you cited (attached) just reinforces the ongoing discussion: " the po...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

For the Transplant Nephrologists here is an interesting study of "incidental" IgA deposition in long term allografts with chronic allograft Nephrop...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

No personal experience with anti-CD38 therapy in AMR. I have found that late-onset AMR (> 6-12 months post-transplant), especially with transplant...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

Thank you for sharing this case Want to know if this patient had previous rejection ? Whats his averrage tacrolimus trough level ? Any recent ...

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RE: Proteinuria and hematuria in 2 siblings 1 day ago

@Michelle Rheault thank you for your comments. We discussed these 2 cases at our case conference today and 2 geneticists from Natera were there. ...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

agree there is mesangial proliferation with mesangial IgA deposits-significant chronic changes. so combination IGAN (whether recurrent vs de novo ?...

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RE: Light chain proximal tubulopathy 2 days ago

Can we see the deidentified kidney biopsy report. Physiologic protein reabsorption droplets should not be monoclonal. What is the UACR, UPCR and a ...

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RE: is it SIADH 2 days ago

See also Feldman BJ et al NEJM 2005 ;352:1884-1890 for a description of the infantile X-linked form of NSIAD. Could certain drugs, like Sertraline,...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

What about the IF staining looks like strong postive for IgA In this longstanding kidney transplant would you consider this denovo IgA or second...

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RE: is it SIADH 2 days ago

as promised see post very interesting IMO ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Unive...

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RE: is it SIADH 2 days ago

NSAID means non steroidal anti inflammatory drugs, like NSAIA non steroidal anti inflammatory agents I think the more preferred term is now SI...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

@Jonathan Zuckerman As a non-pathologist, I see mesangial expansion and cellular proliferation plus primarily mesangial deposition of IgA. The PA...

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RE: Light chain proximal tubulopathy 2 days ago

wow love this case don't see enough tubular (potential) MGRS nothing on EM? ------------------------------ Roger Rodby MD, FASN Professor ...

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Light chain proximal tubulopathy 2 days ago

62 yo WF with MGUS, stage 3a CKD and proteinuria. Repeat kidney biopsy shows acute tubular injury. Proximal tubules with cytoplasmic protein reabso...

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RE: therapeutic Lovenox dose in an ESRD setting 2 days ago

Due to delayed clearance and variable pharmacokinetics, LMWH is not desired in ESKD as it requires careful monitoring and reduced dosing , unfracti...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

Opinions from Transplant nephrologists /pathologists needed (Drs Rubin, Lerman, Venkat, Zuckerman ) but this looks like chronic transplant Glomerul...

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RE: is it SIADH 2 days ago

I guess this might better be called a Nephrogenic Syndrome of anti-diuresis (NSAID) , not SIADH. In this case circulating ADH and Copeptin would be...

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RE: is it SIADH 2 days ago

Sertraline has been associated with drug induced hyponatremia/SIADH. so that is a possibility. Surprisingly in isolated inner medullary collectin...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 2 days ago

Biopsy report from @David Bourne (Arkana). DSA negative. See table below for Banff classification of the biopsy findings: ACUTE Interstit...

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therapeutic Lovenox dose in an ESRD setting 2 days ago

I know I am trying to go thru the eye of the needle. For a patient w. ESRD who can't have warfarin but must have the alternative (Lovenox) for anti...

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RE: Proteinuria and hematuria in 2 siblings 2 days ago

I think this sounds consistent with genetic FSGS due to a mild NPHS2 variant. I'm not sure why the genetic report states that there shouldn't be a ...

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