RE: NUP133 Mutation 3 minutes ago

As an asymptomatic unaffected carrier of an autosomal recessive gene, she may want to have potential mates tested, but for now simple reassurance s...

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RE: Hypokalemia in Pregnancy 1 hour ago

The ABG on the evening of October 1 are consistent with a normal term pregnancy. (Chronic respiratory alkalosis ). The serum creatinine and serum K...

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RE: NUP133 Mutation 2 hours ago

Given the autosomal recessive inheritance the etherozygous pathogenic or likely pathogenic variant should make her a carrier and she should not dev...

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NUP133 Mutation 4 hours ago

Am following a 19 year old college girl who came to me for review of her proteinuria She has been complaining of occasional bubble in the urine ...

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A Special ASN Kidney Week 2026 Event for Fellows: Immigration Journeys, Career Success Stories, and Networking 4 hours ago

Hi all, Do you have questions about navigating the US immigration system while building a career in nephrology? There is an amazing opportunity a...

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RE: Hypokalemia in Pregnancy 5 hours ago

Was there a history of diarrhea? A metabolic acidosis makes it more like a distal RTA and unlikely to be Gitelman or Gellery syndrome. I think a GI...

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RE: Hypokalemia in Pregnancy 5 hours ago

I am gravitating to a mitochondriopathy precipitated by the metabolic stress of her pregnancy & febrile illness. ---------------------------------...

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RE: Hypokalemia in Pregnancy 5 hours ago

The RTA and AKI would seem to make a Gitelman or Geller syndrome unlikely. I do not disagree with genetic testing (I seldom am) but this clinical e...

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RE: Hypokalemia in Pregnancy 6 hours ago

I doubt a singe dose of gent did anything but she may have Gitelman, often symptomatic until pregnancy. is Genetic testing available? Is her BP o...

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Hypokalemia in Pregnancy 11 hours ago

Dear All Good day hoping you are doing well, I'm seeking your input in this case, please A 33-year-old woman, gravida 1 para 0, at 39+4 weeks...

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RE: Would you Re biopsy this IgA? 15 hours ago

Unfortunately, at present there are no non-invasive tests that will confidently exclude or include IgAN in the diagnose. . . --------------------...

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RE: Would you Re biopsy this IgA? 21 hours ago

Dr. Venkat, I think you are right, for completeness sake serology is easy to get, if all negative even more reason not to biopsy. I'll add. Thank y...

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RE: Would you Re biopsy this IgA? 21 hours ago

Dr. Kaur: My suggestion to obtain serological tests was based on non-availability of the kidney biopsy report from the past. While it may not be ab...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 1 day ago

My mind is a bit slow today.. but am not sure of the diagnosis The IF is apparently full house but is being treated as a pauci immune GN with Avac...

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RE: Would you Re biopsy this IgA? 1 day ago

AS above: The COOPERATE trial 2002 JAMA found addition of ARB to ACEi lowered proteinuria more than more ACEi alone. then in 2009 JAMA retracte...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 1 day ago

what did EM show? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transpla...

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RE: Would you Re biopsy this IgA? 1 day ago

diuretics do not change 24 hour urine sodium per se, when you first take them you are in a negative Na balance, but once you reach steady state, an...

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RE: Would you Re biopsy this IgA? 1 day ago

Good morning Dr. Venkat, he did not have RBCs/casts in urine… would you still order serology? I did not add. But good point, if I am contemplating ...

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RE: Would you Re biopsy this IgA? 1 day ago

I do not give ACEI+ ARB any more, but that's only because we now have better alternatives. OTOH, I do not believe there should be a taboo against i...

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RE: Would you Re biopsy this IgA? 1 day ago

Just to ask another practical point, how accurate would a urine 24 hour sodium be if the patient is on a diuretic? ----------------------------...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 1 day ago

With this much glomerulosclerosis and IFTA one would not expect much improvement in GFR with immunosuppression. Were any steroids given with.the RT...

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A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 1 day ago

I am posting this case for a colleague, and I would appreciate the community members input on this case: The patient is a 20-year-old African Ame...

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RE: Would you Re biopsy this IgA? 1 day ago

I too have several patients with IgAN who have done very well (in stable remission with low proteinuria ., no hematuria and unchanged eGFR) on comb...

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RE: Would you Re biopsy this IgA? 1 day ago

A reasonable estimate of 24 hour urinary Na excretion can be obtained from a mid-day spot urine Na/creatinine ratio multiplied by estimated 24 urin...

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RE: Would you Re biopsy this IgA? 1 day ago

I have a few patients on ARB and ACEi, a leftover from 15 years ago, they're doing great with minimal protein urea. Should I continue or stop it? ...

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RE: Would you Re biopsy this IgA? 1 day ago

Did start on Torsemide at the clinic visit for volume, HTN and since increased Losartan. Although do recommend low Na diet [More]

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RE: Would you Re biopsy this IgA? 2 days ago

Excellent clinical point. A failure to reduce proteinuria in glomerular disease can often be attributed to excess NaCl intake. I routinely measure ...

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RE: Would you Re biopsy this IgA? 2 days ago

A detail...but worth noting because, IMO, it does not get enough emphasis. For remnant proteinuria on an ARB, particularly if K is "high normal" or...

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RE: Would you Re biopsy this IgA? 2 days ago

Was referred to Tx at last visit given egfr and younger age (but missed their three calls, he works 6 nights and sleeps during the day and when he ...

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RE: Would you Re biopsy this IgA? 2 days ago

Very happy to say that Rodby and Hirsch are not in opposition; actually, they fit together (in this particular case, and overall!), a good team, I ...

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RE: nephrotic syndrome 2 days ago

if you are waiting 4 week what about steroids in the mean time, maybe it will go away and you wont need a biopsy... granted you wont know exactly w...

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RE: nephrotic syndrome 2 days ago

Thank you Dr Rodby. We are indeed very skeptical for the renal biopsy. We will complete 4 weeks from the interruption of cabozontinib and we will...

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RE: nephrotic syndrome 2 days ago

Thank you Dr Rodby. We are indeed very skeptical for the biopsy. For the moment we are waiting for around 4 weeks after the interruption of caboz...

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RE: nephrotic syndrome 2 days ago

Thank you Dr Rodby. We are indeed very skeptical for the biopsy. For the moment we are waiting for around 4 weeks after the interruption of caboz...

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RE: nephrotic syndrome 2 days ago

I remember eons ago that RCC is rarely associated with MCD, https://link.springer.com/article/10.1007/s11255-024-04069-7 The DD is long (2 dru...

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RE: Would you Re biopsy this IgA? 2 days ago

I would focus on transplantation. sorry to be such a nihilist - a credit to my realism? Dr Hirsch is the anti nihilist - a credit to his optim...

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

hen's teeth are indeed rare but so is this case-would love to hear any additional explanations for NRP 20g/g, normal serum albumin, unremarkable EM...

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RE: Would you Re biopsy this IgA? 3 days ago

Thank you All. Patient believes he can get me the biopsy results from 40 years ago, had bleeding complication at the time of the biopsy. Is on...

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RE: Puzzling Case of Post-Transplant Proteinuria 3 days ago

Alport with NRP at 20 g/g and BOTH (basically) normal EM x 2 despite P having quadrupled AND no hematuria has got to be about as rare as hen’s teet...

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RE: Would you Re biopsy this IgA? 3 days ago

I fully agree with Dr. Hirsch. The therapy for advanced CKD , obesity and diabetes should be optimized. Unfortunately , there are no non-invasive d...

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RE: Likely Active C3G before transplant 3 days ago

please give us followup on your decision if possible -thanks for posting ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST K...

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RE: Puzzling Case of Post-Transplant Proteinuria 3 days ago

Dr. Mahmut Altindal- I think you've made an excellent point. It is possible that the deceased donor kidney in this particular case of unexplained s...

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RE: Would you Re biopsy this IgA? 3 days ago

It is hard for me to believe that after at least 38 years of disease with extensive CKD and increased echogenicity that the risk v benefit calculat...

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RE: Would you Re biopsy this IgA? 3 days ago

Dr. Kaur: If it is not certain that he had IgA nephropathy on the original biopsy and if serological tests currently are non-diagnostic, rebiopsy m...

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RE: Would you Re biopsy this IgA? 3 days ago

Hello, I routinely perform kidney biopsies myself at my hospital. For this particular patient, the main question is: is this progressio of the unde...

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RE: nephrotic syndrome 3 days ago

I thank you all for your comments. We hesitate to perform a KB because of the bleeding risk (according to the literature around 4 weeks ). The...

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RE: nephrotic syndrome 3 days ago

Recovery from proteinuria from VEGF inhibitors typically takes several weeks and may take several months. I about 40% the effects are irreversible ...

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RE: Would you Re biopsy this IgA? 3 days ago

Dr. Dastoor- good point. . The addition of Atrasentan or a conversion from RASi to Sparesentan could certainly be considered but the level of eGFR ...

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RE: nephrotic syndrome 3 days ago

if this is related to Cabozanitinib, why not waiting to see if the proteinuria will resolve after stopping it? ------------------------------ M....

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RE: Puzzling Case of Post-Transplant Proteinuria 3 days ago

Dr Venkat, with all due respect; carriers of COL4 mutations may have very subtle GBM changes. I could not find any other explanation to this case (...

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