RE: Kidney Biopsy in AL Amyloidisis 1 hour ago

Interesting statistic, but not relevant to this case. What % of 70 year old patients with Nephrotic Syndrome and +Congo Red Deposits in Bone Marrow...

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RE: Kidney Biopsy in AL Amyloidisis 2 hours ago

7.4.4 Hematologist-directed diagnosis of AL amyloidosis 7.4.4.1 Interpretation of the monoclonal protein screen In about 10% to 40% of patients wi...

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RE: MGRS/Fanconis 4 hours ago

Dr. Rodby - per Dr. Shah marrow was normal. The serum free light chain ratio seems extremely high, and that could easily be followed during appropr...

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RE: Kidney Biopsy in AL Amyloidisis 4 hours ago

@Mario Rubin @Richard Glassock I agree. Fascinating case and a lot of clinical learning. ------------------------------ Satish Balan MD DM D...

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RE: MGRS/Fanconis 4 hours ago

No - bc these are recent diagnoses - but I guess the crux of the question is - does myeloma therapy improve proximal tubulopathy and associated ...

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RE: MGRS/Fanconis 4 hours ago

Yes, small percentage of plasma cells. The more I read the more I see that the hypophosphatemia is very unlikely to respond. Treating makes sen...

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RE: IgA-Nephropathy: to complement or not to complement? 4 hours ago

The presence of Obesity makes the eGFR -Cystatin C less reliable, bu the only way to resolve the discrepancy is to obtain a measured GFR or a 24 ho...

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RE: Kidney Biopsy in AL Amyloidisis 5 hours ago

Thank you all for this vigorous and enlightening discussion. The patient clearly has systemic Amyloidosis based on the bone marrow and fat pad biop...

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RE: Kidney Biopsy in AL Amyloidisis 5 hours ago

@Satish Balan In the case we discussed, the POST-BIOPSY fat pad and bone marrow congo red staining were both positive for amyloidosis. No further...

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RE: Kidney Biopsy in AL Amyloidisis 5 hours ago

@Mario Rubin Thanks for those pathology pearls. While I absolutely agree with those arguments, in the situation that Dr Glassock posted, assumin...

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RE: Kidney Biopsy in AL Amyloidisis 5 hours ago

I also wanted to share another pearl written by Dr. Fogo et al which was just sent to me by Dr. S. Korbet and briefly discussed at the Rush confere...

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RE: Kidney Biopsy in AL Amyloidisis 5 hours ago

I was also present at the meeting. The case, as presented, was characterized by a slight elevation of IgM lambda with normal IgG, IgM and IgA. The ...

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RE: IgA-Nephropathy: to complement or not to complement? 6 hours ago

" 04/2023 creatinine-based eGFR 76, cystatin C-based 67 04/2025 creatinine-based eGFR 77, cystatin C-based 38 04/2026 creatinine-based eGFR 68,...

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RE: Kidney Biopsy in AL Amyloidisis 6 hours ago

@Richard Glassock: In the patient presented at the Rush University Kidney Biopsy Conference that you referred to, kidney biopsy must have been done...

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RE: MGRS/Fanconis 6 hours ago

Have kappa and lambda levels been increasing over the years? Do you have serial DEXA scans and/or skeletal x-rays showing progressive deterioration...

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RE: MGRS/Fanconis 6 hours ago

I would absolutely treat , following the k/l ratio, the tubulopathy may not improve but I think you are asking for trouble doing nothing. Just opin...

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RE: Kidney Biopsy in AL Amyloidisis 6 hours ago

Unless it has already been mentioned that AL has been confirmed, I think we should still try to type the amyloid detected in the bone marrow biopsy...

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RE: MGRS/Fanconis 7 hours ago

"SPEP = IgG Kappa, FLC ratio = 315." what is IgGK,IgGLambda levels? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCO...

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RE: Kidney Biopsy in AL Amyloidisis 7 hours ago

I think the question here is whether we are sure of the diagnosis and how far we should go to establish that. It is important to get to the source ...

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RE: MGRS/Fanconis 9 hours ago

Not my speciality , though it seems there is a clone causing tubular damage with hypoPO4 . He is 57 years old and probably could live another 20-25...

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RE: IgA-Nephropathy: to complement or not to complement? 12 hours ago

I am not sure if there is a need to measure both creatinine based eGFR and Cystatin C eGFr in this patient . Regarding compliance issues , glucos...

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RE: IgA-Nephropathy: to complement or not to complement? 12 hours ago

@K.K. Venkat: I have to admit that we have not performed a kidney ultrasound for quite some time. I will make sure that he has one at his next vi...

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RE: Kidney Biopsy in AL Amyloidisis 13 hours ago

In the absence of a bleeding tendency (Factor X deficiency) there is little evidence to suggest that renal Amyloidosis confers any additional risk ...

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RE: Kidney Biopsy in AL Amyloidisis 18 hours ago

Dr. Venkat - thanks-important information. My AI consultant (Claude) agrees, so long as the tissue contains Congo Red birefringent deposits of Amyl...

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RE: Kidney Biopsy in AL Amyloidisis 20 hours ago

My AI consultant says that both IMF for light chain-restriction and LMD-MS can be done on bone marrow and abdominal fat pad biopsies positive for a...

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MGRS/Fanconis 21 hours ago

Hello, I have a 57M patient with MGRS manifesting as very stable CKD (bland U/A with no blood, ACR is 5 mg/mmol) and Fanconi's syndrome (very mil...

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RE: Kidney Biopsy in AL Amyloidisis 21 hours ago

Thanks-Dr. Abdalla- I think that mass spectrometry (MS) would require a kidney biopsy. Do we need MS if we "presume" the circulating IgM lambda m...

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RE: Kidney Biopsy in AL Amyloidisis 1 day ago

AL amyloidosis is diagnosed via two distinct non-renal sites (fat pad pad biopsy + bone marrow . ​renal biopsy is unnecessary and carries high blee...

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RE: IgA-Nephropathy: to complement or not to complement? 1 day ago

"His current creatinine-based eGFR is 68, cystatin C-based eGFR is 35." Tough question, Dr. Glassock! Requires evaluation of patient for muscle m...

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Kidney Biopsy in AL Amyloidisis 1 day ago

Here is a question for the Open Forum participants, stimulated by an actual case (discussed recently on the Rush University Kidney Biopsy Conferenc...

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RE: IgA-Nephropathy: to complement or not to complement? 1 day ago

Dr. Venkat- which eGFR (Creatinine or Cystatin C) most likely represents mGFR in this patient? ------------------------------ Richard Glassock MD...

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RE: de-novo MGRS with LCDD 1 day ago

After more digging I still am still unable to find any prior SIEP or free light chains pre-dating her Xpant but as noted by others it seems suspici...

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RE: IgA-Nephropathy: to complement or not to complement? 1 day ago

Dr. Kuhn, do you have serial kidney ultrasound results on this patient? Progressive decrease in the size of the kidneys, increasing echogenicity, a...

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RE: de-novo MGRS with LCDD 1 day ago

In our program, all patients undergoing renal transplant evaluation have serum protein electrophoresis, immunoelectrophoresis, and kappa:lambda lig...

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RE: de-novo MGRS with LCDD 1 day ago

The average time for LCDD to recur is approx 2 years after kidney transplant so It would be consistent with recurrence. It would also be usual for ...

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RE: de-novo MGRS with LCDD 1 day ago

thanks Jonathan, please know I am not being critical of your management, it always easier in retrospect ! You followed the advice of your hematolog...

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RE: de-novo MGRS with LCDD 1 day ago

As I did deeper into this topic I was surprised to find wuite a body of literature about the pros and cons of pursuing possible MGRS in thos cases ...

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RE: de-novo MGRS with LCDD 1 day ago

Below is the Kidney Bx report ------------------------------ Jonathan Slater MD Renal & Transplant Associates of New England Longmeadow ...

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RE: IgA-Nephropathy: to complement or not to complement? 1 day ago

@Hormaz Dastoor: He is of Caucasian ancestry I initially applied for reimbursement for iptacopan because of his young age, impaired kidney functio...

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RE: Intersting case-Need your opinion 1 day ago

Indeed, they give the 900mg dose up to twice weekly. ------------------------------ Paul Grimm MD [Pediatric Nephrology/Transplant] Stanford Univ...

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RE: IgA-Nephropathy: to complement or not to complement? 1 day ago

Thanks you Dr. Glassock for the intellectual exchanges ... I love picking your mind and extracting your thoughts on such topics . Thanks Dr. Kuhn f...

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RE: de-novo MGRS with LCDD 1 day ago

Macro* is a typo she has been on dual IS of Taco/MMF As mentioined she never had native kidney Bx and I can not find a serum immunofixation or fr...

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RE: de-novo MGRS with LCDD 1 day ago

I think it is reasonable to assume if LCDD were diagnosed 11/24 when renal function was baseline, and appropriate treatment begun -graft outcome wo...

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RE: CAKUT, pediatric neph input 1 day ago

" Genetic testing would become more persuasive only if studies identify additional syndromic clues ". Can I conclude from this statement that genet...

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RE: CAKUT, pediatric neph input 1 day ago

Dear Mark, You raise a fair question. The reported hepatomegaly should certainly be evaluated, although it may be entirely unrelated to the renal ...

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RE: de-novo MGRS with LCDD 2 days ago

I'm a bit lost in all of these abbreviations but I dont see how this is not recurrent disease. Isnt this the classic presentation? This is th...

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RE: Dapagliflozin In Hd Patient With Diastolic Dysfunction 2 days ago

Dr. Soobadar. What did you do with the SGLT2i suggestion for therapy of HFpEF in your oliguric patient with ESKD treated by HD ? Just curious. ...

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RE: secondary IgA Nephropathy 2 days ago

But the issue here is the unexplained disparity between Scr and the very benign kidney biopsy findings , the latter perfectly compatible with very ...

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RE: de-novo MGRS with LCDD 2 days ago

In this case it is difficult to determine whether this is de novo or recurrent LCDD - an underlying low grade lymphoma prior to transplant cannot b...

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RE: Colleague Managing Home Hd Cohort 2 days ago

Jorge: I recognize & value you decade's of experience with home HD & agree with almost everything you stated. Except with regard to button-hole tec...

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