RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 hour ago

Thank you, Dr Glassock. Yes, we have tried almost all available binders. However, their use is limited by pt's c/o "diarrhea" and after experienci...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 hour ago

The patient is homozygous for a COL3 VUS, yet the mother is negative on screening. I presume that same VUS in a heterozygous state should be detect...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 hour ago

Dear colleagues, Thank you for your valuable comments. Regarding the sibling's renal biopsie electron microscopy unfortunately was not performed,...

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RE: Case of FSGS with IgM and C3 post transplant 2 hours ago

Thank you so much Dr Glassock very helpful. ------------------------------ Daniel Guevara-Pineda MD West Hartford CT ---------------------------...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 4 hours ago

Tough case. But I doubt that surgical removal of these extra osseus calcinosis deposits is a viable option, as wound healing would likely be poor a...

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RE: Case of FSGS with IgM and C3 post transplant 4 hours ago

On balance, I favor a recurrence of permeability factor related Primary FSGS in this case. If EM was performed on the early graft biopsies.this mig...

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RE: Case of FSGS with IgM and C3 post transplant 4 hours ago

Also primary NOS disease was in the nephrotic range prior to transplant. Post transplant proteinuria pick at 4gr improved with RAS blockage Get O...

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RE: Case of FSGS with IgM and C3 post transplant 4 hours ago

Thank you I thought about that possibility therefore i run a renasight which is negative Get Outlook for iOS

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RE: Case of FSGS with IgM and C3 post transplant 4 hours ago

As Dr. Awais mentioned , DFE with non nephrotic range proteinuria raises the tiny possibility of genetic FSGS ------------------------------ Dr....

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RE: Case of FSGS with IgM and C3 post transplant 5 hours ago

Thank you for sharing this paper dr Venkat this make the diagnosis and management much for complex to date i dont have clear diagnosis for this p...

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RE: Case of FSGS with IgM and C3 post transplant 5 hours ago

Also, please see following reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC5577650/#:~:text=There%20were%20significant%20positive%20correlati...

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RE: Case of FSGS with IgM and C3 post transplant 5 hours ago

From Google AI: "Yes, secondary focal segmental glomerulosclerosis (FSGS) can show IgM deposition. While IgM staining is commonly associated with p...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 6 hours ago

Thank you , Dr Venkat. L spine x ray showed diffuse osteopenia and Hip xray no significant arthropathy ( per report ) Alk phos is normal - 43 ...

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RE: Case of FSGS with IgM and C3 post transplant 6 hours ago

My bad, now I understand your point , to consider that the donor had a COL4 variant , the evaluation of the donor was not done in US , I do not hav...

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RE: Case of FSGS with IgM and C3 post transplant 6 hours ago

thank you Dr Nauman Mother lives in India , from what I gather in the family history , she is doing very well We have a completely negative R...

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RE: Case of FSGS with IgM and C3 post transplant 6 hours ago

This may be a long shot but lack of nephrotic range proteinuria despite diffuse FPE, mother to child donation, I wonder if its genetic FSGS rather ...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 6 hours ago

Serum alkaline phosphatase and bone-specific alkaline phosphatase? Are hand, skull and spine x-rays suggestive secondary hyperparathyroidism? Besid...

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RE: Is Hypertonic Saline appropriate here 6 hours ago

Dr. Abdullah: As I am sure you know, use of IV sodium bicarbonate therapy in metabolic acidosis is a controversial topic. It is generally agreed th...

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RE: Case of FSGS with IgM and C3 post transplant 7 hours ago

thank you Dr Venkat for your comment very much appreciated 1 : is a possibility but his tacro trough have been rather low running 4 to 6 , also ...

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RE: Case of FSGS with IgM and C3 post transplant 7 hours ago

"There is striped interstitial fibrosis with proportional atrophy involving ~40% of the cortical tissue............................ IgM shows 2+ se...

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treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 7 hours ago

Hello, I wanted to get some advice/opinions on how to proceed with management of this unfortunate ESKD pt. 63-year-old male, on PD since Augu...

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RE: Novel COL4A3 Variant and Kidney Transplantation 8 hours ago

Genetists at our institution typically test the whole family unless someone does not consent. This makes interpretation of VUS easier. Though I und...

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Registration Kidneycon 2026 8 hours ago

Nephrologists & Trainees Transform Kidney Care Together- 10 years of all things kidney- mentoring and network building..travel grants open. http:/...

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KidneyCon Invite! 8 hours ago

http://kidneycon.org/registration please come and also share with tour trainees. KidneyCon is around the corner..- Nephrologists & Trainees Transfo...

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Case of FSGS with IgM and C3 post transplant 8 hours ago

Dear Colleagues , I would appreciate your input and advice on this complex case , my apologies for this long post 36-year-old Male with proteinu...

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RE: DKD & Immune Complex GN on biopsy 14 hours ago

80% glomeruli sclerosed ... 90% IFTA... Plan for transplant --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of...

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RE: Is Hypertonic Saline appropriate here 16 hours ago

I am not sure if I would give IV Na Bicarbonate, given it's Na load . Would try to get away with slow correction of the acidosis with oral Na Bicar...

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RE: DKD & Immune Complex GN on biopsy 17 hours ago

Did the EM include examination of a non-sclerotic glomerulus.? I am also curious to see the findings if double contours with mesangial interposit...

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RE: DKD & Immune Complex GN on biopsy 17 hours ago

No election dense deposits by EM raises p possibility that the IF is "false positive". We need to see the IF images. ----------------------------...

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RE: Is Hypertonic Saline appropriate here 20 hours ago

On an unrelated note, if a patient with advanced ckd has concurrent metabolic acidosis, would you consider giving 8% sodium bicarbonate, would you ...

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RE: DKD & Immune Complex GN on biopsy 23 hours ago

The presence of immune deposits by IIF without electron dense deposits by EM would make Pronase digestion an unlikely tool to make a diagnosis . Ju...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

Markedly thickened GBM consistent with diabetic glomerulopathy. Extensive podocyte effacement can occur in heavily proteinuric diabetic glomerulopa...

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RE: Lupus Nephritis 1 day ago

I am not sure if there is any literature showing a benefit of a non Voclosporin CNI ,like Tacrolimus , especially in non nephrotic lupus . In such ...

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RE: Lupus Nephritis 1 day ago

CNIs are effective in higher baseline proteinuric LN but does not mean it is less or less preferable in low baseline proteinuric LN as they have 2 ...

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RE: Lupus Nephritis 1 day ago

I could not open the biopsy report , but if it is indeed Class 4 , I would consider a treatment regimen of Steroids , Mycophenolate and Belimumbab....

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RE: Lupus Nephritis 1 day ago

I fall in the Mayo Clinic School of management of this case. I would not use protocol re- biopsy but follow serology (C3/C4 ; anti-ds DNA antibody ...

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RE: Lupus Nephritis 1 day ago

I think your treatment plan is good. What will be your third medication? MMF + voclosporin or MMF + belimumab? I know that rituximab has not been...

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RE: Lupus Nephritis 1 day ago

Complete remission and hence long-term renal outcome is higher with triple therapy. Some opt for triple and some for double therapy, the vital issu...

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RE: Is Hypertonic Saline appropriate here 1 day ago

Great discussion. One issue which has not been addressed. Is the volume status of your patient. You indicated to me by email that the urine protein...

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RE: Lupus Nephritis 1 day ago

Since early aggressive therapy of Severe LN is important in securing an optimal long term outcome, why not use the best therapy available for initi...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

I concur with Dr. Balan's analysis - we need to know the specific details of the genetic mutations in the recipient and perhaps her affected siblin...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

Hello Dr. Venkat, Thank you for your response. Main EM findings: GBM thickening (~1,457 nm) & segmental GBM lamination / Duplication with cell...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

I agree with Dr. Venkat 100%- this seems to be mostly severe Diabetic Glomerulopathy. With a "minor" component of a superimposed ICGN of undetermin...

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RE: Lupus Nephritis 1 day ago

Looking back at this case, it is more than remarkable, the disconnect with the urine findings and the histology "Investigations showed PCR 27...

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RE: Lupus Nephritis 1 day ago

Disclaimer: Strictly personal opinion. In deciding on induction therapy for LN, I look at both pathological severiry (class IV in this patient) ...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

In the genetic evaluation for a kidney transplant, the evaluation must start from the patient. We must know the genetic diagnosis in the index case...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

What were the EM findings in the GBM in the sibling's kidney biopsy? Were they consistent with hereditary nepritis/Alport Syndrome? Given the age o...

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RE: DKD & Immune Complex GN on biopsy 1 day ago

Rheumatoid factor and serum complement levels (since infection-related GN [IRGN] is a possibility)? Did EM show electron dense deposits (descriptio...

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RE: Canine amyloidosis treatment options 1 day ago

Congo red was positive in the areas of amyloid. EM showed segmental expansion of mesangial zones and the bases of capillary walls by haphazardly ar...

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DKD & Immune Complex GN on biopsy 1 day ago

Hello, I thank you in advance for your feedback on my patient below. 40 y/o Latino Woman with PMH of CKD GII, A3, Nephrotic range proteinuria HT...

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