Non-necrotizing granulomatous interstitial nephritis 5 hours ago

Dear colleagues, I'd like to share a diagnostically challenging case from our nephrology unit, on which I would value the community's input. Pati...

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RE: Post Partum AKI 6 hours ago

Last creatinine os 4.6 frm 2.8, p/c of 17, blood pressure of 130/92 Her Bicarbonate is 17 Phosphate 6 Calcium 7.5. I pulsed her, treated her and pl...

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AKI - 3 weeks post normal vaginal delivery 9 hours ago

Hello All, I have a 31 y/o'clock female, h/o Caroli's disease s/p Liver Transplant 2010, currently on Tacrolimus (trough goal about 3), had a no...

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RE: MPGN with negative IMF 10 hours ago

I think the EM findings likely make Fibrillary GN an untenable diagnosis, unless the images were not examined at high magnification. Could you plea...

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RE: Radioiodine treatment in Patient with CKD stage 4 12 hours ago

zahmad@kidneycareok.com thank you ------------------------------ Zubair Ahmad MD Tulsa OK (585) 329-9640 ------------------------------

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RE: transplant recurrent FSGS 15 hours ago

@Sheldon Hirsch I do not have the answer to your excellent points. Clearly, there is a permeability factor(s) in the sera of patients with recurr...

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RE: transplant recurrent FSGS 15 hours ago

Related...in the reference provided, 40% of patients with neg anti-nephrin Ab still lost their allograft function by six months. Perhaps there is m...

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RE: transplant recurrent FSGS 15 hours ago

Excellent question. I do not have the "answer". As you know, the permeability factor story has changed overtime: the Sabin factor, SUPAR and now an...

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RE: transplant recurrent FSGS 16 hours ago

@Mario Rubin, Do you think that anti-nephrin antibodies is the elusive permeability factor or may there be more to the story, I ask because you w...

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RE: Radioiodine treatment in Patient with CKD stage 4 16 hours ago

We have a special protocol, can share if u email me, using official email.. private domains blocked --------------------------------- Dr. Hormaz ...

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Radioiodine treatment in Patient with CKD stage 4 18 hours ago

I have a 66-year-old male with diabetic nephropathy with CKD stage IV, creatinine of 3.1 and a GFR of 21 mL/min as of May 2026,, CLL, coronary arte...

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RE: transplant recurrent FSGS 18 hours ago

@Astrid Weins @Ibrahim Batal As already stated, this is a very difficult problem but, nowadays, we have an objective tool to assess the possibi...

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RE: transplant recurrent FSGS 19 hours ago

Wow, I had a patient who lost 2 transplant to recurrent disease then on the third with aggressive pheresis was able to keep it, and was eventually ...

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transplant recurrent FSGS 20 hours ago

I have a 37 year old man with ESRD. He presented ~ 2020 with new onset nephrosis, FSGS on biopsy, and progressed to ESRD within one year. He receiv...

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RE: High output HF from AVF? 21 hours ago

No, no tortuous or large. And always, "eye test" is important. Thank you. ------------------------------ Esra Ekiz, MD Nephrology Attending Ph...

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RE: High output HF from AVF? 21 hours ago

AVF occlusion test was done with no improvement in BP, so yes, I too said the same but the question came from ICU as hypotension was not able to be...

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RE: High output HF from AVF? 21 hours ago

Volume overload improved to some extent, though there is still room to go. Our fistula surveillance studies are reported as proximal-mid-distal b...

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RE: MPGN with negative IMF 21 hours ago

Few cases with fibrillary GN without igg have been described( very rare) consider DNAJB9. Long shot May be pathologist can comment -------------...

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RE: Post Partum AKI 21 hours ago

I don't doubt the renal disease but the high proteinuria of 13 g you mentioned above. My next step would be the biopsy. Here I get results within o...

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RE: MPGN with negative IMF 21 hours ago

Is BP well controlled? TMA in the setting of uncontrolled hypertension can cause an MPGN-pattern of injury. ------------------------------ K.K. V...

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RE: MPGN with negative IMF 21 hours ago

Would you be able to post the anonymized pathology report and/or images from the case. Main ddx of MPGN pattern without deposits would be chronic...

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RE: yeast peritonitis and return to PD. 21 hours ago

Sorry, I thought it was the second episode. I had a patient with yeast peritonitis. Restarted after 3 month and a few months later he had the same ...

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RE: MPGN with negative IMF 22 hours ago

If the search for monoclonal gammopathy is unrevealing. I would arrange for IF staining of the biopsy for Fibronectin or send the biopsy specimen f...

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RE: MPGN with negative IMF 23 hours ago

This pattern of injury is most compatible with a MGRS mediated renal limited TMA. Please re-review the EM for signs of sub -endothelial lucencies a...

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MPGN with negative IMF 1 day ago

Dear all, My colleague has an 83-year-old female patient who presented to her clinic with progressive renal dysfunction (creatinine 90 umol/L in ...

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RE: Pd Patient And Lipid Lowering Agent 1 day ago

For the PISCES trial. see Lok C et al NEJM, 2026. It currently applicable only to HD patients, but I do not see why it would not work in PD . Just ...

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RE: Membranous Nephropathy treatment 1 day ago

Not sure about membranous but in Anca vasculitis , CD20 counts more predictive of relapse over Anca titers --------------------------------- Dr. H...

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RE: Pd Patient And Lipid Lowering Agent 1 day ago

The entire concept of treating to prevent ASCVD in dialysis patients has been turned upside down with the findings of the PISCES trial that showed ...

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RE: Membranous Nephropathy treatment 1 day ago

Thanks. The infusion is not hard to get in Atlanta

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RE: Membranous Nephropathy treatment 1 day ago

Hi James , I understand you find infusion hard to get in your centre I would personally check ELiSA and then give rituximab 1g and then 14 days la...

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Pd Patient And Lipid Lowering Agent 1 day ago

Dear colleagues , Primary care physician has queried use of lipid lowering agent in established pd patient Not tolerating statin question about us...

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RE: yeast peritonitis and return to PD. 1 day ago

No previous peritonitis . You mean doing echocardiogram , Ct whole body ? Pet ? Blood cultures negative Never fungaemic and clinically well ( afte...

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RE: Post Partum AKI 1 day ago

Yes, vaginal discharge mixing with urine can confound interpretation of proteinuria. However, this patient has edema, hypoalbuminemia and increasin...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

Just as a followup, after nearly 4 weeks the patient still has persistent protienuria of 14 grams per day Her LM showed MPGN and IF ( though inco...

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RE: High output HF from AVF? 1 day ago

!! Alejandro C Alvarez St. Louis, MO alejoclaudio@gmail.com

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RE: AI in Epic? 1 day ago

Thank you, Dr. Glassock, that's good to know. I was able to update my account on UpToDate to add on that option under my user settings. An extra fe...

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RE: High output HF from AVF? 1 day ago

Above appreciated and more valuable than this, but I like the "eye test", for whatever it is worth, I have only seen high output heart failure in L...

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RE: AI in Epic? 1 day ago

As far as know the decision is up the health system that purchases/ leases the EPiC Program with or without embedded UpToDate option ---------...

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RE: AI in Epic? 1 day ago

that's good to know, but how do you elect for that option? ------------------------------ Mark Cook DO Pikes Peak Nephrology Associates Colorado ...

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RE: High output HF from AVF? 1 day ago

Dr. Ekiz, Those Blood flow volume values are unreliable, as evidenced in the wide range of the measurements above (assuming it is a surgical AVF ...

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RE: AI in Epic? 1 day ago

AI is already available in EPIC with the option of embedded UpToDate (Expert AI). Full disclosure- I am Editor in Chief of the glomerular disease s...

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RE: High output HF from AVF? 1 day ago

Has the volume overload improved with CRRT, and what happened to blood pressure during that time? I don't think a shunt flow of 900 ml/min caused t...

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AI in Epic? 1 day ago

Hi, does anyone know when artificial intelligence for epic will be available for providers? ------------------------------ Mark Cook DO Pikes Pea...

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RE: Post Partum AKI 1 day ago

Postpartum and without curettage, lochia often persists for up to 4 weeks. During this time, proteinuria cannot be interpreted. If necessary, pleas...

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RE: yeast peritonitis and return to PD. 1 day ago

Fungal peritonitis is rare in patients who are not immunocompromised. Was the same pathogen identified in the second episode of peritonitis as in 2...

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RE: low phosphate and smoldering myeloma 1 day ago

In regards to the PO4 loss in the urine ,let's assuming with normal eGFR , his PO4 excretion per day is around 40 mmol/day. However with eGFR of 4...

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RE: Membranous Nephropathy 2 days ago

A CNI will not help ( much) for inducing a lasting immunological remission.- I do not recommend this option. ------------------------------ Richa...

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RE: Post Partum AKI 2 days ago

But was it looked for? Is this the first pregnancy or one of multiple. If multiple, , any toxemia events or proteinuria with prior pregnanies.? -...

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RE: Post Partum AKI 2 days ago

No proteinuria reported in the 1st trimester. --------------------------------- Wael Jebur MD drwaellatif@hotmail.com Dubai ---------------------...

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RE: Membranous Nephropathy 2 days ago

Consider combining a CNI with antiCD 20 inhibitors . The combination seems to work very well. Risk of recurrence is high when you with hold CNI tho...

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