RE: Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 2 hours ago

My guess is that this is a rare example of MN due to a MGRS. I would consider therapy with Daratumumab. Need opinion from Dr. Leung or Dr.Jhaveri ...

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Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 3 hours ago

Dear Colleagues, I have an interesting case I was hoping to get your input. I have a 25 year old female with a history of PCOS and dyspareunia and...

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RE: Fibronectin glomerulopath 3 hours ago

My sense is that the mesangial nodules are often much larger than what is described in the report. "Giant' nodules and dense deposits are usually t...

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RE: Fibronectin glomerulopath 3 hours ago

Just curious- why are you skeptical of a diagnosis of Fibronectin Glomerulopathy? Seems like a pretty classical case! ---------------------------...

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RE: Post Partum AKI 3 hours ago

Anti-GBM antibodies can sometimes present atypically, meaning that some patients may have these antibodies without them binding to their own glomer...

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RE: SIADH conundrum 3 hours ago

Here is the Goldberg paper (attached) first describing the electrolyte-free water clearance we were taught as house officers and fellows at Penn wh...

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RE: SIADH conundrum 3 hours ago

Thank you John. Much appreciated. Mario ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Post Partum AKI 3 hours ago

I think that I would treat this as ANCA vasculitis as well; Rituximab and steroids per Pexivas. What percent of the glomeruli have crescents? ho...

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RE: SIADH conundrum 4 hours ago

I remember when I first read the 1986 AJM paper by Rose (attached above) in which he explains the difference between Osmotic free water clearance a...

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RE: Fibronectin glomerulopath 4 hours ago

I am also skeptical of the diagnosis of fibronectin GN. IHC stain for fibronectin and/or fibrillary deposits on EM would help. Genetic testing for ...

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RE: Fibronectin glomerulopath 4 hours ago

I am also skeptical of the diagnosis of fibronectin GN. IHC stain for fibronectin and/or fibrillary deposits on EM would help. Genetic testing for ...

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RE: SIADH conundrum 4 hours ago

Here it is + a couple of other Burton Rose papers on electrolyte-free water clearance. ------------------------------ John Schwartz MD Dalla...

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RE: Post Partum AKI 5 hours ago

Pauci-Immune crescentic GN -ANCA- negative. RTX + Steroids (rapid raper) , No Avacopan . may be best choice- a short course (8 weeks ) of oral CYC ...

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RE: Post Partum AKI 7 hours ago

IF is negative. C-ANCA and P-ANCA both are negative. EM is pending. How may we go this finding? --------------------------------- Wael Jebur MD d...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 12 hours ago

Could you post some de-identified pictures of the LM findings?. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geff...

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RE: Fibronectin glomerulopath 13 hours ago

Have you confirmrd fibronectin Glomerulopsthy by appropriate staining or other analysis of the kidney biopsy? i so, I would taper and eventually st...

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Fibronectin glomerulopath 14 hours ago

65yr old lady HYPERTENSION detected 11/2025 12/2025 H/O PEDAL EDEMA + TOOK torsemide from local hospital 12/2025 creatinine- 0.9/ACR 1670 4/2026 ...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 16 hours ago

Does your immunohistologist routinely perform a positive control with each kidney biopsy to be sure that the reagents are working properly.? ----...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 18 hours ago

Dr. Dastoor- PLEX is designed to remove circulating antibody, not tissue deposited antibody . CYC, not RTX , is standard of care for anti-GBM antib...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 18 hours ago

Yes, but false positive anti-GBM antibody is equally implausible. If spikes were seen on LM ( silver Methenaminec-Jones stain) with might be anti-G...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 20 hours ago

Seems like u could be dealing with dual positive anti GBM and Membranous Nephroapthy. I also wonder if some of the improvement you see is related t...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 20 hours ago

Thank you prof Glassock. I will ask the histopathologist about that although it would very unlucky to get 6 in IF sample that all sclerosed -----...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 20 hours ago

I forgot to mention that eGFR although dipped to 18ml/min it did come up to 23 while treating the ecoli bacteraemia and she has had excellent urine...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 20 hours ago

This is not "atypical anti-GBM disease. Such "atypical " disease is characterized by negative serum anti-GBM antibodies by conventional tests and b...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 20 hours ago

False positive anti-GBM antibody tests by conventional ELISA using COLIV alpha 3 NC1 domain as the target antigen are very uncommon. ([More]

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Crescentic GN With Raised Anti-GBM But No Immune Deposit 22 hours ago

Dear expert colleagues, We currently have a patient with a slightly atypical presentation of anti-GBM disease, and we would be very grateful for ...

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RE: Post Partum AKI 23 hours ago

Unlikely to be antiGBM disease with this degree of proteinuria, but it is still possible . If anti-GBM disease then PLEX , CYC and steroids. If "pa...

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RE: Post Partum AKI 1 day ago

All immunological tests including ANKA , complement C3, C4 , ANA and ds DNA antibodies are negative. Anti GBM antibody was not done. Biopsy showed ...

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RE: SIADH conundrum 1 day ago

I had the opportunity and privilege of working with Dr. Goldberg when he moved from Penn to Temple University in Philadelphia several decades ago. ...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

One additional perspective from pediatric nephrology and crystallization physiology: What I find particularly interesting here is that the patient...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Dr Ali, Thank you for sending the prior 24 hr urine. A couple of comments about it. The urine creatinine is significantly lower than the most re...

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RE: SIADH conundrum 1 day ago

The electrolyte-free water clearance was first proposed by Marty Goldberg, Medical Clinics of North America, March 1981, pages 251-269. ---------...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

I think she is , but l have to verify, we always ask for availability of alternative donors when face such difficult decisions -----------------...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

I forgot to ask an important question on earlier post - is this the only potential living donor candidate ? if answer is yes - does your program ha...

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RE: Post Partum TMA 1 day ago

Dear Satish, if you believe she had DIC and deranged coagulation, then there is definitely no reason to start her on Eculizumab, as Professor Richa...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

What is the patient's BMI or waist circumference? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Me...

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RE: Post Partum TMA 1 day ago

I believe in interpreting the clinical picture to reach a diagnosis more than other parameters. This is a lady who had a preterm delivery at her ho...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

This is a follow-up on the case: her aldosterone level was 5.3 ng/dL (reference range 0–30), and plasma renin activity was 0.763 ng/mL/h (reference...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

@john asplin ....thanks for the amazing review on citrate and bicarbonate metabolism . I always assumed that in addition to citrate being converted...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

The patient is consuming a high sodium diet, around 5 grams per day, he must be using the salt shaker liberally. This needs attention. I guess that...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Dr. Asplin, Thank you so for much for the response. The patient reports he only meats one portion of meat (Like the size of a hamburger patty) 4 ...

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RE: Post Partum TMA 1 day ago

Thai case has all of the hallmarks of aHUS, even though Post-Partum RCN is strongly suggest. A full reading of the kidney biopsy is not yet availab...

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RE: Post Partum AKI 1 day ago

What did the kidney biopsy show? Thanks. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medici...

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RE: Post Partum AKI 2 days ago

A patient with 13 gm of proteinuria , low albumin, with generalized edema and acute kidney injury (AKI), showing fast deterioration. Is there any h...

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RE: Post Partum TMA 2 days ago

Thank you for sharing this case. It presents significant challenges, as postpartum Thrombotic Microangiopathy (TMA) could be associated with Thromb...

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

Dr Dastoor, As for a combo of Kcitrate and Kbicarb, I view it no differently than Kcitrate. The increase in urine citrate is from the alkali load...

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

What is the density (Hounsfield units) of the stones on the CT? While this doesn't discriminate perfectly among stone compositions, [More]

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

Would you consider replacing K citrate and Na bicarb with Sybnial ( k citrate and K bicarb) ... What's your experience with drug in stone managemen...

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

Note high BUN and Sodium -- likely due to high animal protein intake (? likely processed meat which recently has been labeled as a carcinogen). E...

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RE: Help me make sense of this 24 hr urine study for stones. 2 days ago

In order to interpret the urine I'm going to make a few assumptions: 1) The patient has formed uric acid stones in the past and that is why he is t...

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