RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 1 hour ago

Let me try to answer the question posed by Dr Glassock. I would suggest that the difference between APOL1 variants causing renal disease and CFHR v...

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RE: Subacute rise in creatinine should I biopsy 1 hour ago

A fair proportion of patients with DM will progress rapidly such as this patient. Id shy away from biopsy. ------------------------------ [George...

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RE: Subacute rise in creatinine should I biopsy 2 hours ago

Another thought: This patient's progression seems too rapid for simply DM nephropathy--the reason for the post--but that's in the context of curren...

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RE: Subacute rise in creatinine should I biopsy 3 hours ago

Almost certainly eskd due to diabetic nephropathy. A biopsy would confirm the findings with no difference in treatment options. ----------------...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 12 hours ago

My concerns gave not entirely been put to rest by Dr. Smith answer. Yes, a homozygous deletion mutation of CFHR 1 gene is commonly present the "nor...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 17 hours ago

Thanks- Good answer. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 18 hours ago

@Richard Glassock. Though this was never tested, I would say no effect from the mutation in the donated kidney. Those genes are not expressed in th...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 18 hours ago

Many thanks. Great addition to knowledge. One question remains unanswered - does a kidney with zero copies of CFHR1 transplanted into a recipient w...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 18 hours ago

@Katafan Achkar Thank you for sharing Dr. R. Smith's expert opinion with the group. Now you can put to rest your genomic concerns and make a deci...

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RE: Subacute rise in creatinine should I biopsy 18 hours ago

Assuming no evidence of superimposed parenchymal disease (UA, serology): Could significant volume overload with renal vein congestion explain the w...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 18 hours ago

I received the following response from Dr. Richard smith with MORL Renal Team https://morl.lab.uiowa.edu/complement-mediated-kidney-disease-divisio...

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RE: Subacute rise in creatinine should I biopsy 20 hours ago

Biopsy decision will rest fresh urine sediment microscopic exam and serology. Until these are available I am reluctant to say yes or no to the biop...

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RE: Subacute rise in creatinine should I biopsy 21 hours ago

TYPE 1 DM, BP was uncontrolled UACR 6000mg/gm, very nephrotic Creatinine 3.8 mg/dl to 8 in 8 months seems a bit fast but I doubt I would b...

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RE: Subacute rise in creatinine should I biopsy 22 hours ago

Unfortunately he dont have full records Urine out put 1 liter per day on torsemide 20 mg po I already asked for C3 and C4 urine analysis all s...

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RE: Subacute rise in creatinine should I biopsy 23 hours ago

Urine sediment findings? Daily urine output volume just before he was started on dialysis? Was SCr stable or increasing daily before dialysis was s...

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Subacute rise in creatinine should I biopsy 1 day ago

Dear colleague I hope you help me for a acase of 30 years old who is a known case of T1DM since childhood with history of PDR on Insulin. He was fi...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 1 day ago

I also think this is a renal limited B cell lymphoma. Are the cells monoclonal? Immunohistochemistry should help. An extensive hematology evaluatio...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 1 day ago

Addendum- why was a Bone Marrow biopsy not none? Was a PET/CT scan done? Was a cyto-genetic analysis of the Bcell infiltrates performed? --------...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 1 day ago

Strangel case. The advanced Disbetic Nephropathy seen in the biopsy accounts for the proteinuria and orogrssive loss of GFR. This might be a highly...

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Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 1 day ago

Dear Colleagues I would like to get your opinion about the management of an interesting case 65 years old hispanic male with PMH of DM II, HTN...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 1 day ago

Dr Ali For clarification, could you please post the initial UACR (in mg/gm) and the UPCR (in mg/gm). There may be some confusion as you did not s...

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RE: Double positive ANCA MPO and GBM rapid progressive renal failure 1 day ago

What is the current Anti-MPO ELISA, and anti-GBM.? If both negative I might opt fir monitoring rather than maintenance therapy (with RTX every 4 mo...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 1 day ago

Biopsy might identifying renal disease related to MM which justify treatment. We have seen light chain tubulopathy with minimal or no proteinuria. ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 1 day ago

It would be unusual for such as slow progression. ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 208-1459 --------...

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RE: Double positive ANCA MPO and GBM rapid progressive renal failure 1 day ago

Dear all, I will like to ask your help with this patient. She is still in remission only with induction treatment that i previous described. The...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 1 day ago

I agree fully with Dr. Rodby and Dr. Rubin on the importance of "team management" in this complex case. The patients desires and wishes for future ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 1 day ago

Dr. Leung. Thanks . Just curious. Why would you not consider this case as having Light Chain Cast Nephropathy secondary to a light chain MM? ----...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 2 days ago

@Roger Rodby Thank you for asking my opinion. This is clearly a complex case which requires expertise and team effort. It cannot and should not b...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 2 days ago

"Actually with active cancer now, he's not a candidate for future Transplant anymore and we will be managing him most likely in future" I would s...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 2 days ago

Thanks @Richard Glassock. It depends a lot on whether this patient is a good candidate for chemotherapy. With little albuminuria, I would probably ...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 2 days ago

With a creatinine of 5 his urine ratios are unlikely to be reliable. However he does have hypoalbuminemia. I would not be keen on further immunosup...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 2 days ago

Actually with active cancer now, he's not a candidate for future Transplant anymore and we will be managing him most likely in future -----------...

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RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 2 days ago

With all due respect to the sincere attention you are giving him, Why are you trying to manage this, shouldn't his transplant center team take c...

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management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 2 days ago

African-American gentleman. Age 77, got kidney transplant in April, 2017 because of probable hepatitis C virus associated glomerulonephritis and ty...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

This thread began with a question about possible contraindications for kidney biopsy in the presence of asymptomatic bacteruria and pyuria. In my o...

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RE: Nephrotic range proteinuria associated with cGVHD 3 days ago

Hello everybody. I apologize for answering after such a long time. To answer the questions that you asked me, the patient did receive Tacrolimu...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

I agree with the comments about myeloma and biopsy reiterate that from what I think we've been told the protein in the urine is albumin suspe...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

Thanks Dr. Leung. If you think this is a LC MGUS, with a serum creatinine at the 3 level, but with little albumin in urine would you still do a kid...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

In general the relation between CFHR deletions and complement mediated HUS is through the production of anti CFH antibodies. I am not aware of any ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

As Dr. Rodby and others have said, if this multiple myeloma, a biopsy is probably not going to change the management unless it is amyloidosis which...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? 3 days ago

What was the initial serum kappa free light chain level? If over 500mg/L the diagnosis of Myeloma Cast Nephropathy is very likely. This patient nee...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? Monday, March 31 @ 11:39 AM

If a diagnosis of MM is made I do not see a reason for a kidney biopsy bc the treatment is for MM, not the pattern of renal involvement. Havin...

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RE: AKI, urinary K Wasting and uncontrolled HTN Monday, March 31 @ 10:23 AM

You can continue spironolactone and even escalate the dose to 50 mg /day as far as serum K [More]

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Monday, March 31 @ 8:51 AM

Although her A1C is 5.8, however, her OGTT is within normal limits and has no evidence of increased risk for diabetes as evidenced by calculated an...

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RE: AKI, urinary K Wasting and uncontrolled HTN Monday, March 31 @ 8:50 AM

This elderly patient presents with recent worsening kidney function, accelerated hypertension with spontaneous hypokalemia suggesting possibly seco...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? Monday, March 31 @ 8:35 AM

I strongly recommend biopsy in this case if he can safely be taken off of his anti-platelet agents for the following reasons: The diagnosis of m...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Monday, March 31 @ 8:22 AM

The most recent KDIGO guidelines recommend using a risk calculator to assess the donor's risk and having a cut-off acceptable to the individual cen...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Sunday, March 30 @ 11:09 PM

My answer is only pertaining to genotype of the donor. Birth weight and nephron number aside, she should not be excluded. Risk for the recipient is...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Sunday, March 30 @ 10:51 PM

Thanks very much for the incredibly prompt responseCheersShlomo -- Shlomo Cohney FASN PhD FRACP MRCP MBBS Physician/Nephrologist/Transplant Immu...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 Sunday, March 30 @ 10:37 PM

Her BMI is 29.97, had 2 pregnancies but no gestational Diabetes. We did OGTT since she had HbA1c 5.8, her Fasting was 90 mg/dl and two hours glucos...

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