RE: C3G case 15 minutes ago

Thank you both dear Dr. @Richard Glassock and @Awais Nauman for your reply and clarification. ------------------------------ Rowan Zyada MSc Egy...

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RE: Drug induced ANCA disease or IgA with crescents? 57 minutes ago

My reckless brain wonders how "Hydralazine" or "Similarly accused meds" can induce antibody production towards histones -/+ MPO & turn the place in...

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RE: IgA nephropathy with serum ANCA positivite ( ANA is negative) with no proteinuria 1 hour ago

Recent studies have shown that ANCA positivity in IgA N is seen in about 2% of patients abd tge clinical feature are similar with or without AbCA e...

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RE: IgA nephropathy with serum ANCA positivite ( ANA is negative) with no proteinuria 4 hours ago

What is the full list of medications taken. The anti-MPO antibody might be drug induced. Probably of no consequence, no proteinuria, no indication ...

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IgA nephropathy with serum ANCA positivite ( ANA is negative) with no proteinuria 5 hours ago

I have a 74 year old Male with only h/o HTN presented with AKI. Baseline creatinine in October 2023 is 1.2. He had physicals in Aug'24 and showed c...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 6 hours ago

It's a judgment, but personally, I agree with aldactone here. True, there's no long term RCT looking at hard outcomes, but we do know it predictabl...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 8 hours ago

The data on Spironolactone to slow progression of CKD in T2DM is really a mixed bag. Finerenone has a better track record. With obesity . I would p...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 8 hours ago

Thank you.Her home blood pressure today was 142/92 and she has already stopped using hydralazine because of hives. She has difficulty tolerating ev...

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RE: Drug induced ANCA disease or IgA with crescents? 10 hours ago

I would not discount the role of Hydralazine as the mist likely cause of the ANCA vasculitis. ------------------------------ Richard Glassock MD,...

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RE: membranous GN with advanced CKD-treatment plan 10 hours ago

The very thick GBM may provide an partial explanation for the progressive loss of GFR. The EM describes intra -membranous deposits . Were these dep...

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RE: membranous GN with advanced CKD-treatment plan 11 hours ago

Very unusual case. Progression of MN with proteinuria of this magnitude is seldom seen. Was a Congo Red stain performed . Any fibrillar deposits in...

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RE: C3G case 11 hours ago

The use of IHC on paraffin sections, without Pronase digestion for epitope retreival, raises issues concerning the true diagnosis as concealed mono...

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RE: C3G case 12 hours ago

This patient has a slow smoldering disease. She had symptoms for a year, 2/3rd of gloms are globally or segmentally sclerosed. This degree of chron...

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membranous GN with advanced CKD-treatment plan 13 hours ago

65 yo Cocausian male, history of biopsy proven idiopathic membranous nephropathy in 2014, treated with Cyclophophamide and steroids with very good ...

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RE: Eosinophilic infiltrates in a transplant recipient 15 hours ago

So pleased that measurement of dd-cfDNA was helpful in your case . I do beleive molecular diagnostics can be useful in selected cases. ----------...

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RE: C3G case 18 hours ago

IHC on paraffin secrion, no pronase digestion was done. Pronase digestion is not available here. ------------------------------ Rowan Zyada MSc...

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RE: C3G case 18 hours ago

This may be resolving Infection related GN with c3 takes more time to resolve than immunoglobulin IHC on paraffin after pronase digestion will hel...

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RE: C3G case 20 hours ago

It is IHC on a frozen section not paraffin and there has been no Pronase digestion to reveal concealed epitopes - Correct? ----------------------...

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RE: C3G case 21 hours ago

Thanks for the reply DR. Glassock, we don't have IF, we have IHC. Would it make a difference? ------------------------------ Rowan Zyada MSc Egyp...

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RE: C3G case 1 day ago

Based on the IF and EM findings I would recommend that the kidney biopsy be reprocessed for Paraffin IF, after Pronase digestion, the disparity bet...

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RE: Drug induced ANCA disease or IgA with crescents? 1 day ago

Another guess; this time from a foot soldier of nephrology I feel like IgA started the war first and very damaging, progressive. MPO ANCA and A...

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RE: Drug induced ANCA disease or IgA with crescents? 1 day ago

Thanks. ------------------------------ Viswanathan Iyer MD,FACP,FASN Harrisburg PA 717342 4705 ------------------------------

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C3G case 1 day ago

Dear Community members, I have a 37 year F, who is HBV positive, was not on treatment, No Hx of DM or HTN, presenting with on/off lower extremit...

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RE: Drug induced ANCA disease or IgA with crescents? 1 day ago

Just a guess- but I think the most likely explanation is drug- induced (Hydralazine) ANCA induced crescentic GN superimpised upon Quiescent Celiac ...

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Drug induced ANCA disease or IgA with crescents? 1 day ago

82-year-old woman with htn, djd, hypothyroidism, celiac disease, and exocrine pancreatic insufficiency. -h/o htn many years - maintained on amlodip...

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RE: Very High risk membranous 1 day ago

An important point is that a serum creatinine of this magnitude does not imply irreversibility in MN or other diffuse podocytopathies. ---------...

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RE: Ac proliferative GN w IC deposits 1 day ago

See Meuleman M-S , et al Nephrol Dialysis Transplant, November, 2024 for an excellent recent publication on this topic and how to use analysis of c...

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RE: Very High risk membranous 1 day ago

AKI (due to ATN, "nephrosarca", podocyte effacement interfering with glomerular filtration and/or tubular damage from heavy proteinuria) is most co...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 1 day ago

Tough question. No good evidence to guide decisions making. She likely has underling progressive Diabetic Nephropathy secondary to poorly controlle...

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RE: Ac proliferative GN w IC deposits 1 day ago

If 3+ is maximum, it could be a 4+ or 5+ C3. Separating ICGN from C3GN can be very tricky. Just a suggestion, additional serology might be helpful,...

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candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 1 day ago

White lady age 65 has BMI 38.5, hypertension, major depressive disorder, coronary artery disease, sleep apnea, type 2 diabetes at least since 2006...

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RE: Ac proliferative GN w IC deposits 1 day ago

Can it be C3GN with igG +2 and C3 +3 only 1 order difference and also kappa and lambda are +3 and +2? --------------------------------- Alaa Nabih...

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RE: Very High risk membranous 1 day ago

Wat is the explanation 🤔 of rising creatinin till dialysis dependent with only 25% ifta and no renal vein thrombosis ---------------------------...

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RE: Terlipressin 1 day ago

We too use it in patients with advanced chronic liver disease, ascites, and AKI when there is hypotension. Along with iv albumin if albumin levels ...

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RE: Eosinophilic infiltrates in a transplant recipient 1 day ago

Revisited this discussion after 7 years. The patient continues to have a creatinine of around 1.8 to 2 and apart from obesity and hypertension, is ...

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RE: Case 1 day ago

Dr. Rodby- I see your point. Is her life expectancy too short to give any opportunity for benefits from treatment of a kidney biopsy defined dise...

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RE: Very High risk membranous 2 days ago

With a serum creatinine of 10mg/dL I would be concerned about side effects from the use of a full dose cyclical CYC regimen, in this case. ------...

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RE: Very High risk membranous 2 days ago

PLA2R is 170, high but not astronomical. I look at the PLA2R more than the proteinuria I think rituxan (assuming it worked before) I prefer, ...

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RE: Case 2 days ago

at 74 with albuminuria about 500 mg/g the is total proteinuria about 900 mg/g Cr 0.8 she has "severe COPD, mild -moderate Tricuspid Regurgitati...

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RE: Case 2 days ago

You are missing out on a useful diagnostic test. Too bad. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-88...

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RE: Very High risk membranous 2 days ago

What was his response to RTX previously? The relapse of severe Nephrotic Syndrime after cessation of CNI is not surprising. Cyclical CYC, in usual ...

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RE: Terlipressin 2 days ago

Its a good tool to have at your disposal. Reliably increases MAP without need for ICU and inotropes, which is great in busy hospitals. Reverses HRS...

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RE: cystatin C gfr 2 days ago

amazing discussion and good reminders of the actual factors that need to be focused on ty all for enriching the discussion -------------------...

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RE: Ac proliferative GN w IC deposits 2 days ago

This is an ICGN, probably auto-immune (she has Hashimoto's disease and auto-immune diseases itend to occur together), possibly C3GN. Please add C3 ...

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RE: Ac proliferative GN w IC deposits 2 days ago

Dr Rodby. Please see the LM below Dr Glassock - She DOES have breast cancer but its localized enough to warrant ONLY lumpectomy - no chemo, no...

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RE: Case 2 days ago

Thanks prof. We don’t spin urine in England UK unfortunately . So I would not know Bw --------------------------------- Muhammad Soobadar MBChB...

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Very High risk membranous 2 days ago

Dear Colleagues I need your expert opinion on this case: 40 y old, male, Known Membranous nephropathy. treated with RTX and he was on cyclos...

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RE: Terlipressin 3 days ago

Thanks. Understood. The reason I asked is that some believe that Terlipressin can also be used in septic shock, resistant to nor-epinephrine. --...

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RE: Terlipressin 3 days ago

ADH = Vasopressin We have experience with Vasopressin use in CCU: usually not the first choice in shock states. Vasopressin use is very tricky; y...

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RE: Requesting advice on IgA nephropathy patient 3 days ago

I am not aware of registry of steroid induced avascular necrosis of Hip or major joint. Of severe side effects. Does anyone know that such registry...

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