RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 5 hours ago

Any comments on this DNAJB9 negative " Fibrillary" GN Dr. Fogo? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 38...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 8 hours ago

Interesting - the pathology is compatible with FGN other than the negative DNAJB9 stain ( with a positive control, I presume) Although DNAJB9 negat...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 9 hours ago

DNAJB9 stain was negative Dr. Glassock. ------------------------------ Hussain Karimi Clinical Assistant Professor of Medicine University of Pitt...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 9 hours ago

I meant Obinutuzumab and not Daratumumab for therapy of Fibrillary GN ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (9...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 9 hours ago

From the biopsy report and clinical findings this patient most likely has Fibrillary GN not "polyclonal " LCDD. Please ask the pathologist to stain...

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RE: Granulomatous interstitial nephritis 11 hours ago

This sounds like Macrophage Activation Syndrome. (hematophagocytic lymphoproliferstive disease ) triggered BP by a viral infection . Do you have se...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 11 hours ago

kidney Biopsy Report: A. GLOMERULAR PROTEINACEOUS DEPOSITS AND HYALINOSIS; FAVOR POLYCLONAL LIGHT CHAIN DEPOSITION DISEASE (SEE COMMENT). ...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 11 hours ago

Biopsy proven "polyclonal " LCDD . Is this a recongized entity? . Can you post the deidentified Kidney Biopsy report.? --------------------------...

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Patient with LCDD on kidney biopsy but no clone found in the bone marrow 11 hours ago

50 yo F with biopsy proven polyclonal LCDD on kidney biopsy without any signs of smoldering myeloma or clonal abnormalities on her bone marrow biop...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 14 hours ago

Dr Saad : Totally concur with you ! Now retired but in over 1/2 a Century did not accept ordering a procedure (hemodialysis ) without actually seei...

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Granulomatous interstitial nephritis 14 hours ago

Have an unusual case, presented at the end of December. 63-year-old man with a prior history of DM and FSGS, previously treated with long-term t...

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RE: Recurrent FSGS in Transplant 15 hours ago

Very interesting question. Would Xenotransplantation avoid the risk of recurrent FSGS? Completely unexplored area. Ripe for investigation. ------...

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RE: Recurrent FSGS in Transplant 16 hours ago

Please let us know what your institutional MRB decides. Xenotransplantation is still experimental in the US. There are ongoing clinical trials (NYU...

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RE: Recurrent FSGS in Transplant 16 hours ago

Wonderful discussion and summation. I request Dr Saminathan to please provide us with a follow up if this patient were to undergo transplant. Many ...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 17 hours ago

It depends if he had a shift (hyperglycemia) and they gave enough insulin to shift it, or HCO3 level or if had a bowel movement. I would repeat...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 18 hours ago

The only reason I would come in or have a fellow come in is if I cannot trust the information and physical exam findings conveyed to me. Comple...

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RE: Recurrent FSGS in Transplant 22 hours ago

Thanks for your initial posting . It generated a robust discussion. Keep us informed of the outcomes of your deliberative process and the actual ca...

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RE: Recurrent FSGS in Transplant 1 day ago

Dear all, Thank you for taking the time out to write your opinions and sharing your expertise. This has been truly educational. Our unit h...

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RE: Peritoneal Dialysis PET test: Need for baseline? 1 day ago

The timing of this debate in Kidney-360, and me just now asking that exact question, is uncanny. I am months behind in my journals, catching up is ...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Treatment of hyperkalemia and delaying dialysis has become easier with the availability of better alternatives to Kayexalate. Pulmonary edema in an...

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RE: Recurrent FSGS in Transplant 1 day ago

Nice summary- I agree! ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

All opinion: This scenario is not uncommon. The odd thing I find here is that "the ER and ICU teams were beside themselves". If medical treatment...

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RE: Peritoneal Dialysis PET test: Need for baseline? 1 day ago

Thie is the debate on PET that was recently published in Kidney-360 Ramesh Saxena MD, PhD, FASN Professor, Division of Nephrology, D...

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RE: Recurrent FSGS in Transplant 1 day ago

Dr Glassock Generally recurrence is obvious based on dropping serum albumin alone (and in anuric pts the appearance of proteinuria), so a protoco...

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RE: Recurrent FSGS in Transplant 1 day ago

Thanks Dr. Radhakrishnan for for excellent advice. I think that broad agreement exists that this patient should be considered a candidate for a sec...

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Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Last night on-call I was consulted at midnight by the ER doc for a chronic HD patient with hyperkalemia (7.8 mEq/L) and junctional bradycardia (30/...

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RE: Recurrent FSGS in Transplant 1 day ago

@Selva Saravanan Saminathan Have you all decided what to do. I think the overall consensus on this side of the atlantic is as follows: Opt for...

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RE: Recurrent FSGS in Transplant 1 day ago

@Jai Radhakrishnan Thank you for your expert opinion. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 --------------...

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RE: Recurrent FSGS in Transplant 1 day ago

I note the discussion points with respect to this case. This is undoubtedly a complicated situation, but emerging data as highlighted in the discus...

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RE: Potassium Threshold For Op Management 1 day ago

This is also a pet peeve of mine Dr Rodby. I trained in the era where a potassium in renal clinics of 5.5-6.5mmol/L with no change in renal func...

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RE: Fibronectin Glomerulopathy 1 day ago

I don't understand how the diagnosis of fibronectin GN was made in the setting of positive DNAJB9 and no electron microscopy. I think fibrillary is...

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RE: Possible Pd Case 1 day ago

Dr. Soobadar: Rather than determining eligibility for PD by BMI, I find it more informative to look at "the lay of the land". In other words, what ...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 1 day ago

Please update us of the progress good luck ------------------------------ Arvind Madan MBBS, MD Partner Central Florida Kidney Specialists Or...

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RE: Possible Pd Case 1 day ago

Eligibility for PD as therapy for ESKD is mostly determined on a case by case basis. Extreme (morbid) obesity is regarded by many as a relative, bu...

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Possible Pd Case 1 day ago

1/ Would we refer for pd tube for patient with bmi 65? No hernia or previous abdominal surgery 2/ would we refer someone with lymphoma and retrop...

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RE: Collapsing Fsgs 1 day ago

Thanks a lot Yes CMV and parvo were negative --------------------------------- Shahzad Safdar MD MD Mt. Auburn Nephrology, Inc. Cincinnati OH...

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RE: Would you rebiopsy? Is this C3GN? 2 days ago

Thanks for the update. How is the patient being treated now - another course of prednisone? Please post information on response to treatment. ---...

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RE: Would you rebiopsy? Is this C3GN? 2 days ago

I wanted to post an update as this was a good learning case for me. Dr. Nester was kind to review the path and these were her thoughts: Not a C3GN,...

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RE: Renal thrombotic microangiopathy 2 days ago

No paraprotein was detected in serum immunofixation and the kappa/lambda ratio was normal. Complement tests were unremarkable apart from a slight...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 2 days ago

I have sent slides to Dr. D'Agati at Columbia for second opinion regarding clues to Ab-mediated podocytopathy and am working on Obintuzumab therapy...

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RE: Peritoneal Dialysis PET test: Need for baseline? 2 days ago

I do a PET once in a while in a patient who is willing to work with the same. The reason is to show my residents how it is done and chart the D/P v...

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RE: Peritoneal Dialysis PET test: Need for baseline? 2 days ago

Dr. Rodby , Can you please give an example of one your patients that you started incremental PD and tweaked the prescription clinically , that pr...

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RE: Peritoneal Dialysis PET test: Need for baseline? 2 days ago

I agree Roger and do not think that a baseline PET or regular follow-up PET is necessary in the absence of particular problems such as trying to un...

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RE: tip variant fsgs relapse in pregnancy 2 days ago

Her initial presentation had 13 G of proteinuria, post pulse by a week or 2 she had dropped to 9 G and 2 months later 120 mg so very responsive. ...

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RE: Recurrent FSGS in Transplant 3 days ago

"Thanks Dr. Rubin for your well considered remarks. My "dissent" is largely based on the weaknesses of the TANGO collaboration study design. It is ...

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RE: tip variant fsgs relapse in pregnancy 3 days ago

We usually do NOT recommend a re-biopsy in steroid responsive NS, pregnant or not. If in full relapse she should be treated with Steroid or CsA mon...

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RE: Pla2r positive MN 3 days ago

Understood- but the relapse rate is under 10% for spontaneous and > 25% for treatmdnt relatrd remussikns. This advantage of spontaneous remission a...

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RE: tip variant fsgs relapse in pregnancy 3 days ago

How quickly did her prior episode of proteinuria remit on steroids? Need for repeat biopsy and choice of a short course of steroids vs prolonged CN...

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RE: Pla2r positive MN 3 days ago

The spontaneous remission does occur. At 25% rate means that 3 out of 4 patients will not remit. To make decision about wait or not hinges on the r...

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RE: Peritoneal Dialysis PET test: Need for baseline? 3 days ago

Thanks Swap, The overnight drain volume with the standard 2L 2.5% dianeal fill gives you a good idea whether you can use a 2.5% for the lo...

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