RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 3 hours ago

Good point! If no harms are done why not give it a try. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -...

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RE: Anti Gbm Case 6 hours ago

If a patient with anti-GBM disease has 100% glomerular crescent, oliguria and dialysis dependence, we still treat with PLEX if DAH is present and a...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 7 hours ago

@Richard Glassock You have me there at spironolactone. There is no good clinical evidence only experimental evidence that it would be useful in ...

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RE: Anti Gbm Case 8 hours ago

C3 normal. Will send echo , blood cultures , cryo and repeat ds dna, Ana. Not behaving in septic manner tho. If patient has anti gbm with renal ...

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RE: KFRE 8 hours ago

Thanks prof glassock --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Renal Biopsy Post Plex 8 hours ago

Thanks prof --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Case 8 hours ago

Thanks dr Rodby thought like you. Patient also not keen on biopsy --------------------------------- Muhammad Soobadar MBChB UK ----------------...

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RE: membranous GN with advanced CKD-treatment plan 14 hours ago

Thank u dr Glassock --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ---------------------------------

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RE: C3G case 14 hours ago

Many thanks for these suggestions. I think tgat a search for concealed monoclonal Ig deposits is warranted in this case. I am very skeptical of a d...

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RE: IgA nephropathy with serum ANCA positivite ( ANA is negative) with no proteinuria 14 hours ago

None of these medications are associated with crescent formation in glomeruli, as far as I know. ------------------------------ Richard Glassock ...

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RE: membranous GN with advanced CKD-treatment plan 14 hours ago

Yes. Glomerular hypercellularity is not seen in MN even when active in situ formation of sub-epithelial IC is occurring. Recently formation of in s...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 14 hours ago

I agree with local anti-fungal therapy and teaching better genital hygiene, with temporary withholding of Flozins.. I am a little more skeptical of...

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RE: candiduria after starting cephalexin while already on empagliflozin 25 mg qd for months 18 hours ago

Re the candiduria it is very much likely that she has vaginal candidiasis which has shown up in the urine culture. Vaginal cotrimazole cream may be...

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RE: membranous GN with advanced CKD-treatment plan 19 hours ago

Can intra -membranous deposits . . indicate active in situ formation of IC although there is no endocapilary hypercellularity or any other active l...

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RE: IgA nephropathy with serum ANCA positivite ( ANA is negative) with no proteinuria 21 hours ago

Thank you for your input. He is ANA negative. No crescents in biopsy and no proteinuria. I sent repeat ANCA and MPO which is pending currently. -...

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RE: IgA nephropathy with serum ANCA positivite ( ANA is negative) with no proteinuria 21 hours ago

Medications : ASA, Atorvastatin, Levothyroxine, Vit D, Coreg and Cozaar. Cozaar started recently. ------------------------------ Radhika Thalla M...

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RE: C3G case 22 hours ago

Your pathologist can probably get pronase from you molecular lab. They would routinely use either pronase or proteinase K for DNA extractions. This...

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RE: C3G case 1 day 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? 1 day 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 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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? 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 2 days 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 2 days 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 2 days 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? 2 days 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? 2 days ago

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

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C3G case 2 days 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? 2 days 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? 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days ago

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

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