RE: management of failing rensl transplsnt with suspected nephrotic syndrome, active malignancy and dropping haemoglobin 11 hours 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 12 hours 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 13 hours 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? 22 hours 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 1 day 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? 1 day 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? 1 day 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 1 day 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? 1 day 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? 1 day 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? 1 day ago

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 1 day ago

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 1 day ago

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 1 day ago

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? 1 day ago

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 2 days ago

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 2 days ago

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 2 days ago

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 2 days ago

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

Presumably he has IHD and AF (clopidogrel & apixaban) He is on a lot of pills ! Yet he is not on any RAAS blockade He likely has significant reno...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 2 days ago

Thus is eGFR -by the EKFC equation, not mGFR, but these values should be pretty close to mGFR. (see Astley, M, et al Kidney Int, 2025) ...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 2 days ago

Many of us (in Australia) are hesitant/reluctant when considering younger donors and especially in a child to parent situation If as I understand ...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 2 days ago

The median eGFR for 40-45 year old healthy female is 100ml/min/173m2. An eGFR of 80ml/min /1.73m2 is at the lower limit of "normal" . I agree wit...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 2 days ago

Average GFR in age 40-49 is 80-100 ml/min-1.73-so 80 is lower limit for normal but many LKD programs prefer > 90 in donors with potential longer li...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 2 days ago

I have to find out what was her birth weight. However, my understanding from reviewing literature evaluating normal GFR in general population, is t...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 2 days ago

In addition to the genetic concerns mentioned above, a 44 year-old donor with a GFR is 81 ml/min/1.73. Would cause me to recommend against acceptan...

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RE: AKI, urinary K Wasting and uncontrolled HTN 2 days ago

He was started on spironolactone 25 mg daily on 26 March and since then, creatinine has rose from 3.5 to 4.1, a 17% rise, BUN has rose from 41 to 5...

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RE: AKI, urinary K Wasting and uncontrolled HTN 3 days ago

13,6grams /d of total urine protein excretion , yet only 3.5milligrams/ d of albumin. Something is wrong here. What is the urinary Immunofixation o...

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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 is highly suggestive of LCCN based on high sFLC > 500 mg/l and predominantly non-albumin proteinuria plus kappa light chains predominance. I w...

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RE: AKI, urinary K Wasting and uncontrolled HTN 3 days ago

Thanks for additional informations. Blood gas with knowing of blood PH is important in interpretation of acid-base disorders. Because if we have on...

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

A compound heterozygous (deletion) mutation in CFHR1/3 and CFHR1/ 4 is associated with C3G and anti-Factor H autoantibodies I am eager to learn tge...

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

Pet, scan mentioned above. August, 2024. MRI did not find any bone lesions . April, 2024 and May, 2023 chest x-rays and 2/2023 knee Cray did not fi...

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

Although he has Chronic kidney Disease G3 with recent rise of Creatinine as explained above and Anemia also but for more than 10 years, he has not ...

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

Personally, I suggest you contact any of the following individuals for their expert advise: Dr. Richard Smith and/or Dr. Carla Nester at the Univ...

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

I would love the community's input on the following case: A 44-year-old AA female who is being evaluated as potential donor for her father, who ha...

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

Dr Ali BPH plus UTI with unusual organism. Does he have prostatitis? Incomplete bladder emptying? Tough case. Thank you, Jorge Roman-Latorre MD For...

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

Does this patient have Overt MM (satisfying CRAB criteria) or does he have "Smoldering" MM. I can't tell from the data provided. The very low alb...

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

CRAB - calcium (hypercalcemia, renal (kidney dysfunction), anemia, bone (usually radiographically apparent bone lesions). -----------------------...

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RE: AKI, urinary K Wasting and uncontrolled HTN 3 days ago

There was no Vomiting . 1-2 days of nausea and stomach discomfort resolved after admission . The only Diuretic that he may be using as outpatient w...

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

How would a biopsy change the therapy? ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 31453723...

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RE: AKI, urinary K Wasting and uncontrolled HTN Saturday, March 29 @ 7:30 AM

Any history of repeated vomiting or high dose diuretics use? What doses of NaHCO3 he was on per day? Agree to look for RAS or PA in this setting. ...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? Friday, March 28 @ 6:35 PM

I suppose that Diabetic Nephropathy is also in the differential diagnosis , but he stilll needs therapy for MM ------------------------------ Ric...

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RE: whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? Friday, March 28 @ 6:34 PM

He has Multiple myeloma which largely excludes a "diagnosis " of MGRS. He likely has a renal complication of MM, either AL Amyloid or LC Cast Nephr...

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RE: AKI, urinary K Wasting and uncontrolled HTN Friday, March 28 @ 6:05 PM

Time of flight MRA of renal arteries found today. Limited exam demonstrates normal caliber and appearance of proximal and mid portions of both...

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RE: AKI, urinary K Wasting and uncontrolled HTN Friday, March 28 @ 6:04 PM

Empagliflozin and Sodium Bicarbonate were discontinued on admission. 24HR 24 HOURS WC LB #218979 Collection time: Mar 28, 2025@15:59 Test ...

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RE: AKI, urinary K Wasting and uncontrolled HTN Friday, March 28 @ 6:02 PM

Today the Creatinine is 3.7 but he also had Spironolactone started 25 mg daily on 26th of March. ------------------------------ Sadeem Ali MD Bri...

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whether to Biopsy this Kidney of myeloma patient and whether to treat asymptomatic Uti before Biopsy? Friday, March 28 @ 5:13 PM

White gentleman age 77 with history of BPH, type 2 diabetes(last A1c 8.0 in January, 2025 compared to prior 9.6 in August, 2024), hypertension, COP...

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RE: C3 Glomerulonephritis is an Overlap Lupus Syndrome ? Friday, March 28 @ 10:50 AM

Due to the age of the patient and expected life expectancy, effort to preserve renal tissue is needed. I agree with Dr. Rodby that this is LN with ...

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RE: management of ESRD patient post-parathyroidectomy Friday, March 28 @ 10:39 AM

I agree with Prof Glassock, not sure it will do much, but may be worth a try if Mg is low, which is unusual in ESRD pts -------------------------...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Friday, March 28 @ 8:45 AM

If he shows up for follow-up, how much and how many anti-hypertensive medications he needs to control BP will be interesting to document. If his BP...

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