Category Archives: Kidney Biopsy

I am a 60 year old Caucasian male, 180 lbs, who walks and attends gym regularly, non smoker, no alcohol but HIV+ virus non-detectable – on medication (triumeq tab for HIV+), atenolol (25mg) and Lipitor (10mg) all one per day. My eGFR has gone from 53 in May of 2015 with ups and downs to 42 in September of this year. Creatinine in the same period increased from 1.36 to 1.65. Kidney specialist has completed a battery of blood tests and urine analysis (including 24 hr.) No abnormal results arose from all of the tests and protein in urine is less than 6 mg/dl. Ultrasound shows one simple cyst but no other abnormalities. I have no physical symptoms. And no swollen lymph-nodes or swollen ankles etc., Kidney specialist says that kidney biopsy is the only option to give more information. Are there any other alternative tests that could be done? Many thanks!

A kidney biopsy would seem reasonable in your case. Most cases of kidney disease associated with HIV (+) status are associated with protein in the urine. You mention that your urinary protein is normal. It might be possible that your … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Exercise, GFR, Kidney Biopsy, Kidney-Related Health Questions, Medication and Kidney Disease

I have a 4 year old daughter that was diagnosed with HSP. She is starting to have elevated blood pressure 115/90 as well as blood and protein in her urine. They did a renal panel on her and it came back the her phosphorus level is 6.1 . I guess my question is are her kidneys going bad? Will she need to start seeing a kidney specialist? Will she have to get a kidney biopsy?

Henoch Schoenlein Purpura (HSP) is a type of blood vessel inflammation (vasculitis) that can be seen at any age, but is commonly a short-lived disease in children and resolves without much concern. It can cause severe abdominal pain, diarrhea, skin … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Pediatric Issues, Pregnancy / Kids

My 54 year old husband received a live donor kidney transplant from our 22 yr old son on June 6th. Two days after the initial surgery an exploratory surgery was performed to understand why the kidney was not getting good blood flow. It was determined that an artery/vein crossed and the kidney “ruptured”. The kidney was re-positioned and David was hospitalized for 4 weeks. The creatinine is stabilizing around 4.2, BUN around 47 and potassium running at high range of normal. Recent biopsy reflects “fibrosis” from damage caused from the 1st surgery. The kidney transplant doctor is thinking this may be the best we can achieve from this kidney. We are reaching out to determine other alternatives or avenues to explore. Any guidance, directions, suggestions to those that may be experienced in this area or treat these types of issues would be greatly appreciated.

Once a kidney has been deprived of blood flow for more than a few minutes, the kidney tissue will die.  If two days passed with the kidney not getting any blood flow, then it is unlikely that the kidney will … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Risk factors, Transplantation

Hi, I am in stage 3 and getting to 4 for kidney disease. How an autopsy can affect or benefit the kidney?? Is it true that in stage 4, I will need the dialysis?

An autopsy is a pathological examination of a person who has died.  I don’t think that is what you mean.  If you mean a biopsy or a sample of the kidney that is examined by a pathologist, then this is … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

Dear Doctor, I am from Goa, India. while browsing the internet for related information I got this, so I am sharing my pain with you. One of my friends is facing edema problem, protein loss problem and many from last 2 years. Now she is fed up of her treatment and wishes to end her life. As her friend, I am just asking and finding some information whether can I help her in sickness which she is facing by donating my organ to her to be replaced? As per my information (I am not damn sure) , her sickness directly related to kidney in which she is losing her proteins heavily. Her protein loss ratio at present is 5000. her weight is 89, age 23. Dear sir, please help and suggest me something how I can help my friend to recover soon. Thanking you Yours respectfully.

Your friend likely needs to have a kidney biopsy to find out what is the specific kidney disease that is causing her protein loss in the urine. Only by knowing the specific kidney disease, can one suggest a specific treatment … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Transplantation, Treatments

I have proteinuria for over 9 years. It was first detected in 2008. I’m a male person, 36 years old, with 183 cm height and 90 kg weight. My blood pressure is 120/80 most often. My results from the lab August -03 2017 AlkP 66 U/L AST 16 U/L ALT 16 U/L Gluc C 4.77 mmol/L Urea 4.5 mmol/L CreaC 80.30 umol/L UA 361.8 umol/L TP 72 g/L AlbG 47 g/L Gllob. 25 g/L Na-C 139 mmol/L K-C 4.8 mmol/L CaC 2.39 mmol/L Phos 0.95 mmol/L IgA 2.38 g/L IgG 10.70 g/L IgM 0.62 g/L C3 1.1 g/L C4 0.2 g/L Trig 0.7 mmol/L Clol 5.1 mmol/L UHDL 1.22 mmol/L LDL CALC 3.5 Upro 0.69 g/L (proteins in 24 hour urine) I also did tests during the last few months. (the results were 0.39 , 0.60 , 0.62 g/L) My doctor advised me to do a Biopsy in order to detect the reason of kidney damage. What do you think about my lab results? Is it allowed for me to do physical exercises with this condition ( for example 1 hour of bicycling, or 2 hours of walking 5-6 times per week), knowing that this will increase the amount of proteins in my urine аdditionally? This is very important for me because my BMI is over 26 and I have overweight. I want to do exercise so that I can have a normal weight. Do these proteins that are passing from the kidneys to the urine are damaging my kidneys?

I am unable to make a specific diagnosis of kidney disease based on the information that you present.  You have excess protein in your urine and this can both cause kidney disease and also be the result of kidney disease. … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Treatments

Hello, My fathers kidneys have been declining since 1997 To make a long story short his PCP failed him by not referring him to Nephrologist (based on lab results) He had a complete workout w/ his specialist only to say his kidney functions were at 40% bloodwork, imaging showed no cause as to why his kidneys were declining in function. He recently July 18, 2017 switched to another specialist , the Dr ran extensive work up consisting of blood, lab, imaging tests as well as had his earlier medical records and tests. The dr said he had chronic kidney disease stage 4 All tests revealed indicating declines in both kidneys, Scarring on both kidneys. Sorry I’m not more precise as I’m getting info from my mother. I am going to request his lab results for myself. The Dr said he could not find a cause to what is causing his chronic kidney disease. My dad always had low blood pressure, no diabetes, was not overweight, led active lifestyle, no cardiac issues. No medical history that would explain. He served in Vietnam was drafted late 1960’s. He did receive 3 Purple Hearts. I do know he fell on landmine to save someone in his troop and had graphs put on his face. Also the use of agent Orange. I don’t believe (unsure) if Dr tested for genetic Markers, chromosomal etc.. he did have a biopsy years back which did not help or aid in explaining a cause. My question is what could be causing this? Is their a test that’s not standard or well known to do to help in finding a cause? I know environment, genetics and congenital could be possible causes. I am unsure if blood tests done or workup would show this. Any help would be appreciated. I am requesting my dads medical record. He is 73, Italian (born in Bari, Italy) has lived in MA area since he migrated here. He always had low blood pressure, his kidneys have high blood pressure, protein in urine . The ultrasound revealed small kidneys with extensive scarring. Hope this helps. I apologize for not being more specific while writing this. Any information or resources would be greatly appreciated.

A kidney biopsy should be definitive as far as indicating the cause of chronic kidney disease (CKD).  The kidney biopsy, if the tissue sample was adequate, should give the pathological cause of the CKD.  I suggest that you review the … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments

Hello sir, Patient’s name is ********. Her Histopathological report: Renal biopsy (5slides for opinion) shows 21 glomeruli, 16 show near global glomerulosclerosis. Remaining shows mild increase in mesangial cellularity, capillary wall thickening with double contouring, endothelial swelling, narrowing and occlusion of capillary lumina(acellular glomeruli). There is segmental fibrin disposition and three fibrocellular crescents are also noted. There is modular tubular atrophy. Histological features favour thrombotic microangiopathy with 70-80% chronicity in all renal compartments. Doctors have suggested Plasma therapy now. The patient had dialysis 5-6 times. Today first session of plasma was administered. It is to be given for 15 days daily to replace the plasma. (Maybe, technically, I am wrong about just the plasma thing) I will be extremely grateful if you could advise the expected course of treatment. I will be online after 23 Hrs. I am from India.

I am unable to make medical recommendations, treatment recommendations or offer a prognosis without performing a complete history and physical examination.  The kidney biopsy suggest that the patient could have Hemolytic Uremic Syndrome (HUS), Thombotic Thrombocytopenic Purpura (TTP), malignant hypertension, … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Medication and Kidney Disease, Symptoms and Side Effects, Treatments

60 y/o. female Dx’d with Crohn’s 2010. Put on Mesalamine. Developed Interstitial nephrites dx’d in 2011. Taken off Mesalamine upon which I went into Crohn’s remission for 2 years. My Creatinine which was up to 1.2 returned to .89. In 2013 Crohn’s returned. I was being treated with Infliximab for Crohn’s and then after the 13th infusion noticed an ammonia taste in my mouth. That was the only symptom. A renal panel drawn prior to the next infusion revealed a Creat. over 3 and GFR of 15, I’d like to know whether you think the following biopsy points to Crohn’s as the cause or Infliximab as the cause of this renal injury. Also, was I more likely to have interstitial nephritis again since I had it previously? Thanks. KIDNEY BIOPSY (NEEDLE) SEVERE ACUTE AND CHRONIC INTERSTITIAL NEPHRITIS, WITH AN ISOLATED NON-NECROTIZING GRANULOMA (SEE NOTE) NO EVIDENCE OF IMMUNE COMPLEX-MEDIATED OR PARAPROTEIN DEPOSITION DISEASE; CRITERIA FOR IgG4 RELATED DISEASE ARE NOT MET IN THIS SAMPLE MODERATE CHRONIC CHANGES OF THE PARENCHYMA, INCLUDING: – GLOBAL GLOMERULOSCLEROSIS (10% OF GLOMERULI) – MODERATE TUBULAR ATROPHY AND INTERSTITIAL FIBROSIS – SEVERE ARTERIAL AND ARTERIOLAR SCLEROSIS NOTE: The biopsy reveals widespread plasma cell-rich interstitial inflammation, with a focal small non-necrotizing granuloma. This type of injury is most commonly related to a hypersensitivity reaction to drugs (sulfonamides, beta-lactam and other antibiotics, anti-viral agents, diuretics, NSAIDs, cimetidine and H2-blockers, and a long list of miscellaneous drugs). Other causes of chronic active interstitial nephritis include severe various infectious processes, metabolic diseases (gout and hyperuricemic conditions), toxic processes (lithium, lead, and other heavy metals), aristolochic acid nephropathy (Chinese herb nephropathy), physical causes (obstruction and radiation injury), and other conditions (Balkan nephropathy, sarcoidosis, “idiopathic” interstitial nephritis). For most of these conditions there are no specific or even characteristic morphological findings, and the disease process can only be diagnosed by correlating the biopsy findings and the history of the use or exposure to certain drugs or substances. There is no evidence of immune complex or paraprotein deposition. IgG4 related disease is unlikely, given the results of immunohistochemistry studies (see results below). MICROSCOPIC DESCRIPTION: Sections of formalin-fixed, paraffin embedded tissue were evaluated using H&E, PAS, JMS, and trichrome stains. An H&E-stained frozen section taken from the tissue allocated for immunofluorescence microscopy and semi-thin toluidine blue-stained epoxy sections of the tissue processed for electron microscopy were also evaluated using light microscopy. The sample consists of 57 glomeruli (LM-48; IF-5; EM-4), of which 6 are globally sclerosed and several glomeruli appear hypoperfused. The non-sclerosed glomeruli are of normal size and reveal normal thickness of the glomerular capillary loops. Significant endocapillary proliferation or cellular crescents are not seen in the glomeruli. The mesangium is not significantly expanded. The interstitium reveals large areas of intense inflammation, associated with mild edema and focal tubulitis. The infiltrates are composed of lymphocytes and many plasma cells, several eosinophils and scattered neutrophils. Isolated foci of Tamm-Horsfall protein inspissation are present in the interstitium. A focal small non-necrotizing granuloma is noted, with epithelioid cells, lymphocytes, and an isolated multinucleated giant cell. In less involved areas, tubules reveal normal cellular details. In inflamed areas, tubules reveal tubulitis and focal degenerative changes. Several tubules also contain necrotic cellular debris. Several PAS-positive hyaline casts are also noted. The sample shows moderate tubular atrophy and interstitial fibrosis. Arteries and arterioles show severe sclerosis. Arterioles also show focal hyaline degeneration. IMMUNOHISTOCHEMISTRY RESULTS: The staining for CD138, IgG4, and IgG were performed using immunoperoxidase technique. Numerous CD138-positive plasma cells were identified, but only isolated cells stain for IgG4. The positive control slide and the patient’s negative non-immune control slide (normal serum) show appropriate reactivity. The immunohistochemical tests performed at Brigham and Women’s Hospital were developed and their performance characteristics determined by the Immunohistochemistry Laboratories in the Department of Pathology at BWH. They have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. IMMUNOFLUORESCENCE MICROSCOPY: KIDNEY BIOPSY #: E15-926 The sections of the sample submitted for immunofluorescence studies were incubated with antibodies specific for the heavy chains of IgG, IgA, and IgM, for kappa and lambda light chains, fibrin, albumin, and complement components C3 and C1q. The sample contains 5 glomeruli. There is 1 globally sclerosed glomerulus. No significant immune deposits are seen in the glomeruli. IgM stain shows dusty reactivity in the background of the tissue; there is also fine granular reactivity for IgM (trace) along the glomerular capillary loops. Dull reactivity with fibrin is noted along the glomerular capillary loops. Tubular basement membranes show focal fine granular deposition of C3 (trace). Tubules contain several intraluminal casts reactive for polyclonal IgA. The interstitium reveals scattered fibrin deposits. Some interstitial inflammatory cells are positive for kappa or lambda light chains. The vessels exhibit focal deposition of C3. There is no difference in reactivity between kappa and lambda light chains in the glomeruli, tubular casts or background of the tissue. The immunofluorescence microscopy tests performed at Brigham and Women’s Hospital were developed and their performance characteristics determined by the Immunohistochemistry Laboratories in the Department of Pathology at BWH. They have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. ELECTRON MICROSCOPY: KIDNEY BIOPSY #: E15-926 Blocks: 1 Block examined: 1 thick section; 1 thin section. The sample submitted for electron microscopy examination contains 3 glomeruli; 2 glomeruli are examined ultrastructurally. The glomerular visceral epithelial cells reveal moderate effacement of their foot processes. The glomerular basement membranes are segmentally attenuated. Morphometric analysis was performed on 105 sites, using orthogonal intercept method. The harmonic mean of the glomerular basement membrane thickness is 274 nm. The subendothelial space of the basement membrane is segmentally expanded by electron-lucent fluffy material in a few capillaries; a new layer of basement membrane material is formed under the displaced endothelium (double contours). The endothelial cells show no significant changes. The mesangium reveals normal cellular elements and a normal amount of matrix. No electron dense deposits are present in the mesangium. CLINICAL DATA: History: A 60-year-old female with Crohn’s disease who presents with AKI. BUN 44, Cr 2.79 (baseline 0.89 in 2/2014; peak 3.24 on 7/18/15), Alb 4.0, HbA1c 5.4, C3 86, C4 15, free kappa LC/lambda LC ratio 2.45, negative hepatitis B/C, negative SPEP, urine sediment WBC 4/hpf, UA blood negative, proteinuria 0.14 g/gCr. tissue submitted: A/1. LM. B/2. IF. C/3. EM.

I am not able to give a medical opinion without performing a complete history and physical examination.  I suggest that you discuss your concerns with your nephrologist.  The biopsy diagnosis appears to be an interstitial nephritis but I’m not sure … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Symptoms and Side Effects, Treatments

Hi- History: 60 y.o female Dx’d with Crohn’s 2010. Put on Mesalamine. Developed Interstitial nephrites dx’d in 2011. Taken off Mesalamine upon which I went into Crohn’s remission for 2 years. My Creatinine which was up to 1.2 returned to .89. In 2013 Crohn’s returned. I was being treated with Infliximab for Crohn’s and then after the 13th infusion noticed an ammonia taste in my mouth. That was the only symptom. A renal panel drawn prior to the next infusion revealed a Creat. over 3 and GFR of 15, I’d like to know whether you think the following biopsy points to Crohn’s as the cause or Infliximab as the cause of this renal injury. Also, was I more likely to have interstitial nephritis again since I had it previously? Thanks. KIDNEY BIOPSY (NEEDLE) SEVERE ACUTE AND CHRONIC INTERSTITIAL NEPHRITIS, WITH AN ISOLATED NON-NECROTIZING GRANULOMA (SEE NOTE) NO EVIDENCE OF IMMUNE COMPLEX-MEDIATED OR PARAPROTEIN DEPOSITION DISEASE; CRITERIA FOR IgG4 RELATED DISEASE ARE NOT MET IN THIS SAMPLE MODERATE CHRONIC CHANGES OF THE PARENCHYMA, INCLUDING: – GLOBAL GLOMERULOSCLEROSIS (10% OF GLOMERULI) – MODERATE TUBULAR ATROPHY AND INTERSTITIAL FIBROSIS – SEVERE ARTERIAL AND ARTERIOLAR SCLEROSIS NOTE: The biopsy reveals widespread plasma cell-rich interstitial inflammation, with a focal small non-necrotizing granuloma. This type of injury is most commonly related to a hypersensitivity reaction to drugs (sulfonamides, beta-lactam and other antibiotics, anti-viral agents, diuretics, NSAIDs, cimetidine and H2-blockers, and a long list of miscellaneous drugs). Other causes of chronic active interstitial nephritis include severe various infectious processes, metabolic diseases (gout and hyperuricemic conditions), toxic processes (lithium, lead, and other heavy metals), aristolochic acid nephropathy (Chinese herb nephropathy), physical causes (obstruction and radiation injury), and other conditions (Balkan nephropathy, sarcoidosis, “idiopathic” interstitial nephritis). For most of these conditions there are no specific or even characteristic morphological findings, and the disease process can only be diagnosed by correlating the biopsy findings and the history of the use or exposure to certain drugs or substances. There is no evidence of immune complex or paraprotein deposition. IgG4 related disease is unlikely, given the results of immunohistochemistry studies (see results below). MICROSCOPIC DESCRIPTION: Sections of formalin-fixed, paraffin embedded tissue were evaluated using H&E, PAS, JMS, and trichrome stains. An H&E-stained frozen section taken from the tissue allocated for immunofluorescence microscopy and semi-thin toluidine blue-stained epoxy sections of the tissue processed for electron microscopy were also evaluated using light microscopy. The sample consists of 57 glomeruli (LM-48; IF-5; EM-4), of which 6 are globally sclerosed and several glomeruli appear hypoperfused. The non-sclerosed glomeruli are of normal size and reveal normal thickness of the glomerular capillary loops. Significant endocapillary proliferation or cellular crescents are not seen in the glomeruli. The mesangium is not significantly expanded. The interstitium reveals large areas of intense inflammation, associated with mild edema and focal tubulitis. The infiltrates are composed of lymphocytes and many plasma cells, several eosinophils and scattered neutrophils. Isolated foci of Tamm-Horsfall protein inspissation are present in the interstitium. A focal small non-necrotizing granuloma is noted, with epithelioid cells, lymphocytes, and an isolated multinucleated giant cell. In less involved areas, tubules reveal normal cellular details. In inflamed areas, tubules reveal tubulitis and focal degenerative changes. Several tubules also contain necrotic cellular debris. Several PAS-positive hyaline casts are also noted. The sample shows moderate tubular atrophy and interstitial fibrosis. Arteries and arterioles show severe sclerosis. Arterioles also show focal hyaline degeneration. IMMUNOHISTOCHEMISTRY RESULTS: The staining for CD138, IgG4, and IgG were performed using immunoperoxidase technique. Numerous CD138-positive plasma cells were identified, but only isolated cells stain for IgG4. The positive control slide and the patient’s negative non-immune control slide (normal serum) show appropriate reactivity. The immunohistochemical tests performed at Brigham and Women’s Hospital were developed and their performance characteristics determined by the Immunohistochemistry Laboratories in the Department of Pathology at BWH. They have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. IMMUNOFLUORESCENCE MICROSCOPY: KIDNEY BIOPSY #: E15-926 The sections of the sample submitted for immunofluorescence studies were incubated with antibodies specific for the heavy chains of IgG, IgA, and IgM, for kappa and lambda light chains, fibrin, albumin, and complement components C3 and C1q. The sample contains 5 glomeruli. There is 1 globally sclerosed glomerulus. No significant immune deposits are seen in the glomeruli. IgM stain shows dusty reactivity in the background of the tissue; there is also fine granular reactivity for IgM (trace) along the glomerular capillary loops. Dull reactivity with fibrin is noted along the glomerular capillary loops. Tubular basement membranes show focal fine granular deposition of C3 (trace). Tubules contain several intraluminal casts reactive for polyclonal IgA. The interstitium reveals scattered fibrin deposits. Some interstitial inflammatory cells are positive for kappa or lambda light chains. The vessels exhibit focal deposition of C3. There is no difference in reactivity between kappa and lambda light chains in the glomeruli, tubular casts or background of the tissue. The immunofluorescence microscopy tests performed at Brigham and Women’s Hospital were developed and their performance characteristics determined by the Immunohistochemistry Laboratories in the Department of Pathology at BWH. They have not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. ELECTRON MICROSCOPY: KIDNEY BIOPSY #: E15-926 Blocks: 1 Block examined: 1 thick section; 1 thin section. The sample submitted for electron microscopy examination contains 3 glomeruli; 2 glomeruli are examined ultrastructurally. The glomerular visceral epithelial cells reveal moderate effacement of their foot processes. The glomerular basement membranes are segmentally attenuated. Morphometric analysis was performed on 105 sites, using orthogonal intercept method. The harmonic mean of the glomerular basement membrane thickness is 274 nm. The subendothelial space of the basement membrane is segmentally expanded by electron-lucent fluffy material in a few capillaries; a new layer of basement membrane material is formed under the displaced endothelium (double contours). The endothelial cells show no significant changes. The mesangium reveals normal cellular elements and a normal amount of matrix. No electron dense deposits are present in the mesangium. CLINICAL DATA: History: A 60-year-old female with Crohn’s disease who presents with AKI. BUN 44, Cr 2.79 (baseline 0.89 in 2/2014; peak 3.24 on 7/18/15), Alb 4.0, HbA1c 5.4, C3 86, C4 15, free kappa LC/lambda LC ratio 2.45, negative hepatitis B/C, negative SPEP, urine sediment WBC 4/hpf, UA blood negative, proteinuria 0.14 g/gCr. TISSUE SUBMITTED: A/1. LM. B/2. IF. C/3. EM.

I am not able to give a medical opinion without performing a complete history and physical examination.  I suggest that you discuss your concerns with your nephrologist.  The biopsy diagnosis appears to be an interstitial nephritis but I’m not sure … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, GFR, Gout, Herbal Supplements in Kidney Disease/Failure, Kidney Biopsy, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Symptoms and Side Effects, Treatments