RE: MCD-IgA nephropathy 10 hours ago

I would still treat as a podocytopathy, worth the try, but I wold go with Rituximab alone, steroid sparing avoiding ----------------------------...

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RE: unexplained renal failure 10 hours ago

I would do genetic testing first (if available) before renal biopsy, we have picked up a few COL4A3-4 alports (yes even without hematuria) or some ...

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RE: unexplained renal failure 16 hours ago

Vascular Or tubulointerstitial amyloidosis is more common in AL and ALECT2 amyloidosis rather than AA amyloidosis which more commonly cause glomeru...

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RE: unexplained renal failure 17 hours ago

Yes very uncommon but can present without proteinuria (albumin) ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [...

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RE: MCD-IgA nephropathy 1 day ago

Three kidney diseases in one patient. Dr Hickam was correct!!! ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen...

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RE: MCD-IgA nephropathy 1 day ago

Because of biopsy proven Stage 3 DN in this case I would stress, Metformin, SGLT2i, GLP1RA and Finerenone for ongoing management after successful t...

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RE: unexplained renal failure 1 day ago

First rule out obstruction (ultrasound) and light chain cast Nephropathy (serum FLC and Immunofixation) . If unrevealing , a kidney biopsy is neede...

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RE: MCD-IgA nephropathy 1 day ago

I would not give immunomodulators to target IgAN if proteinuria improved and has complete remission. ------------------------------ Sarah Al Zou...

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RE: unexplained renal failure 1 day ago

Renal AA amyloidosis with deposits confined to or predominantly in the vascular/tubulointerstitial compartments, while uncommon, is a possibility. ...

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RE: unexplained renal failure 1 day ago

Agree with what had mentioned already. Simultaneous UPCR and UACR is important first step to look for plasma cell dyscrasia. AS associated kidney...

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RE: MCD-IgA nephropathy 1 day ago

Dr . Sarah, the article didn’t mention the add-on therapy for DFPE non-MCD like IgAN, maybe MMF for Asian ancestry or CYC for crescentic IgAN. For...

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RE: unexplained renal failure 1 day ago

Agree need SLC and urine protein ekectrophoresis - would also get CRP - kidney biopsy may be necessary if noninvasive is unremarkable ----------...

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RE: unexplained renal failure 1 day ago

Thank you dr weal for sharing this case . How long has his creatinine been at this level? Medication history is important, especially for chronic u...

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unexplained renal failure 1 day ago

72 year old male patient who is a known case of ankylosing spondylitis, not on medication currently, with no features of active disease, he is hype...

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RE: MCD-IgA nephropathy 1 day ago

If the nephrotic syndrome improves and reverse to normal with prednisolon, I mean no proteinuria, is it still indicated to treat the underlying IgA...

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RE: MCD-IgA nephropathy 2 days ago

I would agree with a probable auto-immune diffuse Podocytopathy superimposed on IgAN and stage III Diabetic nodular Glomerulosclerosis - would have...

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RE: MCD-IgA nephropathy 2 days ago

Thank you Dr. Rodby! I agree, he has mesangial deposits on EM but likely missed on the report! Would you add any of the novel treatments for I...

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RE: MCD-IgA nephropathy 2 days ago

Thank you for your thoughts. Agreed with you about the diagnosis, he doesn't seem to have signs and symptoms of infection, diabetes was controlle...

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RE: MCD-IgA nephropathy 2 days ago

That's very helpful, thank you.. I think he fits more into MCD-like IgA, I will take a look to the publication.. Was the type of other IS for non-M...

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RE: MCD-IgA nephropathy 2 days ago

Thank you.. how long would you wait while on steroids, assuming DM is controlled on insulin? ------------------------------ Sarah Al Zoubi MD Oak...

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RE: MCD-IgA nephropathy 2 days ago

That's exactly what I thought, he has mesangial hypercellularity and mesangial IF staining but no IC on EM, I think maybe missed on the report? I w...

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RE: MCD-IgA nephropathy 2 days ago

Many good points written already Dr Venkat the EMS are there below the LM and there are impressive subendothelial deposits and mesangial deposits...

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RE: MCD-IgA nephropathy 2 days ago

Interesting case, thanks for sharing. A few thoughts: Most likely: a minimal change–like podocytopathy superimposed on IgA nephropathy, with bac...

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RE: MCD-IgA nephropathy 2 days ago

What is the MEST-C score of IgAN? Recently published multi-center retrospective study phenotypes patient with MCD and IgAN into 2 variants; MCD-li...

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RE: MCD-IgA nephropathy 2 days ago

"EM showed diffuse FPE, glomerular basement membranes are thickened and contain focal subendothelial deposits with rare subepithelial deposits" D...

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RE: HSP with heavy proteinuria 2 days ago

Only ‘patchy moderate FPE’ but that was already after ‘oral prednisone 40 mg per day tapered over 10 days’ and then ‘IV steroids followed by predni...

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RE: HSP with heavy proteinuria 2 days ago

Thanks all for the input, much appreciated. Below is the text from the biopsy report. FPE described as patchy and moderate. Will see if I can get i...

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RE: HSP with heavy proteinuria 2 days ago

IgAN and IgAV, shared upstream signals (Gd-IgA1) but different downstream effects (renal limited vs renal and skin). For the skin effects, there ar...

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Cheer on Semi-finalists in the FIT Bowl Today! 2 days ago

Today at Kidney Week, please stop by the ASN Futures Theater in Exhibit Hall A, of the Colorado Convention Center, to watch the 2026 FIT Bowl! ...

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RE: MCD-IgA nephropathy 2 days ago

continue steroids with close monitoring for diabetes control. must be sure IgA not secondary to occult infection especially with known diabetes. co...

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MCD-IgA nephropathy 2 days ago

I want to open a discussion about one of my patients in the clinic. A 55 year old male patient with PMHx of well controlled DM and HTN, presented...

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RE: HSP with heavy proteinuria 3 days ago

This is an unexplained phenomenon, seen in (well done) observational (single arm) studies.The "effectiveness" of RTX in IgAV has not (yet) be confi...

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RE: HSP with heavy proteinuria 3 days ago

@Richard Glassock Out of curiosity , why would Rituximab show no benefit in IgA Nephropathy, but good response in igA vasculitis . I am aware that...

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RE: HSP with heavy proteinuria 3 days ago

Drs. Friedman and Venkat. A S0 lesion makes a diffuse Podocytopathy (superimposed on IgAV) less likely, but EM analysis would be of interest, I agr...

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RE: HSP with heavy proteinuria 3 days ago

Since no clinical trials have yet reported efficacy of Atacicept or Atrasentan in IgA Vasculitis, so your conclusions must be extrapolations from I...

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Cheer on your colleagues at the 2026 Fellows-In-Training (FIT) Bowl in Denver! 3 days ago

While at Kidney Week, please stop by the ASN Futures Theater in Exhibit Hall A, of the Colorado Convention Center on Friday, October 23, to watch t...

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RE: Drug-induced lupus and ANCA GN 3 days ago

Thank you Dr. Glassock ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (843) 669-6694 --------------------...

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RE: HSP with heavy proteinuria 3 days ago

I would like to take the contrarian view in that I think the Atacicept and Atrasentan are actually reducing the proteinuria. . However, on withhold...

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RE: HSP with heavy proteinuria 3 days ago

I share Dr. Friedman's impression that there must be a podocytopathy (causing severe nephrotic syndrome) + IgA vasculitis in this patient. How ab...

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2026 Fellows-In-Training (FIT) Bowl in Denver Starts Today, Oct. 22! 3 days ago

FIT Bowl starts today! Come to the ASN Futures Theater in Exhibit Hall A, of the Colorado Convention Center to cheer on your colleagues today, Thur...

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The 2026 ASN FIT Bowl is supported by Asahi Kasei Therapeutics. 3 days ago

FIT Bowl starts today! Come to the ASN Futures Theater in Exhibit Hall A, of the Colorado Convention Center to cheer on your colleagues today, Thur...

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RE: SLE Lupus nephritis Class V 3 days ago

------------------------------ [Sheng] [Kuo] MD, FASN ------------------------------

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RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 3 days ago

Following your helpful advice in August, I would like to share an update on our 29-year-old patient with SLE, lupus nephritis, and recurrent TMA. W...

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RE: Drug-induced lupus and ANCA GN Wednesday, October 21 @ 11:13 PM

This is almost certainly Hydralazine -induced ANCA (anti-MPO) Vasculitis , not Lupus Nephritis. It will remit with discontinuance of the offending ...

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Cheer on your colleagues at the 2026 Fellows-In-Training (FIT) Bowl in Denver! Wednesday, October 21 @ 9:18 PM

While at Kidney Week, please stop by the ASN Futures Theater in Exhibit Hall, of the Colorado Convention Center on Thursday, October 22, and Friday...

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RE: HSP with heavy proteinuria Wednesday, October 21 @ 8:58 PM

She must have had significant FPE. I think the biggest contributor to her NS partial remission then was the IV f/b PO steroids. She has an E1 lesio...

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Drug-induced lupus and ANCA GN Wednesday, October 21 @ 8:19 PM

86 y/o w/f with DM2, HTN, breast cancer presented with non-oligulic AKI. Serum creatinine is 3.8 ( baseline Cr 0.8 ). She has been on hydralazine w...

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RE: HSP with heavy proteinuria Wednesday, October 21 @ 7:17 PM

Neither Atacicept nor Atrasentan have any established role in treatment of IgA Vasculitis. But the patient is doing well. If he can continue to rec...

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RE: HSP with heavy proteinuria Wednesday, October 21 @ 4:19 PM

would continue therapy as responding to present therapy. no need to re-biopsy ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] ...

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HSP with heavy proteinuria Wednesday, October 21 @ 1:31 PM

Appreciate any input on a case of HSP with unusually heavy proteinuria 42 year-old woman with no medical history barring hypothyroidism, presente...

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