RE: rituxan and Obinutuzumab 1 hour ago

Thanks Dr. Aledan. Cases like you describe- nephrotic range proteinuria, without a full NS, a FSGS lesion (undoubtedly secondary) and negative anti...

View Discussion

RE: IgA nephropathy with FSGS and significant IFTA 1 hour ago

Thanks- With this much hematuria (unless the patient has an underlying Alport Syndrome Spectrum disorder), I would be considering anti-inflamm...

View Discussion

RE: rituxan and Obinutuzumab 4 hours ago

Dr. Glassock we have come across many cases like this with relapse MM after many years of complete remission of serum positive PLA2R Ab associated ...

View Discussion

RE: IgA nephropathy with FSGS and significant IFTA 6 hours ago

The Hematuria is persistent for the last few years, as I searched his file in other facilities. It's usually 40-50 RBCs . ---------------------...

View Discussion

RE: PLA2R positive membranous nephropathy 12 hours ago

I agree with Dr. Venturelli- what is the anti-PLA2R antibody level (by ELISA)? Reactivation of latent Tuberculosis by RTX therapy is quite uncommon...

View Discussion

RE: rituxan and Obinutuzumab 13 hours ago

A true clinical relapse after a complete remission in PLA2R induced MN very rarely occurs (<2%) without a reappearance or rise in anti-PLA2R auto-a...

View Discussion

RE: Case Of Progressive ckd / HTN 17 hours ago

WHAT IS THE PATIENTS HEIGHT BECAUSE THE LINGITUDANAL HEIGHT IS PROPRTIONAL TO THE PATIENT .BEFORE US, WE ESTMATED THE NORMAL HEIGHTFROM GLAT PLATES...

View Discussion

RE: Case Of Progressive ckd / HTN 18 hours ago

Thanks Kidney size r 11 cm and l 10 cm ish So not small but agree biopsy will be chronic changes But patient wish ----------------------------...

View Discussion

RE: rituxan and Obinutuzumab 20 hours ago

"I am treating a relapsed MGN patient with Rituxan" Does this mean proteinuria had resolved completely previously and now has reappeared? What is...

View Discussion

RE: to pulse or not to pulse?? 20 hours ago

Both are true . ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

View Discussion

RE: rituxan and Obinutuzumab 20 hours ago

Why are you treating a patient with a negative anti-PLA2R antibody in the circulation but with a positive PLA2R in the tissue . Is this a complete ...

View Discussion

RE: rituxan and Obinutuzumab 22 hours ago

His serum APLA2Rab has always been negative, though it was positive in the biopsy X 2 and we even got his old biopsy tissue from 15 years ago that ...

View Discussion

RE: to pulse or not to pulse?? 22 hours ago

Dr Glassock Is the increased uptake in pulmonary hemorrhage due to the release of Hb and CO can displace CO2 rom Hb. Whereas in CHF the CO uptake...

View Discussion

RE: rituxan and Obinutuzumab 22 hours ago

We used Methylprednisolone 100 mg. When he reacted we gave him another 200 mg whcih quelled the reaction. But I am nervous to risk it. Thanks ---...

View Discussion

RE: Case Of Progressive ckd / HTN 1 day ago

Echogenicity usually means fibrosis in smallish kidneys. That why I did not favor a Bx. Risk/ benefit ratio too high ----------------------...

View Discussion

RE: Case Of Progressive ckd / HTN 1 day ago

Thanks everyone Urine dipstick done not microscopy Us kidneys both kidney appear echogenic Best wishes --------------------------------- Muh...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Dear all, Thanks Colleagues have told me that plex was not for PH but rather due to severity of disease as causing lung/ gi/ neurology / renal / p...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Agree with Dr. Glassock that PLEX is not indicted in this case and agree for CYC based induction therapy. Other non invasive new tool for differen...

View Discussion

RE: PLA2R positive membranous nephropathy 1 day ago

I wouldn't worry a lot about TB reactivation with 2 g of rituximab if the patient is on concomitant latent TB therapy. The risk would be higher if ...

View Discussion

PLA2R positive membranous nephropathy 1 day ago

Greetings to all community members seeking for inputs about this case 40 year old male patient diagnosed with membranous nephropathy since 2015...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Check with your Pulmonary physician. The test is also called "Pulmonary Diffusion Capacity " or the "Krough" test. If the patient is receiving ster...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Mpo>8 ( lab does not give a specific value) new hospital for me not encountered this before --------------------------------- Muhammad Soobadar M...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Thanks prof glassock I don’t think I will do a repeat kidney biopsy . I will just treat as multi system vasculitis . It won’t change management a...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Please do a single breath pulmonary CO uptake, this will differentiate between CHF , pneumonia and alveolar hemorrhage. The CO uptake is very high ...

View Discussion

RE: Case Of Tunnelled Line Bactaeremia With Osteomyelitis And Endocarditid 1 day ago

Thanks both Patient already on taurolock when developed mssa bactaeremia. Think heading to vancomycin Lock Once permanent catheter inserted Lo...

View Discussion

RE: to pulse or not to pulse?? 1 day ago

Just to Update - Friday evening after renal biopsy patient dropped saturation. Oxygen requirement of 2 l. Cxr - bilateral infiltrate . Hb stable ...

View Discussion

RE: Case Of Progressive ckd / HTN 1 day ago

Let us know what the kidney biopsy shows when it is performed. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388...

View Discussion

RE: Jim Kaufman obituary 2 days ago

I too am saddened by the news, Jim Kaufman and I interacted in both the anemia of CKD and the issue of thrombosis of VB fistulas, particularly thos...

View Discussion

Encourage Your Fellows to Participate in the 2025 FIT Bowl at ASN Kidney Week 2 days ago

Encourage your fellows to join the American Society of Nephrology (ASN) Fellows-in-Training (FIT) Bowl at Kidney Week 2025 in Houston, TX. This yea...

View Discussion

Apply to Participate in the 2025 FIT Bowl at ASN Kidney Week by Friday, September 5 2 days ago

Test your knowledge against your peers! Win ultimate bragging rights at Kidney Week! Join the American Society of Nephrology (ASN) Fellows-in-...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Following the discussion, I ask the following. Is he a sip;e SC trat ot Sickle cell + another genetic abnormality. i had 3 patients who had Hemoglo...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

With progression of CKD over 5 years (or more) my guess us that a biopsy will showESKD and will be rather unhelpful in treatment decision , but it ...

View Discussion

RE: Blood flow to dialysate flow ratio for full saturation 2 days ago

Dr Aledan, typically in CRRT, blood flow does not affect clearance at all, if I am correct. If the blood flow is >2.5 times the dialysate flow, whi...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Genetic test for APOL 1 variant is not available in UK. This test is available through National genomic only for potential living kidney donors of ...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

I would be cautious upon making a diagnosis of cardiac amyloid from echocardiogram. The findings are not specific in the presence of CKD as I have ...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Amyloidosis of any type can explain preserved kidney size despite progressive CKD/ESKD. However, active urine sediment with hematuria is unlikely i...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Was hematuria confirmed by urine microscopy? I think patients with sickle cell trait, albeit less frequently l than those with sickle cell disease,...

View Discussion

RE: rituxan and Obinutuzumab 2 days ago

Previously we use hydrocortisone for premedication and we observed many allergic reactions so we switch to methylprednisolone or dexamethasone so t...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

I suppose that this might be hereditary ATTR Amyloidosis which is mire common in patients of West African ancestry and can be associated with Hyper...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Severe hypertension is very uncommon in renal amyloidisis, but it has been seen. ------------------------------ Richard Glassock MD, FASN Laguna ...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Can patient with amyloidosis suffer from severe hypertension?? --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt -----...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

With an eGFR of 6ml/Min an ARR will have no value. I donut think I would do a MRA in this case. ------------------------------ Richard Glassock ...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Thanks why cardiologist suspected amyloidosis any suspicion by echo Aldosterone renin ratio?? As Dr Richard said renal doppler is safe more than ...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

"Baseline eGFR 2020 50 ml/min 2024. 24 ml/min January 2025 15 ml/min" Above course suggests progressive CKD --> ESKD now, even though size of kid...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

No kidney biopsy is needed before genetic testing for APOL1 high risk alleles. If positive for two risk alleles I think that a kidney biopsy and an...

View Discussion

RE: rituxan and Obinutuzumab 2 days ago

I would not give another dose of RTX and try to get approval for OBI or Ofatumumab .What is his Anti-PLA2R-level.. if decreasing from pre-therapy y...

View Discussion

RE: rituxan and Obinutuzumab 2 days ago

Thanks for those references, Dr Rodby. ------------------------------ Michael Klein M.D. New York Medical College Valhalla, NY (914) 493-7701 ---...

View Discussion

RE: rituxan and Obinutuzumab 2 days ago

Thanks for your response, Dr Glassock It was a reaction with hives, shortness of breath, and tachycardia. It resolved with additional steroid and...

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Could not hear Bruits Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Case Of Progressive ckd / HTN 2 days ago

Thanks prof glassock . Will ask radiologist if they can do us Doppler Would I not need kidney biopsy first before genetic test ? ---------------...

View Discussion