RE: Thoughts on immunosuppresion for canine MPGN? 1 hour ago

Jd: A question for you. I have been interested in uremic toxins for years as a clinician. I know cats get renal failure not infrequently. Would you...

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RE: Thoughts on immunosuppresion for canine MPGN? 11 hours ago

ANA or RF would not give you much specificity. Would it be possible to run anti-dsDNA, anti-Smith instead? ------------------------------ Karina...

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RE: Thoughts on immunosuppresion for canine MPGN? 18 hours ago

Since dogs do have and express all four IgG heavy chain subclasses, it is probably best to test for heVy chain rather than LC monotypism, if one is...

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RE: Thoughts on immunosuppresion for canine MPGN? 21 hours ago

Thanks so much for sharing your thoughts. We can definitely run an SPEP and immunofixation to look for any gammopathy that could be present. We...

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RE: Lupus Case 23 hours ago

I agree , a sister facility has used CarT for malignancies and 2 cases of lupus . Awaiting to see their results . But I think it has drawbacks , in...

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RE: Lupus Case 1 day ago

Just an opinion but I dont think that CAR-T cell therspy is quite ready for orime time in bc a case like this quite yet. I have no experience with ...

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RE: Lupus Case 1 day ago

Any thoughts on CarT - CD19/BCMA or TCE therapies ( teclistamab) if it's available at your facility. --------------------------------- Dr. Horma...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Exactly correct. This I s why PGNMID needs to be considered as a cause of a MPGN lesion in this dog with monotypic LC glomerular deposits and a "M ...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

for MPGN I always refer back to this figure from 2013 NEJM review that starts with isolated C3 staining or not The IF in this case puts it to...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Understood. Under these circumstances it will be extremely difficult to establish a " diagnosis" of PGNMID in a dog, in humans PGNMID is usually ...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Bortezomib has been reported in 2 case reports for treating multiple myeloma in our world- one in a cat and another in a dog. The dog was also trea...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Thanks . Understood. This is a problem. In dogs, one cannot exclude a PGNMID by using anti-human LC specific antibody reagents . I suspect that Las...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Thanks for your thoughts, Dr. Glassock. For clarification, the ratio of lambda to kappa light chains in dogs is almost entirely lambda. Kappa sta...

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RE: 9/11 and Nephrology 2 days ago

David, Like you I have flashback as well. Thank you for for the reminder and what it led to . ------------------------------ Anatole Besarab MD A...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

What is LLC? If it is Lambda Light Chain then you need to consider Proliferative GN with monoclonal IgG deposits ------------------------------ ...

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RE: 9/11 and Nephrology 2 days ago

An amazing combination of hilarious, insightful, imaginative, and fascinating. Thanks for sharing! ------------------------------ Sheldon Hirsch ...

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Thoughts on immunosuppresion for canine MPGN? 3 days ago

Hi everyone, I'd love to get some thoughts on potential drug options for a patient of ours. This is a 3 and 1/2 year old French Bulldog who ha...

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9/11 and Nephrology 3 days ago

As I always have flashbacks on 9/11, I thought I would share with you a report and an essay on the nephrologic aspects of that day in New York City...

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RE: Transplant Case 3 days ago

A biopsy is needed. A late PTLPD is usually EBV negative and behaves more like a lymphoma that early PTLPD that often goes away when immunosuppresi...

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RE: Lupus Case 3 days ago

I agree with you Dr. Dastoor. But the BLISS trial may have included too few patients with this severe crescentic GN to draw any firm conclusion abo...

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RE: Lupus Case 3 days ago

I would take the contrarian view. Your patient has severe renal and extra renal involvement , and would benefit more from a Belimumab based regimen...

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RE: Lupus Case 3 days ago

Thanks everyone after 6 pulses of cyclophosphamide Then start mmf ? Thanks --------------------------------- Muhammad Soobadar MBChB UK -----...

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RE: Transplant Case Wednesday, September 10 @ 10:41 AM

Sorry my bad. I thought it was large bowel due to a careless reading of the post. In that case a CT guided lymph node biopsy would be best. ----...

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RE: Transplant Case Wednesday, September 10 @ 10:35 AM

Dr. Balan tissue is needed for PTLD diagnosis but in this case the CT scan shows small bowel involvement.. would you still perform random biopsy in...

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RE: Recurrent ascites in ESRD pt Wednesday, September 10 @ 10:03 AM

Very interesting discussion. I have a patient currently with severe recurrent ascites requiring frequent LVPs where cardiac source has been ruled o...

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RE: Transplant Case Wednesday, September 10 @ 9:09 AM

I think your original suggestion of colonoscopy is great. Everything depends on the tissue diagnosis. If we are able to get a biopsy then the other...

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RE: Transplant Case Wednesday, September 10 @ 8:34 AM

Agree with everything said and we usually involve oncology to help guide PET scan use and treatment. Get Outlook for iOS

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:42 AM

Thank you all. I will provide a table of recent results which Will make things a bit more clearer ------------------------------ M Kaisar Neph...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:33 AM

Mycophenolate sodium 720 mg three times daily (2160 mg/d) is pretty much a maximum dose. I would not push it any further., especially with declinin...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:15 AM

Could you please post the deidentified report of the most recent kidney biopsy - this should help with the decisions about treatment modalities . I...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:04 AM

With these doses , the patient is receiving Mycophenolate sodium not Mycophenolate mofetil. ------------------------------ Richard Glassock MD, ...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:04 AM

I would not consider Rituximab again... Unless biopsy shows high Acuity scores and serology shows high activity . Would probably consider MMF + CN...

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RE: Qb and myocardia stunning Tuesday, September 9 @ 10:00 PM

I too do not know whither there us any good data. No doubt the extracorporeal blood flow in the dialysis circuit is not affected unless the flow ex...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 9:05 PM

Dr Glassock. The word uremic is too broadly used. Some substance retained in the state of ESRD which has an effect in a particular target system is...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 8:50 PM

I agree tou Fr Rodby. How do measure adequate dialysis. After more than 49 years of Kt/V I am convinced that the latter does not do justice to "wha...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 8:15 PM

When I had the ARR determines I was off ARB for a week but took the rest of the medical, of course mt BP did go up -----------------------------...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 6:16 PM

Odd because a "uremic" factor should be acting systemically, yet the serositis is localized exclusively to the peritoneal membrane in cases of "dia...

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RE: 52 year old male with class V LN Tuesday, September 9 @ 4:49 PM

Dr. Kaisar: I am confused about the trends of urine protein, urine albumin and serum albumin levels. If the UPr and UAlb are unchanged but the seru...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 3:37 PM

Im not sure what you mean by odd, but to me, if I am correct that this is uremia, it just tells us how unhealthy you still are despite being consid...

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RE: 52 year old male with class V LN Tuesday, September 9 @ 3:36 PM

His current dose is 720mg TDS which was his dose pre-reduction to twice a day. On the.TDS dose the urine protein level was 8.3 g though the serum a...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 3:21 PM

So the terminology is all wrong - it is "Uremic Ascites" in a patient with uremia treated with HD (and cured by Kidney Transplant) - all rather odd...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 3:12 PM

The only thing I have seen work is transplant I will be curious as HDF gets more common if we see it less ------------------------------ Roge...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 2:44 PM

Dr. Rodby very intriguing hypothesis Any personal experience of improvement with HD intensification , MCO membranes or PBUT removal? --------...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 2:04 PM

"when you say nephrogenic-what would the mechanism be (assuming that if pts has been on dialysis for some time residual kidney function is nil or q...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 12:26 PM

I agree- but measuring ARR while a patient is receiving an ARB is usually not recommended. ------------------------------ Richard Glassock MD, F...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 10:51 AM

The low (assuming it's below the lnl) renin concentration with ARB really points towards primary hyperaldosteronism. ---------------------------...

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RE: Transplant Case Tuesday, September 9 @ 10:23 AM

Agree with Dr. Glassock biopsy/tissue diagnosis is needed. She is 7 years out from transplant. Early post-transplant lymphomas are more commonly EB...

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RE: Transplant Case Tuesday, September 9 @ 10:05 AM

GI involved PTLD seems likely. Is the patient EB+ or -.?Can you get a CT guided biopsy of LN to see if it is CD20+ or not? Reduced IS is always the...

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RE: 52 year old male with class V LN Tuesday, September 9 @ 9:34 AM

What is his current MMF , hydroxychloroquine and steroid dosage? What his current eGFR? Serum Sickness should not occur with OBI- the arthritis is ...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 9:25 AM

Cannot interpret ARR while receiving an ARB. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------...

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