RE: ? overlapping MPO vasculitis + idiopathic MPGN 6 hours ago

Ok -thanks- I just do not understand how the results (MPO + or - ) will help management in this case- please clarify. Important issue! -------...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 9 hours ago

Kidney biopsy does some deposits If immune staining is done in those deposits may help --------------------------------- Bajinder Reen MD Etobico...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 9 hours ago

Thanks Dr. Reen. Interesting paper. I just don't see how a study of MPO in the deposits in this case would help refine the diagnosis (and therapy )...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 10 hours ago

I think arkana and Myo clinic do. If i remember this issue was brought up at last Rush rounds Sent from my iPhoneSpelling mistakes are regretted w...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 10 hours ago

Dr. Reen. Interesting suggestion. How would one go about looking for ANCA by immunocytochemistry on a kidney biopsy?" ---------------------------...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 10 hours ago

You could look for ANCa by immunohistochemistry on kidney biopsy if negative most likey infection If postive anca vasculitis or anca related to dru...

View Discussion

RE: rituxan and Obinutuzumab 12 hours ago

Treatment decisions can be very uncertain in thus patient (and others like this). The benefits if RTX or other AntiCD20 MoAB in the presence of "ne...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 12 hours ago

Symptoms had been present for approximately 6 months before. She had transferred her care from another nephrologist. UA active ~3-4 months ago In...

View Discussion

RE: ? overlapping MPO vasculitis + idiopathic MPGN 12 hours ago

Minimal medication list. Taking lipitor and losartan Only remaining infectious work-up still pending is bartonella, Coxiella burnetii,and Brucell...

View Discussion

RE: rituxan and Obinutuzumab 12 hours ago

Hi Dr Glassock, Thanks for your nuanced response. His APLA2R level was returned as [More]

View Discussion

RE: IgA nephropathy with FSGS and significant IFTA 13 hours ago

One of the noteworthy deficiencies in this study is the lack of inclusion of hematuria and its magnitude and persistence as an "inflammatory" bioma...

View Discussion

RE: rituxan and Obinutuzumab 14 hours ago

I just do not believe that the term "relapsed MN" should be used for patients with PLA2R associated MN with nephrotic range proteinuria without Nep...

View Discussion

RE: IgA nephropathy with FSGS and significant IFTA 14 hours ago

Very mice observational study - whether it can be used to decide modern treatment choices for patients with IgAN and a S1 lesion ( FSGS ) is a ques...

View Discussion

RE: IgA nephropathy with FSGS and significant IFTA 15 hours ago

This is the link to the NDT article Dr. Reen mentioned : Nephrology Dialysis Transplantation, gfaf162, https://doi.org/10.1093/ndt/gfaf162 ...

View Discussion

RE: IgA nephropathy with FSGS and significant IFTA 15 hours ago

Please review this paper just published on line august 18,2025 may be pertinent to this patient Clinical significance of focal segmental glamorous ...

View Discussion

RE: rituxan and Obinutuzumab 18 hours 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 19 hours 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 22 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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?? 1 day ago

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

View Discussion

RE: rituxan and Obinutuzumab 1 day 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 1 day 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?? 1 day 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 1 day 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?? 2 days 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 2 days 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 2 days 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?? 2 days 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?? 2 days 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?? 2 days 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?? 2 days 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 2 days 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?? 2 days 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 2 days 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