RE: Transplant Case 11 minutes ago

If I am reading the lab reports correctly the serum creatinine was "only" 132 micromoles/L on August 5 . we still don't know what kind of a respons...

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RE: IgA nephropathy with FSGS and significant IFTA 46 minutes ago

Good Question- no good evidence based answers, as contemporary biopsy findings have not been used to determine choice of therapy in any of the publ...

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RE: Transplant Case 55 minutes ago

How much did proteinuria decrease with Plex? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Direct...

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RE: Transplant Case 1 hour ago

Agree-Rituximab does not directly deplete mature plasma cells because they lack CD20 expression. Rituximab targets CD20-positive B cells, including...

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IgA nephropathy with FSGS and significant IFTA 1 hour ago

I had 2 patient presented with renal function impairment (serum creatinine 2-2.5 mg/dl) and significant proteinuria of 2.5-3.5 gm/day. both of t...

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RE: Recalcitrant AIN 5 hours ago

Agree to taper steroids and stop both MMF and CNI. Agree for anti-TNF drugs and for refractory cases, there is a role for Janus Kinase (JAK) inhib...

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Young female with malodorous urine 5 hours ago

Good evening I have a 26 years old female with offensive smelling urine (according to patient/friends./family) over the past few months. I have n...

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 5 hours ago

I have a similar case with 74-year-old woman and biopsy proven tip lesion FSGS, complete remission was achieved by high dose steroids without maint...

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RE: Case of recurrent Glomerular disease early post transplant 8 hours ago

The mainstay of treatment recurrent FSGS after kidney transplant is PLEX plus RTX. There are case reports of combining anti-CD20 (RTX or Obinutuzum...

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RE: Transplant Case 15 hours ago

Rituximab has no effect on plasma cells, as they do not express CD20. MMF is also quite ineffective against plasma cells. Only Anti-CD38 MoAB or Pr...

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RE: Transplant Case 21 hours ago

Thanks prof Lerman No creatinine is around 1.4 not had hd since transplant. Protein level have gone up but albumin 3.1 Has only dose of rituxan in...

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RE: Recalcitrant AIN 21 hours ago

Thanks...I asked the pathologist and he will do the immonophenotyping. Regarding mesalamine--he did not receive any. ------------------------...

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RE: Transplant Case 21 hours ago

No good evidence for RTX treating T-cell or B-cell rejection if I'm reading your data correctly, patient currently has heavy proteinuria with a ...

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 22 hours ago

With a steroid responsive NS and a "tip lesion" I would be seriously considering RTX at this point with a "partial relapse". Repeated dosing of RTX...

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RE: Transplant Case 22 hours ago

Thanks prof glassock you are the best !! --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 1 day ago

77 yo and GFR low 60s ml/min (cr is around 1.2 mg/dl). edit: CKD stage II stable (no change in Cr level or GFR values) -------------------...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 1 day ago

Do you believe like I and several others that somehow the report of split function test indicating that the bif kidney only has 15% of total kidney...

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RE: Recalcitrant AIN 1 day ago

I assume that 5-aminosolyckates have been stopped and no NSAID are used. I agree with Dr. Venkat regarding immunophenotyping of the interstitial ce...

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 1 day ago

Age of patient and current SCr/eGFR? Worsening renal function will be a concern vis-a-vis CNI use. ------------------------------ K.K. Venkat MD ...

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RE: Recalcitrant AIN 1 day ago

I would give him rituximab and a TNF blocker infliximab (or etanercept, adalimumab etc) gotta get him off steroids at any cost ------------...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 1 day ago

"Full blown nephrotic syndrome" is unusual with hyper filtration FSGS from atrophic kidney which is typically a secondary FSGS. also sounds some...

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RE: Recalcitrant AIN 1 day ago

Identifying type(s) of cells comprising the interstitial infiltratingusing immunohistochemistry may help to select further therapy. Following ref...

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Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 1 day ago

I'd appreciate expert insights on this case: Diagnosis: Tip-variant FSGS (biopsy-proven, 2020) Treatment History: Complete remission with ste...

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RE: Case of recurrent Glomerular disease early post transplant 1 day ago

Thank Dr Hayder for sharing this interesting articles . Wondering if C5 or Ct5 blockers would a therapeutic option for this patients . I am not aw...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 1 day ago

Agree with biopsying the larger kidney with 85% functions. Thats where most of the proteinuria is coming from. ------------------------------ Awa...

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Recalcitrant AIN 1 day ago

Hello everyone, I am a pediatric nephrologist but this condition is not unique to peds, so I am soliciting any advice. I have a 13 year old mal...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 1 day ago

I agree that there is something puzzling about the split isotopic measurement of function. There was a 2.6 cm difference in longitudinal length bet...

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RE: Case of recurrent Glomerular disease early post transplant 1 day ago

Thank you Dr. Guevera-Pineda to highlight the importance of C3 and IgM deposition and many thanks to Dr. Glassock for his interesting input. Co-de...

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RE: Transplant Case 1 day ago

1) the rise in serum albumin may precede the fall in proteinuria , but this is not well documented in recurrent FSGS 2) i doubt that RTX will hav...

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RE: Transplant Case 1 day ago

Just a thought 1/ In remission of podocytopathy what comes first lowering of urine acr or increasing albumin, Or they happen simultaneously ? 2/ ...

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RE: Case of recurrent Glomerular disease early post transplant 1 day ago

See Shirai Y, et al Kidney Int 2024; 105; 608-617 and Weins A et al JASN;2023: 34;308, ( Abstract-ASN Real Week, November, , 2023) --------------...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 1 day ago

a biopsy of the smaller atrophic kidney would likely yield mostly scar tissue. For a diagnosis, you should biopsy the normal sized one. The "risk" ...

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RE: Case of recurrent Glomerular disease early post transplant 1 day ago

I would love to read those sources as anti nephrin antibodies are not commonly seen in patients with native kidney biopsies that showed primary fsg...

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RE: Case of recurrent Glomerular disease early post transplant 1 day ago

According to some studies anti-nephrin antibodies are implicated in in 70% or more of recurrent FSGS in kidney allografts . --------------------...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 1 day ago

Actually the "risk" of complications following a percutaneous kidney biopsy is higher with an atrophic kidney- I think you are referring to tge ris...

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RE: Case of recurrent Glomerular disease early post transplant 1 day ago

Here is a good article from NEJM about the role of anti nephrin Ab in podocytopaties https://www.nejm.org/doi/full/10.1056/NEJMoa2314471 ----...

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RE: Transplant Case 2 days ago

Plex was done in May post transplant ( 7 sessions ) Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------...

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RE: Case of recurrent Glomerular disease early post transplant 2 days ago

I wasn't aware anti-nephrin antibodies are implicated in primary fsgs, be it pre or post transplant. Can you provide a source for this? ---------...

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RE: Transplant Case 2 days ago

I saw biopsy report . There was no EM unfortunately But biopsy proven Best wishes Belal --------------------------------- Muhammad Soobadar MB...

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RE: Transplant Case 2 days ago

thanks . i have attached albumin and urine acr transplant was done 05/10//25 and first dose rituxan was given arond 05/19/25 seems patien...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 2 days ago

Thank you for your replys. Complement system is normal. The smaller sized kidney is with smooth outline and its function measured by isotope sc...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

A normal RF, lack of C3/C4 depression , a predominantly -MPO serology and a normal TTE makes endocarditis much less likely, but does not exclude th...

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RE: Transplant Case 2 days ago

In recurrence of Primary FSGS in a renal allograft, the finding of FSGS by LM in addition to diffuse FPE by EM is sign of a poor prognosis for full...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

: the possibility of culture-negative endocarditis.eg .Bartonella henselae.. Coxiella burnetii,and Brucella. , is present I recommed to perform a ...

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RE: Transplant Case 2 days ago

Was Recurrent FSGS biopsy proven ? How much proteinuria before and after Plex and RTx - creatinine ? When was last Plex and RTx ? ---------------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

I raised the question about interstitial nephritis because it might focus initial therapy towards search for/interdiction of any medication that ma...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 2 days ago

Agree that is most likely diagnosis is secondary FSGS due to hyperfiltration injury and no empiric steroids unless kidney biopsy EM showed diffuse ...

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RE: Nephrotic syndrome in a patient with unilaterally atrophied kidney 2 days ago

I cannot understand the gross difference in gfr on DTPA imaging where the atrophic kidney has 85 percent renal function. If that is the case one mu...

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RE: Transplant Case 2 days ago

Thanks prof glassock Best wishes --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

? Multiple Issues the presence of proteinuria & haematuria & extra-renal symptoms are of note The glomerular lesion doesn't seem that active &...

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