RE: AAV ? 38 minutes ago

I wish to clarify: 1. I will replace rituximab with cyclophosphamide or use them in combination only if a RPGN-like course is evolving, and/or life...

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RE: AAV ? 1 hour ago

Thanks prof glassock Kind regards --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: AAV ? 5 hours ago

I have no opinions on how to interpret this auto p-antibody in light of the kidney pathology.-I agree with the use of RTX and steroids (as is being...

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RE: AAV ? 5 hours ago

https://pmc.ncbi.nlm.nih.gov/articles/PMC10167150/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10167150/ Attached is review of SSc and antibodies ...

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RE: AAV ? 5 hours ago

@ prof glassock what about the antibody for scl? Any educational point for non expert --------------------------------- Muhammad Soobadar MBChB U...

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RE: AAV ? 7 hours ago

Thanks prof glassock / prof venkat and other colleagues 26 February 0215 dr taam posted same post under different title ANA-Negative Lupus Nephr...

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RE: FSGS conundrum 7 hours ago

Thanks for your prompt response Dr Glassock. Much appreciated! ------------------------------ Donald Mitema MD Mississippi Baptist Medical Center...

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RE: AAV ? 7 hours ago

Agree with Dr. Glassock that the nature of the GN is not clear in this patient. If the initial SCr of (?) 3.1 mg/dL ("31 mg/L") is rapidly increasi...

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RE: FSGS conundrum 7 hours ago

I would treat with Obinutuzumab and document full peripheral B cell depletion. If non response in 3-4 months , I Would switch to PLEX or Lipid Aphe...

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FSGS conundrum 7 hours ago

Hi everyone, I would love your insight on this case. Young otherwise healthy patient of African ancestry develops fairly rapid edema and nephr...

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RE: AAV ? 8 hours ago

Dr. Soobadar - I really cannot draw any conclusions as to what is best therapy in this case. I think I would try RTX and steroids , but I have very...

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RE: AAV ? 8 hours ago

And your thoughts about anti pm scl antibody and scl? Kind regards --------------------------------- Muhammad Soobadar MBChB UK ---------------...

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RE: AAV ? 8 hours ago

Thanks prof glassock Is the ANA negative till we do another assay to confirm ? @ prof glassock I am interested to know how you would treat ? ...

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RE: AAV ? 8 hours ago

It is not possible to categorize this patient as having Lupus Nephritis with a negative ANA, none of thev published trials on treatment of LN are r...

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RE: Opinions plz 9 hours ago

Yes, I agree; IgAV; formerly Henoch-Schönlein purpura My bias: The triggers possibly midodrine + Velphoro use. Midodrin causing microcirculation ...

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RE: AAV ? 10 hours ago

I also note that there is a lot of fibrosis on kidney biopsy but it would not stop me from treating Kind regards ------------------------------...

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RE: AAV ? 10 hours ago

Many thanks for case Many thanks prof glassock for input Does patient have any symptoms of PMR or GCA?( rule out large vessel vasculitis ) Any ...

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RE: Pseudohypertension or true uncontrolled HTN 10 hours ago

HTN in Elderly 1. Old people have less ability to activate RAAS. They have Low Renin type hypertension and they do not respond to ACEi & BRB ...

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RE: intra-operative CRRT 14 hours ago

We did that routinely with most liver transplant. However, after a regime change in the surgical side, we rarely do need it. The new team uses much...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 16 hours ago

Thank you all Pretransplant creatinine was 0.7 mg/dL with with an eGFR 97 mL/min and posttransplant eGFR 98 mL/min remained stable through July 20...

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RE: Pauci-Immune GN, Chronic, Minimally Active 16 hours ago

This might be considered as a case of "smoldering " ANCA Vasculitis ( renal limited).: Uncommon, but deserving of therapy. She should respond to th...

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RE: intra-operative CRRT 16 hours ago

We have done this in the past but surgeons have improved and demand this less and less. The main problem occurs with acidosis in the anhepatic phas...

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RE: Pauci-Immune GN, Chronic, Minimally Active 19 hours ago

Dr. Nauman this is my opinion only this is most probably a slowly progressing microscopic polyangiitis (or MPO-ANCA associated GN) While it's ...

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RE: intra-operative CRRT 23 hours ago

Thankfully this has not come up in years at our center bc it was a logistical nightmare when surgeons in the past demanded it. One reason was to he...

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RE: Opinions plz 23 hours ago

He lost two transplants. Any idea what the biopsies showed on those? this is an impressive rash! Looks like leukocytoclastic but the DD if even t...

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RE: Membranous nephropathy 1 day ago

@ dr aleydan @ I would not do screening in mn plar 2 positive Do you mean you don’t do CT whole body or you don’t ask any questions ( history talk...

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RE: Membranous nephropathy 1 day ago

- avoid CNI due to poor eGFR and it not great to induce remission on its own vs ritux but maybe can be used as add on if eGFR preserved with ritux ...

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RE: Membranous nephropathy 1 day ago

Thanks for caseand discussion some learning points for me - kidney biopsy considered in eGFR 60 ml/ min or less to rule out 2nd pathology . (...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

Agree with Dr. Glassock about the need for IS therapy in this patients with low activity and documented chronicity. Given the history of breast c...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

I don't think hat a history of breast cancer is a contraindication to RTX therapy. Just an opinion. ------------------------------ Richard Glasso...

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RE: Opinions plz 1 day ago

Diagnosis first. What are the C3/C4, HBV/HCV serology, Rheumatoid Factor, CryoCrit, cardiac exam. WBC , Hemoglobin, ----------------------------...

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Opinions plz 1 day ago

65-yr-old white male with ESRD. Original renal Dz was non-proteinuric & was not a toxin or medication-induced as far as one could tell. Had advance...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

Important to keep in mind history of breast cancer in 2012 with recurrence in 2021 vis-a-vis immunosuppression in this patient. -----------------...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Her last bone marrow was still positive so it is not going to give us any more information. Did she have a baseline SAP scan? If so, it might be he...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Thanks everyone @ dr Leung what are your thoughts about SAP scan for monitoring disease activity ? What about repeat bone marrow ? Kind regards ...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Dr. Mohiuddin: What did her bone marrow show pre-SCT and findings on post-SCT marrows? If a clonal cell population persists or has increased in the...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Very true Dr. Glassock and I suspect that is what is happening. These patients will often have a stable creatinine while using up their renal reser...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

The maintenance of total eGFR o Dr time does not inform about nephron loss if residual nephrons can increase their individual GFR (adaptive hyper-f...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Renal function has been maintained. Normal creatinine at 0.6-0.8 mg/dl Sent from my iPhone

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

With hematuria (any acanthocytes or red cell casts) , proteinuria, declining kidney function, positive Anti-MPO ANCA and a barely adequate kidney b...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Dr. Leung - no meaningful response of proteinuria after a good but incomplete hematological remission. Does this mean that that the chronic damage ...

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Pauci-Immune GN, Chronic, Minimally Active 1 day ago

53 yr lady, Multiple Sclerosis not on any active therapy, Ca Breast diagnosed in 2012, had lumpectomy had chemotherapy with Adriamycin/Cyclophospha...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

I don't see any meaningful response. What is the creatinine doing? ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) ...

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intra-operative CRRT 1 day ago

wondering if colleagues who practice in liver transplant centers can comment on use of intraop CRRT during liver transplant -are you doing that r...

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RE: Membranous nephropathy 1 day ago

Very good point Dr. Venkat , unless the Anti-PLA2R antibody by ELISA is a false positive, which can occur uncommonly in patients with T2DM. Doing a...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

Very interesting and astute observation Dr. Aledan. Many thanks. But if I understand the phenomenon correctly, an "auscultatory gap" if present wou...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

@Hayder Aledan I did not look for an auscultatory gap in this patient (was not even thinking about it till I read more on arterial stiffness) To ...

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RE: Membranous nephropathy 1 day ago

I get the impression that Drs. Glassock and Rodby will treat with rituximab/obintuzumab regardless of degree of chronicity on biopsy because PLA2R-...

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RE: Managing severe hypertension in outpatient settings 2 days ago

I would not send to the ER and try to confirm HTN with HBPM or ABPM. Review mediations such as NSAIDs, stimulants, alcohol and asking for any pain...

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RE: Pseudohypertension or true uncontrolled HTN 2 days ago

Any big auscultatory gap is present? --------------------------------- Hayder Aledan MD, FASN Professor Basra Nephrology and Transplantation Cente...

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