RE: Post infectious MPGN 3 hours ago

Dr. Glassock: I suggested the possibility of a superimposed new podocytopathy on preexisting glomerulopathy for the following reasons: 1. Such seve...

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RE: Post infectious MPGN 5 hours ago

Dr. Venkat - interesting suggestion, but I do not know how one can distinguish between a superimposed Primary diffuse Podocytopathy and a secondary...

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RE: Post infectious MPGN 5 hours ago

With such massive proteinuria a diffuse effacement of the foot processes would be expected as a reaction to severe capillary wall injury in MPGN . ...

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RE: Post infectious MPGN 6 hours ago

What was the baseline SCr before current SCr of 1.7 mg was documented? Do you have any past urine studies showing abnormalities? How much weight ha...

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RE: Post infectious MPGN 6 hours ago

Does the LM show a clear MPGN pattern of injury (with double contour capillary walls)? ------------------------------ Richard Glassock MD, FASN L...

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RE: Post infectious MPGN 8 hours ago

If the Pathologist will not do a Paraffin IF, at least have the biopsy studied for IgG subclass distribution. If the heavy chain is monoclonal this...

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RE: Post infectious MPGN 9 hours ago

what are your thoughts on the 21gm of protein and diffuse foot process effacement? There is no evidence of infection. Pathology insists no value to...

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RE: Post infectious MPGN 9 hours ago

I have not seen this much proteinuria with diffuse foot process effacement. with no evidence of infection is there any role for steroid. Pathology ...

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RE: Post infectious MPGN 10 hours ago

Any time I am told of a PIGN, and especially if C3 is predominant, I consider C3 GN. This may have too much other Igs to consider C3GN , but I ALWA...

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RE: rituxan and Obinutuzumab 10 hours ago

As proteinuria is a marker for poor cardiokidney outcome and tend to admit that those patients with nephrotic-range proteinuria without nephrotic s...

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RE: Post infectious MPGN 10 hours ago

Occasionally the Frozen IF IgG can show weak but positive IgG deposition in patients with concealed PGMID. C3 deposition by frozen IF is typically ...

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RE: Blood flow to dialysate flow ratio for full saturation 11 hours ago

Hey Dr. Omar and team -- I agree almost entirely with everything that is said. Like Dr. Rodby initially said, keeping blood flow at least...

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RE: Post infectious MPGN 11 hours ago

I requested the pronase digestion but the pathologist told me they only do it when the staining is negative on IF and did not think it would be hel...

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RE: Post infectious MPGN 12 hours ago

The SPEP, ANA and RF are normal. Blood and urine cultures are negative. No murmurs. --------------------------------- J Gunnell, MD Attending...

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RE: Post infectious MPGN 12 hours ago

I think I would also ask the kidney pathologist to perform a Pronase digestion of a paraffin embedded specimen to test for concealed monoclonality ...

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RE: Post infectious MPGN 12 hours ago

Can you post the de-identified kidney biopsy report. Did the serologic investigation include ANCA, Rheumatoid factor,, serum FLC and ANA? . Any new...

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

We are looking at Indian subcontinent population. Hopefully we will have data to share early next year --------------------------------- Bajinder...

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

Agrred - ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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

Valiga study also supports value of sub-classifying S lesions in IgA and there cohart was mostly European --------------------------------- Baji...

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Post infectious MPGN 14 hours ago

I have a 76yo male patient with no other medical problems admitted with anasarca which started about 3 weeks prior. His serum Cr 1.7. There have be...

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RE: rituxan and Obinutuzumab 15 hours ago

He had partial remission to 2 grams from 7. Renal function normal. Biopsy shows minimal sclerosis or fibrosis. Now up to 5.5 grams by ration and 7 ...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 16 hours ago

Sorry for delayNot will rule out infection, but it also tells me to treat this patient like vasculitis even if there is a dual pattern of injury on...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 16 hours ago

I think this us correct, but the likelihood of an infection cause of crescentic GN was already very low in this patient. Nevertheless, anti MPO sta...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 16 hours ago

I think the idea of the dr reen is that if ANCA is positive by immunohistochemistry, this rules out infection-related --------------------------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day ago

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

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day ago

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

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day 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 )...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day 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...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day ago

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

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day 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...

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RE: rituxan and Obinutuzumab 1 day 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...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day 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...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 1 day ago

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

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RE: rituxan and Obinutuzumab 1 day ago

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

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RE: IgA nephropathy with FSGS and significant IFTA 1 day 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...

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RE: rituxan and Obinutuzumab 1 day 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...

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RE: IgA nephropathy with FSGS and significant IFTA 1 day 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...

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

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

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

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

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RE: rituxan and Obinutuzumab 1 day ago

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

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

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

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RE: rituxan and Obinutuzumab 1 day 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 ...

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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 . ---------------------...

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RE: PLA2R positive membranous nephropathy 2 days 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...

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RE: rituxan and Obinutuzumab 2 days 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...

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RE: Case Of Progressive ckd / HTN 2 days ago

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

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RE: Case Of Progressive ckd / HTN 2 days 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 ----------------------------...

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RE: rituxan and Obinutuzumab 2 days ago

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

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RE: to pulse or not to pulse?? 2 days ago

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

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RE: rituxan and Obinutuzumab 2 days 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 ...

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