RE: Cystine stone and penicillamine 1 hour ago

we have seen NELL 1 MGN from alpha lipoid acid a couple times in our biopsy conference what does proteinuria do to supersaturation of various po...

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RE: Nephroic syndrom with hypotension 1 hour ago

dsDNA is negative. I discussed the possibility of Lupus nephritis class V with the pathologist, absence of full house deposition and particula...

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RE: Iptacopan For IC- MPGN 2 hours ago

Dr. Glassock , while histologically , i do agree , that under the present classification , this case cannot be C3G This is primarily due to a " F...

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RE: Nephroic syndrom with hypotension 2 hours ago

Wouldn't the combination of positive 1) anti PLA2R by IF, 2) absence of mesangial/sebendothelial deposits, 3) absence of C1q be vanishingly rare in...

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RE: Cystine stone and penicillamine 3 hours ago

One other point about ALA, to keep Dr. Glassock engaged, it's been reported to be associated with NELL1 membranous nephropathy! Is that more or les...

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RE: Cystine stone and penicillamine 3 hours ago

Dr Crivelli brings up alpha lipoic acid. I'm not sure what to do about this drug as of this moment. The initial report using a KO mouse with cystin...

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RE: SLE : treatment options 3 hours ago

@ Dr. Glassock: you mentioned that IC- MPGN , as in this patient is a disease of the classic pathway. However, his complement profile with low C3 ...

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RE: Cystine stone and penicillamine 5 hours ago

There is some preliminary evidence that alpha lipoic acid (ALA) may help. This is an interesting RCT which showed a decrease in stone burden in the...

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RE: Nephroic syndrom with hypotension 5 hours ago

Could this be Class V LN. Possibly, but positive PLA2R antigen would not be common. The IHC looks very strong for PLA2R. The IgG4 staining would be...

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RE: Proteinuria/Hematuria without kidney biopsy 5 hours ago

Just wanted to give an update on this patient. Biopsy was finally done the following week after we started him on steroids. It showed: Pathologic...

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RE: Nephroic syndrom with hypotension 6 hours ago

Double antibody in MN is very rare, but possible. What is the anti-dsDNA and other SLE serology.? Do you have the capacity to do LD/MS on the biops...

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RE: Nephroic syndrom with hypotension 7 hours ago

Besides the sink and possibilty of clinical remission coming soon... Is it possible she could have another antibody... Such as THSD7A simultaneousl...

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RE: Nephroic syndrom with hypotension 11 hours ago

ANA was positive . I mentioned negative in the first post , sorry ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai ---...

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RE: Nephroic syndrom with hypotension 11 hours ago

Clinical history 58 year-old female, previously healthy, presenting with nephrotic syndrome. Proteinuria 9 g/day. Serology is positive for ANA. ...

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RE: Nephroic syndrom with hypotension 11 hours ago

------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai ------------------------------

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RE: Cystine stone and penicillamine 16 hours ago

Hi Amy, I hope you're doing well! Thank you so much for sharing the attached cystinuria dietary tips and your comment! --------------------------...

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RE: SLE : treatment options 16 hours ago

@Hormaz Dastoor, it is possible that the original VUS may have been resolved into a benign variant and so not mentioned in the second report. But d...

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RE: Cystine stone and penicillamine 17 hours ago

Hi Jinwook! Hope all is well in Louisville. I have nothing to add from what Drs. Goldfarb and Asplin (the real experts) mentioned. I do have one wo...

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RE: 52 year old male with class V LN 18 hours ago

Sorry My mistake !8 gm is correct Sent from my iPhone

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RE: 52 year old male with class V LN 18 hours ago

Probably an error when preparing the Table!!. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------...

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RE: Is this extra renal ANCA vasculitis? Switch from ritux to cyc? 18 hours ago

Thanks so much for your thoughts! On DC his creat was trending down (albeit slowly) and his rash disappeared after 1 day. He had staph epidermidis ...

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RE: Cystine stone and penicillamine 19 hours ago

Drs. Goldfarb and Asplin. I thought that Captopril therapy reduced Cystine excretion rate via a systemic action, not stone formation by a chelation...

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RE: Cystine stone and penicillamine 21 hours ago

Dr. Goldfarb, Thank you so much for sharing your valuable experience and insights! ------------------------------ Jinwook Park MD Assistant Profe...

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RE: 52 year old male with class V LN 21 hours ago

8 June : 8 grams on 24 hour , random uACR 112!!!!! Serum albumin 38 Not sure how to interpret these labs --------------------------------- Dr. Ho...

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RE: Cystine stone and penicillamine 22 hours ago

Jinwook, Her cystine excretion is what I would call "average", i.e. 1gm. A conventional calculation would be that she needs 4L of urine to get t...

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RE: SLE : treatment options 22 hours ago

Also just wanted to highlight few variations in his genetic studies . His genetics done at Biogenix Germany revealed VUS in CFHR1 and 3 in 2024 R...

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RE: SLE : treatment options 22 hours ago

Sorry, was away on a short trip without internet . In the question regarding low AH50, it was low before the start of treatment . It refers to co...

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RE: Cystine stone and penicillamine 22 hours ago

Dear Dr. Glassock, Dr. Rodby, Dr. Goldfarb, and Dr. Asplin, Thank you so much for sharing your input. The following are the cystine excretion val...

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RE: Cystine stone and penicillamine 22 hours ago

I defer to the better judgement and vastly greater experience of Drs. Goldfarb and Asplin in this case. ------------------------------ Richard Gl...

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RE: SLE : treatment options 22 hours ago

Thanks prof glassock and dr balan. @ dr balan copy of number of variants ? What would it tell you ? Appreciate input Bw Belal ------------------...

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RE: Cystine stone and penicillamine 23 hours ago

I agree with David Goldfarb's comments, but also want to know what was her cystine excretion on her 24 hr urine? Knowing how much cystine she excre...

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RE: Cystine stone and penicillamine 23 hours ago

Jinwook, I would definitely start d-pen. Yes, there are some associated AEs, and nephrotic syndrome is not a good thing. But it resolves with stopp...

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RE: Cystine stone and penicillamine 1 day ago

@David Goldfarb @John Asplin @Amy Yau ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Neph...

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RE: SLE : treatment options 1 day ago

All very good points, Dr. Balan. Many thanks. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------...

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RE: Cystine stone and penicillamine 1 day ago

Penicillamine therapy for Cystinuria is associated with adverse events, some serious, requiring discontinuation in 50-60% of patients so treated. W...

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Cystine stone and penicillamine 1 day ago

Female patient in her 20s with recurrent cystine stone requiring urologic intervention approximately three times per year. She expresses significan...

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RE: 52 year old male with class V LN 1 day ago

A GLP1RA sounds like a good idea. With the abnormal eGFR I would try to avoid aCNI. Opinion only. ------------------------------ Richard Glassoc...

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RE: SLE : treatment options 1 day ago

I think the genetic link in this case is quite tenuous. For one the CFHR variant described is very common in the general population, even the varie...

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RE: 52 year old male with class V LN 1 day ago

I have been a bit tied up. Have attached a PDF with recent progress. Clinical relapse after reducing MMF within 2 weeks in June. Responding to incr...

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RE: Nephroic syndrom with hypotension 1 day ago

Age, low albumin, low bp, anemia, high ESR although v nonspecific but still count as manifestations of cancer. Here is a case report of PLA2R po...

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RE: SLE and chronic b/l HN w proteinuria. MN? Biopsy? 1 day ago

I'd be also concerned about the coexistence of IgG4 disease (bilateral hydro) and SLE, see https://pmc.ncbi.nlm.nih.gov/articles/PMC6643167/ ...

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RE: Nephroic syndrom with hypotension 1 day ago

Dr Glassock, if you found only intramembranous deposits I could totally see the argument to watch. No circulating pla2r and no new epimembraonous...

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RE: Nephroic syndrom with hypotension 1 day ago

Dr. Jebur- Please let us know what you decided to do in thus case and what were the outcomes? If you have an EM report of the kidney biopsy (d...

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RE: Iptacopan For IC- MPGN 1 day ago

This case cannot be C3G. Too much C1q staining and equal C3 and IgG staining . EM rules out DDD Increased C5b-C9 or C3NeF are not specific for C3G....

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RE: Nephroic syndrom with hypotension 1 day ago

None of these manifestations of cancer were present in the case posted to this site. Which of the followers of this Forum would undertake a specifi...

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RE: Is this extra renal ANCA vasculitis? Switch from ritux to cyc? 1 day ago

The new AFib and resistant anemia/pancytopenia are better explained by comorbidities (HTN/CKD, early MDS) rather than extra-renal vasculitis; only ...

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RE: Nephroic syndrom with hypotension 1 day ago

Well generally , there can be Mets to adrenal causing AI, hepatologic or ovarian CA, myeloma causing amyloid, and even tumor burden itself can lead...

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RE: Iptacopan For IC- MPGN 1 day ago

@dr hormaz did the biopsy show c3 staining ? Complements normal ? If you have c 3 nephritic does it not become c3 gn? ( if you can’t find c3 neph...

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RE: Nephroic syndrom with hypotension 1 day ago

She has orthostatic hypotension , I forget to mention ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai ---------------...

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RE: Nephroic syndrom with hypotension 1 day ago

Low blood pressure can occur in cancer patients and it can be caused by dehydration, anemia, some chemotherapies, cardiomyopathy, autonomic nervous...

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