RE: lupus mesangial class 2 with podocytopathy 3 hours ago

What does “moderately effaced” mean?. In Lupus Podocytopathy there is usually diffuse foot process effacement (> 80% ). What method was used for me...

View Discussion

lupus mesangial class 2 with podocytopathy 4 hours ago

62-year-old African American male history of SLE, COPD (mild) previous  latent TB (remote) serum creatinine is 0.6 mg/dL. Serum albumin is 3.3 g/d...

View Discussion

RE: Rituximab for maintenance in ANCA vasculitis 5 hours ago

I would give 1000mg RTX and a short course of oral steroids. Check the CD19 and antiMPO in 3 months. Opinion only. No repeat kidney biopsy needed. ...

View Discussion

RE: Rituximab for maintenance in ANCA vasculitis 7 hours ago

I had a similar patient, 63 y/o f diagnosed MPO vasculitis in Jan 2018 with pulmonary symptoms, Cr 2.7, MPO 224, treated with rituximab 600 mg week...

View Discussion

RE: membranous nephropathy 8 hours ago

Hi Dr Jha, I greatly appreciate your input and thank you, as you said its always new twist and turns in management, will keep you posted depending ...

View Discussion

Nephrology Quiz and Questionnaire KW21 9 hours ago

Your help is needed.  We need you to take the Nephrology Quiz and Questionnaire and try to outsmart the Nephrology Program Directors and the Nephro...

View Discussion

RE: C3gn ? 9 hours ago

If the genetic analysis were to reveal a pathogenic mutation, would you pursue any treatment, like steroids or MMF?If you have already decided not ...

View Discussion

RE: PLA2R Positive Membranous Nephropathy in elderly - To treat or not to treat 9 hours ago

I  am sorry to side track from the main issue. But i was struck with the recent diagnosis of hypothroidism in this elderly gentleman.  I have in my...

View Discussion

RE: C3gn ? 9 hours ago

I am not aware if he has any Greek ancestry I thought about genetic testing but I kind of have some hesitancy since he’s 80 years old and has moder...

View Discussion

RE: C3gn ? 10 hours ago

Does the patient happen to be of Greek-Cypriot ancestry? A mutation in CFHR5 needs to be considered as it is a cause of “C3GN” appearing in older s...

View Discussion

RE: C3gn ? 11 hours ago

Scr 2,5 stable Since Last yr No M spike Upep not done Complement levels notmal Kappa 72, lambda 38. Ratio 1.8 Thnx for the input ----------------...

View Discussion

RE: Addressed to Dr Glassock Age and CKD 12 hours ago

Dr. Reen— many thanks for your kind words and also for your many excellent contributions to the ASN Communities. Much appreciated. ---------------...

View Discussion

RE: Treatment of IgA Nephropathy 12 hours ago

The fish-oil therapy is likely not effective, but usually harmless. The best option would be to use optimized RASi + SGLT2i (Dapagliflozin), but ad...

View Discussion

RE: C3gn ? 14 hours ago

It's really a diagnosis of exclusion, which adds to its rare occurrence. Check out @Paresh Jadav tweetorial on C3GN (it's quite informative): http...

View Discussion

RE: Treatment of IgA Nephropathy 14 hours ago

Why would you not consider steroids in her again?? Your statement on Chinese patients implies , certain doubts you have on the validity of the stud...

View Discussion

RE: Treatment of IgA Nephropathy 14 hours ago

I'm glad you clarified the pregnancy status...I was like Dr. @Richard Glassock and thought she was currently pregnant! I'd agree with HCQ (even th...

View Discussion

RE: C3gn ? 15 hours ago

Tough case.  The findings are very suggestive of C3GN, of a very advanced nature.  Prinary C3GN is exceedingly uncommon in the very elderly, so an ...

View Discussion

RE: Treatment of IgA Nephropathy 15 hours ago

She was pregnant in 2020, she is currently not pregnant , at that time she had PCR of 5 g/g , subsequent to this her PCR is down to 2.5 g/g on low ...

View Discussion

RE: C3gn ? 15 hours ago

Numerous mesangial electron dense deposits Moderate foot process effacement Severe BM thickening No esonophilia or signs of atheroemboli ------...

View Discussion

RE: Treatment of IgA Nephropathy 15 hours ago

Please clarify the Pregnancy issue.  Is the patient currently pregnant and if so what is her stage of gestation? Many agents, including RASi, are c...

View Discussion

Treatment of IgA Nephropathy 19 hours ago

Will be seeing a 25 year old patient next week, for a second opinion Seems she was diagnosed with IgA nephropathy in 2018 , with 3-5 grams/day of p...

View Discussion

RE: membranous nephropathy 20 hours ago

Thanks for sharing the informations further. I was mistaken that your first patient had two biopsies.  I would believe that stable 4-5 gm of prot...

View Discussion

RE: C3gn ? 22 hours ago

Has atheromatous emboli been excluded? Is any eosinophilia present? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Da...

View Discussion

RE: C3gn ? 22 hours ago

What does the EM show? ------------------------------ Richard Glassock MD, FASN Emeritus Professor David Geffen School of Medicine at UCLA Laguna ...

View Discussion

C3gn ? 1 day ago

Would u treat this as c3GN ?! neg workup for gammopathies no recent major infectious etiologirs ------------------------------ Ramez Sunna MD ...

View Discussion

RE: membranous nephropathy 1 day ago

pt only had one biopsy not two. i only met 65 yo aa male pt twice once at initial office and wanted to biopsy give his chronic proteinuria in nephr...

View Discussion

RE: Addressed to Dr Glassock Age and CKD 1 day ago

I have learnt lot from Dr Glassock over the years I am always touched by his humility and down to earth personality A great teacher but above all ...

View Discussion

RE: PLA2R Positive Membranous Nephropathy in elderly - To treat or not to treat 1 day ago

"given elderly age and association of malignancy with MGN, should there be screening for cancer before starting immunosuppressive treatment?" This...

View Discussion

RE: membranous nephropathy 1 day ago

It may be useful to compare the first and 2nd biopsy.  Patient had chronic PLA2R positive MN with insignificant serum ANTI- PLA2R who did not recei...

View Discussion

RE: PLA2R Positive Membranous Nephropathy in elderly - To treat or not to treat 1 day ago

Rituximab would take months before it shows any effect. Would such an elderly patient be able to tolerate such severe nephrotic syndrome for >6 mon...

View Discussion

RE: Rituximab for maintenance in ANCA vasculitis 1 day ago

I think the point that Dr. Rodby is making, and I agree with him, that moderately severe MPO Vasculitis in Complete immunological and clinical remi...

View Discussion

RE: Rituximab for maintenance in ANCA vasculitis 1 day ago

In RITAZEREM they gave ritux 1 g q4 months (as opposed to azathioprine):  https://datastudio.google.com/s/pUcZ_u4icec I don't believe they fol...

View Discussion

RE: Primary Hyperoxaluria type -2 in hemodialysis 1 day ago

Sampath, I would also urge you to try some of the online crowdfunding by Milaap Ketto etc. I remember a child treated at Amritha Institute in Kochi...

View Discussion

RE: Save the Date: Virtual Town Hall on Wednesday, October 20, 2021 1 day ago

This just a save-the-date.  Registration information will follow. Fellows and residents have not been invited to this Town Hall.  Perhaps a later ...

View Discussion

RE: Rituximab for maintenance in ANCA vasculitis 1 day ago

Many thanks Dr Rodby. For the trial they redose if CD19 OR ANCA reappeared. Nevertheless, I am inclined to monitor further just wanted to be sure s...

View Discussion

RE: Primary Hyperoxaluria type -2 in hemodialysis 1 day ago

Thanks Dr Satish for that encouraging information from my neighbouring state of Kerala. Very helpful and insightful inputs from the Forum. I will k...

View Discussion

RE: Addressed to Dr Glassock Age and CKD 1 day ago

Many thanks Dr. Kesavan.  I am deeply humbled by your kind remarks.  Teaching and learning go together like two sides of the same coin.  I am very ...

View Discussion

Addressed to Dr Glassock Age and CKD 1 day ago

Most respected Dr Glassock Thoroughly enjoyed listening to your recent excellent discussion on Age CKD diagnosis I have used term Age Related fal...

View Discussion

RE: Primary Hyperoxaluria type -2 in hemodialysis 2 days ago

Regarding Type 2 hyperoxaluria based on the discussion here, it is clear that it is definitely worthwhile to perform a liver kidney transplant in t...

View Discussion

RE: Rituximab for maintenance in ANCA vasculitis 2 days ago

I think since this is MPO vasculitis (much less relapse the Pr3 vasculitis) , and the ANCA is negative, I would feel comfortable watching for now (...

View Discussion

Rituximab for maintenance in ANCA vasculitis 2 days ago

45 year old Caucasian woman diagnosed with pauci immune  MPO ANCA Vasculitis 9/2019 with peak creatinine 3.3 and UPC 3,917 mg/g. Induction therapy ...

View Discussion

RE: Post transplant: Clotted AV fistulas, 2 days ago

I agree wit Dr. Glassock. Double bind problem of minimizing risk from flow induced LVH vs likelihood of needing an AVF in the future if kidney gra...

View Discussion

RE: Post transplant: Clotted AV fistulas, 2 days ago

This is the kind of issue (among many) that I do not foresee any guidelines being created anytime soon. Opinion based guidelines are not very helpf...

View Discussion

RE: PLA2R Positive Membranous Nephropathy in elderly - To treat or not to treat 2 days ago

It depends on the nature of the target antigen.  A thorough evaluation for underlying malignancy is "mandatory" in PLA2R negative, NELL1 + or THSD7...

View Discussion

RE: Post transplant: Clotted AV fistulas, 2 days ago

I used to not pay much attention to patent AVFs in my successful transplant patients and would ligate them mostly upon patient request after severa...

View Discussion

RE: Primary Hyperoxaluria type -2 in hemodialysis 2 days ago

We still do not know if partial liver transplantation from a heterozygous living donor will be effective in Primary Hyperoxaluria   Type 2 or wheth...

View Discussion

RE: PLA2R Positive Membranous Nephropathy in elderly - To treat or not to treat 2 days ago

given elderly age and association of malignancy with MGN, should there be screening for cancer before starting immunosuppressive treatment? ------...

View Discussion

RE: Save the Date: Virtual Town Hall on Wednesday, October 20, 2021 2 days ago

Where do we register for this? Also, will there be fellows representing and perhaps a few residents?Their input will be most valuable over oursKena...

View Discussion

RE: membranous nephropathy 3 days ago

@Agnes Fogo can you take a look at the EMs earlier in this thread and opine on the chronicity. The clinical story is that of chronic MGN but the ...

View Discussion

RE: Primary Hyperoxaluria type -2 in hemodialysis 3 days ago

@David Goldfarb "Amazing case Roger. What I find surprising is what seems like early development of oxalosis, i.e. soon after development of kidne...

View Discussion