RE: Diffuse Scleroderma And Thrombotic Microangiopathy 1 minutes ago

Since this us not SRC I do not think that it will make no difference if you use ACEi or ARB for BP control. I agree with stopping MMF. I would avoi...

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RE: Diffuse Scleroderma And Thrombotic Microangiopathy 50 minutes ago

Thanks Dr Glasock Will discuss with Rheumatology and will proceed with Rituximab especially also symptomatic Myositis So will stop Cellcept Any r...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 4 hours ago

Below is a small study that showed value of repeat biopsy relapsing MN and that in absence of fresh deposits can be treated with conservative thera...

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RE: MMF/Myfortic/cyclosprin/proton Pump Inhibitor 8 hours ago

PPI interfere with GI absorption of Mycophenolic acid (MMF and MPA. They have no effects on Mycophinale metabolism. PPI Lower the acheuvement of th...

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RE: High dose Rosuvastatin and non glomerular proteinuria 8 hours ago

Tubular damage is increased in patients receding high -dose Rosuvastatin. ------------------------------ Richard Glassock MD, FASN Laguna Woods ...

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RE: Diffuse Scleroderma And Thrombotic Microangiopathy 9 hours ago

With a normal serum creatinine this is not SRC, but rather renal limited TMA in the presence of Scleroderma-overlap syndrome Type. Treatment is not...

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RE: Would you give empiric rituxan for pulmonary renal syndrome? PLEX not available 9 hours ago

Yes- this is highly likely to be RPGN and DAH due to anti-TNF biologics (Golimumab). High dose IV and oral steroids and RTX are empirically justifi...

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Would you give empiric rituxan for pulmonary renal syndrome? PLEX not available 10 hours ago

Hi all, looking for insight on my very sick patient. In short I suspect pulmonary renal syndrome. Earliest a kidney biopsy would be able to be done...

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RE: follow up case 11 hours ago

Maybe try OBI then. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: follow up case 12 hours ago

Thank you. He had Rituximab in late January. ------------------------------ M Kaisar Nephrologist Brisbane ------------------------------

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RE: Light chain deposition disease in transplant kidney allograft 12 hours ago

She has been referred to hematology/oncology and further investigations are pending. ------------------------------ Pongstorn Pitiranggon MD Pee ...

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Diffuse Scleroderma And Thrombotic Microangiopathy 13 hours ago

Thanks and would appreciate help from the expert on this 31-year-old married Caucasian female with no smoking alcohol or drug abuse. history of R...

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RE: follow up case 13 hours ago

The course is most consistent with Primary diffuse Podocytopathy (MCD/ FSGS) resistant to steroids and CNI. I suppose you could try RTX or Obinutuz...

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follow up case 13 hours ago

Good morning, Apologies for all the detail. I would be grateful for feedback regarding this case. The original posting is as below from June l...

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RE: Mpo Vasculitis Case 14 hours ago

What medications are being used for treatment of hypertension. This might be a hydralazine induced positive MPO. What does the IF and EM show? -...

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Mpo Vasculitis Case 16 hours ago

Dear all, Would like an opinion on this case 80 male bg HTN Presented with lethargy and tiredness Crp raised mpo 70(0-20) creatinine 0.84 urine ...

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RE: Light chain deposition disease in transplant kidney allograft 17 hours ago

Are you asking what to do regarding the LCDD or C4d? The good news is that dara VD should take care of both assuming that this is a plasma cell clo...

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RE: High dose Rosuvastatin and non glomerular proteinuria 18 hours ago

Thanks Dr Rodby very helpful If no tubular damage then why increasing incidence of microhematuria and renal failure Thanks ---------------------...

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RE: Light chain deposition disease in transplant kidney allograft 19 hours ago

Transplanted kidneys are still kidneys and such a case is a great reminder of that. I would follow the same workup we do for a patient without tr...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 20 hours ago

I truly believe we are treating the PLA2R antibody, and that everything else will follow. One approach is to not even treat that, but to give An...

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RE: High dose Rosuvastatin and non glomerular proteinuria 22 hours ago

Rosuvastin increases tubular proteinuria , this is well established, but this is not tubular damage per se, it is blocking normally filtered normal...

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Using telenephrology and initiating new dialysis for urgent indication or otherwise 22 hours ago

I am assuming many of us do TeleNephrology for consultations in the hospitals especially in regional sites where we do not have in-person Nephrolog...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 22 hours ago

In my humble clinical practice with a patient with PLA2R +ve MN who achieve CR after 2 grams of RTX, I do the following: 1. Monitor serum creatinin...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 22 hours ago

Interesting discussion. I have the opportunity to repeat kidney biopsy in one case of MN. A 65-years-old woman with biopsy-proven MN at our center...

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MMF/Myfortic/cyclosprin/proton Pump Inhibitor 1 day ago

Question for Transplant experts Cyclosporine inhibits the enterohepatic recirculation of mycophenolic acid (MPA), the active metabolite of MMF, red...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Dr. Balan- how would (or could ) you distinguish a spontaneous remission from a "response" to RTX in these situations., without a randomized trial....

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High dose Rosuvastatin and non glomerular proteinuria 1 day ago

Have seen 3 pts with this last one year We’re on 40 mg with creatinine 1 EGFR 50 Improved after stopping or reducing the dose What is others exp...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

A reasonable approach , Dr, Nauman, but not one that has been validated for more favorable patient outcomes. by prospective trials . Some might arg...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

For patients in longterm remission, like a few I have been in remission for years, I do not measure ANtiPLA2R routinely, its just Urine PCR and che...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Dr. Balan- how would (or could ) you distinguish a spontaneous remission from a "response" to RTX in these situations., without a randomized trial....

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

((Relapse without rising antiPLA2R titers does happen. In fact the reference below has collected data in that and carefully documented rituximab re...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Yes in that instance I would agree with you. But imagine we have a biopsy proven membranous nephropathy with IC deposits and significant IFTA. Seru...

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RE: Light chain deposition disease in transplant kidney allograft 1 day ago

DSA is negative. Sorry for not mentioning that earlier. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (8...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 1 day ago

Does diet, including food coloring, and medication history indicate unusual intake. The recovery is against the diagnosis of lymphoma. Did the pati...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

With all due respect for your valuable opinion -my opinion differs. If the anti-PLA2R antibody was undetectable ([More]

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Speaking for myself, I do not see a need to rebiopsy. As I see it, persistent proteinuria could be due to three reasons. Incomplete remission, rela...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

I would not, in general, but the specific detaiils of individual cases (e.g. RPGN or AKI) might warrant a rebiopsy. It depends! -----------------...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Dr Glassock, please clarify:if " the immunologic sink phenomenon is usually quite transient, so that it can often be recognized by serial measureme...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

This is an interesting but very timely question. Membranous nephropathy, like other 'primary' nephrotic syndromes follows a different trajectory in...

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RE: Light chain deposition disease in transplant kidney allograft 1 day ago

C4d deposition can be a feature of LCDD in the kidneys, I do not think that this minimal finding necessarily indicates the concomitant presence of ...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

Dr. Hirsch. These phenomena are quite uncommon, so data that might answer your questions is scanty . However, the immunologic sink phenomenon is us...

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RE: Light chain deposition disease in transplant kidney allograft 2 days ago

Thank you for sharing this case . Seems that this is a case of denovo LCDD . However I would like to bring the attention of some findings in the bi...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

Dr Glassock, For the patient I described, do you suggest a repeat biopsy to distinguish "immunologic sink" (and need for yet more immunosuppression...

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RE: Light chain deposition disease in transplant kidney allograft 2 days ago

Thank you so much Dr. Glassock. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (843) 669-6694 -----------...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

These kind of patients are very uncommon, but have been described. A repeat kidney biopsy often shows extensive ( *? Irreversible) capillary wall c...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

There is phenomenon that I never understood well when a patients with PLA2R Membranous and in CR with negative PLA2R present with worsening protein...

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RE: Light chain deposition disease in transplant kidney allograft 2 days ago

We need to see the EM, Congo Red stain but this looks like de novo LCDD in a kidney allograft .An evaluation, involving complete blood cell count ,...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

Thanks Dr Hirsch. This is what make writing "Guidelines" and then applying them to individual patients so difficult. The more we know about "diseas...

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Light chain deposition disease in transplant kidney allograft 2 days ago

Seeking expert advice: This is a 55-year-old female with HTN, hyperlipidemia and ESRD due to IgA nephropathy and s/p DDKD in 2000 with good allog...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

In terms of "what is going on?", FWIW, I (n =1) have taken the PLA2R measurements seriously, based a lot on what I have learned from you guys in th...

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