RE: Fibrillary GN with IgG lambda 4 hours ago

According to the consensus report by the IKMG published this past year, certain monotypic forms of fibrillary GN are considered to be MGRS. @Nelson...

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RE: Rituximab in class 3/4 lupus nephritis 4 hours ago

Yes we need biopsy data to opine on reinduction. 3 grams isnt that much really and if this were potentially reversible I would probably give anothe...

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RE: Medical Nephrectomy 4 hours ago

Does this patient have primary  hyperoxalosis?  Is this something you would consider evaluating her for? https://datastudio.google.com/s/sTjnyUVB8l...

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RE: Fibrillary GN with IgG lambda 6 hours ago

Monotypism of L chains is very uncommon in DNAJB9 Fibrillary GN, so I would surmise that except for the very rare heavy chain Fibrillary GN, this c...

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RE: Medical Nephrectomy 7 hours ago

Although I cannot imagine esrd from primary hyperoxaluria doing this well for 2 years on HD without developing oxalosis, but the story otherwise so...

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RE: Medical Nephrectomy 8 hours ago

Although I can’t recall facing the precise problem, I would not think that a medical nephrectomy would be a good solution, and might even make it w...

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Medical Nephrectomy 8 hours ago

60 years old woman, ESRD secondary to longstanding Nephrolithiasis/Calcium oxalate  which she had since adolescence. Hemodialysis dependent since 2...

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RE: PD In Patients Who Make Up Their Weights 12 hours ago

I have had rare patients on HD who lied about their dry weight, because they wanted the nurses to take off more fluid. ----------------------------...

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RE: Fibrillary GN with IgG lambda 13 hours ago

Thank you for the clarification. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Fibrillary GN with IgG lambda 13 hours ago

Yes I think so, keeping in mind that many cases of what appear to be "monoclonal fibrillary" by routine IF are not monoclonal on pronase IF (all of...

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RE: PD In Patients Who Make Up Their Weights 13 hours ago

I have a care conference scheduled with her next week. Despite her living with her parents, her mother is not very supportive with her diagnosis/di...

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RE: Rituximab in class 3/4 lupus nephritis 13 hours ago

Extent of glomerulosclerosis, IF-TA and chronic occlusive arteriopathy in biopsy will be key to determining renal prognosis? BP control? ----------...

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RE: Fibrillary GN with IgG lambda 13 hours ago

@Lynn Cornell  Thank you Lynn. Yes I was aware of that case and I discussed it in the past with Nelson. So my current interpretation of the DNAJB9 ...

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RE: Rituximab in class 3/4 lupus nephritis 16 hours ago

It sounds suspicious for non-compliance with the MMF maintenance regimen. Did the patient have a complete or partial remission with IV CYC? How lon...

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RE: Fibrillary GN with IgG lambda 13 hours ago

We have observed only one kind of fibrillary GN that does not stain for DNAJB9- that is fibrillary GN with monoclonal heavy chain staining by IF.  ...

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RE: Rituximab in class 3/4 lupus nephritis 13 hours ago

Requiring dialysis every 3-4th day as no urine output. Previous cyclophosphamide dose around 5gm.. Don't hav d complete biopsy report.. Just d di...

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RE: Potential kidney donor w parathyroid adenoma 13 hours ago

I think the real message to the original post- is any potential donor who has an abnormality but otherwise a “good “ candidate needs a careful eval...

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RE: Fibrillary GN with IgG lambda 13 hours ago

TYPO! MGRS not MFRS ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Fibrillary GN with IgG lambda 13 hours ago

@Lynn Cornell @Nelson Leung Please clarify the following for me: Do all primary fibrillary GNs stain for DNAJB9 while the fibrillary MFRS ones don'...

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RE: Rituximab in class 3/4 lupus nephritis 14 hours ago

I agree with Dr. Glassock that this is very suspicious for non-compliance.  Also, we haven't heard anything about the corticosteroid dosing.​ -----...

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RE: Fibrillary GN with IgG lambda 14 hours ago

I agree with Dr. Leung. We have seen that by pronase IF, many of these "monoclonal" fibrillary cases by routine IF on frozen tissue are actually po...

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RE: Fibrillary GN with IgG lambda 15 hours ago

I would definitely have DNAJB9 stain performed.  We have a new paper coming that show MGRS associated fibrillary is exceeding rare.  Also, pronase ...

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RE: Rituximab in class 3/4 lupus nephritis 16 hours ago

Pt dialysis dependent? Can you post the biopsy report without patient identifiers. Sounds like there are two issues here, induction regimen minimiz...

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Rituximab in class 3/4 lupus nephritis 17 hours ago

22 yr female - diagnosed case of lupus nephritis class 3/4(biopsy proven) went into remission with cyclophosphamide (nih protocol) and started on m...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

I think you are all being very considerate. Im very skeptical. I would cut a deal with her and until she can go to HD with no shenanigans, for say ...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

In addition to time-limited PD trial, do you have the capacity for assisted PD (as close to supervised as you’ll get in home setting without coinha...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

This is a tricky one. As an adult she should have some autonomy in decision-making, so her desire to try PD is difficult to overrule. She has a PD ...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

Thanks a lot Dr Glassock for your details about management that's exactly what I did with my patient and get good results and till now continue on ...

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RE: Fibrillary GN with IgG lambda 1 day ago

Mayo Clinic is using rituximab and presented a poster of 11 patients who received it:  https://datastudio.google.com/s/tLPA3pe6jY8 ----------------...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

Dr. Krediet's plan has many merits. Many thanks. -- Dick Glassock Please note and save my new email address: rjglassock@gmail.com

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RE: PD In Patients Who Make Up Their Weights 1 day ago

​I think patient motivation is a strong predictor for sucessful PD. This is certainly not an easy patient because of her obsession with her body we...

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RE: another membranous case :( 1 day ago

Thanks again everyone Both of his biopsies stained equally for kappa and lambda, and strongly positive for PLA2R with IgG4 subclass. There is no ev...

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RE: Fibrillary GN with IgG lambda 1 day ago

Thank you Dr Desai and Dr Glassock. DNAJB9 staining was not reported on the biopsy results. From treatment perspective, Rituximab first and if no r...

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RE: Fibrillary GN with IgG lambda 1 day ago

This would be classified as a MGRS lesion, even if all efforts to find a clone are unrewarding. Many experts advise an initial treatment with anti-...

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RE: Fibrillary GN with IgG lambda 1 day ago

I'm not sure a search for a plasma cell clone is absolutely needed if the diagnosis of fibrillary GN is confirmed (with DNAJB9 staining). I'm sure ...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

The patient has been off steroids for some time and has been receiving rituximab. My approach has been to: 1. educate patients about risk for weigh...

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Fibrillary GN with IgG lambda 1 day ago

I would appreciate the input on the management of this 62 yr patient with h/o DM, HTN who was referred for proteinuria Pt was noted to have nephro...

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RE: another membranous case :( 1 day ago

This is an interesting case of MN, resistant to multiple drugs, as underlined by Pr. Glassock and others. A few questions: 1. Did you stain for IgG...

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RE: another membranous case :( 1 day ago

Yup, just a “pipe dream” for now. --------------------------------- Oded Friedman ---------------------------------

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RE: another membranous case :( 1 day ago

To my knowledge, immunoadsorption fir anti-PLA2R mediated MN is not clinically available yet (although research on this therapy is continuing ).PLE...

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RE: Daily dialysis in nursing home settings with ternal catheters 1 day ago

I am not aware of any such study, but I would presume that frequent catheter manipulation would increase the risk of infection merely because it is...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

In fact with hypotension attacks with HD may be difficult to be shifting her again for HD and she was young so long term dialysis may be better wit...

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RE: Potential kidney donor w parathyroid adenoma 1 day ago

Might be advisable to check 24-hr UCa/FECa re: PHPT vs FHH only after vitamin D repletion. --------------------------------- Oded Friedman --------...

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RE: Potential kidney donor w parathyroid adenoma 1 day ago

May I seek some clarification: The starting point of concern in this otherwise healthy potential donor is persistent hypercalcemia. With persistent...

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RE: another membranous case :( 1 day ago

Am curiously awaiting more evidence for immunoadsorption; compared to PLEX (although I’ll admit I have no personal experience with PLEX-treated MN)...

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RE: another membranous case :( 1 day ago

thanks Dr. Glassock for this reference. this is a very interesting proposition Plex and anti-CD 20 they seem to prefer to do the the plex after the...

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RE: PD In Patients Who Make Up Their Weights 1 day ago

It us so difficult to “deny” or even dissuade a pt from PD. They “all” think they can still lose weight but with the sugar load it is very unusual ...

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RE: Potential kidney donor w parathyroid adenoma 1 day ago

Like Dr Lucca said, these is not uncommon, and at least in two case of donor with light hypercalcemia  and positive sestamibi  we discard donation ...

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RE: another membranous case :( 1 day ago

See Podesta MA, et al. Nephron 2020;144:30-35 for a study of PLEX + Ofatumumab in Resistant PLA2R MN. Sent from my iPad

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RE: Potential kidney donor w parathyroid adenoma 1 day ago

Thanks for sharing your valuable advice. It looks like caution is advisable and additional studies needed to confirm PHPTH before an operation. Sen...

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