RE: Full house with negative serolgy 8 hours ago

Thanks so much Dr Glassock for the variable responses ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Full house with negative serolgy 8 hours ago

Thank you so much Dr Zuckerman that was very insightful. ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Full house with negative serolgy 8 hours ago

Dr. Zuckerman- great response. A good reason for discussants to be cautious regarding interpretation of kidney biopsy reports submitted as part of ...

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RE: Full house with negative serolgy 10 hours ago

I don't have any direct experience with IHC for day to day clinical biopsies. These sorts of issues are also lab depended. So if weak C1q staining ...

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RE: Full house with negative serolgy 10 hours ago

Based on the description of the report only it is difficult for me to come to a specific diagnosis as there may be other features in the biopsy not...

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RE: Please help with a case of IGA nephropathy 10 hours ago

I agree with you 100% , I am not sure if AI condenses and presents all the available literature , or is making it's own biased assumptions . -...

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RE: Please help with a case of IGA nephropathy 11 hours ago

Very interesting AI consult. Did your electronic consultant take into account the findings if the TESTING trial (with respect to biopsy lesions? If...

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RE: Full house with negative serolgy 11 hours ago

Thanks Dr Zuckerman, I just want to say that this is on immunohistochemistry and not immunofluorescence, would it is still be as sensitive in detec...

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RE: Full house with negative serolgy 11 hours ago

Thanks Dr Glassock. I will ask the pathologist is this is possible ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Interesting GN case 11 hours ago

Dr.Dastoor- look at the description of the patient eligibility for the PEXIVAS trial (NEJM)- the largest trial ever conducted concerning treatment ...

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RE: Full house with negative serolgy 11 hours ago

Thanks Dr. Zuckerman. Based on the findings described in the Pathology Report, is sufficient evidence available to make a "diagnosis" rather than a...

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RE: Interesting GN case 12 hours ago

Is a positive ANCA enough to diagnose the patient as an ANCA vasculitis of the kidney ( MPO MPA Anca vasculitis) The biopsy seems more like FSGS......

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RE: Please help with a case of IGA nephropathy 12 hours ago

@Richard Glassock yes you are right about the low Kappa for E lesions . However these lesions are the earliest responders to therapy as well. It wo...

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RE: Full house with negative serolgy 12 hours ago

yes, I think KM55 staining here would be helpful, a strong positive staining would favor IgAN. However, there are report of LN cases with KM55 posi...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 13 hours ago

The major known risk with using complement inhibitors is for encapsulated bacteria. So vaccination is recommended against meningococcal, pneumococc...

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RE: Please help with a case of IGA nephropathy 14 hours ago

The E lesion has the worst inter observer reproducibility among the MEST-C scores (Kappa about O.45) so i would not attach too much significance to...

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RE: Please help with a case of IGA nephropathy 14 hours ago

She has C1 on both biopsy. I think its significantly indicative of active IgA nephropathy, particularly where E was 0 in the second biopsy. Dose th...

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RE: Interesting GN case 14 hours ago

Interesting points. I think this patient would have met the entry criteria for the PEXIVAS trial of ANCA vasculitis without a kidney biopsy. ----...

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RE: Please help with a case of IGA nephropathy 15 hours ago

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

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RE: Interesting GN case 15 hours ago

I think having a proper biopsy is imperative in this context. Creatinine is only 1.2 and last one is 1.4 which is better than previous readings as ...

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RE: Please help with a case of IGA nephropathy 15 hours ago

Since she has active IgA Nephropathy, and u plan to start her on Lisinopril, then why not increase steroids to control her disease . Once she has c...

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Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 15 hours ago

27-year-old male with CKD stage 3a (baseline Cr 1.7 mg/dL stable ×1.5 years) and HTN ×3 years (controlled on losartan 100 mg daily by PCP) but no w...

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RE: Full house with negative serolgy 17 hours ago

With a non-specific nephritic-nephrotic presentation, lack of systemic features and a pattern of injury finding by kidney biopsy we fo not have a d...

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RE: Full house with negative serolgy 19 hours ago

Seems it is a Non Lupus " Full House Pattern" with low specificity for Lupus Nephritis on biopsy. The Differential could include 1. IgA nephropat...

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RE: Full house with negative serolgy 20 hours ago

To any renal pathologist- would KN55 stains (gdIgA) be indicated here? Dr. Zuckerman? Dr. Fogo? Dr. Caza? Dr. Haas? -----------------------------...

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RE: Full house with negative serolgy 20 hours ago

Non-diagnostic Biopsy. So far. Hard to categorize as a non-lupus full house nephropathy with such weak IgM and C1q stains. Can you do a"rescue"?EM ...

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RE: Full house with negative serolgy 20 hours ago

IgA antibody deposition is dominant or co-dominant, its non proliferative GN, Nephrotic syndrome is difficult to explain by the current findings on...

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RE: Full house with negative serolgy 22 hours ago

Be sure to stain the biopsy for DNAJB9 (Fibrillary GN ) and for IgG subclasses (MGRS with masked LC monotypism ). What are serum FLC values? ----...

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RE: Interesting GN case 22 hours ago

Just an opinion- I think you have enough information to pull the RTX -trigger now, rather than waiting -but it is a judgement call. -------------...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 23 hours ago

@Anuja Java So , just to summarize infection prophylaxis ... What would be the recommedned prophylaxis with : 1. High dose steroids ie Prednisolon...

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RE: Interesting GN case 1 day ago

I agree - the RA could have been a missed ANCA vasculitis diagnosis. I have her on Prednisone 60 mg/d while awaiting the final biopsy results....

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RE: Interesting GN case 1 day ago

She is not. ------------------------------ Daniele Rios Leite MD University of Florida Jacksonville FL (864) 448-4781 ---------------------------...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 1 day ago

Dear Dr Chandran, Thank you very much for your thoughtful comments and for highlighting these important considerations. Apart from an intermittent...

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RE: Please help with a case of IGA nephropathy 1 day ago

It has been a while since I got a complete UA. Last UA showed rbc of 1-5. I am repeating UA soon so will update as i get that. Also there is a stro...

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Full house with negative serolgy 1 day ago

Hi all, I would appreciate your input on this patient. 32M with no past medical history, presented with nephrotic syndrome UPC 4500 mg/g, UACR 3...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 1 day ago

Thanks Dr. Rodby! Good to know. ------------------------------ Anuja Java, MD (pronouns: she/her/hers) Associate Professor of Medicine Director,...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 1 day ago

You can always go back and edit a post ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology ...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

"Would you attempt to assess central Aortic mean pressure, by non-invasive means, before beginning antihypertensive therapy in this patient with a ...

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RE: Interesting GN case 1 day ago

Her seronegative RA could have been MPA all along. 6 gloms is not enough to comfortably rule out a FOCAL, segmental necrotizing lesion, and that ...

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RE: Interesting GN case 1 day ago

Be sure the patient is not on hydralazine . ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------...

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RE: Interesting GN case 1 day ago

Based on the information available. I would treat with RTX and steroids, but no PLEX unless anti-GBM positive or linear IgG when IF returns (unlike...

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RE: Interesting GN case 1 day ago

Unfortunately I couldn't spin her urine. ------------------------------ Daniele Rios Leite MD University of Florida Jacksonville FL (864) 448-478...

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RE: Interesting GN case 1 day ago

Tough case- 60 year okd with hematuria. Proteinuria without hypoalbuminemua, decline in eGFR, strongly positive anti-MPO , no anti-GBM antibody don...

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RE: Please help with a case of IGA nephropathy 1 day ago

The presence of an E1 lesion did not predict the response to steroids in the TESTiNG trial so I don't agree with your statement about the E lesion ...

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Interesting GN case 1 day ago

This is a 60 yo F with PMH of HTN (since around 2024, well controlled), sero-negative RA (previously on MTX, now on HCQ only), pre-DM. Family h/o G...

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RE: Please help with a case of IGA nephropathy 1 day ago

I am not sure that another round of IS therapy, will induce remission in the patient . The E lesion , as of endothelial proliferation , is the mos...

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RE: Pseudohypertension or true uncontrolled HTN 1 day ago

Another concern is what happens to DBP when isolated Systolic Hypertension is treated. The critical value of 60-70mmHg for MAP can be breached. (MA...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 2 days ago

Thanks Dr. Java for highlighting this very important clinical question. I fully understand the uncertainties that exist today and I am greatly enco...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 2 days ago

"Errare humanum est" Thank you for your prompt response Dr. Java. It exemplifies, once again, that we have only uncover the tip of the iceberg an...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 2 days ago

Apologies for misspelling Dr. Rubin's name. I find it sloppy when people misspell names. I am so embarrassed I did this. SO SORRY!! -------------...

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