RE: HSP with heavy proteinuria 3 minutes ago

would continue therapy as responding to present therapy. no need to re-biopsy ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] ...

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HSP with heavy proteinuria 2 hours ago

Appreciate any input on a case of HSP with unusually heavy proteinuria 42 year-old woman with no medical history barring hypothyroidism, presente...

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RE: SLE Lupus nephritis Class V 3 hours ago

If EXT I/II +, I may sit tight and monitor as it pertains to good prognosis. I will try to obtain the actual EM image. --------------------------...

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RE: SLE Lupus nephritis Class V 3 hours ago

Interesting idea. No data. No clinical trials to support use. Will endothelin blockers be effective for FGGS. I don't know, but I doubt it. -----...

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RE: SLE Lupus nephritis Class V 3 hours ago

Any role for off label use of Endothelin blockers to reduce proteinuira, if primarily driven by sclerosis --------------------------------- Dr. H...

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RE: SLE Lupus nephritis Class V 3 hours ago

How does a positive versus a negative EXT I/II change the approach in this type of patients? Has renal vein thrombosis been excluded in this pati...

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RE: SLE Lupus nephritis Class V 6 hours ago

Thanks- would it be possible to post a deidentified photo micrograph of a representative glomerulus by EM?I am particularly interested in the degre...

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RE: SLE Lupus nephritis Class V 7 hours ago

EM: Numerous subepithelial and intramembranous electron-dense deposits along the BM. GBM are variably thickened. No subendothelial deposit. Scatter...

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RE: SLE Lupus nephritis Class V 20 hours ago

Yes- non Class V active LN is often treated with triple IS, but the 2024 KDIGO CPG did not suggest IS therapy for "pure" Class V Lupus Membranous N...

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RE: SLE Lupus nephritis Class V 20 hours ago

Thanks Dr. Dastoor- in the USA OBI is not approved for "inactive " LN. It might be easier to start with RTX. Not true in UAE. -------------------...

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RE: SLE Lupus nephritis Class V 20 hours ago

I think it may be best to try and go for Obi over RTX. If the patient does not respond to RTX , as it seems he won't , you will be second guessing ...

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RE: SLE Lupus nephritis Class V 20 hours ago

Thanks dr Kuo Makes sense to stop volclosporin as has not worked also Ifta as you mention Make sense not to use belimumab as has not worked / o...

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RE: SLE Lupus nephritis Class V 20 hours ago

Thanks prof glassock For class 3/4 in my unit I notice people using dual therapy ( mmf +obi or mmf + volclo) with steroids and hydroxychlorquine an...

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RE: SLE Lupus nephritis Class V 21 hours ago

Tough question- it depends- For non-nephrotic "pure" Class V LN-MMF + low dose steroids or a CNI +iow dose steroids or RTX and no steroids, But nev...

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RE: SLE Lupus nephritis Class V 21 hours ago

Since OBI is approved by the FDA only for "active" LN and your patient has an Activity Index of zero (as expected for Pure Class V Lupus Membranous...

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RE: SLE Lupus nephritis Class V 23 hours ago

1. IF from 2025 still with “Full House”. I will update EM finding when I have the report in front of me again. 2. He developed or manifested LN whi...

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RE: SLE Lupus nephritis Class V 23 hours ago

Thanks prof glassock for input Non nephrotic our class v what would be your starting therapy ? And if things not improving let’s say 6 month to a...

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RE: SLE Lupus nephritis Class V 1 day ago

My goodness- triple therapy for non-nephrotic "pure" Class V Membranous Lupus Nephropathy. I do not think so. Other opinions welcome!! ----------...

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RE: SLE Lupus nephritis Class V 1 day ago

I think that Dr. Rodby's suggestions are very reasonable, but not "backed up" by "hard (RCT) evidence (yet). The % global sclerosis is about 2-3 x ...

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RE: SLE Lupus nephritis Class V 1 day ago

Was patient on mmf 1 g bd before Thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: SLE Lupus nephritis Class V 1 day ago

Thanks for case Why was volclosporin stopped? Was patient compliant ? Present mmf 1g bd was patient on this dose? Any worsening of extra renal s...

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

Yes prof glassock thanks . My question was on hypothesis pronase was negative and diagnosis as combination of rejection and idiopathic Mpgn And ...

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RE: MPO-ANCA Vasculitis 1 day ago

Thanks for case Creatinine improved Crp improved Urine acr stuck Urine dip active sediment Have you done any repeat lung imaging to see resolu...

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RE: MPO-ANCA Vasculitis 1 day ago

We have a large experience in completely withdrawing corticosteroids in kidney transplant recipients. Some patients develop severe myalgias/arthral...

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RE: SLE Lupus nephritis Class V 1 day ago

Since class-V LN developed when the patient was on Benlysta, I wondered if anti-CD20 therapy will be effective in this patient. However, my AI cons...

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RE: SLE Lupus nephritis Class V 1 day ago

He is on "MMF 1 g BID, losartan 100 mg, eplerenone 25 mg, and empaglifozin 10 mg." that is a lot of medicine I woud give him rituximab 2 gr...

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RE: SLE Lupus nephritis Class V 1 day ago

Always a problem with "Pure" Class V LN. Proteinuria is a poor indicator of the "activity" of immune complex formation and deposition. The AI and C...

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RE: SLE Lupus nephritis Class V 1 day ago

8/60 global sclerosis. 0/60 focal sclerosis. EXT II negative --------------------------------- [Sheng] [Kuo] MD, FASN --------------------------...

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RE: SLE Lupus nephritis Class V 1 day ago

At the time of 2025 biopsy (and also 2021), activity score was 0. I can’t attribute the proteinuria to the chronicity based on the report and he ha...

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RE: SLE Lupus nephritis Class V 1 day ago

How much, if any, superimposed FSGS lesions were seen in the second Kidney Biopsy in 2025? Was the biopsy stained for EXTI/II? ------------------...

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RE: SLE Lupus nephritis Class V 1 day ago

He has normal kidney function, no RBC, normal complements , activity score 0, some chronicity , and a very mildly raised dsDNa... Would you conside...

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RE: SLE Lupus nephritis Class V 1 day ago

Patients with Pure Class V LN were nit included in thexREGENCY trial so we cannot be certain concerning response to OBI. I probably would not chang...

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SLE Lupus nephritis Class V 1 day ago

40-year-old Chinese male with history of hypertension, Sjogren's syndrome, and SLE complicated by lupus nephritis LN class V came to our practice f...

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RE: MPO-ANCA Vasculitis 1 day ago

My two cents: Pt is doing well and has responded. I would stop everything and just go with rituxumab 500-1000 q 6 months for maintenance for ma...

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RE: MPO-ANCA Vasculitis 1 day ago

Thank you so much for reply. No sign of rhabdo, CK is normal (todays value, but no cramps this morning) Last Cyclophosphamide given May 7th, 75...

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RE: MPO-ANCA Vasculitis 1 day ago

The muscle cramps could be due to steroids or CYC (or both). They will likeky improve over time. Any signs of rhabdomyolysis , Potassium or Magnesi...

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MPO-ANCA Vasculitis 1 day ago

Input greatly appreciated on following case - MPO-ANCA vasculitis treatment and problem w cramps Caucasian male, 59 yrs old. No comorbidity. D...

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RE: C5 blocker in IgA and other controversial recommendations 1 day ago

Not sure if this is the right forum, but I would like to know your thoughts on how the prices of these can be taken down to a realistic level. Righ...

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

I am not sure that I would use Pegcetacoplan in this case, as it remains unproven that it represents de novo Primary IC-MPGN in a kidney allograft....

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

Assuming dual pathology --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

Thanks tac , mmf and steroids pegcetacoplan for ( rejection and idiopathic immune complex Gn ) --------------------------------- Muhammad Soobadar...

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

from the rejection ( as I already stated IV high dose steroids already given might have treated TCR - for maintenance IS -Tac +MMF+ low dose steroi...

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RE: C5 blocker in IgA and other controversial recommendations 1 day ago

Dr. Dastoor. Many thanks for your description of the pharmaceutical prescribing environment in UAE. In many ways, the differences between UAE and t...

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RE: Treatment of progressing Fabrys 1 day ago

Really grateful for this erudite discussion! ------------------------------ Valerie Luyckx MD, MS, PhD Renal Division, Brigham and Women;s Hos...

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RE: Treatment of progressing Fabrys 1 day ago

BP is around 120 systolic but I have ordered a 24h ABPM, if any higher I was planning an ACEI…cardiac MRI is totally normal ---------------------...

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RE: Treatment of progressing Fabrys 1 day ago

Thank you! ------------------------------ Valerie Luyckx MD, MS, PhD Renal Division, Brigham and Women;s Hospital, Boston, MA; Department of Paed...

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RE: Treatment of progressing Fabrys 1 day ago

I am hoping this may be the case ;) ------------------------------ Valerie Luyckx MD, MS, PhD Renal Division, Brigham and Women;s Hospital, Bo...

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RE: C5 blocker in IgA and other controversial recommendations 2 days ago

Dr. Dastoor- thanks for your detailed response- very helpful. Here are somexcomments. 1) you might find a better response to oral systemic ster...

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RE: Denovo Idiopathic MPGN of Renal Allograft 2 days ago

And in this case there is dual pathology and if this is idiopathic Mpgn with rejection what to use to treat ? Tac and steroids and mmf ? -----...

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RE: C5 blocker in IgA and other controversial recommendations 2 days ago

Dr. Dastoor- Your point #1 above, specifically stating that excluding all cost considerations all patients with IgAN (except these with an Oxford...

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