RE: ig a v vs anca vs ctd 49 minutes ago

Weak and equivocal lambda staining, not confirmed by ParaffinIF with Pronase digestion . Not veryl convincing, in my opinion --------------------...

View Discussion

RE: ig a v vs anca vs ctd 53 minutes ago

It might also be worth pointing out that published guidelines concerning use of PLEX in ANCA vasculitis differ and the 2024 KDIGO guidelines use th...

View Discussion

RE: ig a v vs anca vs ctd 1 hour ago

Dr. Dastoor- my opinions on the utility (lack of) of PLEX in ANCA vasculitis have been informed by the compelling arguments of Drs.Fervenza and Spe...

View Discussion

RE: ig a v vs anca vs ctd 1 hour ago

This is lambda restriction is non significant?? ------------------------------ Ahmed Mahedy PhD Banha Faculty of Medicine Banha -----------------...

View Discussion

RE: DKA in post transplants 1 hour ago

Yes ------------------------------ Sandip] [Das] [PGDHCM] [GO] [Primary Health Care] [Tamluk] [West Bengal] [9564535651] ------------------------...

View Discussion

RE: ig a v vs anca vs ctd 1 hour ago

Is it possible for @Richard Glassock and @Roger Rodby to state their positions on why they are against and for PLEX , in ANCA vasculitis . That wo...

View Discussion

RE: DKA in post transplants 5 hours ago

Thanks a lot Dr Glassock the c peptide 1.7 ng / ml and anti GAD Ab less than 0.5IU/ml regarding the primary cause of CKD only history of NS...

View Discussion

RE: DKA in post transplants 6 hours ago

NODAT is a common (10-15%) complication of steroid and CNI therapy of KT recipients. Reducing sterouds , reducing Tacrolimus, shifting to CsA or Ra...

View Discussion

RE: ig a v vs anca vs ctd 6 hours ago

An important caveat about RTX (and CYC) therapy of AAV is that HBV -infected patients may suffer from complications of reactivation or enhanced vir...

View Discussion

DKA in post transplants 6 hours ago

Dear All colleagues A 15 years old male presented to me as acidotic breathing he was 2,5 years post renal transplant on prednisone 5 mg EOD , Ta...

View Discussion

RE: IgA nephropathy 6 hours ago

Thank you Dr. Glassock.. I would dare not disagree with you. Honestly your feedback and your posts have made me a much smarter physician, and I al...

View Discussion

RE: ig a v vs anca vs ctd 7 hours ago

I fully agree with Dr. Rodby except for PLEX. This is Pauci-immune necrotizing and crescentic GN. My choice of therapy would be RTX, Avacopan And P...

View Discussion

RE: IgA nephropathy 7 hours ago

Dr. Dastoor- thanks for sharing. Very interesting approach. In the UpToDate formulation both Atrasentan and Sparsentan ) are not part of the prefer...

View Discussion

RE: Renal denervation 12 hours ago

Fewer than 10% of patients studied had stage 3b CKD with 10–15 mmHg office SBP reduction lasting at least 3 years. Very few patients with stage 4 ...

View Discussion

RE: IgA nephropathy 12 hours ago

My indication for use of Iptacopan is similar to Uptodate . This patient is classified as high risk based on . 1. Decline in eGFR that exceeds gr...

View Discussion

RE: Renal denervation 13 hours ago

@Gary Singer what percent of the patients receiving this procedure had CKD 3b or more? "4–7 mmHg in ambulatory SBP and 6–10 mmHg in office SBP...

View Discussion

RE: ig a v vs anca vs ctd 13 hours ago

I would ignore the IgA this appears to be pauci immune crescentic GN most consistent with a vasculitis. I would treat as such with Pexivas prot...

View Discussion

RE: ig a v vs anca vs ctd 14 hours ago

and in this case if she has UTI would colleagues favour plex? would plex remove glycosylated Ig A? thanks for help ------------------------...

View Discussion

ig a v vs anca vs ctd 15 hours ago

question is this ig a vasculitis ? or anca? or both or lupus? ( i dont think lupus no c1q no full house complement) CTD?? would colleagues wait...

View Discussion

RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 17 hours ago

Thank you very much Congo red staining is pending DNAJB9 send out, and in progress. No history of NSAIDs use except low dose Aspirin No recent hi...

View Discussion

RE: IgA nephropathy 18 hours ago

Dr. Dastoor- Many thanks for sharing . So far, I have had very little experience with Iptacopan as patients with high risk IgAN respond very well t...

View Discussion

RE: Renal denervation 21 hours ago

Hi-I am one of the nephrologists and HTN specialists at the Stanford HTN Center. I work closely with our center's director Vivek Bhalla and we rece...

View Discussion

RE: IgA nephropathy 22 hours ago

While on the subject of IgA , it has been around 3 weeks since we started using Iptacopan on 3 patients . One patient did his labs today, and for...

View Discussion

RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

Thanks DR. Zuckerman. Very helpful. C3GN seems very unlikely . The EM images should be informative. ------------------------------ Richard Gl...

View Discussion

RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

My read of the clinical situation is: nephrotic syndrome (10 G protein, Alb 2.6, and edema) who also has renal failure (sCr 2.8). Microscopic hemat...

View Discussion

RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

As could as I remember she is suffering from Nephritis ------------------------------ Sandip] [Das] [PGDHCM] [GO] [Primary Health Care] [Tamluk] ...

View Discussion

RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

I am not an expert on C3G, but the C3 staining does not seem to be 2 OOM higher than the other stains . Regardless, if this is confirmed C3G, and...

View Discussion

RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

Difficult case. The EM findings may help sort this out as the IF is equivocal, but suggestive of mesangial localization of C3 without Ciq. No evide...

View Discussion

RE: IgA And SLE 1 day ago

Yes- but a little MMF will not likely do any harm for extra-renal SlLE, and might even have some favorable effects. -----------------------------...

View Discussion

? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

Good morning 65 years old white female Obese HFpEF Worsening proteinuria, about 10 GM, serum albumin of 2.6 Microscopic hematuria but no RBC casts ...

View Discussion

RE: IgA And SLE 1 day ago

just to confirm, the MMF is for IgA and hematuria , right , not for extra renal Lupus!! --------------------------------- Dr. Hormaz Dastoor. MD,...

View Discussion

RE: IgA And SLE 1 day ago

In my opinion, this case is a fundamental expression of Hickams Dictum- "a patient can have as many Diseases as as they damn well please" -------...

View Discussion

RE: IgA And SLE 1 day ago

I would also add Hydroxychloroquine to the regimen, with appropriate eye screening follow up. ------------------------------ Richard Glassock MD...

View Discussion

RE: IgA And SLE 1 day ago

I Will add MMF and resume low dose steroids Will update the thread in 3-6 months Thank you so much --------------------------------- Ashra...

View Discussion

RE: Renal denervation 1 day ago

It is great that CMS covers now. Private carriers still fight back. The cost is high and might be future barrier. Last figure I was quoted was $50,...

View Discussion

RE: IgA nephropathy 1 day ago

The answer to the first question is not known due to conflicting findings in published material I have no experience with KN 55 staining in IgA dep...

View Discussion

RE: Renal denervation 1 day ago

We had an opportunity to try both methods RF and Ultrasound on ESRD patients . However we did not see any benefit after 6 months . Need to realize...

View Discussion

RE: IgA nephropathy 1 day ago

Academically, would KM55 staining help to differentiate Primary from secondary forms of IgA . What other features on a biopsy would help to disting...

View Discussion

RE: IgA nephropathy 2 days ago

Yes, I agree. No IgM results were posted originally, IgAN with no IgG or C3 is uncommon as well. Something just does not fit in this case,. Up to 1...

View Discussion

RE: IgA nephropathy 2 days ago

@Richard Glassock Non specific deposits of IgA are very uncommon. Usually IgM has non specific trappings , especially in sclerotic segments. ----...

View Discussion

RE: IgA nephropathy 2 days ago

What I am interested in knowin is what was the actual measured dimension of GBM width. Does it show areas of thinning or attenuation.,? --------...

View Discussion

RE: IgA nephropathy 2 days ago

Sure I will suggest with genetic testing. Thank you all ------------------------------ Sara ------------------------------

View Discussion

RE: IgA nephropathy 2 days ago

Just 2+ IgA, No IgG or C3 and no electron dense deposits in mesangium by EM. Is this really IgAN , or FSGS with coincidental, non-pathogenic IgA de...

View Discussion

RE: IgA nephropathy 2 days ago

There was no basement membrane thickening, alternations or spikes ------------------------------ Sara Ssa MBChB ------------------------------

View Discussion

RE: IgA nephropathy 2 days ago

Thanks- What was the thickness of the GBM and were any GBM abnormalities present by EM.,? ------------------------------ Richard Glassock MD, F...

View Discussion

RE: IgA nephropathy 2 days ago

Thank you Dr Glassock and Dr Dastoor for your valid inputs. Electron microscopy showed no electron dense deposits, focal mild foot process effa...

View Discussion

RE: IgA nephropathy 2 days ago

Addendum- it should be noted that Omega 3 FA are no longer viewed as standard of care therapy for IgAN and that SGLT2i are not effective in non-o...

View Discussion

RE: IgA nephropathy 2 days ago

In the absence of a detailed description of the EM and LM it is difficult to say if a diffuse Podocytopathy is present in this case. If the serum a...

View Discussion

RE: IgA And SLE 2 days ago

My guess is that this is IgAN in a patient with SLE. I would not use RTX or OBI and Iptacopan or anti-APRIL would be second tier, at least for now,...

View Discussion

RE: Renal denervation 2 days ago

Across modern sham-controlled trials and meta-analyses, renal denervation consistently produces additional, durable reductions of roughly 4–7 mmHg ...

View Discussion