RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 hours ago

In PGNMID, it is very rare that PET/CT will pick up something with a negative bone marrow. It is seen more in MIDD. But given the high percentage o...

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RE: Refractory membranoproliferative glomerulonephritis 4 hours ago

Regarding 2024 biopsy: "the result was a copy/paste of the previous one" Biopsy in 2022 showed 20% IFTA. Did the most recent biopsy show further ...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 12 hours ago

Thx Dr Leung k 32 and lambda 33 mg/L no flow done. Will ask path. thx for all the help ------------------------------ Flavio Alvarez MD SAN...

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RE: Frequent relapsing MCD 14 hours ago

Rituximab is the way to go. That dosing is fine, and assuming it works I would give her another dose at 6 months and even 12 perhaps if easy t...

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RE: Fsgs 14 hours ago

Can we labeled this as steroid-resistant FSGS with this partial remission? Because if there is partial remission to steroids, I will use anti-CD20 ...

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RE: Frequent relapsing MCD 15 hours ago

Frequent relapses are uncommon at this age, do you have the ability to perform serum anti-nephrin Ab? Any IgG dusting on biopsy? Agree for RTX and...

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RE: Fsgs 15 hours ago

My guesstimate is he will relapse on tapering CNI. I would like to give Rituximab before tapering CNI. Genetic testing, degree of FPE, age of patie...

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RE: Timings for stoping Mycophenolate after Rituximab 16 hours ago

Dr Glassock, thanks for your feedback. This is my colleague's patient with MCD. Seems to have storrid responsive MCD but with frequent relapses and...

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RE: Fsgs 17 hours ago

Question better rephrased In Partial remission of fsgs with cyclosporine and 0red 5 mg after 2 years of therapy can I stop ? And if so if relapse ...

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Frequent relapsing MCD 19 hours ago

A 63 year old woman had MCD during 2020. Treated with full sterid course with slow taper. Had 1 relapse at 2023 and another one April 2024. But ano...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 20 hours ago

Thanks Dr. Leung. Very helpful. Do you have any experience or opinions about the utility of PET-CT scans or MALDI.ToF-MS in cases of PGNMID like th...

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RE: Timings for stoping Mycophenolate after Rituximab 20 hours ago

Not studied as far as I know. But Rituximab works on B cells within 24 hours so I think MMF could be stopped as soon as RTX given. What disease is ...

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Timings for stoping Mycophenolate after Rituximab 22 hours ago

When is the best time to stop Cellcept after giving Rituximab, should we wait until Rituximab starts working ? How long, 2-4 months ? -------...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 23 hours ago

First of all, 8% bone marrow plasma cell is not normal. The upper limit of normal is 5%. The question is whether this represents a biclonal gammopa...

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RE: Vasculitis Question 1 day ago

Thanks prof rodby --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Refractory membranoproliferative glomerulonephritis 1 day ago

I fully agree with Dr. Rodby. Planning for an effective treatment depends on defining the underlying pathogenetic mechanisms of the MPGN pattern of...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 1 day ago

Thx for the info Dr Rodby ------------------------------ Flavio Alvarez MD SAN ANTONIO TX (210) 614-1231 ------------------------------

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RE: Refractory membranoproliferative glomerulonephritis 1 day ago

Dear Roger, thank you for these suggestions, I will look up all these informations and come back to you.

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RE: Primary Hyperparathyroidism 1 day ago

Thanks prof sprague dr wael and everyone Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Primary Hyperparathyroidism 1 day ago

Thank you Prof venkat , I appreciate your effort and time In terms of the Transplant patients who become hypercalcaemic is that 2nd hyperpararhyro...

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RE: Refractory membranoproliferative glomerulonephritis 1 day ago

MPGN type 1 is an old classification, and MPGN is now better classified based on the IF etc. what did the IF and the EMs show, can you post a deind...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 1 day ago

I would start with Dr Leung https://www.mayoclinic.org/biographies/leung-nelson-m-d/bio-20053674 @Nelson Leung Your case seems fairl...

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Refractory membranoproliferative glomerulonephritis 1 day ago

Dear community, I present to you the case of a 68-year-old female who presented to IR in 2017 with proteinuria of about 6 g/24h. (ANA/ANCA neg, ...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 1 day ago

Thx for all the valuable input. Dr Glassock who would be the best person at Mayo to contact to try to get directions on how to get the MALDI-TOF ...

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RE: Primary Hyperparathyroidism 1 day ago

Decreased filtered calcium due to decreased GFR make urinary calcium unreliable in CKD. Phosphate retention with decreased GFR make low SPO4 unreli...

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RE: Fsgs 1 day ago

Thanks prof glassock . My case patient has reached partial remission not full remission So stop at 2 years . Can I consider adding on rituximab to...

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RE: Primary Hyperparathyroidism 1 day ago

Hi I have filed the notes for this patient . She had not had dexa. There are 2 values that the lab gives ( calcium and adjusted calcium for albumin...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 1 day ago

Thanks Dr.Friedman for this important contribution to this discussion thread. Application of the MALDI-ToF-MS for monoclonal light chains in PGNMID...

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RE: Fsgs 1 day ago

Thanks for this information Dr. Jebur. A complete and lasting-drug free remission of steroid resistant Primary FSGS after Prolonged CsA therapy is ...

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RE: Fsgs 2 days ago

We have similar patient who improved significantly after Cyclosporin therapy, before that he was steroid resistant FSGF. CYC. stopped gradually aft...

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RE: Nephrotic syndrome and VEGFR inhibitors 2 days ago

Unilateral acute RVT would be a possible explanation , if the patient has secondary MN due to RCC. A rather unlikey prospect, in my opinion. ---...

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RE: Nephrotic syndrome and VEGFR inhibitors 2 days ago

I'm aware that this is a bit off target, since serum creatinine went up just from 1,2 to 1,8 mg/dl, and no flank pain was reported... But, what abo...

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RE: Primary Hyperparathyroidism 2 days ago

The biochemical abnormalities in this patient are best explained by CKD, not primary hyperparathyroidism, in my opinion. -----------------------...

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RE: Primary Hyperparathyroidism 2 days ago

Correcting total serum calcium for serum albumin is no longer recommended as its diagnostic accuracy is less than an uncorrected total serum calciu...

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RE: Primary Hyperparathyroidism 2 days ago

I would check calcium clearance to creatinine clearance ratio, ratio of 0.2 favors PHPT. ------------------------------ Tahsin Masud Emory Uni...

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RE: Nephrotic syndrome and VEGFR inhibitors 2 days ago

@K.K. Venkat Works! Thank you ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Nephrotic syndrome and VEGFR inhibitors 2 days ago

@Mario Rubin: I am sorry for the problem with the link. You may want to try the following link: https://doi.org/10.1016/j.amjms.2023.09.005 Alter...

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RE: Fsgs 2 days ago

I think you could stop steroids after a period of slow tapering. There no reason at all to keep him on very low dose sterouds . I believe that cumu...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

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

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

Just something I’ve read about, no personal experience. UpToDate section & reference paper below. ‘MS is based on the unique sequence of the antig...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

@Oded Friedman Would it be possible for you to explain how this technique (originally developed to identify microbial strains) applies to the spe...

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RE: Nephrotic syndrome and VEGFR inhibitors 2 days ago

@K.K. Venkat The article you suggested cannot be retrieved. The following message comes up: You have reached a page that is no longer in use. W...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

Will find out iwhere it could be sent. Thx. ------------------------------ Flavio Alvarez MD SAN ANTONIO TX (210) 614-1231 ----------------------...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

I assume no detectable monoclonal IgG in serum by usual methods. Are you able to send it for mass spectrometry (MS), eg MALDI-TOF MS assay? ‘The ...

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RE: IgA nephropathy case in a young Caucasian female 2 days ago

Agree with Dr. Glassock, pretty advanced case and will not initiate IS therapy whatever the formulation. Treat her as a case of CKD to decrease an...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

Thx Dr Glassock. No PET yet but will order it. All input appreciated. Young lady, elementary school teacher,etc. ------------------------------ F...

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RE: Nephrotic syndrome and VEGFR inhibitors 2 days ago

The Cabozantinib is a hybrid agent with both anti-VEGF and TKI properties. In the absence of TMA and with the rather abrupt onsent of NS, I favor a...

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RE: Diffuse proliferative Gn with IgG kappa deposits allograft failure 2 days ago

Diffucult case. This is most likely PGNMID without an identifiable clone and a recurrence in a kidney allograft. In the abscence of therapy, a repe...

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RE: Fsgs 2 days ago

Thanks prof he is on 5 mg of pred already . How long would you give cyclosporin ? When would you stop pred? I reduced it to 4 mg today Not sure wi...

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RE: IgA nephropathy case in a young Caucasian female 2 days ago

With a T2 lesion, only slight hematuria and no good evidence of inflammation, she is not a good candidate for steroids,(oral systemic or TRF Budeso...

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