RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 1 hour ago

here is an article and editorial on Anti CD 20 and anti CD 38 for FSGS recurrent in a transplant, granted transplant, but I think this is the same ...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 1 hour ago

The one (one) paper I have seen on this says you can plex after ritux but wait 3 days. attached I would probably give the rituximab (or ...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 4 hours ago

Dr. Rodby, would it be better to do the PLEX first then anti-CD20 to keep the drug in for its natural clearance time? ---------------------------...

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RE: 3 different PLA2R responses 4 hours ago

Agree that both ELISA phenomena exist in broader literature but there’s an important distinction between baseline Dx screening vs. longitudinal F/U...

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RE: is it primary hyperaldosteronism? 6 hours ago

sorry @Roger Rodby - if that link doesn't work, PDF also attached! Endo Society guidelines are also a (longer) and useful resource! Swap ...

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RE: is it primary hyperaldosteronism? 6 hours ago

Im not sure this link sent by @Swapnil Hiremath worked, it didnt for me.. Let's try it again https://www.cmaj.ca/content/195/11/E410 ...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 6 hours ago

I think lipid apheresis if available (seems to be best treatment for resistant FSGS that i have seen - personally one pt...) after 2 grams of obi ...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 7 hours ago

In the Mayo Clinic experience patients presenting with Nephrotic Syndrome and a urine protein excretion of > 8 gms/d very, very seldom had a monoge...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 8 hours ago

Sometimes genetic causes are uncovered by an event. Most of genetic testing is exon sequencing, and intronic mutations are missed. What is patie...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 8 hours ago

Regarding Dr. Venturelli's suggestion, please see following reference: https://www.google.com/goto?url=CAESZQHEIkXXR6TAy-Nf0ZYxF-tZra8BN3r1mpoK4E...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 9 hours ago

This is very likely a case of multi-drug resistant auto-immune acquired Primary FSGS . You have four choices of further therapy- Obinutuzumab, PLEX...

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RE: Treatment suggestions for resistant FSGS in 18yo woman wanted 10 hours ago

Dr. Øvrehus Thanks for sharing this difficult case of multi drug resistant FSGS. this is my opinion only This is either a case of genetic podocyt...

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Treatment suggestions for resistant FSGS in 18yo woman wanted 13 hours ago

Dear Community, Input wanted on treatment resistant nephrotic syndrome in 18yo woman with FSGS. Case: Caucasian, diagnosed with nephrotic synd...

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RE: 3 different PLA2R responses 23 hours ago

--The ELISA is reported as "< 4" so I don't know if <2, or 2-3.9 --Yes, the CD 19 was depleted --although rare, both the false positive and "fa...

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RE: 3 different PLA2R responses 1 day ago

I might rebiopsy pt #1 #3 did you check ti see if your depleted CD 19? ------------------------------ Roger Rodby MD, FASN Professor of Medic...

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RE: 3 different PLA2R responses 1 day ago

Thanks Dr. Hirsch- interesting cases. If the sample size is large enough "exceptions " to "general rules " concerning the relationship of serum ant...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

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

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

@Radu Raducuthank u, I will ask out lab to send these tests to the Mayo clinic --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FAS...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

4. Sciascia S, Sanna G, Murru V, Roccatello D, Khamashta MA, Bertolaccini ML. Anti-prothrombin (aPT) and anti-phosphatidylserine/prothrombin (aPS/P...

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RE: is it primary hyperaldosteronism? 1 day ago

"24 hour urines are overutilized and cause more confusion than clarity." thanks-but perhaps I am just old-fashion but measuring creatinine in 24 hr...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

Very interesting. Can you please post the supportive references? Thank you. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252...

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RE: 3 different PLA2R responses 2 days ago

Re: pt 2, ELISA+/IFA- discordance with low-titer < 20 during F/U reported but titer of 70 & increasing with clinical inactivity has got to be rare,...

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RE: is it primary hyperaldosteronism? 2 days ago

Thank you very much for the fruitful discussion. I will post the full tests results shortly. --------------------------------- Wael Jebur MD, FAS...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

In a systematic review, Sciascia et al demonstrated that the presence of anti-PS/PT IgG antibodies is an independent risk factor for arterial and/o...

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3 different PLA2R responses 2 days ago

I've recently seen 3 membranous patients in follow up, each one with a different PLA2r response that might be of interest to this group (with thank...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

did you check anti factor H antibody ? , Mayo is doing the Phosphatidylserine/prothrombin antibodies ------------------------------ Radu Raducu ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

there are some second tier testing for antiphospholipid syndrome and I think Mayo clinci is doing some of them, It is most useful when clinical sus...

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RE: is it primary hyperaldosteronism? 2 days ago

I am not sure why there is so much confusion. This is typical of the paralysis that results in low screening rates. Much has changed in the last ...

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RE: is it primary hyperaldosteronism? 2 days ago

I think that we are chasing our tails with our discussions at this point. No one is arguing that beta blockers and ARB can have opposite effects on...

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RE: is it primary hyperaldosteronism? 2 days ago

Thanks, Dr. Dastoor. Very helpful. Too bad that combinations of agents were represented- in my opinion the combination of Beta blockers and ARB lea...

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RE: is it primary hyperaldosteronism? 2 days ago

Please see the attachment --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh Shakhbout Med...

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RE: Renal Autologous cell therapy 2 days ago

Thank you, yes i was referring to MSC infusions . --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrolo...

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RE: Renal Autologous cell therapy 2 days ago

Thanks Dr. Dastoor. I am not sure that this experience is relevant to the Ongoing Phase 3 RCT of Rilparencel (PROACT1) being conducted at several s...

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RE: Renal Autologous cell therapy 2 days ago

Several years ago we had patients travelling to Thailand and China for renal cell therapy. They were given results showing their creatinine was bac...

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RE: is it primary hyperaldosteronism? 3 days ago

See the following paper that is very relevant to this discussion of the effect ARB and BB (and their combination ) on serum PRA and aldosterone lev...

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RE: is it primary hyperaldosteronism? 3 days ago

It depends on dosage. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA Laguna Woods...

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RE: is it primary hyperaldosteronism? 3 days ago

Thanks Sheldon for the bingo. This forum is the gift that keeps giving from the standpoint of discussion and education. I think maybe more importan...

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RE: is it primary hyperaldosteronism? 3 days ago

Yes in my opinion ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Trans...

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RE: is it primary hyperaldosteronism? 3 days ago

B- blockers decrease renin and aldosterone but effect renin more than aldosterone. ARB increase renin and decrease aldosterone . Since this patient...

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RE: is it primary hyperaldosteronism? 3 days ago

De Lerman: "the fly in the ointment regarding this case is Urine K is 6 meg/24 hours-suggest repeat 24 hr urine k and sodium" Bingo! Obviously, u...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 days ago

I don't offer these patients antibiotic suppression / prophylaxis unless it's possible to eliminate the bacteria from the urinary tract. For anyone...

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RE: is it primary hyperaldosteronism? 3 days ago

Is it usual to have this level of massively suppressed PRA (almost undected ) only because of B blocker application?? ----------------------------...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 days ago

I assume the high urine PH is from urease effect hence supraphysiologic. I admittedly am not keen for potassium citrate as expect urine PH to rise....

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 days ago

She has never had oxalate stone. MSU never grown any organism and stone culture was not done when she had surgery, though likely colonisation in vi...

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RE: is it primary hyperaldosteronism? 3 days ago

I would think best to stop the agents above. Repeat ARR off above meds. Use Hydralazine or Prazosin for BP pending repeat tests. I assume CT adrena...

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RE: is it primary hyperaldosteronism? 3 days ago

I would prefer to stop the atenolol and repeat ARR after three weeks.. ------------------------------ Richard Glassock MD, FASN Emeritus Professo...

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RE: is it primary hyperaldosteronism? 3 days ago

Given all this interesting discussion, there's ample reason to get imaging of the adrenal glands which could resolve the diagnosis. ------------...

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RE: is it primary hyperaldosteronism? Monday, November 9 @ 6:13 PM

The suppressed PRA is likely due to Beta Blockers. The elevated ARR is a false positive. Just an opinion ------------------------------ Richard G...

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RE: Renal Autologous cell therapy Monday, November 9 @ 6:06 PM

Fine analysis Dr. Friedman! Negative study. Period. No good reason to pursue Intravenous MSC for renal regeneration . Just an opinion. ----------...

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RE: is it primary hyperaldosteronism? Monday, November 9 @ 5:32 PM

Have you measured urine sodium ? Spot or 24 hr urine ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Med...

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