RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 6 hours ago

In my opinio this is not CAPS but rather macro-vascular thrombosis In patients with severe LN and hydralazine induced Anti-MPO due to non-criteria ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 7 hours ago

My only suggestion is that this patient needs "triple immunosuppressive therapy " for aggressive Proliferative LN .pi woukd avoid any exposure to a...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 7 hours ago

I agree- adding Atrasentan to a stable (maximal) dose of RASI should be "as good as " switching to Sparsentan (for supportive care in IgAN) , but t...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 8 hours ago

How long was hydralazine exposure? What was Salbumin at presentation? Did he have a ‘bubble’ echo study? What about anti-beta2GPI? “Lesions of TM...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 12 hours ago

thanks , the ADAMS TS13 activity is normal and no antibodies I would just like to add that on admiision his creatinine was 420 umoll/l ( 4.8 mgdl...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 12 hours ago

"I would go with a diagonis of SLE , and associated TMA suggested by fibrin thrombi" agree but you have called this renal limited TMA, remembe...

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Atrasentan in Genetic FSGS and IgA Nephropathy 12 hours ago

As we still do not have Sparsentan in our formulary , i wanted to highlight and share with the community our expreience with Atrasentan , in select...

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Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 13 hours ago

48 year old male from the UAE . Apparently was normal and working in the military . 4 weeks ago noticed that he had SOB and was diagnosed as PE and...

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RE: unexplained renal failure 17 hours ago

Susan-thanks for your suggestion-question assuming AS in this patient is not active how would you explains ESR > 100 if ADTKD and no family history...

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RE: unexplained renal failure 18 hours ago

It is not entirely true that ADTKD will not reveal itself on a kidney biopsy. PAS + glycoprotein aggregates surrounding the TAL with associated inf...

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RE: unexplained renal failure 19 hours ago

It could be ADTKD? Autosomal Dominant Tubulointerstitial Kidney Disease. Genetic testing is the only way to diagnose (will not show up in a biopsy)...

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RE: MCD-IgA nephropathy 1 day ago

I would still treat as a podocytopathy, worth the try, but I wold go with Rituximab alone, steroid sparing avoiding ----------------------------...

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RE: unexplained renal failure 1 day ago

I would do genetic testing first (if available) before renal biopsy, we have picked up a few COL4A3-4 alports (yes even without hematuria) or some ...

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RE: unexplained renal failure 1 day ago

Vascular Or tubulointerstitial amyloidosis is more common in AL and ALECT2 amyloidosis rather than AA amyloidosis which more commonly cause glomeru...

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RE: unexplained renal failure 1 day ago

Yes very uncommon but can present without proteinuria (albumin) ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [...

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RE: MCD-IgA nephropathy 2 days ago

Three kidney diseases in one patient. Dr Hickam was correct!!! ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen...

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RE: MCD-IgA nephropathy 2 days ago

Because of biopsy proven Stage 3 DN in this case I would stress, Metformin, SGLT2i, GLP1RA and Finerenone for ongoing management after successful t...

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RE: unexplained renal failure 2 days ago

First rule out obstruction (ultrasound) and light chain cast Nephropathy (serum FLC and Immunofixation) . If unrevealing , a kidney biopsy is neede...

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RE: MCD-IgA nephropathy 2 days ago

I would not give immunomodulators to target IgAN if proteinuria improved and has complete remission. ------------------------------ Sarah Al Zou...

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RE: unexplained renal failure 2 days ago

Renal AA amyloidosis with deposits confined to or predominantly in the vascular/tubulointerstitial compartments, while uncommon, is a possibility. ...

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RE: unexplained renal failure 2 days ago

Agree with what had mentioned already. Simultaneous UPCR and UACR is important first step to look for plasma cell dyscrasia. AS associated kidney...

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RE: MCD-IgA nephropathy 2 days ago

Dr . Sarah, the article didn’t mention the add-on therapy for DFPE non-MCD like IgAN, maybe MMF for Asian ancestry or CYC for crescentic IgAN. For...

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RE: unexplained renal failure 2 days ago

Agree need SLC and urine protein ekectrophoresis - would also get CRP - kidney biopsy may be necessary if noninvasive is unremarkable ----------...

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RE: unexplained renal failure 2 days ago

Thank you dr weal for sharing this case . How long has his creatinine been at this level? Medication history is important, especially for chronic u...

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unexplained renal failure 2 days ago

72 year old male patient who is a known case of ankylosing spondylitis, not on medication currently, with no features of active disease, he is hype...

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RE: MCD-IgA nephropathy 2 days ago

If the nephrotic syndrome improves and reverse to normal with prednisolon, I mean no proteinuria, is it still indicated to treat the underlying IgA...

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RE: MCD-IgA nephropathy 3 days ago

I would agree with a probable auto-immune diffuse Podocytopathy superimposed on IgAN and stage III Diabetic nodular Glomerulosclerosis - would have...

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RE: MCD-IgA nephropathy 3 days ago

Thank you Dr. Rodby! I agree, he has mesangial deposits on EM but likely missed on the report! Would you add any of the novel treatments for I...

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RE: MCD-IgA nephropathy 3 days ago

Thank you for your thoughts. Agreed with you about the diagnosis, he doesn't seem to have signs and symptoms of infection, diabetes was controlle...

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RE: MCD-IgA nephropathy 3 days ago

That's very helpful, thank you.. I think he fits more into MCD-like IgA, I will take a look to the publication.. Was the type of other IS for non-M...

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RE: MCD-IgA nephropathy 3 days ago

Thank you.. how long would you wait while on steroids, assuming DM is controlled on insulin? ------------------------------ Sarah Al Zoubi MD Oak...

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RE: MCD-IgA nephropathy 3 days ago

That's exactly what I thought, he has mesangial hypercellularity and mesangial IF staining but no IC on EM, I think maybe missed on the report? I w...

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RE: MCD-IgA nephropathy 3 days ago

Many good points written already Dr Venkat the EMS are there below the LM and there are impressive subendothelial deposits and mesangial deposits...

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RE: MCD-IgA nephropathy 3 days ago

Interesting case, thanks for sharing. A few thoughts: Most likely: a minimal change–like podocytopathy superimposed on IgA nephropathy, with bac...

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RE: MCD-IgA nephropathy 3 days ago

What is the MEST-C score of IgAN? Recently published multi-center retrospective study phenotypes patient with MCD and IgAN into 2 variants; MCD-li...

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RE: MCD-IgA nephropathy 3 days ago

"EM showed diffuse FPE, glomerular basement membranes are thickened and contain focal subendothelial deposits with rare subepithelial deposits" D...

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RE: HSP with heavy proteinuria 3 days ago

Only ‘patchy moderate FPE’ but that was already after ‘oral prednisone 40 mg per day tapered over 10 days’ and then ‘IV steroids followed by predni...

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RE: HSP with heavy proteinuria 3 days ago

Thanks all for the input, much appreciated. Below is the text from the biopsy report. FPE described as patchy and moderate. Will see if I can get i...

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RE: HSP with heavy proteinuria 3 days ago

IgAN and IgAV, shared upstream signals (Gd-IgA1) but different downstream effects (renal limited vs renal and skin). For the skin effects, there ar...

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Cheer on Semi-finalists in the FIT Bowl Today! 3 days ago

Today at Kidney Week, please stop by the ASN Futures Theater in Exhibit Hall A, of the Colorado Convention Center, to watch the 2026 FIT Bowl! ...

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RE: MCD-IgA nephropathy 3 days ago

continue steroids with close monitoring for diabetes control. must be sure IgA not secondary to occult infection especially with known diabetes. co...

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MCD-IgA nephropathy 3 days ago

I want to open a discussion about one of my patients in the clinic. A 55 year old male patient with PMHx of well controlled DM and HTN, presented...

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RE: HSP with heavy proteinuria Friday, October 23 @ 1:25 AM

This is an unexplained phenomenon, seen in (well done) observational (single arm) studies.The "effectiveness" of RTX in IgAV has not (yet) be confi...

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RE: HSP with heavy proteinuria Thursday, October 22 @ 7:09 PM

@Richard Glassock Out of curiosity , why would Rituximab show no benefit in IgA Nephropathy, but good response in igA vasculitis . I am aware that...

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RE: HSP with heavy proteinuria Thursday, October 22 @ 6:54 PM

Drs. Friedman and Venkat. A S0 lesion makes a diffuse Podocytopathy (superimposed on IgAV) less likely, but EM analysis would be of interest, I agr...

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RE: HSP with heavy proteinuria Thursday, October 22 @ 6:50 PM

Since no clinical trials have yet reported efficacy of Atacicept or Atrasentan in IgA Vasculitis, so your conclusions must be extrapolations from I...

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Cheer on your colleagues at the 2026 Fellows-In-Training (FIT) Bowl in Denver! Thursday, October 22 @ 6:31 PM

While at Kidney Week, please stop by the ASN Futures Theater in Exhibit Hall A, of the Colorado Convention Center on Friday, October 23, to watch t...

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RE: Drug-induced lupus and ANCA GN Thursday, October 22 @ 3:57 PM

Thank you Dr. Glassock ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (843) 669-6694 --------------------...

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RE: HSP with heavy proteinuria Thursday, October 22 @ 2:21 PM

I would like to take the contrarian view in that I think the Atacicept and Atrasentan are actually reducing the proteinuria. . However, on withhold...

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RE: HSP with heavy proteinuria Thursday, October 22 @ 12:09 PM

I share Dr. Friedman's impression that there must be a podocytopathy (causing severe nephrotic syndrome) + IgA vasculitis in this patient. How ab...

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