RE: Membranous Nephropathy with Rapid Progression 36 minutes ago

Dr. Soobadar- thanks for your comments on the Vargas-Brochero et al paper in KI Reports A few points of clarification concerning this seminal an...

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RE: Membranous Nephropathy with Rapid Progression 7 hours ago

ANA and Antidsdna is negative with C3 and C4 normal as well. ------------------------------ Hassan Abdullah MBBS Resident Nephrology Shaikh Zayed...

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RE: Chronic Active Thrombotic Microangiopathy - kidney biopsy 12 hours ago

Thanks dr Bianco for great case Any update on case ? --------------------------------- Muhammad Soobadar MBChB UK ----------------------------...

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RE: Membranous Nephropathy with Rapid Progression 13 hours ago

Thanks prof glassock for sharing educational and fascinating paper and well done study It’s really long time follow up. Proteinuria 3.5 ...

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RE: Membranous Nephropathy with Rapid Progression 15 hours ago

Based on the biopsy, IF was positive for multiple antibodies and trace C1q but negative IgA, this along with one crescent make me wonder if you sho...

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RE: Membranous Nephropathy with Rapid Progression 18 hours ago

Your assumption that "only" 60% of patients with MN and Nephrotic Syndrome achieve a remission with RTX is incorrect. Please see Vargas-Brochero MJ...

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RE: Membranous Nephropathy with Rapid Progression 19 hours ago

This is a very nice discussion thanks to everyone for participation ( senior and non senior )😃 I have read the dr Nile’s cyclo- ritux protocol. I...

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RE: FSGS conundrum 22 hours ago

While no RCT have addressed the issue of Steroid or CNI responsiveness in patients with FSGS lesions and 2 High risk alleles for APOL1 , observatio...

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RE: FSGS conundrum 23 hours ago

The "conundrum" of treatment for Primary (as well as Genetic ) FSGS has been complicated by the results of the DUPLEX trial of Sparsentan (compared...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Thanks Dr. Abdullah. If urine output progressively increases to 1.5 to 2.0 L daily and pre-dialysis SCr levels become progressively lower, recovery...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Anca and GBM serologies have come back negative. Unfortunately patient developed acute Epididymoorchitis around 8-10 days after his Cyclophosphamid...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

------------------------------ Hassan Abdullah MBBS Resident Nephrology Shaikh Zayed Hospital Lahore Lahore 03074280146 ---------------------...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Unfortunately we don't have that information as dialysis was initiated at another facility with a serum Creatinine of 13. Patient does not give his...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Thanks Dr. Abdullah for the additional information. Questions: 1. What was the SCr level and daily urine volume just before you started dialysis? 2...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Yes, the kidneys are normal sized. I'll trace the full report in a bit but no, there wasn't a suggestion of the collapsing variant fsgs. Patient ...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Dr. Abdullah: Please do post short-term and long-term updates on your patient. It will be very educational to know: 1. If immunosuppression aimed a...

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RE: Refractory membranous Nephropathy 2 days ago

The current standard of care monitoring includes an anti-PLA2R antibody of [More]

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RE: Membranous Nephropathy with Rapid Progression 2 days ago

I agree with the senior Dr. Rodby, except I might use a combination of standard dose RTX + low dose - short duration CYC ( Niles-Zonozi protocol )....

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RE: Membranous Nephropathy with Rapid Progression 2 days ago

"Any response from the seniors would be appreciated." "Senior" is in the eye of the beholder This senior will keep it simple The clinical out...

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RE: Membranous Nephropathy with Rapid Progression 2 days ago

SCr was already at 3.9 mg/dL by late 2025. Remnant nephron hyperfiltration may have kept SCr at 3.9 mg and this compensation may fail rapidly, and ...

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RE: Membranous Nephropathy with Rapid Progression 2 days ago

Significance of a Single Fibrocellular Crescent: Even relatively low percentages of crescents in MN (median ~4–5% of glomeruli) are associated wit...

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RE: Membranous Nephropathy with Rapid Progression 2 days ago

Thanks for case Did The biopsy findings suggest collapsing fsgs? ? There is no haematuria and if it’s bad crescentic case would expect microscopic...

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RE: Membranous nephropathy 2 days ago

Currently, no large randomized trials directly testing routine combination CNI+rituximab versus rituximab monotherapy exist; most data derive from ...

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RE: Membranous nephropathy 2 days ago

RE: Refractory membranous Nephropathy Thanks prof glassock - drop in proteinuria with weight loss / diabetes management - normal albumin - high ...

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RE: Refractory membranous Nephropathy 2 days ago

@ prof glassock - I got confused with another case this case does not warrant CT The other case had improvement of proteinuria with weight loss a...

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RE: Refractory membranous Nephropathy 2 days ago

https://doi.org/10.1016/j.ekir.2025.07.043 Elisa plar2 cut off at baseline and for disease monitoring --------------------------------- Muhamma...

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RE: Refractory membranous Nephropathy 2 days ago

Thanks prof glassock -Negative serum plar2 with possible active immune disease tho initially positive - drop in proteinuria with weight loss / d...

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Membranous Nephropathy with Rapid Progression 2 days ago

We had a patient, 20 yr old male, known case of Pla2r positive membranous (titer not known) in 2022, nephrotic range proteinuria, treated conservat...

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RE: Refractory membranous Nephropathy 2 days ago

What is odd about this case- why would you obtain a CT (of what) ? Your reasoning is quite obscure to me- please try for greater clarity. Thanks. ...

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RE: Refractory membranous Nephropathy 2 days ago

I think if I am allowed to guess your thought process prof glassock Is if Elisa plar2 2-14 then consider it positive I guess ( hope I am ok righ...

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RE: Refractory membranous Nephropathy 2 days ago

< 2RU / ml is the lower limit of sensitivity of the ELiSA assay. The distinction at 14RU between a positive and a "negative" test is arbitrary and ...

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RE: Refractory membranous Nephropathy 2 days ago

Thanks prof glassock Anything more than 2 in this case you would consider positive ? Can you explain your thinking please? -------------------...

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RE: Refractory membranous Nephropathy 2 days ago

Negative is any value less than 14RU/ml. This is not not the same as<2RU/ml which is the lower limit of sensitivity of the ELISA method. An importa...

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RE: Refractory membranous Nephropathy 2 days ago

Dr dastoor said plar2 Elisa is negative prog glassock Whether its shares epitope leading to false negative not sure . But iFA will be more sensitiv...

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RE: Refractory membranous Nephropathy 2 days ago

First, we need ti know if the serum anti-PLA2R antibody (by ELISA) is less than 2RU /ml. Yes or no? ------------------------------ Richard Glasso...

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RE: Refractory membranous Nephropathy 2 days ago

@ dr dastoor one thought came to mind . What about IFA assay? It would help in case it’s false negative plar2 --------------------------------- ...

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RE: Membranous nephropathy 2 days ago

Thanks for help prof glassock and prof aledan --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 2 days ago

Helpful input in case --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 2 days ago

@dr Leung thanks for your helpful cases I would be interested to know due to lack of experience / knowledge -if you use SAP baseline and monitor...

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RE: Pauci-Immune GN, Chronic, Minimally Active 2 days ago

Lower compared to higher dose steroids in the LoVas trial of anti-MPO Vasculitis treated with RTX were non-inferior in terms of efficacy but were a...

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RE: Membranous nephropathy 2 days ago

Any proposal to link Prostate Cancer with PLA2R antibody induced MN is weak and unsubstantiated, in my opinion. ------------------------------ R...

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RE: Membranous nephropathy 3 days ago

I do not currently suggest enhanced screening (beyond routine age- and sex adapted screening ) for cancer in PLA2R positive MN. I occasionally wi...

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RE: FSGS conundrum 3 days ago

I have no experience with combined OBI and DARA in treatment resistant FSGS. I suppose that this is a rational approach as CD20- Plasma Cells can b...

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RE: Membranous nephropathy 3 days ago

Dr. Soobadar- Practical approach is to perform routine age-appropriate cancer screening and to escalate screening when clinical suspicion exists ev...

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RE: Pauci-Immune GN, Chronic, Minimally Active 3 days ago

While I see no particular reason to spare steroid in this patient, I wonder if lower (LoVAS study) dose steroid can be enough in this particular ca...

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RE: FSGS conundrum 3 days ago

Thank you, Drs Rodby and Glassock. A bit worrisome that in the series by Zand et al that only 40% reach full/partial remission with obinutuzumab in...

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RE: intra-operative CRRT 3 days ago

At our institution, surgeons request intraoperative CRRT support mainly in patients already on dialysis preoperatively, significantly fluid overloa...

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RE: intra-operative CRRT 3 days ago

@David Charytan As it has been pointed out, there is NO evidence whatsoever that the use of intra-operative dialytic modalities (continuous or in...

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RE: FSGS conundrum 3 days ago

Addendum- in the Phase 2 trial of Zand, et . 60% of patients with treatment resistant presumed Primary FSGS failed to receive any benefits from O...

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RE: FSGS conundrum 3 days ago

Dr. Rodby- you may be correct concerning your comments about "independence" of the beneficial effects of OBI and full peripheral CD19 Bcell depleti...

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