RE: DKD & Immune Complex GN on biopsy 10 minutes ago

80% glomeruli sclerosed ... 90% IFTA... Plan for transplant --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of...

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RE: Is Hypertonic Saline appropriate here 2 hours ago

I am not sure if I would give IV Na Bicarbonate, given it's Na load . Would try to get away with slow correction of the acidosis with oral Na Bicar...

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RE: DKD & Immune Complex GN on biopsy 3 hours ago

Did the EM include examination of a non-sclerotic glomerulus.? I am also curious to see the findings if double contours with mesangial interposit...

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RE: DKD & Immune Complex GN on biopsy 3 hours ago

No election dense deposits by EM raises p possibility that the IF is "false positive". We need to see the IF images. ----------------------------...

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RE: Is Hypertonic Saline appropriate here 6 hours ago

On an unrelated note, if a patient with advanced ckd has concurrent metabolic acidosis, would you consider giving 8% sodium bicarbonate, would you ...

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RE: DKD & Immune Complex GN on biopsy 9 hours ago

The presence of immune deposits by IIF without electron dense deposits by EM would make Pronase digestion an unlikely tool to make a diagnosis . Ju...

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RE: DKD & Immune Complex GN on biopsy 10 hours ago

Markedly thickened GBM consistent with diabetic glomerulopathy. Extensive podocyte effacement can occur in heavily proteinuric diabetic glomerulopa...

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RE: Lupus Nephritis 11 hours ago

I am not sure if there is any literature showing a benefit of a non Voclosporin CNI ,like Tacrolimus , especially in non nephrotic lupus . In such ...

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RE: Lupus Nephritis 11 hours ago

CNIs are effective in higher baseline proteinuric LN but does not mean it is less or less preferable in low baseline proteinuric LN as they have 2 ...

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RE: Lupus Nephritis 13 hours ago

I could not open the biopsy report , but if it is indeed Class 4 , I would consider a treatment regimen of Steroids , Mycophenolate and Belimumbab....

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RE: Lupus Nephritis 14 hours ago

I fall in the Mayo Clinic School of management of this case. I would not use protocol re- biopsy but follow serology (C3/C4 ; anti-ds DNA antibody ...

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RE: Lupus Nephritis 15 hours ago

I think your treatment plan is good. What will be your third medication? MMF + voclosporin or MMF + belimumab? I know that rituximab has not been...

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RE: Lupus Nephritis 15 hours ago

Complete remission and hence long-term renal outcome is higher with triple therapy. Some opt for triple and some for double therapy, the vital issu...

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RE: Is Hypertonic Saline appropriate here 16 hours ago

Great discussion. One issue which has not been addressed. Is the volume status of your patient. You indicated to me by email that the urine protein...

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RE: Lupus Nephritis 16 hours ago

Since early aggressive therapy of Severe LN is important in securing an optimal long term outcome, why not use the best therapy available for initi...

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RE: Novel COL4A3 Variant and Kidney Transplantation 16 hours ago

I concur with Dr. Balan's analysis - we need to know the specific details of the genetic mutations in the recipient and perhaps her affected siblin...

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RE: DKD & Immune Complex GN on biopsy 16 hours ago

Hello Dr. Venkat, Thank you for your response. Main EM findings: GBM thickening (~1,457 nm) & segmental GBM lamination / Duplication with cell...

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RE: DKD & Immune Complex GN on biopsy 16 hours ago

I agree with Dr. Venkat 100%- this seems to be mostly severe Diabetic Glomerulopathy. With a "minor" component of a superimposed ICGN of undetermin...

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RE: Lupus Nephritis 17 hours ago

Looking back at this case, it is more than remarkable, the disconnect with the urine findings and the histology "Investigations showed PCR 27...

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RE: Lupus Nephritis 19 hours ago

Disclaimer: Strictly personal opinion. In deciding on induction therapy for LN, I look at both pathological severiry (class IV in this patient) ...

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RE: Novel COL4A3 Variant and Kidney Transplantation 19 hours ago

In the genetic evaluation for a kidney transplant, the evaluation must start from the patient. We must know the genetic diagnosis in the index case...

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RE: Novel COL4A3 Variant and Kidney Transplantation 19 hours ago

What were the EM findings in the GBM in the sibling's kidney biopsy? Were they consistent with hereditary nepritis/Alport Syndrome? Given the age o...

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RE: DKD & Immune Complex GN on biopsy 19 hours ago

Rheumatoid factor and serum complement levels (since infection-related GN [IRGN] is a possibility)? Did EM show electron dense deposits (descriptio...

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RE: Canine amyloidosis treatment options 20 hours ago

Congo red was positive in the areas of amyloid. EM showed segmental expansion of mesangial zones and the bases of capillary walls by haphazardly ar...

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DKD & Immune Complex GN on biopsy 20 hours ago

Hello, I thank you in advance for your feedback on my patient below. 40 y/o Latino Woman with PMH of CKD GII, A3, Nephrotic range proteinuria HT...

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Novel COL4A3 Variant and Kidney Transplantation 21 hours ago

Dear colleagues, I would like to share a clinical case and seek your opinion regarding its genetic interpretation and the implications for living d...

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RE: Canine amyloidosis treatment options 1 day ago

you could send tge biopsy to the Mayo Clinibfor Laser Dissection- Mass Spectometry . What did the Congo Red stains and the EM show?., the polyuria ...

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Canine amyloidosis treatment options 1 day ago

Hello everyone, I was hoping to gain some insight on therapeutics for a recent patient of mine. This is a 7 year old mixed breed dog, only ~ 6kgs...

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RE: Lupus Nephritis 1 day ago

Initial "triple therapy " for severe LN consistent of MMF or CYC + Steroids (and another agent- (CNI, BELI or OBI). In the AUrRora trial of Voclosp...

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RE: Hyponatremia 1 day ago

I fully agree. Excellent clinically relevant and pragmatic advice from D Teixeira. Many thanks. We should be doing fewer, not more, Posm in evaluat...

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RE: Lupus Nephritis 1 day ago

@ prof glassock thanks for input Could you let me know your thoughts about triple therapy using mmf based regime and is there evidence for using tr...

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RE: Lupus Nephritis 1 day ago

Unless you monitor CD19 + B cells in peripheral blood and aim for 100 % depletion, then RTX is not indicated in LASs IVLN, and none of the current ...

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RE: Lupus Nephritis 1 day ago

Dr alhejaj / Prof aledan Another option is maybe 2 pulse cyclo with MMF and steroid / hydroxychloroquine could be another option. ( not ebm) I won...

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RE: Lupus Nephritis 1 day ago

If we also use euro lupus induction does it mean we don’t have to add belimumab or Cni or ritux / obi initially ? Thanks -----------------------...

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RE: Lupus Nephritis 1 day ago

Thanks prof aledan. I guess if you see it in a different way adding CNI to MMF / steroids / hydroxychloroquine could allow you wean steroids more q...

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RE: Lupus Nephritis 1 day ago

The option of RTX by Hayder Alhajaj for induction therapy of class IV LN was not aligned with my plan as discussed this based on failure and as we ...

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RE: Lupus Nephritis 1 day ago

Dr. Soobador- This was my first thought and discussion with the fellow to start with MMF and PRD because of slight proteinuria but because of clas...

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RE: Lupus Nephritis 1 day ago

Many thanks for great suggestions. We take care of this patient in our center and posted by our esteemed fellow (Hayder Alhajaj). My plan was to ...

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RE: Lupus Nephritis 1 day ago

If Obinutuzumab and Belimumab are not available and the family refuses Cyclophosphamide, can Rituximab be used instead as induction therapy? -----...

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RE: Lupus Nephritis 1 day ago

Thanks for case and input from colleague what about mmf and steroids/ hydroxychloroquine and adding belimumab / ritux /obi/ volclosporin/ Tac if n...

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RE: Hyponatremia 1 day ago

two 👍 👍 for the points made by Dr Teixeira. ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrolo...

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RE: Lupus Nephritis 1 day ago

In the REGENCY trial, obi was added to MMF and prednisone only (not tested v a CYC based protocol) I totally support avoiding CYC for most initi...

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RE: Lupus Nephritis 1 day ago

Dr. El-Meanawy- By 'Standard " therapy. I presume you mean MMF not CYC (Euro-Lupus dosing) . But both of these regimens are regarded as essential...

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RE: Lupus Nephritis 1 day ago

Due to the young age, I would use standard therapy plus obinutuzumab which got the label for LN. ------------------------------ Ashraf El-Meanaw...

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RE: Is Hypertonic Saline appropriate here 1 day ago

@John Mellasthank u for your response as well. My understanding is that in the treatment of hyponatremias we have moved away from the concept of ac...

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RE: Is Hypertonic Saline appropriate here 1 day ago

Interesting interpretation of the problem by Dr Dastoor. I would interpret the physiology as both hyperosmolar and hyperosmolar hyponatremia, in th...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

Actually 900 mg in 600 ml. Yes that seems to be the consensus. Because the changes seem much more drastic than the course of the disease. Probably ...

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RE: Is Hypertonic Saline appropriate here 1 day ago

What is UPC and UAC ? Is this AKI or Diabetic nephropathy (CKD) ? agree with careful 3% saline for symptomatic hyponatremia. Agree with renal US. ...

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RE: Is Hypertonic Saline appropriate here 1 day ago

Hi, how are her vitals? any concerns for salt wasting nephropathy? did you by any chance check cortisol levels? ------------------------------ Di...

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RE: Lupus Nephritis 1 day ago

Hi, given her age, I would try MMF+ pred + belimumab with ACEi/ARBs and HCQ. I have limited experience with obinutuzumab. ----------------------...

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