RE: Secondary Membranous Evaluation 1 hour ago

It this is clearly “Secondary” MN, not “Primary” MN in one of the non-PLA2R antigen forms. A role for CYC or RTX or combinations of these agents is...

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RE: Secondary Membranous Evaluation 2 hours ago

I second Dr. Rodby's screening question. Age-specific cancer screening should be done. Is the deposit both Kappa and Lambda or restricted to one?...

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RE: Secondary Membranous Evaluation 3 hours ago

Where do we draw the line on malignancy workup for PLA2R negative MGN? Age 20, 30,40, 41? I tried to see if malignancy .while may not be IgG4, can ...

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Nephrology training or job 9 hours ago

Good morning, Brazil's congress recently passed a law for a minimum wage for all nursing careers, in this scenario of inflation, almost every dial...

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RE: Secondary Membranous Evaluation 1 day ago

Lupus-like MN is rather uncommon and may evolve to overt SLE over time in a minority of cases. C1q Nephropathy is a remote possibility. If a chroni...

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RE: Secondary Membranous Evaluation 1 day ago

With Sub-endothelial and mesangial ED deposits, this is not likely to be Primary MN of any antigen subtype. Can you do IgG subclass, EXTI/II staini...

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Secondary Membranous Evaluation 1 day ago

41 year old male with no significant past medical history presents with nephrotic syndrome, biopsy shows membranous nephropathy. PLA2R negative in ...

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RE: Memberanous Nohropathy With PE 1 day ago

Sheldon, I LOVE rituximab, but Ponticelli has a long history of tolerance The cumulative cyclophosphamide dose is not that much, and the steroids...

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RE: Memberanous Nohropathy With PE 1 day ago

The role of the high doses of IV MP in the CYC based "modified" Ponticelli regimen for MN is not known due to the lack of suitably designed RCT. So...

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RE: Memberanous Nohropathy With PE 2 days ago

Dr Glassock and others, do you have any experience with or thoughts about a "modified modified Ponticelli" protocol which follows the modified prot...

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RE: Memberanous Nohropathy With PE 2 days ago

Any anti-CD20 or CD38 therapy plus anti-coagulation. If he has high PLA2R antibodies, it will provide something to evaluate serologic response. T...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 2 days ago

Craig is quite correct that this forum serves as an invaluable reference. Keep watching. I cannot tell you how many cases of nephrotic syndrome I ...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 2 days ago

"She/he who knows, knows that she/he knows, is wise - learn from that person. She/he who knows not and knows that she/he knows not - teach her/him....

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 2 days ago

To elaborate on Dr. Glassock's Donald Rumsfeld quote: To know that we know what we know, and to know that we do not know what we do not know, ...

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RE: Lupus Nephritis - now w change of class 2 days ago

So - currently she is on mmf 1.5 bid ; max ace; diuretics pcr continues 5.5; Cr 0.7 on eliquis - hx of splenic v thrombosis from last MGN -> Q1. s...

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RE: Lupus Nephritis - now w change of class 2 days ago

Dear Dr Rodby you mentioned "So what do you treat class 5 lupus relapse with anyway? I'd be fine with MMF, or rituximab alone and watch for now. I ...

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RE: Lupus Nephritis - now w change of class 3 days ago

Thanks, Dr. Glassock and Dr. Mallat. I totally agree with you two currently, however, if positive, maybe we can follow the levels, and see what ha...

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RE: SIADH - how much to pursue workup? 3 days ago

Did you consider a reset osmostat? Carlos Galvao-Sobrinho ------------------------------ Carlos Galvao-Sobrinho MD, PhD Physician All Saints Hosp...

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RE: Unexplained intermittent hypokalemia 3 days ago

I truly appreciate everyone who has taken the time to respond. I don't really know the patient's acid base status in detail because nobody has done...

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RE: Unexplained intermittent hypokalemia 3 days ago

Do you have the serum chemistries during one of these episodes? It may prove helpful. ------------------------------ John Mellas MD Nephrology and...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 3 days ago

You are very welcome. The “Standards of Care” are constantly in a state of evolution . Published guideline go quickly “out-of-date”. -------------...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 3 days ago

Thank you all for the input to my specific case and also the numerous other cases that have helped me sort out managing difficult cases or cases wh...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 3 days ago

The risk of a relapse is about 15-20% or a little less after 3 years of FU. A clinical relapse will most often be heralded by a reappearance and st...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 3 days ago

I would follow serum PLA2R Ab, serum albumin, serum creatinine, lipid profile and UPCR every 3 months till 6 months after the second dose; if every...

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RE: 20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 3 days ago

"- 4/2/2021: Presented to hospital SOB, CTA multiple PE's, DVT neg. UA 4+ prot (dip), Cr 0.6, Alb 1.7 (NO RENAL CONSULT - NS diagnosis missed)" wo...

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20 y/o with PLA2R-ab positive Membranous - in remission after Ritux. Ab tracking? 3 days ago

This is a 20 y/o woman who has no significant past medical history. - 4/2/2021: Presented to hospital SOB, CTA multiple PE's, DVT neg. UA 4+ prot ...

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RE: Memberanous Nohropathy With PE 3 days ago

At least in the USA, IV CYC regimens are not "standard of care" for Primary MN and the data supporting efficacy and safety of IV CYC regimens is ve...

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RE: Unexplained intermittent hypokalemia 3 days ago

Dear Dr Faber, As the above comments, I think it is important to evaluate the acid base status. The othe problem he has is that probably his arritm...

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RE: Memberanous Nohropathy With PE 3 days ago

Report came from his counter He received pulse steroids 1 gm 8,9,10 may and endoxan 1 gm 9/5 and kept on predinslone 40 mg then presented to us by ...

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RE: Memberanous Nohropathy With PE 3 days ago

Thank you --------------------------------- Samir Mallat Professor of Clinical Medicine American University of Beirut Beirut Lebanon ---------...

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RE: Memberanous Nohropathy With PE 3 days ago

This is biopsy report --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH KUWAIT 00965 51377736 --------------------------...

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RE: Lupus Nephritis - now w change of class 3 days ago

Anti-PLA2R associated LMN is so common on LMN that we do not know whether it requires some special category of treatment tegimen . OK to measure it...

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RE: Memberanous Nohropathy With PE 3 days ago

Sorry this modified piontcelli approach contains cyclophosphamide and prednisone together from the first or cyclic any experience ??? ------------...

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RE: Memberanous Nohropathy With PE 3 days ago

Somewhat confusing as I thought that the final report is not available and diagnosis of MN was only assumed by history. If so I will withdraw from ...

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RE: Lupus Nephritis - now w change of class 3 days ago

Thank you Dr Liu Indeed MN can Co exist with many other lesions No harm to do anti PLA2 receptors. I believe this will not affect therapy ----...

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RE: Lupus Nephritis - now w change of class 3 days ago

Hello everyone, I have a question. For this pt, I wonder if we should check the PLA2R antibody level since one article showed PLA2R antibodies can...

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RE: Unexplained intermittent hypokalemia 3 days ago

Do you have urine Ca? ------------------------------ Song Liu MD River Forest IL (570) 594-9881 ------------------------------

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RE: Not all Hypokalemia and Hypomagnesemia in a young patient is Gitelman's or Bartter 3 days ago

I recently had a patient referred to our Office for hypomagnesemia- she is in her mid 50, she was having progressive weakness and muscle aches for...

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RE: Unexplained intermittent hypokalemia 3 days ago

in spite of above reasonable discussion, I would still get genetic testing for Gitelman syndrome. easily available now through Natera. this just ...

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RE: Lupus Nephritis - now w change of class 3 days ago

Class 3 means a segmental lesion and it is described as segmental proliferation, not segmental necrosis, that matters to me. Assuming the Ems do no...

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RE: Unexplained intermittent hypokalemia 3 days ago

Episodic hypokalemia (+/- hypomagnesemia) suggests episodes of respiratory alkalosis (panic attacks/hyperventilation), periodic paralysis (familial...

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RE: Lupus Nephritis - now w change of class 3 days ago

Class III with an activity level of 1. Not much to worry about. I would treat like ClassV, perhaps exacerbated by a recent viral infection. A perlu...

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RE: Memberanous Nohropathy With PE 3 days ago

Yes prof Dr Glassock --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH KUWAIT 00965 51377736 ----------------------------...

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RE: Memberanous Nohropathy With PE Monday, August 8 @ 5:48 PM

I thought that the description of this case included a history of MN (presumably proven by a prior kidney biopsy). Is this correct? --------------...

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RE: Lupus Nephritis - now w change of class Monday, August 8 @ 4:13 PM

I will consider this a a a relapse membranous and somewhat early. Will add Rituximab --------------------------------- Samir Mallat Professor of...

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Unexplained intermittent hypokalemia Monday, August 8 @ 4:00 PM

Any help from the esteemed readership and faculty of this forum with diagnosis or management of this patient would be appreciated. I am treating a ...

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RE: Memberanous Nohropathy With PE Monday, August 8 @ 4:00 PM

Not an uncommon scenario Of course therapeutic anticoagulation with heparin and warfarin Somewhat bothered by the fact that no final diagnosis by b...

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RE: Memberanous Nohropathy With PE Monday, August 8 @ 2:58 PM

"history of MN with history of biopsy 3 month waiting for the report" Do you have at least a preliminary report confirming MN? While MN is the comm...

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RE: Lupus Nephritis - now w change of class Monday, August 8 @ 2:54 PM

I agree with Dr. Venkat. I do not think that either Voclosporin or Belimumab are indicated at this time in this patient. Just an opinion. --------...

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RE: Memberanous Nohropathy With PE Monday, August 8 @ 2:42 PM

Either RTX or CYC (Modified Ponticelli) or RTX + low dose oral CYC (MGH Regimen). Can you obtain Anti-PLA2R levels ( by ELISA)? This would help a l...

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