increasing rituximab from maintenance dose for Rise of c ANCA in GPA 3 hours ago

#White gentleman age 80, renal biopsy done in March, 2020, found -CRESCENTIC ANCA-RELATED PAUCI-IMMUNE GLOMERULONEPHRITIS; CONSISTENT WITH MIC...

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RE: A 60 year old kidney donor with diabetes 4 hours ago

"Due to financial issues, she is receiving only one to two sessions per week and has been so for the last 3 months." Given the above problem, does ...

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A 60 year old kidney donor with diabetes 6 hours ago

Hello, I hope this message finds you well. I have a 60 year old man who has come forward as a potential donor to his daughter. He has been healthy...

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RE: Renal Physiology For Fellows 8 hours ago

Our program is also starting a series based on Koepen and Santon's book from September. We haven't done this before but we have used Koepen and Sta...

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RE: Maintenance therapy for MPO nephritis 9 hours ago

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007352/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678839/ Dr Glassock, what do we know about C...

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RE: Maintenance therapy for MPO nephritis 9 hours ago

Thank you @dr Rodby the issue of CD19 is not clear in my mind since it is not followed in all situations. As an example the CD 19 was not part of ...

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RE: Renal Physiology For Fellows 13 hours ago

Our program read Burton Rose, Channel Your Enthusiasm style but is switching to a different book as Rose was considered too much of a time commitme...

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Renal Physiology For Fellows 1 day ago

Hello, big question: Do any programs still teach a longitudinal physiology course during fellowship? If you do, how long is it? (I am a HUGE FAN of...

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RE: Maintenance therapy for MPO nephritis 1 day ago

If it normalizes there is a much less risk of relapse, but it is unknown if treating those longer or more aggressively that did not normalize will ...

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RE: Maintenance therapy for MPO nephritis 1 day ago

Thank you for your reply.Is there any role for measuring MPO titers in MPO vasculitis? ------------------------------ Syed Ali,MD ----------------...

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RE: Maintenance therapy for MPO nephritis 1 day ago

The hard question for MPO vasculitis is how long do you continue maintenance for. Something between never and forever. I tend to continue for year...

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RE: Maintenance therapy for MPO nephritis 1 day ago

I have seen it vary from 500 mg every 6 months to 1 g every 4 months. I think 500 q6 is probably fine but initially at least I would follow CD 19 c...

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Maintenance therapy for MPO nephritis 1 day ago

Hello everyone I wanted to confirm the rituximab dosing regimen for maintenance therapy for MPO positive nephritis I understand that for maintenan...

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RE: Recalcitrant FSGS case 2 days ago

Thank you for your help.

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RE: Recalcitrant FSGS case 2 days ago

If a response to pheresis is going to ocurr it will usually happen within 4 weeks of 3x week sessions- 12 sessions. If lipid Apheresis is available...

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RE: Recalcitrant FSGS case 2 days ago

Thank you Dr. Glassock. I was afraid that this would lead to unfamiliar territory for me. Family history is negative. I will look into genetic tes...

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RE: Recalcitrant FSGS case 2 days ago

Tough case. Unfortunately, these kind of multidrug resistant, slowly progressive cases of “FSGS” are not uncommon. I presume that the family histor...

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RE: SGLT2 inhibitors and Urine sodium Osm 2 days ago

Agree with Dr Radhakrishnan in that SGLT2-I's have been described in the treatment of SIADH, where glycosuria would enhance renal free water cleara...

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RE: SGLT2 inhibitors and Urine sodium Osm 2 days ago

TSH Cortisol were normal. No known meds that can cause SIADH. CT chest negative. Urine sodium 75 and Urine Osm around 300-350. clinically did not a...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

I have seen one case too. Dr. Anurag Tikaria Lansing, MI ------------------------------ Anurag Tikaria MD MD Sparrow Health System Lansing MI ...

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Argatroban as an anticoagulant for HD in outpatient clinic 2 days ago

Does anyone has experience in using long term Argatroban as an anticoagulant for HD in outpatient clinic? What kind on monitoring is required? Once...

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Recalcitrant FSGS case 2 days ago

Hello I have a stubborn FSGS case that I would like your opinion on. This Hispanic gentleman is now 40 yo but his renal problems were discovere...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

Here is study Dr Glassock was referring to (attached) ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Unive...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

Yes . It is very hard to prove causation. However, can it cause flare up of underlying known GN? There are several reports suggestive flaring up af...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

A recent study from Switzerland has shown no increase in GN cases , except possibly MCD, during the COVID era, supporting the notion that most of t...

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RE: SGLT2 inhibitors and Urine sodium Osm 2 days ago

As with everything, there are always two sides to pathogenesis. 1. Solute diuresis (similar to urea) may improve serum sodium in SIAD https://pubm...

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RE: Marked hyperuricemia 2 days ago

Many thanks . Very helpful information. ------------------------------ Richard Glassock MD, FASN Emeritus Professor David Geffen School of Medicin...

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RE: Marked hyperuricemia 2 days ago

. Another thought on this challenging problem - if the gout attacks are equal or less than 2 per year, maybe they could be handled with medrol d...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

SARS-CoV-2 vaccines are exceptionally common, with hundreds of millions of doses in the United States alone. By pure chance, a rare disease is like...

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RE: Marked hyperuricemia 2 days ago

From what I've seen the Co-Pay is typically covered in full by the company that distributes Krystexxa Horizon. ------------------------------ Barr...

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RE: Marked hyperuricemia 2 days ago

Just curious. What are the typical co-payments for Pegloticase in non-Medicare patients with employee sponsored insurance ? ----------------------...

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RE: Marked hyperuricemia 2 days ago

For those like me that didn’t know the difference. “In contrast to rasburicase, pegloticase is pegylated to increase its elimination half-life fro...

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RE: SGLT2 inhibitors and Urine sodium Osm 2 days ago

May be similar to diuretics (loops mainly) they can cause hypoNa and they can be used to treat hypona , all depends on water intake. ------------...

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RE: SGLT2 inhibitors and Urine sodium Osm 2 days ago

Interesting and challenging We need more details on the results TSH, urine osmolarity and urine sodium and status of his volemia but I would think...

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RE: Marked hyperuricemia 3 days ago

Such a valid point the cost is quite high roughly 20,000 USD per dose. luckily Pegloticase is typically covered by insurance including Medicare....

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RE: Marked hyperuricemia 3 days ago

I like the drug Desensitization approach by dr Rudnick . I would make sure it was someone well versed however you don’t want a DRESS syndrome… ---...

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RE: SGLT2 inhibitors and Urine sodium Osm 3 days ago

I don’t know how you could assess endogenous kidney function on an SGlT2i. I would discontinue as well as diuretics and reassess. How low was PNa,...

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SGLT2 inhibitors and Urine sodium Osm 3 days ago

Appreciate your thoughts on this. Recently came across a hyponatremia patient, Urine labs consistent with SIADH (UNa, UOsm) with no particular pre...

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RE: Marked hyperuricemia 3 days ago

Nice idea, but what is the cost for 6 months of therapy. --------------------------------- Richard Glassock MD, FASN Emeritus Professor David Ge...

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RE: Marked hyperuricemia 3 days ago

This is a perfect case for Pegloticase. It's the Uricase enzyme with a PEG to help evade immunogenicity and prolong the half life. The dose is 8 mg...

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RE: Marked hyperuricemia 3 days ago

Thanks Dr. Rudnick. Very impressive list of new drugs in the pipeline. Maybe one of them we’ll help this patient or one’s like it, eventually. ---...

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RE: Marked hyperuricemia 3 days ago

The only realistic option for this patient is to try Probenicid- but it will likely not work. Peglotidase is very expensive and I wonder if the eff...

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RE: Marked hyperuricemia 3 days ago

Attached is an article describing successful desensitization for febuxostat over a 28 d period. I also attached a 2022 update article on gout manag...

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RE: Marked hyperuricemia 3 days ago

Is this hyperuricemia new? How was the patient managed over the years ? --------------------------------- Samir Mallat Professor of Clinical Med...

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RE: Marked hyperuricemia 3 days ago

You can consider IV pegloticase if with severe symptomatic hyperuricemia and if insurance approves it. Need to screen her for g6pd deficiency first...

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RE: Marked hyperuricemia 3 days ago

Sorry. Missed the history gout and diuretics . Are her attacks frequent ------------------------------ Michael Rudnick MD University of Pennsylvan...

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RE: Marked hyperuricemia 3 days ago

Can you provide some additional information. Has she had symptomatic gout or uric acid stones? Is she on diuretics? Have you obtained a fractional ...

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RE: Primary Membranous Nephropathy 3 days ago

@dr Glassock Thank you for your clarifications. Great discussion

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Marked hyperuricemia 3 days ago

Hello All I would appreciate your help with this case 59YOF with CKD stage IV/ eGFR 23 gout with marked hyperuricemia with uric acid of 11---> 14 ...

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RE: Prostrate Ca and NELL1 positive Membranous nephropathy Sunday, June 26 @ 9:10 PM

Thank you ASN community for all the responses and guidance regarding this case 1.I had discussed with patient regarding anticoagulation with DOAC A...

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