RE: Lupus Case 12 minutes ago

Any thoughts on CarT - CD19/BCMA or TCE therapies ( teclistamab) if it's available at your facility. --------------------------------- Dr. Horma...

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RE: Thoughts on immunosuppresion for canine MPGN? 5 hours ago

Exactly correct. This I s why PGNMID needs to be considered as a cause of a MPGN lesion in this dog with monotypic LC glomerular deposits and a "M ...

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RE: Thoughts on immunosuppresion for canine MPGN? 14 hours ago

for MPGN I always refer back to this figure from 2013 NEJM review that starts with isolated C3 staining or not The IF in this case puts it to...

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RE: Thoughts on immunosuppresion for canine MPGN? 15 hours ago

Understood. Under these circumstances it will be extremely difficult to establish a " diagnosis" of PGNMID in a dog, in humans PGNMID is usually ...

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RE: Thoughts on immunosuppresion for canine MPGN? 22 hours ago

Bortezomib has been reported in 2 case reports for treating multiple myeloma in our world- one in a cat and another in a dog. The dog was also trea...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Thanks . Understood. This is a problem. In dogs, one cannot exclude a PGNMID by using anti-human LC specific antibody reagents . I suspect that Las...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Thanks for your thoughts, Dr. Glassock. For clarification, the ratio of lambda to kappa light chains in dogs is almost entirely lambda. Kappa sta...

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RE: 9/11 and Nephrology 1 day ago

David, Like you I have flashback as well. Thank you for for the reminder and what it led to . ------------------------------ Anatole Besarab MD A...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

What is LLC? If it is Lambda Light Chain then you need to consider Proliferative GN with monoclonal IgG deposits ------------------------------ ...

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RE: 9/11 and Nephrology 1 day ago

An amazing combination of hilarious, insightful, imaginative, and fascinating. Thanks for sharing! ------------------------------ Sheldon Hirsch ...

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Thoughts on immunosuppresion for canine MPGN? 1 day ago

Hi everyone, I'd love to get some thoughts on potential drug options for a patient of ours. This is a 3 and 1/2 year old French Bulldog who ha...

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9/11 and Nephrology 2 days ago

As I always have flashbacks on 9/11, I thought I would share with you a report and an essay on the nephrologic aspects of that day in New York City...

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RE: Transplant Case 2 days ago

A biopsy is needed. A late PTLPD is usually EBV negative and behaves more like a lymphoma that early PTLPD that often goes away when immunosuppresi...

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RE: Lupus Case 2 days ago

I agree with you Dr. Dastoor. But the BLISS trial may have included too few patients with this severe crescentic GN to draw any firm conclusion abo...

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RE: Lupus Case 2 days ago

I would take the contrarian view. Your patient has severe renal and extra renal involvement , and would benefit more from a Belimumab based regimen...

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RE: Lupus Case 2 days ago

Thanks everyone after 6 pulses of cyclophosphamide Then start mmf ? Thanks --------------------------------- Muhammad Soobadar MBChB UK -----...

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RE: Transplant Case 2 days ago

Sorry my bad. I thought it was large bowel due to a careless reading of the post. In that case a CT guided lymph node biopsy would be best. ----...

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RE: Transplant Case 2 days ago

Dr. Balan tissue is needed for PTLD diagnosis but in this case the CT scan shows small bowel involvement.. would you still perform random biopsy in...

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RE: Recurrent ascites in ESRD pt 3 days ago

Very interesting discussion. I have a patient currently with severe recurrent ascites requiring frequent LVPs where cardiac source has been ruled o...

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RE: Transplant Case 3 days ago

I think your original suggestion of colonoscopy is great. Everything depends on the tissue diagnosis. If we are able to get a biopsy then the other...

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RE: Transplant Case 3 days ago

Agree with everything said and we usually involve oncology to help guide PET scan use and treatment. Get Outlook for iOS

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RE: 52 year old male with class V LN 3 days ago

Thank you all. I will provide a table of recent results which Will make things a bit more clearer ------------------------------ M Kaisar Neph...

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RE: 52 year old male with class V LN 3 days ago

Mycophenolate sodium 720 mg three times daily (2160 mg/d) is pretty much a maximum dose. I would not push it any further., especially with declinin...

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RE: 52 year old male with class V LN 3 days ago

Could you please post the deidentified report of the most recent kidney biopsy - this should help with the decisions about treatment modalities . I...

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RE: 52 year old male with class V LN 3 days ago

With these doses , the patient is receiving Mycophenolate sodium not Mycophenolate mofetil. ------------------------------ Richard Glassock MD, ...

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RE: 52 year old male with class V LN 3 days ago

I would not consider Rituximab again... Unless biopsy shows high Acuity scores and serology shows high activity . Would probably consider MMF + CN...

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RE: Qb and myocardia stunning 3 days ago

I too do not know whither there us any good data. No doubt the extracorporeal blood flow in the dialysis circuit is not affected unless the flow ex...

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RE: Recurrent ascites in ESRD pt 3 days ago

Dr Glassock. The word uremic is too broadly used. Some substance retained in the state of ESRD which has an effect in a particular target system is...

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RE: Recurrent ascites in ESRD pt 3 days ago

I agree tou Fr Rodby. How do measure adequate dialysis. After more than 49 years of Kt/V I am convinced that the latter does not do justice to "wha...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 3 days ago

When I had the ARR determines I was off ARB for a week but took the rest of the medical, of course mt BP did go up -----------------------------...

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RE: Recurrent ascites in ESRD pt 3 days ago

Odd because a "uremic" factor should be acting systemically, yet the serositis is localized exclusively to the peritoneal membrane in cases of "dia...

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RE: 52 year old male with class V LN 3 days ago

Dr. Kaisar: I am confused about the trends of urine protein, urine albumin and serum albumin levels. If the UPr and UAlb are unchanged but the seru...

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RE: Recurrent ascites in ESRD pt 3 days ago

Im not sure what you mean by odd, but to me, if I am correct that this is uremia, it just tells us how unhealthy you still are despite being consid...

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RE: 52 year old male with class V LN 3 days ago

His current dose is 720mg TDS which was his dose pre-reduction to twice a day. On the.TDS dose the urine protein level was 8.3 g though the serum a...

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RE: Recurrent ascites in ESRD pt 3 days ago

So the terminology is all wrong - it is "Uremic Ascites" in a patient with uremia treated with HD (and cured by Kidney Transplant) - all rather odd...

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RE: Recurrent ascites in ESRD pt 3 days ago

The only thing I have seen work is transplant I will be curious as HDF gets more common if we see it less ------------------------------ Roge...

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RE: Recurrent ascites in ESRD pt 3 days ago

Dr. Rodby very intriguing hypothesis Any personal experience of improvement with HD intensification , MCO membranes or PBUT removal? --------...

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RE: Recurrent ascites in ESRD pt 3 days ago

"when you say nephrogenic-what would the mechanism be (assuming that if pts has been on dialysis for some time residual kidney function is nil or q...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 3 days ago

I agree- but measuring ARR while a patient is receiving an ARB is usually not recommended. ------------------------------ Richard Glassock MD, F...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 3 days ago

The low (assuming it's below the lnl) renin concentration with ARB really points towards primary hyperaldosteronism. ---------------------------...

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RE: Transplant Case Tuesday, September 9 @ 10:23 AM

Agree with Dr. Glassock biopsy/tissue diagnosis is needed. She is 7 years out from transplant. Early post-transplant lymphomas are more commonly EB...

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RE: Transplant Case Tuesday, September 9 @ 10:05 AM

GI involved PTLD seems likely. Is the patient EB+ or -.?Can you get a CT guided biopsy of LN to see if it is CD20+ or not? Reduced IS is always the...

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RE: 52 year old male with class V LN Tuesday, September 9 @ 9:34 AM

What is his current MMF , hydroxychloroquine and steroid dosage? What his current eGFR? Serum Sickness should not occur with OBI- the arthritis is ...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 9:25 AM

Cannot interpret ARR while receiving an ARB. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------...

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RE: 52 year old male with class V LN Tuesday, September 9 @ 9:14 AM

Thank you Professor Aledan I have just received his latest labs. The UACR is down to 400+ from a peak of 900+. Interim level was around 600 2 wee...

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RE: 52 year old male with class V LN Tuesday, September 9 @ 9:13 AM

Thank you Professor Glassock. He had OBI after Rtx and developed serum sickness type reaction. I have just received his latest labs. The UACR is do...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 8:50 AM

@Emilio Venturelli What we measure in our lab is direct renin concentrations in ng/l and she was on ARB on board. --------------------------------...

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Transplant Case Tuesday, September 9 @ 8:05 AM

Dear Colleagues, I would appreciate input/MDT for this case 38 Female DCD en bloc transplant 2018 Historical anti DP on dual agent( Tac and Aza...

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RE: Recurrent ascites in ESRD pt Monday, September 8 @ 9:15 PM

I suppose that it is worth remembering that Eleanor Roosevelt. , the former First Lady of the USA , died of unrecognized Miliary Tuberculosis. -...

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RE: Recurrent ascites in ESRD pt Monday, September 8 @ 8:58 PM

1 case in 500ver 40 years of practice and it was early in my care. The patient had a positive PPD and evidence of "healed" lesions on his chest x-r...

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