RE: aki caused by RAS? 15 minutes ago

thanks blood film no shistochytes now and ldh normal after bp well controlled with 4 agents started hd via temporary vascath and might be recover...

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biopsy in patient BMI 14 thought? 19 minutes ago

43-year-old lady who has a BMI of 14. Her kidney function has been around eGFR 60 ml/min since 2018 but since September 2025 her eGFR has dropped t...

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RE: Hyponatremia 1 hour ago

Dr. Gunnell: Was patient euvolemic on physical exam? BUN, SCr and (if available) serum uric acid baseline and when SNa was 117 meq/L? Urine output ...

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RE: Rituximab maintenance for lupus nephritis 4 hours ago

Dr. Rodby- understood and your experience driven opinions are extremely valuable. What this pist is examining is whether RTX (or OBI or Voclosporin...

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RE: Hyponatremia 5 hours ago

I would repeat the urine osmolality and lytes again along with Urine Urea . The fact that his Uosm is less than Posm and also less than 100 , sug...

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Hyponatremia 6 hours ago

Curious how you would treat this patient. He is a 53yo with complex regional pain syndrome admitted with intractable pain. His sodium 138 on admitt...

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RE: Rituximab maintenance for lupus nephritis 6 hours ago

There are a lot of answered questions here 1) the role of rituximab for induction in SLE (v recently approved Obi) 2) The role of Ritux or obi ...

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RE: Rituximab maintenance for lupus nephritis 7 hours ago

Thanks Dr. Dastoor for your much appreciated comments . It is the totality of the Open Forum experience that makes it such a unique learning format...

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RE: Rituximab maintenance for lupus nephritis 9 hours ago

Thank you Dr. Glassock... I have to say we are very fortunate to continue learning from you ... Each and every case is a learning opportunity for a...

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RE: mpo renal limited anca vasculitis 9 hours ago

Thanks , that makes , non evidence based , clinical sense ... Probably the best and possibly safest option. --------------------------------- Dr....

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RE: Rituximab maintenance for lupus nephritis 11 hours ago

Dr. Emara: Can you please post serial values for UAlb/Cr and/or UPr/Cr, C3, C4 and anti-ds-DNA antibody with dates obtained? Trend of these values ...

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RE: Rituximab maintenance for lupus nephritis 20 hours ago

The requirement for "routine" CD19 assay for the degree of B cell depletion for justifying the use of RTX in LN is uncertain. A post hic analysis o...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 21 hours ago

I agree - the negative pre-implantation biopsy essentially excluded donor derived Collapsing FSGS, but it does not exclude de novo Collapsing FSGS ...

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RE: mpo renal limited anca vasculitis 21 hours ago

Good question. No evidence based answer as there are no well powered RCT of treating Dialysis Dependent ANCA + Vasculitis . The PEXIVAS trial exclu...

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RE: mpo renal limited anca vasculitis 1 day ago

@dr glassock what would be a course of Rituximab? would you give 2 doses as initial therapy and then continue 6 monthly maintenance . In such a cas...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

@Richard Glassock: Point you make about discordance in FSGS/CG occurrence in recipients of kidneys from donors with 2 high risk APOL1 variants is v...

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RE: Rituximab maintenance for lupus nephritis 1 day ago

@dr glassock. Is it routine to measure CD19 counts with Rituximab. I would think that the majority will have suppression of CD19 in the blood, it's...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

Thanks for the additional information. I understand your conclusion but how convincing is the evidence that the other kidney did not develop Collap...

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RE: Rituximab maintenance for lupus nephritis 1 day ago

We do not know where the patient started from two years ago terms of proteinuria, serum albumin , hematuria, Scr, anti-dsDNA antibody and C3/C4 lev...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

Also, BKV and CMV blood PCRs repeatedly negative over the first 9 months post-transplant. HBSAg, HBV PCR, HCVab, HIVab, Parvovirus PCR, and EBV PCR...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 1 day ago

@Richard Glassock : Thank you for your comments. Kidney donor was African American. Unfortunately, APOL-1 information is not available on the do...

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RE: mpo renal limited anca vasculitis 1 day ago

Noted. Thank you. She has totally normal renal function as far as I can tell. Creatinine was 0.7 1 year ago. Very unremarkable imaging/other work u...

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RE: Rituximab maintenance for lupus nephritis 1 day ago

I'm concerned with the balance between under/over immunosuppression and predicting the side effects during use of RTX as an add-on MMF rather than ...

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Post-Doc Funding From the ASN Foundation 1 day ago

Good afternoon, If any of you are looking for funding for your next post-doc, applications are open for the Ben J. Lipps Research Fellowship unti...

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RE: Rituximab maintenance for lupus nephritis 1 day ago

C3 & C4 are normal now Anti dsDNA mildly positive Creatinine 0.9 UPCR 1 gm Class IV --------------------------------- Ahmed Emara MD, FASN Ai...

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RE: mpo renal limited anca vasculitis 1 day ago

Besides urine sediment and CRP/ESR, kidney size/echogenicity/cortical thickness on ultrasound, duration of failure-to-thrive/weight loss symptoms, ...

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RE: mpo renal limited anca vasculitis 1 day ago

Thank you Dr. Rodby. i will do Rixutan with appropriate infection prophylaxis. Her hep b is negative. Best, tt ---------------------------...

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RE: mpo renal limited anca vasculitis 1 day ago

I agree with Dr Glassock, I think you have to give it the "college try", "the benefit of the doubt" Im not sure there is a role for plasmapheres...

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RE: IV iron chelators 1 day ago

Our patients treated with a combination of iron chelators did not experience infection, but their spleens were functional. In addition, I had the o...

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RE: mpo renal limited anca vasculitis 1 day ago

Thank you Dr. Glassock for your input. ------------------------------ Tai Truong MD Valdosta GA (404) 625-8798 ------------------------------

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RE: mpo renal limited anca vasculitis 1 day ago

With only 7 glomeruli in the biopsy sample you might be missing some component of partially reversible disease(e.g. cellular crescents)- i agree th...

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mpo renal limited anca vasculitis 1 day ago

Hello, I have a 62 years old Caucasian female presented with failure to thrive and weight loss. She was found to have a bun of 110 and cr of 9. N...

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RE: Ext 1 poistive biopsy 1 day ago

This patient would not have met the Inclusion criteria fir the Regency trial of OBI in LN, so technically the label does not apply to her. I am not...

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RE: Ext 1 poistive biopsy 1 day ago

I am in Dr. Venkat camp to chose Obinutuzumab over Steroid and even Rituxan especially the FDA granted the label for Lupus nephritis. Some stero...

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RE: Rituximab maintenance for lupus nephritis 1 day ago

By the way, RTX is not considered Standard of Care for Class III or IV LN + or - Class V for initial or subsequent therapy, and is not approved for...

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RE: aki caused by RAS? 2 days ago

I share Dr.Rodby's discomfort with the prospect of a kidney biopsy in this case. I do not think that it is worth the risk.. ---------------------...

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RE: aki caused by RAS? 2 days ago

Thanks a lot really helpful I will senf updated haemolytic screen Bw --------------------------------- Muhammad Soobadar MBChB UK -------------...

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RE: Rituximab maintenance for lupus nephritis 2 days ago

What lesion are you treating? What is the C3/C4 and anti-dsDNA antibody? What is the UPCR and SCr.? I do not routinely monitor IgG level in patient...

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RE: Measuring GFR 2 days ago

I agree. I hardly ever measure serum Cystatin C. It is no more accurate than serum Creatinine for estimating GFR, except for patents with moderate ...

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Rituximab maintenance for lupus nephritis 2 days ago

Hi everyone, when you give your patient RTX as an add-on MMF+ psl for not achieving complete remission (UPCR ~ 1gm) after 2 years otherwise, p...

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RE: Measuring GFR 2 days ago

The technology is good and accurate. I, as Dr. Glassock mentioned, doubt the clinical use in everyday practice. Accurate measurement of GFR has onl...

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RE: Ext 1 poistive biopsy 2 days ago

I asked Arkana Lab, which is our reference lab for kidney biopsies. They routinely perform the PLA2R stain when the biopsy indicates membranous nep...

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RE: MCD and thymic cyst 2 days ago

I do not think Rituximab increases post -op infection risk much at all. Prednisone totally, rituximab, minimally if at all, I would just give ...

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RE: Ext 1 poistive biopsy 2 days ago

Hi, I'm not sure, The pathology lab we use is a dedicated nephropathology lab. I will reach out to them and let you know. -------------------...

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RE: MCD and thymic cyst 2 days ago

Thanks Dr Rodby, is there any preference to when to give Rituximab in relation to the surgery? Before or after? Would you think its more reasonab...

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RE: Measuring GFR 2 days ago

I agree. Most likely to be used where pharmaceutical dosing is important. ------------------------------ Anatole Besarab MD ABesarab Consulting ...

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RE: Collapsing Glomerulopathy in a Kidney Transplant Recipient 2 days ago

Curious findings. CG by LM but only moderate FP effacement by EM and no hypoalbuminemia. . SGLT2i and GLP1RA therapy may be blunting full expressio...

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RE: MCD and thymic cyst 2 days ago

I agree 100% with Dr. Rodby. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: Measuring GFR 2 days ago

Interesting new technology. I do not forsee that it will replace the outpatient use of eGFRcr+CysC, except maybe in special situations, like kidney...

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Collapsing Glomerulopathy in a Kidney Transplant Recipient 2 days ago

Questions: 1. What is the likely cause of collapsing glomerulopathy (CG) in this patient's transplant kidney? 2. Is CG the cause of progressive inc...

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