RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 hours ago

The pathology report does not identify any MPGN features and PGNMID was excluded. The lack of organized deposits makes FGN unlikely. This seems to ...

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RE: Kidney stones for prospective kidney donor 3 hours ago

Thank you for the reference and view regarding donation ------------------------------ Daniel Christiadi Canberra Hospital Canberra ACT ---------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 4 hours ago

Thanks This 65 year old female ptn with MPOANCA with fibrocellular crescent and EM cellular crescents After excluding infection ,I think puls...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 5 hours ago

Rheumatoid factor was negative. Complements normal Serological workup only significant for + MPO ------------------------------ David Hwang,...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 5 hours ago

Thank you for the reply Dr Glassock and Dr Venkat DNAJB 9 stain was not completed. Final path results as below: RENAL BIOPSY: 1. CHRONIC ACTI...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 5 hours ago

EM findings? Was a DNAJB 9 stain done? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------...

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RE: Case of recurrent Glomerular disease early post transplant 5 hours ago

Good points- I thought that EM the transplant biopsy showed diffuse FPE. Please clarify-,with massive proteinuria and hypoalbuminemia (Salb= 2.0 gm...

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RE: metabolic acidosis 7 hours ago

"Dr. Rodby why would she have a false positive AG? Does that happen specifically with Sjoegren? So should i order work up for Sjoegren?" W...

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RE: Case of recurrent Glomerular disease early post transplant 7 hours ago

@Richard Glassock: My understanding is that diffuse podocyte effacement was in the native kidney biopsy. In the transplant biopsy there was "podocy...

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RE: Case of recurrent Glomerular disease early post transplant 8 hours ago

Thank you so much Dr Glassock ------------------------------ Daniel Guevara-Pineda MD West Hartford CT ------------------------------

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RE: Case of recurrent Glomerular disease early post transplant 8 hours ago

Segmental deposition of IgM and C3 with evidence of C activation has been described in recurrent FSGS. The very low serum albumin, extremely high U...

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RE: Case of recurrent Glomerular disease early post transplant 8 hours ago

Dear Dr Venkat all good points . They started tacrolimus in the first 2 days with sub therapeutic levels and then stopped it due to concern of D...

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RE: Case of recurrent Glomerular disease early post transplant 9 hours ago

Thank you so much for your input and advice ------------------------------ Daniel Guevara-Pineda MD West Hartford CT ---------------------------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 10 hours ago

"Differential per path includes crescenteric GN 2/2 infection vs underlying cryo" Percentage of glomeruli affected by creases? Segmental vs circu...

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RE: Case of recurrent Glomerular disease early post transplant 10 hours ago

"with robust urine out put in the first 48hrs then UOP progressively declined and became anuric" 1. Did SCr decrease during the first 48 hours ...

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RE: Steroid dependant FSGS 10 hours ago

It dropped from 4.4 to 3.2 within a 2 weeks period approximately. I will continue to check it weekly and start anticoagulation if needed. I have al...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 11 hours ago

To add more detail b/l SCr 1s as of 11/2024. Worsening from 1.3, now 1.6 ACR 300-500s, + RBC since 12/2024 ANCA 1:640, MPO 63 (positive from ...

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RE: Case of recurrent Glomerular disease early post transplant 12 hours ago

In my opinion, this is highly likely to be recurrent Primary FSGS in a renal allograft. I would treat with RTX and PLEX -------------------------...

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RE: metabolic acidosis 12 hours ago

Agree with Dr. Grimm that this is may me pre-analytical error and I face this problem many time until we solve the issue with the lab by filling th...

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? overlapping MPO vasculitis + idiopathic MPGN 13 hours ago

Hello ASN community, I am caring for a 65 y/o F. Plugged in with rheum previously for + arthralgia, myalgia. + ANCA, MPO titers (markedly elevate...

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RE: Steroid dependant FSGS 13 hours ago

What is happening with serum albumin level, if rapidly to below 2.5Gm/dL then she is at risk for a VTE and prophylactic anticoagulation might be in...

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RE: Steroid dependant FSGS 14 hours ago

Agree to initiate CNI for the hope of proteinuria reduction until RTX work and this not for 12-18 months as in case of SRNS but for few months then...

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RE: metabolic acidosis 15 hours ago

Dr. Rodby why would she have a false positive AG? Does that happen specifically with Sjoegren? So should i order work up for Sjoegren? ------...

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RE: Steroid dependant FSGS 16 hours ago

Thank you Dr Glassock for your very helpful inputs. In the last 5 days, her uacr has doubled from 4.5 to 9 GM. I have had her on 40 mg on steroi...

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RE: Guidance on Next Steps in the Management of AKI in CMML with Positive ANCA Screen and Thrombocytopenia 16 hours ago

I recommend this review by Dr. Attieh et al in Kidney Medicine 2023 Dec 5;6(2):100769. doi: 10.1016/j.xkme.2023.100769. The differential diagnosi...

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RE: Case of recurrent Glomerular disease early post transplant 16 hours ago

Dear Dr Glassock thank you for your reply , ill get back to you with C3 : 96 ( normal value > 90 ) and C4 13 ( Normal value > 10 ) , pre transplant...

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RE: Case of recurrent Glomerular disease early post transplant 16 hours ago

What was the serum albumin during the pre-transolsnt course? Was the donor obese.? What are the actual values for serum C3 and C4? Was diffuse FPE ...

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RE: Kidney stones for prospective kidney donor 16 hours ago

Though the criteria for excluding stone formers have changed, and generally are more liberal, I agree with Joe that "unresolved metabolic problems"...

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RE: Steroid dependant FSGS 17 hours ago

1) in FRNS treated with RTX a relapse can still ocurr when RTX stopped. Observational studies have suggested that MMF can prolong the relapse free ...

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Case of recurrent Glomerular disease early post transplant 17 hours ago

I am presenting this case on behalf of a pediatric transplant center in Latin America . I would appreciate your input in the etiology of primary di...

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RE: Glomerular disease with deposits, high anti MPO 18 hours ago

I actually enjoy making decisions that you are force do to do with inadequate information (Inadequate biopsy, vasculitis is focal and easily missed...

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RE: Steroid dependant FSGS 18 hours ago

Dr. Glassock thank you for your insightful comments. Do we really need to maintain patients with frequent relapsing podocytopathy (MCD or FSGS) on...

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RE: Guidance on Next Steps in the Management of AKI in CMML with Positive ANCA Screen and Thrombocytopenia 19 hours ago

The positive IIF ANCA and negative ELISA for antiMPO and antiPR3 antibody suggests either a false positive IIF ANCA OR other Vasculitis associated ...

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RE: Glomerular disease with deposits, high anti MPO 20 hours ago

Hydralazine-associated GN usually has more immune deposits than typical ANCA-associated pauci-immune GN. In your patient, I’m not sure what you wou...

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RE: Guidance on Next Steps in the Management of AKI in CMML with Positive ANCA Screen and Thrombocytopenia 1 day ago

Thanks- if the acanthoytes were over 5% of total erythrocytes in urine this is strong evidence for a Vasculitis /glomerular disease., If the albumi...

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RE: Steroid dependant FSGS 1 day ago

Thank you so much Dr Glassock! I really appreciate your guidance. Sincerely ------------------------------ Manini Vishwanath MD ----------...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Dicyclomine, omeprazole, zofran ------------------------------ Lawrence Kwon MD Westchester Medical Center Valhalla, NY (845) 330-3541 ----------...

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RE: Guidance on Next Steps in the Management of AKI in CMML with Positive ANCA Screen and Thrombocytopenia 1 day ago

Urine sediment showed only acanthocytes, no RBC casts. I took photos through the microscope lens (lab does not have a camera attachment); RBCs have...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

She has seen numerous GI doctors. I have contacted rheumatology to arrange an appointment as soon as possible. ANCA negative (<1:20). -----------...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Negative of celiac and IBD ------------------------------ Lawrence Kwon MD Westchester Medical Center Valhalla, NY (845) 330-3541 ---------------...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Diarrhea is watery and not bloody. Main GI symptoms are abdominal pain, nausea, and vomiting. Not sure if stool was tested for leukocytes or RBCs. ...

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RE: Guidance on Next Steps in the Management of AKI in CMML with Positive ANCA Screen and Thrombocytopenia 1 day ago

I would also consider a diagnosis of acute Lysozyme associated nephropathy in this case. A simultaneous UACR and UPCR and a serum Lysozyme level mi...

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Guidance on Next Steps in the Management of AKI in CMML with Positive ANCA Screen and Thrombocytopenia 1 day ago

I'm seeking advice on the next steps for a 74-year-old male with chronic myelomonocytic leukemia (CMML), who presents with AKI and constitutional s...

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RE: Glomerular disease with deposits, high anti MPO 1 day ago

Did you have EM? If not do a DNAJB9 stain on the one glomerulus . This might be Fibrillary GN. i would stop the Hydralazine and probably treat with...

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RE: minimal change disease steroid dependent 1 day ago

thank yo so much DR glassock!!! your amazing. ------------------------------ Shivangi Patel Nephrology Morristown NJ -------------------------...

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RE: metabolic acidosis 1 day ago

Valid point, Dr. Rodby, regarding the fact that achieving a pCO2 of 24 may require persistent and robust hyperventilation. We need a VBG to continu...

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RE: minimal change disease steroid dependent 1 day ago

Every 6 months RTX is usually sufficent unless CD20 B cells in circulation replenish more quickly than usual, ------------------------------ Rich...

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RE: Steroid dependant FSGS 1 day ago

I doubt that the 'anti-proteinuric" effects of Tacrolimus in steroid-dependent FSGS are due to "Immunosuppression " -more likely a reversible effec...

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RE: minimal change disease steroid dependent 1 day ago

Hi question, got insurance company to approve rituxan, she got 2 doses of rituxan, labs today (she bit noncomplaint) but no edema and lost all w...

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RE: Steroid dependant FSGS 1 day ago

I figured the ritux will take at least 2 months to reach peak levels. I want to induce immediate immunosuppression with tacro to "tide her over" ti...

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