RE: treatment for hypophosphatemia 5 hours ago

I agree 100% with Dr. Rodby's assessment and recommendations. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) ...

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RE: treatment for hypophosphatemia 6 hours ago

This seems like a board question , almost too good, so depending on the IV iron it may stimulate FGF 23 (set attached) I would get a FGF 23 l...

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treatment for hypophosphatemia 9 hours ago

Good afternoon, A pt with h/o IV iron exposure has developed hypophosphatemia. Is currently on 200 mg elemental phosphorus/day PO and iv kphos...

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RE: C3 or IgA 13 hours ago

This exercise is generating a lot of misinformation. At least it has been decided that CFHR variants have a positive association with IgAN, not the...

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RE: C3 or IgA 1 day ago

KN 55 staining has high specificity but lower sensitivity for identifying Primary IgAN (or IgAV) so only positive staining would have pathogenic si...

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RE: C3 or IgA 1 day ago

I think it may be available at Arkana by request,. Both of these cases were outside the USA. ------------------------------ Richard Glassock MD, ...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

I discussed with hematologist, he is of the view to err on the side of caution in view of the HBV serology and closely watch HBV serology gor 6 mon...

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RE: C3 or IgA 1 day ago

How available is KM55 in the US? Most reports are from China, Japan and India. Thanks. Mario ------------------------------ Mario Rubin, M.D. Hou...

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RE: C3 or IgA 1 day ago

Thanks for allowing me to get a little more sleep. One way to better understand the two cases would be to stain the kidney biopsy with IgA deposits...

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RE: C3 or IgA 1 day ago

With a CFHR5 mutation, the patient could have presented with C3 or IgA . I would have expected Pegcetacoplan to have the pathways leading to expres...

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RE: C3 or IgA 1 day ago

I don't think we can have a proper answer to that. There are case reports of CFH mutations with C3GN becoming HUS after kidney transplant. These ar...

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RE: C3 or IgA 1 day ago

Thank you, but am still waiting for an explanation on how he went from C3 deposits , to IgA deposits after treatment with C3 inhibitors .. no point...

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RE: C3 or IgA 1 day ago

Centogene has reported it as a VUS. I think you should get this published to add to the literature on this variant. ClinVar has reported this as be...

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RE: C3 or IgA 1 day ago

Centrogene- from Germany has reported on it .. please see attachment --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Co...

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RE: C3 or IgA 1 day ago

Thanks for the genetic update. CFHR5 486dup is described as a variant of uncertain significance. There are also reports stating that it is benign. ...

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RE: C3 or IgA 1 day ago

Thanks .. let's wait for the Professor to wake up and give a response ... I bet he is thinking over the possibilities while he lays in bed . ----...

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RE: C3 or IgA 1 day ago

Both hypothyses i.e, complement mutations confering susceptibility to IgA as well as C3GN and IgA-Antidrug antibodies make intuitive sense. My case...

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RE: C3 or IgA 1 day ago

Ok, great ... So to summarize this case , with his CFHR5 mutation he is at risk for C3G and IgAN. Prior to Pegcetacoplan he manifested as C3G, and ...

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RE: C3 or IgA 1 day ago

It is very clear that CFHR5 mutations are associated with an INCREASED risk of both C3GN and IgAN. ------------------------------ Richard Glassoc...

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RE: C3 or IgA 1 day ago

He had a biopsy at 3 months and 6 months post transplant . He also got 1 dose Eculizumab, 1 week prior to the transplant and a second dose 2 weeks ...

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RE: C3 or IgA 1 day ago

Thanks for the follow-up. How long following kidney transplantation is follow up available. I would judge that there is a high risk of recurrence o...

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RE: C3 or IgA 1 day ago

I was under the same assumption as Dr. Balan. That is the generic mutations causing aHUS/C3 , were protective against IgA . These mutations are ver...

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RE: C3 or IgA 1 day ago

This patient had a successful kidney transplant . His post transplant biopsy is pristine , no IgA or C3 . On a regimen on Tac and MMF ------------...

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RE: C3 or IgA 2 days ago

Addendum- I Would probably stop the Pegacetocoplan and start MMF and moderate does of steroids or even Iptacopan. But who really knows how to treat...

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RE: C3 or IgA 2 days ago

This provides the Answer to your question. This mutation (CFHR5) is associated with an increased risk of BOTH C3GN and IgAN!!! Why the Pegacetocopl...

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RE: C3 or IgA 2 days ago

See attachments --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidney Care. Nephrology Consulta...

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RE: Renal phosphate wasting 2 days ago

Another suggestion. If you are thinking of Albers Schonberg disease, (and which seems likely here), then please screen other family members as this...

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RE: C3 or IgA 2 days ago

What was the genetic variant in this patient? To add to the complexity, CHFR variants are known to protect against IgA nephropathy -------------...

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RE: C3 or IgA 2 days ago

I also suppose that in such counter-intuitive outcomes, a technical error needs to be given serious consideration. Time will tell. -------------...

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RE: C3 or IgA 2 days ago

Btw... The first 2 biopsies were done in the Kingdom of Bahrain, I did try to contact them but was unsuccessful . I could make another push though ...

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RE: C3 or IgA 2 days ago

Agree this is a strange and counter-intuitive outcome. All the more reason to pursue the cause with greater intensity and depth. Nature may be tryi...

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RE: C3 or IgA 2 days ago

This thread only has 2 cases , my patient with C3G had 3 biopsies --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consul...

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RE: C3 or IgA 2 days ago

Come to think of it , C3 inhibitors such as Pegcetacoplan are being trialled in IgA nephroapthy... So for them to cause igA deposits would be stran...

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RE: Initiating Statin In Dialysis Patient 2 days ago

For thosw who do not use the international units for various blood components, would be helpful to provide the values in amount/dL or L, or also pr...

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RE: C3 or IgA 2 days ago

Thinking out loud. How would the intial insult that led to C3 disease be followed by IgA qhich requires a first hit by the lymphoid tissue in the g...

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RE: Renal phosphate wasting 2 days ago

This is a very interesting case and I agree with Dr Glassock that the combination of what sounds like Osteopetrosis and phosphaturia suggests an Os...

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RE: C3 or IgA 2 days ago

The first approach would be to be to stain the post therapy biopsy with KN55 (anti-gdIgA) and the second would be to do Pronase digestion and Paraf...

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RE: C3 or IgA 2 days ago

I really don't have an answer ... was hoping for the forum to assist , as this case has been on my mind for a few months . ----------------------...

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RE: C3 or IgA 2 days ago

So are these cases examples of drug induced (Secondary) IgA deposit disease (not true de novo Primary IgAN)? I think this is very possible. Further...

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RE: C3 or IgA 2 days ago

The patient also had significant Generic mutations consistent with C3G. So am inclined to believe it's not Pseudo C3 deposits -------------------...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 2 days ago

Are you worried about RTX reactivating HBV with + anti-HBc antibody.? I am. ------------------------------ Richard Glassock MD, FASN Laguna Woo...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 2 days ago

Cr now normal after ritux steroids and plex for Pauci immune GN with pulmonary hemorrhage in setting of MULTIPLE infections. what is urinalysis n...

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RE: C3 or IgA 2 days ago

These are "ominous" findings. Is it possible that the apparent "de novo" IgAN represents an IgA antibody response to "planted"Pegacetocoplan or Ecu...

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RE: C3 or IgA 2 days ago

Unable to explain the reason but have observed the same in one of my patient, initial biopsy C3GN, second biopsy after treatment with Eculizumab, s...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 3 days ago

Thank you all for the valuable and enriching discussion. We had a case of bilateral lower limb dry gangrene, and calciphylaxis was suspected, we d...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 3 days ago

Tough case. Judgement call. No data to support any particular regimen as best. MMF has been marginally effective in maintaining remission in AntiPR...

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RE: C3 or IgA 3 days ago

The patient had an URTI , followed be Nephrotic syndrome . First biopsy : had 30% IFTA ; Second Biopsy : had 40% IFTA The gap between the seco...

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RE: Initiating Statin In Dialysis Patient 3 days ago

Thanks . Not diabetic Cholesterol 4.9 mmol/l LDL 3 mmol/l Triglyceride 2.4 mmol/l Hdl 0.8 mmol/l --------------------------------- Muhammad Soob...

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RE: Recalcitrant severe hyponatremia 3 days ago

Thank you, Dr. Rodby, for your article. In it, 7 control and 8 hyponatremic psychiatric patients in the setting of a Clinical Research Center and r...

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RE: C3 or IgA 3 days ago

De novo IgAN following Pegacetocoplan therapy. I doubt it. Can you arrange for Pronase digestion and Paraffin IF on the prior two kidney biopsies.?...

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