RE: Membranous Nephropathy - ? Antigen undetermind 14 minutes ago

Not so rare in Huangzhou, China. What is the frequency of this lesion in patients diagnosed as MCD or MN in non-Chinese series.? Just curious.. the...

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RE: Membranous Nephropathy - ? Antigen undetermind 15 minutes ago

Yes in my experience very rare and a very difficult diagnosis to make as the presence of IC deposits typically excludes MCD/podocytopathies as a dd...

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RE: Membranous Nephropathy - ? Antigen undetermind 33 minutes ago

Thanks-Dr. Zuckerman - very helpful analysis. I was not aware of "mixed Membranous Nephropsthy and diffuse Podocytopathy ( minimal change diseas...

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RE: Membranous Nephropathy - ? Antigen undetermind 49 minutes ago

I agree with Dr. Glassock, The IF images look more like the typical podocyte "dusting" with IgG that we typically see in auto-antibody mediated pod...

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RE: Hyponatremia with recent diarrhoea, after treating CHF exacerbation 1 hour ago

I agree with Dr. Balan. Gatorade would be contraindicated in this case and possibly harmful. ------------------------------ Richard Glassock MD, ...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 2 hours ago

The study here fits your patient almost exactly - unless of course it is a monotypic disease. Obinutuzunab was extremely effective in rituximab res...

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RE: Hyponatremia with recent diarrhoea, after treating CHF exacerbation 2 hours ago

The question to be asked with a urine osmolality >100 is Why is the vasopressin elevated? In this case, with your description and the low urine sod...

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RE: Hyponatremia with recent diarrhoea, after treating CHF exacerbation 2 hours ago

How have daily weights varied during this? Sent from my iPhone

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RE: Hyponatremia with recent diarrhoea, after treating CHF exacerbation 14 hours ago

Collection time: Dec 22, 2025@21:33 Test Name Result Units Range --------- ------ ----- ----- SODIUM 15 mmol/L POTASSIUM 12.9 mmol/L OS...

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RE: Hyponatremia with recent diarrhoea, after treating CHF exacerbation 15 hours ago

For now, ordering orthostats, holding on spironolactone, reducing oral urea to once a day, giving one-time sodium chloride 1 g, suggesting alternat...

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Hyponatremia with recent diarrhoea, after treating CHF exacerbation 15 hours ago

White gentleman age 74, with history of low renin hypertension probably primary hyperaldosteronism,(in 2021, potassium 4.6, renin undetectable and ...

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RE: Membranous Nephropathy - ? Antigen undetermind 15 hours ago

I agree that this looks more like a diffuse Podocytopathic lesion. The IF is compatible with an auto- antibody induced Podocytopathy, not MN, possi...

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RE: IgA nephropathy with nephrotic syndrome 16 hours ago

I agree that this patient is behaving as a case of a diffuse Podocytopathy Superimposed on glomerular IgA deposition (which may be merely co-incide...

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RE: Membranous Nephropathy - ? Antigen undetermind 16 hours ago

Appreciate all the discussion. Attaching the images. Ahmad ------------------------------ Ahmad Masood MD Nephrology Asscoiates Of Mich...

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IgA nephropathy with nephrotic syndrome 19 hours ago

Dear colleagues, would appreciate your input on this patient 70F, with T2dm, hypertension baseline creatinine 80 umol/l diagnosed with IgAN in 20...

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RE: Intradialytic hypertension 22 hours ago

Today we did " Cardio- Bioimpedence" - which is similar to an external Swan Ganz , and measured SVR , based on Cardiac output and BP. Keeping in ...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 1 day ago

Prof Ashraf El-Meanawy, I really thank you for your suggestions. I already spoke with the pathologist and we are starting the pronase digestion...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 1 day ago

I second Dr. Glassock recommendations. CYC and MFM are modulator and not ablative therapy. The goal in these groups of diseases is to try to ablate...

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RE: Membranous Nephropathy - ? Antigen undetermind 1 day ago

Interesting idea. The LM does show a "tip" FSGS lesion. We would need to see the photos (deindentified) of the IF and EM to be sure. . ---------...

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RE: Refractory IgA Nephropathy 1 day ago

No evidence that using both is safe or more effective than either one alone. The labels permit it, but combined use is discouraged. The combined co...

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RE: Refractory IgA Nephropathy 1 day ago

Can both be used same time Sibeprenlimab and Iptacopin Thanks --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology, Inc. ...

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RE: Membranous Nephropathy - ? Antigen undetermind 1 day ago

Looking at the biopsy report - there's no spikes/holes on the silver stain, the IF only has faint (1+) positivity, and the EM has only "rare" and "...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 1 day ago

Many thanks- hard to say if CYC will be helpful in this case. Only about 10% of cases of MN are refractory to RTX so we have very little data beari...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 1 day ago

Dear Dr Glassock, Thank you very much for the time you spent reviewing our case. We truly appreciate your thoughtful input. Do you think that cyc...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 1 day ago

Dear Prof Rodby, Thank you very much for your response regarding the challenging case I shared with you. Your guidance was extremely helpful and p...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 1 day ago

Dear Professor Glassock, Thank you very much for your thoughtful, generous, and truly outstanding response to the challenging case I shared with ...

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RE: Membranous Nephropathy - ? Antigen undetermind 2 days ago

I agree with Dr. Rodby concerning the current opinion about the lack of utility of separating MM into 2 categories -Primary snd Secondary - in this...

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RE: Membranous Nephropathy - ? Antigen undetermind 2 days ago

I think it is time to abandon the primary and secondary MGN terminology? more confusing than helpful WE are entering the age of Ag definition ...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 2 days ago

Even if you do pronase digestion and determine that there is not light chain restriction, you can still try Dara or Plasma cell directed therapy, s...

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RE: Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 2 days ago

IgG 3 anti-PLA2 mediated MN is quite rare and thus nay explain the resistance to RTX. Such cases can be due an underlying gammopathy (most commonly...

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RE: Membranous Nephropathy - ? Antigen undetermind 2 days ago

Not true. PLA2R + does not define Primary- MN. Such findings can be seen in HBV, Sarcoid, IgG4/Related disease and uncommonly in LN and Cancer. The...

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Refractory PLA2R-Positive Membranous Nephropathy – Management Options When Cyclophosphamide Is Refused 2 days ago

Dear colleagues, I would appreciate your opinion on the management of a patient with high-risk, rituximab-refractory primary membranous nephropath...

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RE: Membranous Nephropathy - ? Antigen undetermind 2 days ago

Using Starlink, so am not sure if this message gets through on the flight . But isn't the definition of Primary or Secondary , now based on the ty...

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RE: Membranous Nephropathy - ? Antigen undetermind 2 days ago

Whether this is Primary or Secondary MN cannot be determined from the available information- it appears to be due to one of the less common antigen...

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Membranous Nephropathy - ? Antigen undetermind 2 days ago

Hi, Would appreciate some input on this case 54 yo woman pre diabetic, initially seen in office Nov, 2024 for proteinuria. UACR 3280 mg/g. Ser...

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RE: macroscopic haematuria in young patient 2 days ago

Any further information --------------------------------- Conjeevaram Kesavan MD, MBBS, FASN Duluth GA (678) 699-8521 -------------------------...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD 2 days ago

ANCA Testing was performed and was negative. We do not have any results from Anti-GBM testing, but the absence of Hematuria makes crescentic diseas...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD 3 days ago

Could ANCA testing deserve consideration? ------------------------------ Ahmed Yasin, MD,FASN Al Ahmady,Hospital, Madina,KSA --------------------...

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RE: Refractory IgA Nephropathy 3 days ago

Understood- but the trials of Sibeprenlimab randomized too few patients with this severe eGFR decline to be certain of a long term benefit on furth...

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RE: Refractory IgA Nephropathy 3 days ago

"Dr. Rodby- Why would you choose Sibeprenlinab over Iptacopan in this case.?" I think the GFR stabilization data is better with APRIL inhibition?...

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RE: Refractory IgA Nephropathy 3 days ago

Serial kidney ultrasonography findings - size, echogenicity, cortical thickness? ------------------------------ K.K. Venkat MD Troy MI (248) 420 ...

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RE: Refractory IgA Nephropathy 3 days ago

Dr. Rodby- Why would you choose Sibeprenlinab over Iptacopan in this case.? My guess is that you may be correct about your reluctance to put much w...

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RE: Refractory IgA Nephropathy 3 days ago

I am going to take the alternative opinion, Im not sure what I would find that would sway me from treatment? 12/2025: sCr 2.8mg/dL, >30 RBC, alb...

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RE: Refractory IgA Nephropathy Friday, December 19 @ 10:59 AM

Thank you for the response, we are planning on repeating the biopsy. ------------------------------ Melissa Vega MD PGY5 Nephrology Fellow Bay...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD Friday, December 19 @ 10:20 AM

Short answer: repeat biopsy no empiric treatment until results are back cross fingers but be prepare for an end stage kidney that my not be w...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD Friday, December 19 @ 7:57 AM

How long was SCr stable around 5.7 mg/dL before dialysis was started? Longer it has been stable, more likely biopsy will show irreversible global g...

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RE: MPO-ANCA Vasculitis in the Setting of Infective Endocarditis - Infection triggered mimic? Friday, December 19 @ 4:05 AM

Thanks for the FU. Fascinating and highly instructive case. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-88...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD Friday, December 19 @ 4:03 AM

With such low grade red blood cells in urine, a crescentic lesion superimposed on MN or DN or both is unlikely, so I seen no clear immediate need f...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD Friday, December 19 @ 2:30 AM

There is no documented evidence of diabetic retinopathy to date; however, the patient has been referred for an ophthalmologic examination today for...

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RE: 66 year old woman witth nephrotic syndrome and AKI on CKD Friday, December 19 @ 2:21 AM

The patient demonstrated a progressive rise in serum creatinine over time. There was no pulse steroid therapy administered during the initial phase...

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