RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 39 minutes ago

Because of the tandem gene duplication mutation, special PCR based methods are required. These mutations may escape detection by WGS methods. --...

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RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 1 hour ago

I totally agree with prof Richard I wonder if Repeat genetic testing by using Wide genome sequencing would be helpful any family history of C...

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RE: H. Influenza Vaccination before Eculizumab 2 hours ago

Tried it but no response. I am even considering to enroll that patient in a clinical trial for pegcetacoplan but not sure if they are still enrolli...

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RE: H. Influenza Vaccination before Eculizumab 2 hours ago

I think that current recommendation for vaccination before use of C inhibitors include one dose of H. influenza vaccine. The data on overall effica...

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RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 4 hours ago

I suspect that Dr Glassock is spot on. Two genetic testing strategies that may be employed would be to do a whole genome sequencing to look for int...

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H. Influenza Vaccination before Eculizumab 4 hours ago

Hello Nephrology Community, I am planning on starting a patient of mine on Eculizumab for C3GN and was wondering if they need to be vaccinated...

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RE: IgA nephropathy with recurrent RPGN 5 hours ago

How do you define 'True" Crescentic IgAN compared to IgAN with crescents? Just curious. ------------------------------ Richard Glassock MD, FASN...

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RE: IgA nephropathy with recurrent RPGN 5 hours ago

Just one RCT showing adverse event rate increase in AZA treated patients with IgAN (Pozzi et al JASN 2010). Never duplicated as far as I know, but ...

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RE: IgA nephropathy with recurrent RPGN 7 hours ago

This idea that aza works here and doesnt work here always bothered me for instance it (was) the preferred maintenance drug for vasculitis (before...

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RE: IgA nephropathy with recurrent RPGN 7 hours ago

Addendum- it is worth remembering that Azathioprine is ineffective and possibly harmful in IgAN. See Pozzi C, et al. JASN 2010; 21: 1783-1790. It...

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RE: Anca vasculitis relapse without circulating antibodies 8 hours ago

Thanks- interesting suggestion. No TMA in original biopsy. No comments about peripheral manifestation of TMA with relapse. A repeat biopsy would be...

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RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 8 hours ago

Thanks for these suggestions but I am not sure that they will be able to resolve the genetic diagnosis dilemma in this case. See Arrondell C et al ...

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RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 9 hours ago

I suggest performing a Collagen 4 stain on the renal biopsy and conducting Whole Exome Sequencing (WES) for genetic analysis instead of a targeted ...

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RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 10 hours ago

Dear All, I absolutely agree and appreciate for dissecting and analyzing the patient so well. His interpretation and diagnostics acumen can only be...

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RE: Anca vasculitis relapse without circulating antibodies 10 hours ago

Thank you, Dr. Glassock, for sharing the research paper. I believe we can consider the possibility of thrombotic microangiopathy (TMA), especially...

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RE: IgA nephropathy with recurrent RPGN 10 hours ago

Will it be possible for you to post the first biopsy report ? Was it a true crescentic IgA or IgA with crescents ? ------------------------------...

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RE: IgA nephropathy with recurrent RPGN 11 hours ago

Did your patient have gross hematuria or was it only microscopic? Gross hematuria occurring in patients not on anticoagulation has been reported to...

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RE: Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 12 hours ago

Your patient almost certainly has X-linked Alport Syndrome, in my opinion . Up to 20% of such patients will have false negative tests for pathogeni...

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Resistant Childhood Nephrotic Syndrome and Negative Genetic Testing 14 hours ago

Dear Colleagues 14 year old male, Hypothyroidism, proteinuria discovered on routine investigations two years ago, Initial Albumin 32, 24 Hr Urine...

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RE: IgA nephropathy with recurrent RPGN 15 hours ago

From your description the prior episode of biopsy proven crescentic IgAN when treated with IV CYC + Steroids had a full remission and restoration o...

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RE: Anca vasculitis relapse without circulating antibodies 16 hours ago

Great question, very difficult to specifically answer - your proposal is possible, but impossible to prove. M0 lesions are fairly common (27%) in p...

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RE: Anca vasculitis relapse without circulating antibodies 17 hours ago

Am I correct to think that the presence of mesangial IgA deposition in this case is likely incidental rather than indicative of IgA nephropathy, es...

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IgA nephropathy with recurrent RPGN 18 hours ago

Good day, I have a 47 yrs old known crescentic IgA N Diagnosed 3 yrs back, previously inducation with cyclophosphamide 500 mg, 6 dosed and pulse...

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RE: Anca vasculitis relapse without circulating antibodies 23 hours ago

Serum creatinine, hematuria and proteinuria all increased very significantly. I think this is a relapse of crescentic IgAN with RPGN, partially tre...

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RE: Anca vasculitis relapse without circulating antibodies 23 hours ago

Again, I am not convinced he relapsed based on increase in creatinine alone, ANCA now negative CD 19 supressed Personally I would not escalat...

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RE: IgA nephropathy 1 day ago

Kidney Biopsy Sample size is borderline. This makes it a bit more difficult to be sure about C0 score. Were many RBC casts observed in renal tubula...

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RE: Anca vasculitis relapse without circulating antibodies 1 day ago

Thank you very much for the discussion. It was very helpful! ------------------------------ Tiago Cerqueira, MD, MSc, MBA, FASN Evangelical Hospi...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

So sorry try this 10.7759/cureus.30189 ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director K...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

Thank you Dr lerman, but unfortunately this link doesn't work https://doi.org/10.7759/cureus --------------------------------- Ahmed Emara MD, M...

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RE: IgA nephropathy 1 day ago

If you have access to Budenoside I would prefer to start and get her into remission. Time averaged proteinuria is associated with worse kidney surv...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

No significant difference in graft survival between LRD vs LURD kidney transplants though incidence of AR may be higher in unmatched live donors (L...

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RE: IgA nephropathy 1 day ago

Thanks a lot dr Glassock sample size 11 Glomeruli no crescents , EM already done revealed renal cortex with glomeruli. Ultrastructu...

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RE: Anca vasculitis relapse without circulating antibodies 1 day ago

Great question. I think I would prefer MMF over RTX, since he seems to have crescentic IgAN, not IgAV and relapsed with full B cell suppression. ...

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RE: IgA nephropathy 1 day ago

This is a tough one. Can I assume that no crescents were seen (C0)? What was the sample size (# glomeruli). I guess no EM was done- so a coincident...

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RE: Anca vasculitis relapse without circulating antibodies 1 day ago

It makes a lot of sense, since his KB shows a lot of chronic interstitial lesions that may be compatible with an underlying disease that had been g...

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RE: IgA nephropathy 1 day ago

tjanks a lot Pro Glassok for your reply Blood pressure now controlled 120/67 on telmisartan 20 mg then increased to 40 mg BMI 19 ( BW 59 kg...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

Thank you Dr Satin so much Based on this paper, the number of mismatches rather than the specific loci of matches is the issue that matters. Do I...

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RE: IgA nephropathy 1 day ago

Additional information needed. What is the BP now?What was the degree of hematuria at presentation and now.? What was the Oxford-MEST-C score for t...

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IgA nephropathy 1 day ago

27 years old female patient presented with headache and Hematuria Blood pressure 230/110 creatinine 150 blood pressure controlled 24 ho...

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RE: Would you rebiopsy? Is this C3GN? 1 day ago

Great question. I kind of doubt that this lesion falls within the spectrum of "Lupus Podocytopathy" but will defer judgement to my Nephropathology ...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

See this paper ------------------------------ Satish Balan MD DM DNB Senior Consultant Department of Nephrology Kerala Institute of Medical Scie...

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RE: Would you rebiopsy? Is this C3GN? 1 day ago

Given positive ANA and anti-ds-DNA antibody and only very sparse electron deposits, could this be lupus podocytopathy? --------------------------...

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RE: neuropsychiatric Management 1 day ago

Thank you! ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: neuropsychiatric Management 1 day ago

see Mendez LMG, et al CJASN 2018; 13: 1502-1509. Post Hoc analysis of the LUNAR trial. ------------------------------ Richard Glassock MD, FASN L...

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RE: neuropsychiatric Management 2 days ago

@Richard Glassock Could you please tell us where this post-hoc analysis of the Lunar study which showed a beneficial effect of rituximab was publ...

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RE: lupus nephropathy ? 2 days ago

Looks like non lupus full house I will suggest to skin biopsy for immunoflorence studies If full house pattern on skin biopsy, will watch for deve...

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RE: lupus nephropathy ? 2 days ago

This case should most probably be classified as "Non-Lupus Full House Nephropathy " (NLFN) not Lupus Nephritis. I doubt C3GN, but this is always po...

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RE: neuropsychiatric Management 2 days ago

Dr. Balan-you are quite correct that the LUNAR trial of RTX in LN failed to meet its Primary Efficacy end-poiint. But subsequent post-hic analyses ...

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lupus nephropathy ? 2 days ago

Hello to the entire community, Please allow me to request your opinions regarding a young patient, 14 years old, from a non-consanguineous marria...

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RE: Would you rebiopsy? Is this C3GN? 2 days ago

Thanks for posting the report . ED subepithelial C containing deposits by EM is not compatible with " Minimal Change Disease". We need expert consu...

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