RE: Possible Case Of TIN 47 minutes ago

Seems like slow recovery for ATN and AIN is a possibility but Diabetic with osteo says IgA dominant infection related gn, but her urine should be a...

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RE: Possible Case Of TIN 11 hours ago

Urine analysis and urine sediment findings? UPr/Cr and UAlb/Cr? Skin rash, fever, arthralgias, fever, +/- eosinophilia? Tempo of worsening of eGFR ...

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Possible Case Of TIN 16 hours ago

Dear all., 56 female increased bmi admitted with right 3rd toe osteomyelitis . Egfr 90 dec 24 on admission went to 10 then had amputation . Admitte...

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RE: Mpgn 16 hours ago

He has Age related macular degeneration and there are some cases of genetic linked c3gn associated with this . Will speak to national complement ce...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 17 hours ago

No good data to answer your question- but most physicians I know always try steroids first. IgA V cannot be definitively diagnosed by kidney biopsy...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 17 hours ago

Just for my learning, what is the difference between igA vasculitis with kidney involvement and igA nephropathy? I called the pathologist and he sa...

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RE: Anticoagulation and kidney biopsy 18 hours ago

Hematuria? Do you do serologic tests tgat we do in humans, eg Ana, complements etc? What is your pre biopsy top 3 diagnoses in a miniature golden d...

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RE: Anticoagulation and kidney biopsy 18 hours ago

Just some thoughts. In humans as already pointed out, we would definitely try a course of steroids. I wouldn't do a biopsy on clopidogrel and rivar...

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RE: C3 GN with Vasculitic picture 19 hours ago

Dr Glassock, you are the expert. I don't know the answer of which drug would be preferred it alternate pathway defect is involved in this particula...

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RE: PKD and SGLT2inhibitors 22 hours ago

Two points: As was already mentioned, published clinical experience is very small and limited, and controversial as well. (Morioka F et al, J of...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 22 hours ago

Thanks Dr Glassock, I will go ahead with rituximab for this patient while tapering steroids. Maybe iptacopan can get attempted if there is no impr...

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RE: tip variant fsgs relapse in pregnancy 22 hours ago

I do understand. ------------------------------ Dr V Lachman Nephrologist South Africa ------------------------------

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RE: Anticoagulation and kidney biopsy 22 hours ago

PLA2R has been characterized in canine podocytes (Expression of phospholipase A2 receptor in primary cultured podocytes derived from dog kidneys - ...

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RE: Anticoagulation and kidney biopsy 1 day ago

If human with same clinical picture - would agree with Dr. Glassock and give empiric steroids without biopsy as risk of holding anticoagulation wit...

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RE: C3 GN with Vasculitic picture 1 day ago

Extensive complement testing (except for genetic testing) do not point to alternate complement pathway. I think it is quite clear that her underlyi...

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RE: Anticoagulation and kidney biopsy 1 day ago

Empiric steroids is an option. Minimal change disease is quite uncommon in our patients. Only 7.4% of proteinuric dogs were found to have this lesi...

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RE: Mpgn 1 day ago

I agree with hematology consult that the Kappa/lambda FLC ratio is within normal limits when the patients eGFR is taken into consideration. The ser...

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RE: Mpgn 1 day ago

Em will be done by Thursday. Not sure if urine has been done but will chase it. New hospital new it system still figuring things out Bw -------...

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RE: Mpgn 1 day ago

Thanks so much C3 1.16(0.9-1.8 ) C4 0.24 ( 0.1-0.4) Serum kappa 65.1 (3.3-19.4) Serum lambda 27.6 (5.7-26.3) Serum k/l 2.4 (0.26-1.65) Serum ele...

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RE: C3 GN with Vasculitic picture 1 day ago

If such studies were done and they showed convincing evidence of alternative C pathway activation, which of the following drugs would you choose fo...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

There are no pathognomonic findings on kidney biopsy for IgAV- it is always a clinical + pathological diagnosis . The 1000 ng X 2 regimen for RTX h...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Dr Glassock, I see your point. Now that I recall, she had a recurrence of a mild vasculitic rash on her abdomen even when on high dose steroids. Sh...

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RE: C3 GN with Vasculitic picture 1 day ago

Regarding using Eculizumab, I think it is reasonable to screen for alternate pathway activation by complement testing/genetic studies. ---------...

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RE: Mpgn 1 day ago

Agree with Pronase digestion and Paraffin IF for monoclonal LC. What are the absolute levels of serum Kappa and Lambda LC by FLC assay.? What are t...

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RE: Anticoagulation and kidney biopsy 1 day ago

Why not try a course of oral prednisone without a biopsy under the assumption that it is NS due to MCD like lesion.? ---------------------------...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

If this is IgA Vasculitis, and I think the evidence points in this direction, then the next treatment of choice is RTX, not Sparsentan, Iptacopan ,...

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Mpgn 1 day ago

80 male cognitively intact good et 27/12/24 admitted with haematuria for 2 weeks and kidney function drop . Hb drop 133/116 Cystoscopy and and non ...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Thank you Dr Glassock and Dr Rodby for your input Complements and ANCA were negative For immunosuppressive component of her treatment - I was c...

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Anticoagulation and kidney biopsy 1 day ago

Hi everyone, We were wondering what approach would be taken for a human with a similar scenario,. We have 7 year old miniature golden doodle wi...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

IO think the easiest question is the last one " Could this be secondary IgA from underlying possible cirrhosis? " which is pretty much a no. Ha...

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RE: IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Complex case . This is not likely IgA Nephropathy . The IgA deposits might be related to Cirrhosis . What are the C3/C4 levels, HBV and HCV serolog...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

thank you ------------------------------ Usha Peri MD North Texas Kidney Disease Association lewisville TX (214) 356-3428 -----------------------...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Dr. Peri- Please see the long-term follow up of the Mainritsan trials (referenced in my earlier post). For Vasculitis these findings seen to cont...

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IgA nephropathy with AKI and nephrotic range proteinuria despite steroid therapy 1 day ago

Esteemed colleagues, would really appreciate help with this case. 59 yo with h/o DM well controlled, referred to me for an acute rise in creatin...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Thanks, Dr Glassock ------------------------------ Ella Koifman-Zeltzer MD Tel-Aviv ------------------------------

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Thanks, Dr Glassock ------------------------------ Ella Koifman-Zeltzer MD Tel-Aviv ------------------------------

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Great question- no hard data to proved a firm answer. I usually recommend that a BL IgG level be obtained at initiation of RTX therapy and the IgG ...

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RE: PKD and SGLT2inhibitors 1 day ago

I tend to agree with Dr. Rodby and would NOT use SGLT2i in ADPKD, unless there is another indication - e.g. T2DM with preserved Kidney Function or ...

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RE: PKD and SGLT2inhibitors 1 day ago

I shared the skepticims that SGLT2i might help ADPKD for those same reasons, but here is a good review which illustrates the complexity of effects ...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Dr Rodby, Dr Glassock What is your approach to monitor IGG levels during B cell depleting therapies? To the best of my knowledge, Kdigo 2024 do...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Thanks for this discussion. The relevant recent reference to the MAINRITSAN studies is -Delestre S et al Ann Rheum Dis 2024;83:233-241. ...

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RE: PKD and SGLT2inhibitors 1 day ago

Thanks for bringing me up to speed on this research. I would not predict that SGLT2 inhibition would do anything in ADPKD as it is a genetically ...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

I know many folks follow IgG levels after rituximab and give Iv Ig if it falls below a certain amount, thus rituximab does not reliably or predicta...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

I am not sure that this is evidence based approach, but I follow IGG levels during RTX treatment, and if it falls close or below 300 mg/dl, I follo...

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RE: PKD and SGLT2inhibitors 1 day ago

This is actually a very very good question. There are conflicting mouse models regarding effects of SGLT-2 inhibitors in PKD. Dr. Rodby attached on...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

Thanks! I wonder if this applies to other diseases. For instance, MGN? We rely on the PLA2R Ab level to determine initial response and that predi...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

I believe that this is the study mentioned by Dr Glassock ( (MAINRITSAN2) ------------------------------ Ella Koifman-Zeltzer MD Tel-Aviv -...

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RE: Is It LN?? 1 day ago

Good luck! Let us know the patient responds. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------...

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RE: PKD and SGLT2inhibitors 1 day ago

see attached: "Conclusion. In CKD patients with ADPKD,dapagliflozin may increase kidney volume but may have a protective effect on kidney function...

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RE: rituxan sensitivity test ( cd 20) 1 day ago

This is good to know. I would love any references on that. ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Univer...

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