RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 3 hours ago

The patient received AZA and steroids for transplant IS and both agents were found in 1998 to help MG (Palace Study of Prednisolone Plus Azathiopri...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 4 hours ago

1. Logically some dialyze able factor[s] - likely water soluble - are the culprits. 2. Dr. Rubin's attached paper - case report does explain an i...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 7 hours ago

Here you go. Unfortunately, it does not clarify the current case. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ----...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 8 hours ago

Due to its large molecular weight IgG is minimally removed by dialysis unless High Cut Off Membranes (as used in some cases of myeloma) are being e...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 9 hours ago

Intrigued by Dr. Glassock's suggestion of dialysis membrane adsorption of IgG4 or cytokines, and by the failure of CRRT to improve weakness. Makes ...

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RE: Difficult to control hypertension with one kidney and AAA 9 hours ago

You're invited! Please click on the invitation to see more details and to RSVP. BIRTHDAY Saturday, July 11, 2026 Don't want invitations from t...

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Dear Friends & Family join me for a joyful gathering on the 4th of July Please Open RSVP by using a Windows desktop for the link to work properly and make Sure you Install The Invitation after Downloading It, See you There ! 9 hours ago

You're invited! Please click on the invitation to see more details and to RSVP. BIRTHDAY Saturday, July 11, 2026 Don't want invitations from t...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 10 hours ago

I found this but cannot for the life of me get the actual paper ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rus...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 11 hours ago

Dr. Bleyer- Many thanks for posting this fascinating case. Clearly nature is trying to tell us something -but "what" is the question . I am curio...

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28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 15 hours ago

Appreciate the help of any colleagues in figuring out a difficult case of a 28 year old female with ESRD who has ventilator-dependent myasthenia th...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 16 hours ago

In the patient presented, a major diagnostic consideration is JC virus infection. Is neurology confident that JC virus infection has been definitiv...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 17 hours ago

Belatacept has potential effects that can enhance CNS inflammatory conditions such as CNS PTLD which has been reported.The recommendation to discon...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 1 day ago

Thanks so much! That's really helpful. ------------------------------ Mohammed Mahdi Althaf MD, MS, MSc, FASN Consultant Nephrologist and Acute P...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

Can I ask omitting belatcept and not continuing is that because of encephalitis ? Is AKI contraindication to iv ig ? Neurology should take lead o...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

Thanks Dr Kesavan Dr Gassock and Dr Lermon for your expert recommendations Dr Lerman Sorry about the confusion He had proteinuria 4-grams initi...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

as a nephrologist will comment on recommendations relative to failing allograft. continue MMF and low dose steroids as already advanced Transplan...

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RE: lupus/ctd and MN ( with serum and kb plar2 -ve and not full house complement with raised anti-ccp and ck) 1 day ago

Will look at cream used for psoriasis many thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: lupus/ctd and MN ( with serum and kb plar2 -ve and not full house complement with raised anti-ccp and ck) 1 day ago

Thanks so much . Really appreciate your help --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: lupus/ctd and MN ( with serum and kb plar2 -ve and not full house complement with raised anti-ccp and ck) 1 day ago

Linkage to CTD uncertain. C3 negative uncommon in Primary MN. C4d positive very common in Primary MN. If you had EXT1/2 Staunton, I woukd not be su...

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RE: lupus/ctd and MN ( with serum and kb plar2 -ve and not full house complement with raised anti-ccp and ck) 1 day ago

Thanks for prompt reply prof glassock . Could you answer some of the other questions if you can . Would mean the world to me🙏🏼🙏🏼 ------------...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

What’s does mvc, ams and Mogad mean ? --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

Experience in a seronegative steroid-refractory case like this - did second-line immunotherapy change the trajectory? No experience but literature...

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RE: lupus/ctd and MN ( with serum and kb plar2 -ve and not full house complement with raised anti-ccp and ck) 1 day ago

PLA2R negatve MN. Possibly NELL 1. I would treat with RTX. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen Sc...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 1 day ago

Merci prof lambeau pour partager ( thanks for sharing prof lambeau ) --------------------------------- Muhammad Soobadar MBChB UK ---------------...

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Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 1 day ago

Steroid-refractory seronegative demyelinating encephalitis in a belatacept/MMF kidney transplant recipient 27F, kidney transplant ~14 years ago (...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

Strongyloides stercoralis is a soil-transmitted helminth (threadworm) unique for its ability to replicate entirely within the human host. This capa...

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lupus/ctd and MN ( with serum and kb plar2 -ve and not full house complement with raised anti-ccp and ck) 1 day ago

45 Female Diagnoses: CCP positive arthralgia (78.3) - at high risk of rheumatoid arthritis Possible psoriasis with likely mechanical back pain (...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 1 day ago

There are indeed a few case reports on PLA2R1-MN cases and associated lupus. See attached, if this helps. ------------------------------ Gerard ...

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RE: Atypical Anti-GMB? 1 day ago

Thanks prof glassock Sorry can I ask another question ( due to my lack of knowledge on this issue ) Can you explain to me how ig g subclass would...

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RE: Atypical Anti-GMB? 1 day ago

Diabetes is associates with diffuse linear IgG + albumin, but not IgG alone by IF. IgG subclass staining might evaluate monoclonality of deposits, ...

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RE: Atypical Anti-GMB? 1 day ago

Also involve haematologist maybe could benefit from velcade based chemo ? --------------------------------- Muhammad Soobadar MBChB UK -------...

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RE: Atypical Anti-GMB? 1 day ago

@ prof glassock question what you looking for albumin staining ? And is it because fibrin gets degraded to fibrinogen then it means TMA on KB ---...

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RE: Atypical Anti-GMB? 1 day ago

Thanks for case There is kappa restriction Pronase showed anything ? Ig g linear staining can be because of diabetes tho no lm changes of diabe...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

Serological investigations for Strongyloides infection cannot distinguish between active infection and a prior infection, successfully treated. If ...

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RE: Atypical Anti-GMB? 1 day ago

Really tough case. I suppose that it is possible that this is a monoclonal protein driven diffuse endothelial injury (akin to Toxemia or VEGF toxic...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

How is his muscle mass and fat mass. Please get combined eGFR for creatinine and cystatin C for better guessing his GFR. Renal echogenicity on US F...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

There is an obvious Strongyloidos stercoralis infection history. Alternative cause for eosinophilia which is a chronic challenging helminthic infec...

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RE: Avacopan 1 day ago

If you learned that something you are eating has the potential to poison you, would you continue to eat it? If you were to be poisoned, wouldn't yo...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

a little confused post 2 days ago- "Eosinophilia is going on for at least 10 years, has minimal proteinuria on medication," now 4gms albuminuria, ,...

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RE: Recurrent CaPhos stones with low urinary citrate 1 day ago

Sir, Thank you again for your detailed insight. Absent a low serum bicarbonate level, I hadn't considered the topiramate to be potential...

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RE: Avacopan 1 day ago

I would not continue this drug; my (probably) naive view is that given potential risk for adverse events (with this or any drug), doing so may leav...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 day ago

Thanks Dr Glassock Creatinine 2.4 GFR 24 for the last few years had albuminuria 4 Grams Prof My impression was that if it is eosinophilic intersti...

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RE: Atypical Anti-GMB? 1 day ago

No data are available regarding albumin staining. Anti-GBM antibodies were assessed by ELISA and indirect immunofluorescence. Despite the patien...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 2 days ago

Dr. Safdar. So you believe that the renal impairment (CKD4) is related to Diabetic Nephropathy and is stable on RASi and SGLT2i. The CKD is not dir...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 2 days ago

Thanks appreciate all the input and help from respected members Sorry for delayed response briefly his creatinine has been stable for the last fo...

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RE: Resistant FSGS 2 days ago

Dr. Lerman you are most welcome. The assay for these antibodies is not yet widely available (to my knowledge in the USA is only being done at the M...

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RE: Resistant FSGS 2 days ago

Dr. Rubin thanks for sharing this very important paper. Given that the presence of anti-nephrin abs in these patients with presumed primary non-gen...

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RE: Resistant FSGS 2 days ago

For medical students and fellows in Renal medicine: In clinical medicine in good old days we start by presenting the case with age race family ori...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 2 days ago

In my opinion the entire clinical picture of Eosinophilic syndrome is related Strongyloides stercoralis infection. This unique human helminthic inf...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 2 days ago

Many thanks, Professor Glassock and Muhammad, for your thoughtful replies and for taking the time to review this case. I have found your comments i...

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