RE: IgAN with nephrotic syndrome 2 hours ago

It seems reasonable, I haven't noticed serum albumin --------------------------------- Peter Youssef, MRCP (UK), FRCP Cairo, Egypt --------------...

View Discussion

RE: PLA2R-membranous nephropathy 4 hours ago

Dear Dr Rodby, unfortunately, the lab that reported the second biopsy doesn't do tissue staining. We had the paraffin block sent to the lab that re...

View Discussion

RE: PLA2R-membranous nephropathy 4 hours ago

Did the recent biopsy show PLA2R positive staining? I assume the IF pattern was c/w a membranous pattern, a shame no EMs but... How quickly im...

View Discussion

RE: IgAN with nephrotic syndrome 5 hours ago

Pre-biopsy UPr/Cr of 6.8 g/g and SAlb 3.3 g/dL not typical of a podocytopathy. These values + microscopic hematuria favor IgA nephropathy as sole d...

View Discussion

PLA2R-membranous nephropathy 5 hours ago

26/F, presented in Oct '22 with hypertension, reduced eGFR and nephrotic syndrome (creat 2.3, alb 3.1, uPCR 6.7). Biopsy was membranous nephropathy...

View Discussion

RE: Primary membranous nephropathy 10 hours ago

Maybe I am playing devil's advocate for the sake of an academic discussion for this Forum, but I would propose a different look at this. That biops...

View Discussion

RE: Primary membranous nephropathy 10 hours ago

Thank you Dr Glassock . ------------------------------ Adrian Sequeira MD, FASN Professor of clinical medicine LSU Health Sciences Shreveport LA...

View Discussion

RE: IgAN with nephrotic syndrome 14 hours ago

I have a patient with a similar picture however the scenario is different he presented at the age of 16 with pure nephrotic syndrome and he was tre...

View Discussion

RE: IgAN with nephrotic syndrome 14 hours ago

I think short course ( 3-6 months) oof oral medium dose prednisone. - (TESTING Protocol) might be tried first. If no response, then Sibeprenlimab ....

View Discussion

RE: Primary membranous nephropathy 17 hours ago

With this serology ,and Dialysis-dependent ESKD I see no rationale for immunosuppressive therapy, You could send the biopsy for LD/MS to see if a v...

View Discussion

RE: IgAN with nephrotic syndrome 17 hours ago

Thank you Dr. Venkat, At the time of biopsy: Salb 3.3 g, UPCR 6.8, S cholesterol 240 (while taking a statin) Currently: S alb 3.4, UPCR 6.1, I ...

View Discussion

RE: IgAN with nephrotic syndrome 17 hours ago

Thank you Dr. Rodby. She had about 20 rbcs on UA at the time of biopsy, currently 6/hpf. She used to have 4-8 rbc with ~ 0.5 g/g proteinuria fo...

View Discussion

RE: Primary membranous nephropathy 18 hours ago

Dr Glassock, PLAR2: ELISA < 2 RU/ml PLAR2 IF Negative Results are from 11/2025. Not repeated ------------------------------ Adrian Sequeir...

View Discussion

RE: Primary membranous nephropathy 18 hours ago

Is the serum still negative for ant-PLA2R by ELISA abd IFA- what are the exact levels by ELISA.? ------------------------------ Richard Glassock ...

View Discussion

RE: Primary membranous nephropathy 18 hours ago

Thanks Edgard for your input. No NSAIDs, Alb 1.5-1.9 over 7 months Bx Final Diagnosis Kidney, native, biopsy: -Membranous nephr...

View Discussion

RE: Primary membranous nephropathy 19 hours ago

I would do an age appropriate screening for malignancy- will be needed anyway for kidney transplant evaluation This rapid drop in kidney function...

View Discussion

Primary membranous nephropathy 19 hours ago

Hi everyone, Would appreciate insight into this scenario: 55 y/o AAF with HTN, DM2, obesity noted to have 7gm proteinuria. Immunological and in...

View Discussion

RE: IgAN with nephrotic syndrome 19 hours ago

Regarding the possibility of podocytopathy in this patient (besides the presence of hematuria): What were the SAlb, UPr/Cr (and/or UAlb/Cr) and lip...

View Discussion

RE: DKA with severe Hypernatremia 21 hours ago

Yes- i have seen several, not many , patients with hyperglycemic hypernatremia of this magnitude (or worse) all with good outcomes. . This patient ...

View Discussion

RE: Fibrillary GN relapse 22 hours ago

Good suggestion. https://clinicaltrials.gov/search?referringSource=articleShare&cond=Fibrillary%20Glomerulonephritis&term=Obinutuzumab ----...

View Discussion

RE: Fibrillary GN relapse 22 hours ago

Wondering if he would benefit in the enrollment on the ongoing phase 2 clinical trial at Mayo- OBINUTUZUMAB in Treatment of Fibrillary Glomerulonep...

View Discussion

RE: DKA with severe Hypernatremia 22 hours ago

Thank you Dr. Mellas. I did not check FeNa, just urine Na,K, glucose and osmolality. I did not know it would help in non oliguric state, but pat...

View Discussion

RE: Fibrillary GN relapse 22 hours ago

Please see below figure 2 from the Mayo paper posted earlier. No correlation between the clinical course of proteinuria and rituximab therapy over ...

View Discussion

RE: DKA with severe Hypernatremia 23 hours ago

Per Dr Rubin's post about the importance of volume repletion before water repletion in hypovolemic hypernatremia, even though NS has a Na of 154...

View Discussion

RE: Fibrillary GN relapse 23 hours ago

Forgive my over simplification on this case, but if Rituximab seemed to work before (hard to believe the urine protein went from 3.2 grams to 400 m...

View Discussion

RE: IgAN with nephrotic syndrome 23 hours ago

Is this worsening of IgAN or a podocytopathy either related to or independent of her IgAN? 6 g with 75% PFE meh, but 90% maybe is a podocytpathy...

View Discussion

IgAN with nephrotic syndrome 23 hours ago

Hello all, I would appreciate your input on the following case. 68 y/o Hispanic woman, h/o HTN, CKD with eGFR ~ 55-60 ml/min, prediabetes, obe...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Dr. Rubin. Good idea. I agree fully. The degree of global Glomerulosclerosis in a kidney biopsy can be an important prognostic factirc with respect...

View Discussion

RE: Fibrillary GN relapse 1 day ago

I am attaching the reference mentioned by Dr. Glassock which is a very interesting read. ------------------------------ Mario Rubin, M.D. Houston...

View Discussion

RE: Fibrillary GN relapse 1 day ago

How many gout flares have been occurring in this patient? Are any subcutaneous tophi present? Is the patient still on low dose Allopurinol. ? What ...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Thank you Dr. Glassock for sharing the reference from the Turin's group. Actually they also had a poster at the last ASN, here in Houston. They mak...

View Discussion

RE: Fibrillary GN relapse 1 day ago

With frequent gout attacks off Allopurinol, Krystexxa should be considered. ------------------------------ Michael Etomi MD, FASN Metrolina Nephr...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Dr. Rubin is quite correct. The posited benefits of RTX in FGN are limited and observational only. We still do not know if a reduction in proteinur...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Thank you for the information. To my knowledge, the only evidence of a beneficial effect of rituximab in FGN (on kidney function, not in proteinuri...

View Discussion

RE: DKA with severe Hypernatremia 1 day ago

Dr Rubin's comments and references certainly represent the classic approach and should be studied. In case such as these I typically use 2 IV rou...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Hard to say with certainty that this evolution is causally connected to RTX, Spontaneous fluctuation of proteinuria has been observed, albeit uncom...

View Discussion

RE: Fibrillary GN relapse 1 day ago

It took 9 months for the UPCR to go down to <500 after the Ritux infusion and he only stayed in remission for 3 months. -------------------------...

View Discussion

RE: Fibrillary GN relapse 1 day ago

The UACR is 2.5 g and UPCR 3.4 g which makes it more glomerular in origin. --------------------------------- Kinjal Gosalia MD Dix Hills NY (51...

View Discussion

RE: DKA with severe Hypernatremia 1 day ago

Unless the patient had a superimposed Central DI (probably excluded by the very high U-OSM) . I doubt that the DDAVP did anything to hasten his rec...

View Discussion

RE: DKA with severe Hypernatremia 1 day ago

Dr. Kaur. I will encourage you to thoroughly read the publication of Dr. Peter Feig which I attached. All your questions (and much more) will be an...

View Discussion

RE: DKA with severe Hypernatremia 1 day ago

Thank you Dr. Rubin, Thank you for the attachments. Will review. He received 2 L LR and 2 L NS but he kept putting out quite a bit of urine wit...

View Discussion

RE: DKA with severe Hypernatremia 1 day ago

I just wanted to emphasize that the initial treatment of a hypertonic-hypovolemic state should be NS till volemia is restored. Once an euvolemic st...

View Discussion

RE: Fibrillary GN relapse 1 day ago

How long did it take following the administration of rituximab for the proteinuria to decrease from a nephrotic value to < 500 mg/day? For how long...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Thanks- i suppose you mightvdo a UACR/UPCR to confirm that the rise in proteinuria is glomerular snd not tubulo-interstitial in origin. ---------...

View Discussion

RE: Fibrillary GN relapse 1 day ago

Thank you Dr. Glassock. Appreciate your advice. He has a history of significant gout and had frequent gout flares when he was not on it. --------...

View Discussion

RE: Fibrillary GN relapse 2 days ago

Why is he on Allopurinol. If it is for asymptomatic hyperuricemia. I would discontinue it. I gather that no progressive decline of eGFR has been ob...

View Discussion

RE: DKA with severe Hypernatremia 2 days ago

Yes absolutely, thank you, he surprisingly did not need much K, some K and Phos. Cr is back down to 1's range. ------------------------------...

View Discussion

RE: DKA with severe Hypernatremia 2 days ago

True, I think hospitalists and critical care does that… then they call us ;-) but I had to give him DDAVP, Na was not coming down and had reac...

View Discussion

RE: DKA with severe Hypernatremia 2 days ago

Thank you all. urine Osm was 892 from 1/4 AM when Urine Na was [More]

View Discussion

Fibrillary GN relapse 2 days ago

Dear colleagues, I have a 50 year old male with history of biopsy proven Fibrillary GN that responded well to 2 doses of Rituxan in 2023 with UPCR...

View Discussion