RE: The patient who keeps on giving 8 hours ago

The presence of organized deposits in the first kidney biopsy makes an infectious cause (other than Chronic HCV infection) unlikely, in my opinion....

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FREE HOME DIALYSIS WEBINARS ANNUAL DIALYSIS CONFERENCE 8 hours ago

Dear fellows, The Annual Dialysis Conference is offering FREE webinars focusing on critical home dialysis topics. These webinars will provide val...

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FREE HOME DIALYSIS WEBINARS ANNUAL DIALYSIS CONFERENCE 8 hours ago

Dear fellow educators, The Annual Dialysis Conference is offering FREE webinars focusing on critical home dialysis topics. These webinars will pr...

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RE: Tocilizumab in renal AA amyloidosis 8 hours ago

The literature supporting use of Tocilizumab or Anakinra for renal AA Amyloidosis is mainly case reports and small observational studies This le...

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RE: The patient who keeps on giving 8 hours ago

What was the IF finding in the second biopsy? Seems an incredible turnaround in the renal biopsy findings. In view of the varied findings do we nee...

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RE: Atrasentan experience and first thoughts 10 hours ago

I am glad that you bring up the issue of cost of when taking care of such patients. Maybe that is why "Insurance" turn down treatment. Agree why we...

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Tocilizumab in renal AA amyloidosis 13 hours ago

This is a 83 year old woman w/ clinical records of bronchiectasis and respiratory superinfections. She presented progressive proteinuria in 6 month...

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RE: Atrasentan experience and first thoughts 18 hours ago

Sorry in my initial description I meant both high risk patients were approved for IPTACOPAN, not AVACOPAN. As their insurance refused to pay $450,0...

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RE: The patient who keeps on giving 19 hours ago

Very interesting . Biopsy #1 showed unequivocal Fibrillary deposits by EM. No Pronase digestion or paraffin IF was done. What was the EM magnificat...

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RE: The patient who keeps on giving 19 hours ago

His repeat biopsy was negative for any fibril deposition on EM. SPEP , UPEP, IFE did not detect a monoclonal spikes -----------------------------...

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RE: Rituximab Contraindicated in ILD?? 20 hours ago

On initial presentation with AKI, he had dyspnea . CXR and CT of the lungs showed ILD and COPD . The findings were similar to his previous CXR done...

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RE: Atrasentan experience and first thoughts 20 hours ago

Dr. Rodby's response is both highly reasonable and pragmatic. It is going to take a long time to acquire the data he appropriately requests. Post H...

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RE: Atrasentan experience and first thoughts 20 hours ago

Both patients had previously received oral steroids and MMF for 6 and 12 months respectively . Nefecon is still unavailable in our area. Our PTC in...

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RE: primary membranous nephropathy 20 hours ago

Just a little over 50 years ago , Donadio J , et al (Kidney Int 1974; 6:431-439) from the Mayo Clinic reported a small (and likely underpowered) pr...

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RE: primary membranous nephropathy 20 hours ago

My CNI suggestion is only a antiproteinuric bridge. In PLA2R+ MGN you are treating the PLA2R ab so yes if after 3 (maybe 4) months of CYC the PLA...

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RE: Atrasentan experience and first thoughts 21 hours ago

Agree, VERY LOGICAL CONCLUSION that has permeated the IgAN community but until we have a complement inhibitors trial compared to ET1 inhibitors f...

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RE: Rituximab Contraindicated in ILD?? 22 hours ago

I agree with Dr. Rodby that RTX is not contraindicated in this case. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (9...

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RE: The patient who keeps on giving 23 hours ago

With DNAJB9 negative Fibrillary deposits on EM this is not Primary IC-MPGN . Has a MGRS been excluded.? ------------------------------ Richard ...

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RE: Atrasentan experience and first thoughts 23 hours ago

Interesting response to Atrasentan. In a patient with this much inflammation , I would have used steroids (initial IV pulse then daily moderate dos...

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RE: primary membranous nephropathy 1 day ago

I do not have much enthusiasm for CNI in MN- it is "second class " treatment (for a curable condition) with a very low frequency of complete remiss...

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RE: Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 1 day ago

Dr. Lerman: Thanks for your comments. Losartan 25 mg daily was started only on day #105 post-transplant. There were wide fluctuations in dipstick u...

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RE: primary membranous nephropathy 1 day ago

@Roger Rodby Thanks You mentioned the option of short-course oral cyclophosphamide without steroids, and possibly adding a CNI as a bridge to redu...

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RE: primary membranous nephropathy 1 day ago

I am OK with treating based on the PLA2R alone That is a high PLA2R and CYC works faster than rituximab in that setting I too would anything t...

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RE: Rituximab Contraindicated in ILD?? 1 day ago

what his the cause of the ILD? Why isn't this a manifestation of the vasculitis? and rituximab has been used for that https://pmc.ncbi.nlm.ni...

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RE: Atrasentan experience and first thoughts 1 day ago

endothelin antagonists have shown excellent antiproteinuric effects , better than budesonide and it seems to translate into slowing progression o...

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RE: The patient who keeps on giving 1 day ago

As a follow up , after initial normalisation of renal function and Complement levels including C5b-9 , he went into a clinical relapse with worseni...

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Atrasentan experience and first thoughts 1 day ago

Good evening , I wanted to describe my expereience with the use of Atrasentan for 2 high risk patients with IgA Nephroapthy Both patients were...

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Rituximab Contraindicated in ILD?? 1 day ago

Good Evening Have/Had a 71 year old male with newly diagnosed MPO-pANCA Vasculitis with renal (AKI , Creatinine of 1500 umol or 18 mg/dl) and Pul...

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RE: Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 1 day ago

Dear Dr. Venkat , why are you reluctant to accept anti proteinuric effect of losartan in this case rather than postulating seroma or lymphocele as ...

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RE: Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 1 day ago

Dr. Glassock: I looked again at all the urinalyses reports in the patient I posted. Milky/white/cloudy appearance of urine them. is not mentioned i...

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RE: primary membranous nephropathy 1 day ago

@Richard Glassock Diabetes history: 3 years • Glycemic control: HbA1c 5.4% (well controlled) • BMI: 36 • Diabetic retinopathy: None • Renal fu...

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RE: primary membranous nephropathy 1 day ago

Addendum- in my opinion, this patient needs an antiPLA2R antibody by an IFA test before considering RTX monotherapy or Triple therapy. other opinio...

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RE: primary membranous nephropathy 1 day ago

Very difficult case. How long has T2DM been present? What is the degree of glycemic control? What is current BMI? Any diabetic retinopathy present?...

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RE: primary membranous nephropathy 1 day ago

It's really unfortunate that he wasn't able to receive a biopsy since in a patient with diabetes (and morbid obesity) the non invasive diagnosis mi...

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primary membranous nephropathy 1 day ago

Patient: 55-year-old male with type 2 diabetes mellitus, status-post bariatric surgery. • Presentation: Generalized edema, nephrotic-range proteinu...

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RE: Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 1 day ago

Intriguing suggestion. . I suppose intermittent Chyluria is possible and it is likely that this can be proven by careful observation. Gas this ever...

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RE: Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 2 days ago

Thanks Dr. Glassock. One possible explanation (certainly far fetched) for the widely fluctuating protenuria: Based on its creatinine level, the per...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thanks for your question. He required one transfusion before biopsy , and Hb then stabilized at 10.5 g/dL (admission was 12.0).. ---------------...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thanks so much Dr Filler for your detailed and valuable input. As you said the biopsy and course are most consistent with ANCA-negative pauci-immun...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thank you Dr Filler. The higher frequency of ANCA negativity in children indeed supports the diagnosis of pauci-immune vasculitis in this case. I a...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thank you Dr Venturelli . You raise a very important point about monogenic vasculitis and it does affect management -we haven't tested yet but will...

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RE: Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 2 days ago

Dr. Venkat- fascinating case. I cannot provide a good explanation for the extra-ordinary fluctuation in proteinuria in this case. It is my impressi...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thank you, Dr. Glassock, for your comments. One nuance from the pediatric perspective is that ANCA-negative pauci-immune necrotizing GN is more com...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thank you for sharing this interesting case. The clinical picture (fever, arthritis, rash, AKI with hematuria/proteinuria) does overlap with IgA v...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Does the improvement of SCr from 180 micromol/L to "normal" with bolus --> oral prednisone make a monogenic form of auto-inflammatory-vasculitis un...

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Widely ctuating post-transplant proteinuria in a patient with IgA Nephropathy in transplant kidney biopsy 2 days ago

I seek the impressions/recommendations of Forum participants regarding the following patient: Analysis Of The Case: Although biopsy-proven IgA nep...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Dr, Venturelli- brilliant suggestion!!. Genetic testing for a monogenic form of auto-inflammatory -vasculitis is definitely worthwhile in this case...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Dr. Ajarmeh very interesting case. Unfortunately, I have no clinical experience in this setting. Any evidence of arteritis /medium size vessel i...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

Thank you Dr. Glassock for your input. We also feel this is most consistent with pauci-immune necrotizing GN, despite being ANCA negative, and will...

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RE: A child with vasculitis picture, negative serology and AKI 2 days ago

I am not a Pediatric Nephrologist so I have little experience with patients presenting in this manner. The patient has some of the hallmarks of paa...

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