RE: Linear Glom IgG deposit , cANCA and -ve Anti-GBM 4 hours ago

SCr doubled between 2023 and 2024, doubled again by 2025, and has increased further over the past year. Lot of chronicity in the biopsy. ATN and AI...

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RE: ANCA associated vasculitis 6 hours ago

I think you can resume RTX without Avacopan or CYC. Just an opinion. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (94...

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RE: ANCA associated vasculitis 6 hours ago

Thanks for the reply Dr Rodby and Dr Glassock. Yes this is the protocol we were following taken from this paper. He received so far 1 g RTX...

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RE: Linear Glom IgG deposit , cANCA and -ve Anti-GBM 7 hours ago

What were the albumin stains by IF.? The + ELISA for anti-PR3 might be false +. No clear indication for CYC or RTX. -----------------------------...

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RE: ANCA associated vasculitis 7 hours ago

I agree with Dr. Rodby. I see no reason to use Avacopan here. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-...

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RE: ANCA associated vasculitis 7 hours ago

What happened to his Cr thus far, and no more DAH? If he seems to have responded I may not give more CYC. If not, since you are already essenti...

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RE: Pregnant woman with proteinuria 7 hours ago

I have posted the correct reference regarding Amyloid P protein staining. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5...

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RE: Pregnant woman with proteinuria 7 hours ago

I think you nailed it! You should contact Dr. Larsen at Arkana for amyloid P protein staining of the biopsy ------------------------------ ...

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RE: Pregnant woman with proteinuria 7 hours ago

Wondering if this is a case of atypical membranous nephropathy with organized deposits. --------------------------------- Edgard Wehbe MD, FASN ...

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RE: Pregnant woman with proteinuria 7 hours ago

13 grams proteinuria is more than what you would expect with pregnancy hyperfilteration. I would a CNI, and taper steroids. ---------------------...

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RE: Linear Glom IgG deposit , cANCA and -ve Anti-GBM 7 hours ago

Thank you for your reply Agree with presence of linear IgG in Diabetic nephropathy Elisa +ve , PR3 ------------------------------ Dr.Nai...

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ANCA associated vasculitis 7 hours ago

Hi everyone, I have a 62M with PR3-AAV presented with AKI creat of 220-250 umol/L (normal baseline Cr 80 one month back). Kidney bx showed pauci i...

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RE: Pregnant woman with proteinuria 9 hours ago

Happy New Year all! I wanted to circle back to this patient. We tried to treat her proteinuria with steroids, then cyclosporine, which all failed. ...

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Linear Glom IgG deposit , cANCA and -ve Anti-GBM 9 hours ago

Good evening colleagues, I would like to share an interesting and challenging case for discussion and to seek your valuable opinions. Patient pro...

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RE: PLA2R-membranous nephropathy 10 hours ago

These tests are not free, unless they are performed as a part of sponsored research. LD/MS= laser dissection-mass spectrometry . ----------------...

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RE: Lupus : Role of OBi vs TCE 10 hours ago

The serum creatinine and eGFR are normal. Would recommend a 3 month course of weekly INH and Rifapectin as TB prophylaxis as best option. I think...

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RE: PLA2R-membranous nephropathy 11 hours ago

Out of curiosity when a thread reads ... Send it off for confocal, mass spectrometry to Mayo clinic etc... are these tests done for free , if not w...

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RE: IgAN with nephrotic syndrome 11 hours ago

Academically Sibeprenilamab may be a good option, but realistically if Tarpeyo was not approved , I am not sure how Sibeprenilamab would be . I d...

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RE: PLA2R-membranous nephropathy 12 hours ago

What is kd/nsx? Mass spectrometry --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: PLA2R-membranous nephropathy 12 hours ago

Thanks for case , There is less fibrosis in second biopsy than first If no EM and clinically nephrotic with IG highly positive guess means relap...

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RE: PLA2R-membranous nephropathy 13 hours ago

"Active " PLA2R MN with consistently negative anti-PLA2R antibody By ELISA and IFA in serum is very uncommon. It raises the possibility possibility...

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RE: PLA2R-membranous nephropathy 15 hours ago

Typically resorbed deposits show relatively weak IF staining as well. So the presence of strong IgG staining (4+) argues strongly for active diseas...

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RE: Primary membranous nephropathy 16 hours ago

That is a very rapid drop in GFR from 54 to [More]

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RE: Primary membranous nephropathy 18 hours ago

Thank you Hayder. ------------------------------ Adrian Sequeira MD, FASN Professor of clinical medicine LSU Health Sciences Shreveport LA (318)...

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RE: IgAN with nephrotic syndrome 19 hours ago

The higher the extent of FPE, the worse the outcome. This agree for the use of steroids despite clinical demographics. -------------------------...

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RE: PLA2R-membranous nephropathy 20 hours ago

The usual timeline for resorption of immune deposits in treated MN varies but generally spans months to years (can take 1-3 years or longer) depend...

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RE: Lupus : Role of OBi vs TCE 21 hours ago

What was the serum creatinine and eGFR? What was the serum albumin? I would repeat biopsy. I agree with Dr. Glassock about the use of Obinutuzum...

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RE: Primary membranous nephropathy 22 hours ago

I think that bilateral RVT has been ruled out as a cause of AKI in severely nephrotic patient. The vital question in this case is does the kidneys...

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RE: Primary membranous nephropathy 1 day ago

Thanks Dr Rodby for your input. There was a fast drop over 7months. No reason could be ascertained. When I saw the biopsy result, it surprised me...

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RE: IgAN with nephrotic syndrome 1 day ago

Thank you all for your insight and guidance. I am leaning towards trial of steroids per TESTING trial. Will follow-up with clinical course. ----...

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RE: Lupus : Role of OBi vs TCE 1 day ago

i would choose Obinutuzumab.. her poor compliance history makes her a less desirable candidate for enrollment in a clinical trial. Just an opinion....

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RE: IgAN with nephrotic syndrome 1 day ago

I agree with Dr. Venkat - the relatively normal or only slightly reduced serum albumin level makes the lesion the lesion more in line with IgAN tha...

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RE: IgAN with nephrotic syndrome 1 day ago

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

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Lupus : Role of OBi vs TCE 1 day ago

Was asked to consult on a 22 year old young girl who was diagnosed with SLE in 2019 She had a full spectrum of disease with lupus arthritis , myo...

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RE: PLA2R-membranous nephropathy 1 day 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...

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RE: PLA2R-membranous nephropathy 1 day 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...

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RE: IgAN with nephrotic syndrome 1 day 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...

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PLA2R-membranous nephropathy 1 day 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...

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RE: Primary membranous nephropathy 1 day 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...

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RE: Primary membranous nephropathy 1 day ago

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

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RE: IgAN with nephrotic syndrome 1 day 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...

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RE: IgAN with nephrotic syndrome 1 day ago

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

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RE: Primary membranous nephropathy 2 days 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...

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RE: IgAN with nephrotic syndrome 2 days 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 ...

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RE: IgAN with nephrotic syndrome 2 days 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...

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RE: Primary membranous nephropathy 2 days ago

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

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RE: Primary membranous nephropathy 2 days ago

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

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RE: Primary membranous nephropathy 2 days ago

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

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RE: Primary membranous nephropathy 2 days ago

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

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Primary membranous nephropathy 2 days 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...

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