RE: IgA Nephropathy Dual Immunotherapy 51 minutes ago

I would not recommend use of simultaneous or sequential use of Sibe and Nefecon. In my opinion, this patient needs therapy with oral systemic stero...

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IgA Nephropathy Dual Immunotherapy 1 hour ago

Does anyone have experience with simultaneous initiation of vs sequential budesonide (Tarpeyo) and sibeprenlimab (Voyxact)? Patient with IgA nephro...

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RE: macroscopic haematuria in young patient 1 hour ago

We have been fortunate to see 2 patients with flank pain, hematuria and nutcracker syndrome Constitutionally , these patients need to be skinny ...

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RE: LUPUS WITH ANCA 1 hour ago

Approximately 15-20% of LN patients are ANCA positive (even in tha absence of drug-induced lupus). Eighty % of these patients are MPO +ve and only ...

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RE: macroscopic haematuria in young patient 4 hours ago

A narrowing or tortuous appearance at the UPJ on CT urogram can be considered normal or simply reflect ureteral peristalsis, especially if contrast...

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RE: LUPUS WITH ANCA 5 hours ago

@Richard Glassock@K.K. Venkat thank you. What do you make of the high positive PR3 Anca . The IF in all glomeruli , shows full house pattern of sta...

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RE: Idiopathic fsgs csa dep 5 hours ago

Thx for the feedback and suggestions- super helpful as the patient and I sort out best next steps His last flare was 15 months ago and not sure i...

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RE: Idiopathic fsgs csa dep 6 hours ago

Hi, in children we were able to discontinue CSA after maintaining remission for at least 2 years. I taper CSA over a period of 12-24 months an...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 6 hours ago

I would use the 1gm X2 AA two week interval initially. What did the IF on the Kidney Biopsy show.. Any IgG "dusting".? --------------------------...

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RE: LUPUS WITH ANCA 6 hours ago

Challenging case of Class IV LN with superimposed ANCA + Vasculitis and a thrombophilia related To a Lupus anticoagulant . Three diseases in one pa...

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RE: LUPUS WITH ANCA 6 hours ago

Given diffuse/granular capillary wall IMF pattern may have significant class-V lupus (membranous) component in addition to class-IV explaining heav...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 6 hours ago

? lupus podocytopathy. Agree with rituximab. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ------------------------------

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LUPUS WITH ANCA 7 hours ago

56 year old female was admitted with left sided hemiperesis Labs : Creatinine : Normal ; uPCR : 8 grams Serology : ANA 1: 320 (IIF) ; DsDNA 1:...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 10 hours ago

Would you dose Rituximab 1 g IV every 6 mos or 1 g IV x 2 two weeks apart? ------------------------------ Kelly Liang MD, MS, FASN Kansas City KS...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 14 hours ago

Thanks so much for your prompt reply Dr. Glassock! I was also thinking Rituximab would be the next best choice. I am unsure if the complement inhib...

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RE: Minimal change disease relapse after steroid discontinuation despite on cyclosporine 15 hours ago

I think this patient, with steroid dependent , biopsy proven diffuse Podocytopathy, , is a good candidate for RTX. The pro-thrombotic state imposed...

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RE: macroscopic haematuria in young patient 15 hours ago

Thanks, Dr. Rubin. I missed the description of Left Flank pain. This puts Nutcracker Syndrome at #1 in the differential diagnosis, but bilateral to...

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Minimal change disease relapse after steroid discontinuation despite on cyclosporine 15 hours ago

Hi! Need advice on a case of minimal change disease (MCD) in an adult. 66 yo M with h/o ​Afib s/p ablation​, pancytopenia s/p bone marrow (BM) bi...

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RE: Idiopathic fsgs csa dep 17 hours ago

I have an almost identical case , MCD not FSGS but podocytopathy just the same. Very CNI sensitive and very CNI responsive and relapses when you ...

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RE: macroscopic haematuria in young patient 17 hours ago

@Sheldon Hirsch "Obviously, the question of renal biopsy lurks, but I wanted first to make sure the blood is coming from both ureters so I sent h...

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RE: macroscopic haematuria in young patient 17 hours ago

@Richard Glassock The original post states: " He describes left flank pain, but he does not know if it is related to macroscopic haematuria or no...

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RE: macroscopic haematuria in young patient 17 hours ago

I would not seriously consider Nutcracker syndrome with painless hematuria. This is not likely to be Glomerular. If if urine albumin excretion is l...

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RE: Idiopathic fsgs csa dep 17 hours ago

Primary FSGS, maybe due to anti podocyte auto-anti-body. Because of treatment responsiveness he may eventually become a candidate for RTX or Obinut...

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Idiopathic fsgs csa dep 18 hours ago

22 y/o Chinese Male Nsyn at age 2 and kidney bx in China w FSGS with reported many relapses responded to steroids and relicated to US 4 years ago ...

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RE: macroscopic haematuria in young patient 19 hours ago

This reminds me of a similar case I am following, a 30 yo healthy lady who developed the abrupt onset of the urine below a few months ago. The diff...

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RE: recurrent pla2r 19 hours ago

I have presemed that the patient is non-diabetic. If so , a FP anti-PLA2R is very unlikely in this setting. If the patient is diabetic, I agree wit...

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RE: recurrent pla2r 19 hours ago

Great question. Presumed non-biopsy based diagnosis of PLA2R Primary MN with a CR (clinical and immunological ) following RTX monotherapy. Now she ...

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RE: recurrent pla2r 19 hours ago

I would do an IIF assay for PLA2r ab to exclude a false positive ELISA. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-55...

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RE: macroscopic haematuria in young patient 20 hours ago

I would do a CT angio and venogram to exclude a vascular anomaly such as Nutcracker syndrome. If a vascular disorder is not found (AVM, left renal ...

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recurrent pla2r 20 hours ago

78 yo lady presented Jan 2023 with abrupt onset of 9 gms albuminuria, PLA2R 41 by ELISA, no other etiology apparent, given Ritux X2 with no biopsy....

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RE: ig a v vs anca vs ctd 20 hours ago

We use 2 pulse cyclo iv and 2 ritux 1 g as induction over 14 days with prednisolone and avacopan and no plex --------------------------------- Mu...

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RE: ig a v vs anca vs ctd 20 hours ago

Thanks skin lesion is dermatomal and looks like shingles When you say skin biopsy what are you thinking prof glassock ? -----------------------...

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RE: macroscopic haematuria in young patient 20 hours ago

Thanks . Why is clots not associated with GN? Good idea prof rodby ct angiogram looking for renal vein obstruction.? ( so that I know what I am loo...

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RE: glycosuria in young patient 21 hours ago

All the above normal prof rodby --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: glycosuria in young patient 21 hours ago

save me the google - glucose 4.2mmol/l hb1ac 38 mmol/mol are those normal? was the k normal, the bicarb etc? -------------------------...

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RE: macroscopic haematuria in young patient 21 hours ago

is a LOT of blood for any GN and if clots, probably not GN and AC ratio normal, hard to believe the proteinuria is not just blood. The hearing...

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RE: Recurrent UTI 22 hours ago

Pardon for crazy idea, after just commenting from sidelines, not treating this lady. Pain not changed after antibiotic treatment. Cystoscopy does n...

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RE: macroscopic haematuria in young patient 1 day ago

Did this patient have trauma of the lower abdomen? I remember a patient with a fall when beeing drunk, standing up in the night for voiding his b...

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RE: Recurrent UTI 1 day ago

Thanks Dr. Crivelli ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: IgA Nephropathy 1 day ago

Poly antibodies response interesting including and especially lupus serology besides the others needs explanation since cannot be ignored from ther...

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RE: macroscopic haematuria in young patient 1 day ago

From clinical description Alport syndrome stands out with hearing impairment in a young male Hence top priority is Genetic studies Ophthalmologic...

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RE: macroscopic haematuria in young patient 1 day ago

Urine acr/pcr done simultaneously we dont spin urine so cant answer if dysmorphic Is the hearing loss conductive or neural?- Patient has had a ...

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RE: glycosuria in young patient 1 day ago

glucose 4.2mmol/l hb1ac 38 mmol/mol thanks prof ------------------------------ Muhammad Soobadar MBChB UK ------------------------------

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RE: glycosuria in young patient 1 day ago

Do you know what the blood glucose levels we're at the time of Gkycisurua . What is the Hemiglobiobin A1c. ------------------------------ Richard...

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RE: macroscopic haematuria in young patient 1 day ago

Blood clots in urine are very, very uncommon in glomerular Dusease. Are your sure of thus sign? You need to do a UACR and aUPCR simultaneously. Are...

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RE: ig a v vs anca vs ctd 1 day ago

This is PR3 positive ANCA assicured Vasculitis. I think you can ignore the weak IgA deposition. It is likely just an incidental finding. Does the b...

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RE: ig a v vs anca vs ctd 1 day ago

And can someone explain how they knew it was anca and not ig a based on history and clinical signs? and not Ig A vasculitis or CTD with renal in...

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macroscopic haematuria in young patient 1 day ago

21 year old macroscopic haematuria which started in June 2025. He does not recall any possible initiating event. He reports haaematuria happening...

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RE: ig a v vs anca vs ctd 1 day ago

@ prog glassock you made a point at conference last Sunday that 10% of biopsy has Ig a and mean nothing however in this case it has c3 and iga do...

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glycosuria in young patient 1 day ago

20 year old glycosuria in the context of a viral illness in September where he tested five samples of urine over two weeks which were positive for ...

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