Lupus planning pregnancy, now with low C3/C4. 2 hours ago

30 year old significant for Hypothyroidism, SLE with history dating back to 2015 ,Renal Biopsy done with results of lupus nephritis classs III and ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 4 hours ago

Thanks. Good discussion. The current FDA endorsed pivotal Phase 3 Trial of Felzartamab in MN uses CNI as a comparative arm , not OBI so it will not...

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RE: PLA2R negative Membranous Nephropathy- Management Q 5 hours ago

@Richard Glassock: Is there more information that you are aware off about the Trillini cohort. Few things are missing for me to make heads or tails...

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RE: PLA2R negative Membranous Nephropathy- Management Q 6 hours ago

Trial of Felzartamab against Obinutuzumab has to be designed with non-inferiority endpoint. Companied do not like to conduct such trials. A double ...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 1 day ago

Thanks Dr. Lambeau for these fresh and important insight into the connection between PLA2R and Cancer!! ------------------------------ Richard Gl...

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RE: Latent TB and Membranous Nephropathy 1 day ago

In the MENTOR trial of RTX vs CsA NEJM) infectious complications were twice as frequent with CsA. My AI consultant (Claude) stTes very clearly that...

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RE: Latent TB and Membranous Nephropathy 1 day ago

Thanks dr dastoor for learning experience and sharing your experience @ prof glassock thanks for learning experience Can I ask if there is paper...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 1 day ago

I would suspect a link between MPN and PLA2R1-MN. PLA2R1 has been proposed as a tumor suppressor gene, and is involved in various types of cancer, ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

This discussion may be moot- as Felzartamab has no benefits in RTX resistant MN- see Trillini et al KI Reports, 2026 ---------------------------...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 2 days ago

I think this is a very reasonable approach, considering the clinical circumstances. Good luck. ------------------------------ Richard Glassock ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

We do not use CNI for membranous, at least I don't . However at the ERA 2026 , when the Obi trial was presented , the first and main question that ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

I see-it is all about access, not comparative efficacy and safety.. Do you really think that CNI are safe and effective for MN in an era of biologi...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 2 days ago

Dear colleagues, As per the previous discussion, and after reading the article Dr.Rodby suggested, I repeated his anti-PLA2-R level, and decided...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

I agree but the Obi trial should have also been compared to Rituximab. I think it was compared to CNI for 2 reasons 1. Rituximab is not FDA appro...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

How can such a trial of Felzartamab show superiority to OBI-assuming that OBI is approved by the FDA for therapy of MN as a consequence of the MAJE...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

@Richard Glassock could you elaborate why Felzartamab would be a meaningless approval , if OBI was also compared to a CNI. ----------------------...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

In my opinion, CNIs (Tacrolimus or Cyclosporin + or - low dose steroids ) are no longer considered a standard of care for treatment of MN. If one a...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Thank you, have put in for Obi prior Auth. Have a great weekend. ------------------------------ T. Kaur, MD FACP Nephrologist/HTN/Kidney Stones ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Will Felzartamab gain approval for MN from FDA by comparison to a CNI ?. If so . the approval will be meaningless. The comparator will have to be O...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

Regardless of PLA2Ra positive or other. This is an antibody driven disease and therapy is targeting the antibody producing cells. I agree with abov...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

I fully agree with Dr. Rodby- a CR with RTX makes Cancer less likely but either way with NELL1 disease you have to look hard for triggers. Mercury ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

As you know, Nell1 MGN is Cancer, medications, herbals, Hg containing skin creams, lipoic acid, ask about everything... It is often segmental and...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

Biopsy is NELL 1 positive. THSD7A negative. Does that change the management? Cancer screen was negative. still Ola to watch he proteinuria a...

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RE: Latent TB and Membranous Nephropathy 3 days ago

Yes Quantiferon is part of screening in our hospital. I do it because , it avoids conflict with the infusion and ID teams who have created the prot...

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RE: Latent TB and Membranous Nephropathy 3 days ago

Thanks Quantiferon is not part of pre rituxan screen in my centre --------------------------------- Muhammad Soobadar MBChB UK ----------------...

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RE: Latent TB and Membranous Nephropathy 3 days ago

YES, especially when steroids are used n conjunction with a CNI. I would definitely avoid any CNI or steroid use in this patient ---------------...

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RE: pr3 +ve is it endocarditis ? 3 days ago

well PTH was not suppressed and urine calcium was borderline high so could be primary HPTX especially since serum phos low. eGFR 65 with creatinine...

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RE: Latent TB and Membranous Nephropathy 3 days ago

Is Cni risk higher than rituxan for latent tb reactivation prof glassock --------------------------------- Muhammad Soobadar MBChB UK ---------...

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RE: Latent TB and Membranous Nephropathy 3 days ago

I would not advise use of a CNI,especially with steroids, for MN in a patient with latent TB. Just an opinion. ------------------------------ Ri...

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RE: pr3 +ve is it endocarditis ? Thursday, July 30 @ 2:49 PM

Prior to cinecalcet --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 2:45 PM

Respiratory MDT Reviewed case Agree TB highly unlikely given reassuring CT, stability of bronchiectasis and only Sx weight loss Given product...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 1:12 PM

Thanks Dr. Dastoor fir your commentary on this case.. It is not uncommon to see combinations of CNI and RTX used to "speed up" the trajectory towar...

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ASN Loan Mitigation Program Thursday, July 30 @ 12:39 PM

ASN is now accepting applications for the ASN Loan Mitigation Program as a part of its continued efforts to decrease the loan burden of those enter...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 8:30 AM

Couple of questions 1. Was the Quantiferon checked , because you planned to give Rituximab or because of his symptoms of chronic cough and weight...

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RE: pr3 +ve is it endocarditis ? Thursday, July 30 @ 8:10 AM

Was serum calcium and urine calcium prior to or after cinecalcet? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP E...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy Thursday, July 30 @ 7:00 AM

I am grateful for your input to help me with this case. The platelets are normal @ Dr.Soobadar. ------------------------------ Safa Now...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy Thursday, July 30 @ 6:07 AM

If I am not mistaken the malignancy seems to have predated the onset of suspected Membranous Nephroapthy by a relatively long duration. I would con...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 2:52 AM

Thanks prof glassock He is on treatment dose enoxparin So you would not do PET or bronchoscopy ? CTTAP - -ve Psa negative No breast lump Us...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 1:11 AM

I would treat with RTX in the absence of any positive screenings for occult cancer .. ------------------------------ Richard Glassock MD, FASN Em...

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RE: Latent TB and Membranous Nephropathy Wednesday, July 29 @ 8:52 PM

With a negative tissue PLA2R I see no point in repeating the serum Anti-PLA2R . With the severe NS I would not wait too long before treating with R...

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RE: Latent TB and Membranous Nephropathy Wednesday, July 29 @ 8:30 PM

Cannot do thrombospondin --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Latent TB and Membranous Nephropathy Wednesday, July 29 @ 8:30 PM

“Ibwoiul repeat tgecdeerumbPLA2R one by ELISA” What do you mean prof glassock --------------------------------- Muhammad Soobadar MBChB UK ----...

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RE: Latent TB and Membranous Nephropathy Wednesday, July 29 @ 8:29 PM

Plar 2 negative biopsy Request for nel . They can do either serum or tissue thrombospondin --------------------------------- Muhammad Soobadar M...

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RE: Latent TB and Membranous Nephropathy Wednesday, July 29 @ 8:24 PM

I think the TB findings are co-incidental and not causal. This is pretty advanced Dusease. Let's see what the PLA2R is in glomeruli first. I would ...

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RE: pr3 +ve is it endocarditis ? Wednesday, July 29 @ 8:19 PM

Calcium 2.91( 2.20-2.60) --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: pr3 +ve is it endocarditis ? Wednesday, July 29 @ 8:17 PM

Bilirubin 12(5-21) Ferritin 238 (30-337) Yes have access to measured gfr but not sure how fast it will be done Are you thinking if mgfr low then k...

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RE: pr3 +ve is it endocarditis ? Wednesday, July 29 @ 8:16 PM

What was the serum calcium when the PTH was 8? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medic...

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RE: pr3 +ve is it endocarditis ? Wednesday, July 29 @ 8:14 PM

Improving calcium with cinecalcet not fluids 24hr urine for calcium 6.11(2.5-7.5) 24 hr volume 2.74 L Urine calcium 2.23 mmol/L ----------------...

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RE: pr3 +ve is it endocarditis ? Wednesday, July 29 @ 8:12 PM

Chloride normal Pth 8 ( 1.5-7.6) Vitamin D 111 mmol/L 1-25 OH pending --------------------------------- Muhammad Soobadar MBChB UK ----------...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy Wednesday, July 29 @ 8:11 PM

Isn't this most likely PLA2R+ MN in a Patient with MDS? The choice of RTX for initial therapy seems quite reasonable, especially in the face of a d...

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