RE: Renal Biopsy Findings Post Cyclophosphamide In Mpo+ve Patients 1 minutes ago

We have used Avacopan , without any hepatoxiicity in our patients .. there is a higher incidence of Vanishing bile duct syndrome in the Japanese po...

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RE: Renal Biopsy Findings Post Cyclophosphamide In Mpo+ve Patients 13 minutes ago

We do not have a great deal of serial kidney biopsy information in ANCA Vasculitis and virtually none at 10 days after starting therapy . I agree w...

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RE: Renal Biopsy Findings Post Cyclophosphamide In Mpo+ve Patients 1 hour ago

10 days is way too soon for histologic resolution of ANCA vasculitis. What was the clinical presentation? Anca Elisa, pattern, hematuria, protein...

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RE: SIADH conundrum 1 hour ago

Yes. Great to hear from you ------------------------------ Eric Neilson MD, FASN Northwestern University Chicago IL (312) 503-0340 --------------...

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RE: SIADH conundrum 2 hours ago

Thank you Qais. It must be an excellent APP as it incorporates the traditional formula (see below). LOL My primary concern with these application...

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RE: SIADH conundrum 2 hours ago

Eric Daniel's app is called Water and Sodium Formulas in the App Store ------------------------------ Qais Al-Awqati MBChB Columbia University N...

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Renal Biopsy Findings Post Cyclophosphamide In Mpo+ve Patients 3 hours ago

Dear colleagues , One dose of cyclophosphamide , 3 pulse methylprednisolone , and avacopan in mpo positive patients then kidney biopsy normal after...

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RE: Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 3 hours ago

I agree with Dr. Glassock first reply and choice of anit-CD38 monotherapy. Rituxan is likely not to be effect. Even if BM biopsy is negative, extra...

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RE: MPGN with negative IMF 8 hours ago

The absence if fibrils by EM makes Fibrillary GN unlikely. Can you stain the biopsy for Fibronectin deposits? ------------------------------ Rich...

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RE: MPGN with negative IMF 9 hours ago

Her chronic med list includes: Amlodipine, calcium carbonate+vit D combination tablet, glucosamine, prazosin, simvastatin, valsartan, vit B complex...

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RE: MPGN with negative IMF 9 hours ago

Thank you for the suggestion. Would the absence of fibrils on the EM point against fibrillary GN? ------------------------------ Emmett Tsz Yeung...

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RE: MPGN with negative IMF 9 hours ago

Her blood pressure has ranged between 129-159/60-84. She's on valsartan 80mg OM, amlodipine 5mg OM and prazosin 1mg ON for control. But her histolo...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 9 hours ago

Pros and Cons for and against PLEX I think In favor of it maybe positive anti GBM in serum, which could have weak binding to another antigen on GBM...

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RE: MPGN with negative IMF 9 hours ago

We don't have the images readily available but the report reads Diagnosis: MRPN pattern GN, scary subendothelial electron dense deposits on elec...

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RE: MPGN with negative IMF 9 hours ago

Thank you for the suggestion. She has been referred to the hematologist for further evaluation ------------------------------ Emmett Tsz Yeung Wo...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 11 hours ago

ANCA negative, antiGBM was only done after biopsy result because clinical presentation didn’t fit suspicion of anti-gbm and often anti-gbm get requ...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 13 hours ago

Dr. Glassock, when all the results are available , it would be helpful if you could summarize your final thoughts on the case . I especially refer ...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 16 hours ago

What makes this case even more fascinating is the recognition that a kidney biopsy may not have even been carried out, in some settings.. -------...

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RE: SIADH conundrum 16 hours ago

The history of fluid and electrolyte disorders is so fascinating and delectable, but often ignored. Thanks to everyone forctheir "delicious" posts ...

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RE: SIADH conundrum 16 hours ago

Thank you Eric. Much appreciated. Mario ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Fibronectin glomerulopath 16 hours ago

Thanks- the EM will be very interesting. Incomplete penetrance and the lack of genotype -phenotype correlations present real chslldnges making the ...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 17 hours ago

One thing I forgot to ask is what are results of ANCA testing (anti-MPO and anti-PR3) - these serological results might be relevant to your decisio...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 19 hours ago

No plasma exchange? If you are going to treat as if thus was anti-GBM Dusease due to the high levels of anti-GBM antibodies in the serum by two dif...

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RE: Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 19 hours ago

I guess by definition this is not "Masked" Monotypic MN even though the age group is suggestive. But no auto-immunity is present . I agree with obs...

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RE: Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 19 hours ago

​Given her remote history of PAN what is her baseline Hepatitis B panel ?? --------------------------------- Alaa Nabih Abdalla nephrology fellow ...

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RE: Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 20 hours ago

This case reminds me of what Arkana has reported (see attached) , MGN with IgG kappa restriction but not felt to be an MGRS (by extensive exclusion...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 21 hours ago

Yes, our immunologist routinely does use control IF staining. I will try to get some LM pictures I am planning to give steroid +cyclo and keep cl...

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RE: Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 1 day ago

My guess is that this is a rare example of MN due to a MGRS. I would consider therapy with Daratumumab. Need opinion from Dr. Leung or Dr.Jhaveri ...

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Segmental Membranous Glomerulopathy with IgG1 Kappa Deposits 1 day ago

Dear Colleagues, I have an interesting case I was hoping to get your input. I have a 25 year old female with a history of PCOS and dyspareunia and...

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RE: Fibronectin glomerulopath 1 day ago

My sense is that the mesangial nodules are often much larger than what is described in the report. "Giant' nodules and dense deposits are usually t...

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RE: Fibronectin glomerulopath 1 day ago

Just curious- why are you skeptical of a diagnosis of Fibronectin Glomerulopathy? Seems like a pretty classical case! ---------------------------...

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RE: Post Partum AKI 1 day ago

Anti-GBM antibodies can sometimes present atypically, meaning that some patients may have these antibodies without them binding to their own glomer...

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RE: SIADH conundrum 1 day ago

Here is the Goldberg paper (attached) first describing the electrolyte-free water clearance we were taught as house officers and fellows at Penn wh...

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RE: SIADH conundrum 1 day ago

Thank you John. Much appreciated. Mario ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Post Partum AKI 1 day ago

I think that I would treat this as ANCA vasculitis as well; Rituximab and steroids per Pexivas. What percent of the glomeruli have crescents? ho...

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RE: SIADH conundrum 1 day ago

I remember when I first read the 1986 AJM paper by Rose (attached above) in which he explains the difference between Osmotic free water clearance a...

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RE: Fibronectin glomerulopath 1 day ago

I am also skeptical of the diagnosis of fibronectin GN. IHC stain for fibronectin and/or fibrillary deposits on EM would help. Genetic testing for ...

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RE: Fibronectin glomerulopath 1 day ago

I am also skeptical of the diagnosis of fibronectin GN. IHC stain for fibronectin and/or fibrillary deposits on EM would help. Genetic testing for ...

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RE: SIADH conundrum 1 day ago

Here it is + a couple of other Burton Rose papers on electrolyte-free water clearance. ------------------------------ John Schwartz MD Dalla...

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RE: Post Partum AKI 1 day ago

Pauci-Immune crescentic GN -ANCA- negative. RTX + Steroids (rapid raper) , No Avacopan . may be best choice- a short course (8 weeks ) of oral CYC ...

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RE: Post Partum AKI 1 day ago

IF is negative. C-ANCA and P-ANCA both are negative. EM is pending. How may we go this finding? --------------------------------- Wael Jebur MD d...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

Could you post some de-identified pictures of the LM findings?. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geff...

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RE: Fibronectin glomerulopath 1 day ago

Have you confirmrd fibronectin Glomerulopsthy by appropriate staining or other analysis of the kidney biopsy? i so, I would taper and eventually st...

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Fibronectin glomerulopath 1 day ago

65yr old lady HYPERTENSION detected 11/2025 12/2025 H/O PEDAL EDEMA + TOOK torsemide from local hospital 12/2025 creatinine- 0.9/ACR 1670 4/2026 ...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

Does your immunohistologist routinely perform a positive control with each kidney biopsy to be sure that the reagents are working properly.? ----...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

Dr. Dastoor- PLEX is designed to remove circulating antibody, not tissue deposited antibody . CYC, not RTX , is standard of care for anti-GBM antib...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

Yes, but false positive anti-GBM antibody is equally implausible. If spikes were seen on LM ( silver Methenaminec-Jones stain) with might be anti-G...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

Seems like u could be dealing with dual positive anti GBM and Membranous Nephroapthy. I also wonder if some of the improvement you see is related t...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

Thank you prof Glassock. I will ask the histopathologist about that although it would very unlucky to get 6 in IF sample that all sclerosed -----...

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RE: Crescentic GN With Raised Anti-GBM But No Immune Deposit 1 day ago

I forgot to mention that eGFR although dipped to 18ml/min it did come up to 23 while treating the ecoli bacteraemia and she has had excellent urine...

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