RE: GN in post transplant 8 minutes ago

Chances that the donor is two APOL1 risk alleles positive is about 15% . ------------------------------ Richard Glassock MD, FASN Emeritus Profes...

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RE: GN in post transplant 15 minutes ago

@saja mohammed Hi Dr.Mohammed Donor is black but we do not have any APOL1A testing on the sample

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RE: Treatment of MVI 35 minutes ago

don't forget there could be nonDSA causing MVI and graft dysfunction ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCO...

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RE: Membranous Patient 45 minutes ago

I am not exactly clear as to why you started CYC + Prednisone in this patient. Switching Fromm RTX to an Obinutuzumabb based regiment withot steroi...

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RE: Treatment of MVI 1 hour ago

Thank you for your input. Changing CSA to tacrolimus is a good suggestion. I had even considered switching to belatacept, although I am not sure ...

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Membranous Patient 1 hour ago

Posting this for one of my colleagues here. Seeking thoughts/assistance with this case. 77-year-old gentleman referred for evaluation of nephr...

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RE: GN in post transplant 2 hours ago

The reading pathologist already excluded pseudo-crescents and no mention of collapsing features is in the posted report. Let's await for Dr. Caza's...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 2 hours ago

This is very high risk anti-PLA2R related MM complicated by crescentic GN - he will need very aggressive immunosuppressive therapy . RASi will not ...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 5 hours ago

It was CT guided renal biopsy by IR. No complications so far post biopsy. ------------------------------ Vikram Beemidi MD MD NEPHROLOGY AND HYPE...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 5 hours ago

Thank you, Dr Glassock, for your valuable input. ------------------------------ Vikram Beemidi MD MD NEPHROLOGY AND HYPERTENSION ASSOCIATES Clark...

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RE: GN in post transplant 12 hours ago

Thank you for sharing this case. I agree with the possible diagnosis of collapsing FSGS and pseudocrescent lesions rather than true crescentic lesi...

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RE: GN in post transplant 13 hours ago

unless it's not true crescent, more of pseudocrescent with severe ischemic changes ------------------------------ Saja Mohammed MD, MBChB, FAS...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 16 hours ago

ANCA negative Vasculitis superimposed on PLA2R MN, I would give RTX 100O mg X2 two weeks apart. + PEXIVAS steroids. No Avacopan, unless the circula...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 19 hours ago

Thanks dr beemidi. Great case Last question which I am interested to learn from you. As single kidney biopsy did you use us nephrology kb or radi...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 19 hours ago

No glomerular hypertrophy reported on kidney biopsy. Secondary FSGS was high on my differential diagnosis, but it turned out to be MN. Thank yo...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 21 hours ago

Thanks dr beemidi Please update us to response once treatment is given Can I also ask was there any glomerular hypertrophy ( secondary hyperfiltra...

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RE: GN in post transplant 21 hours ago

I asked for Dr.Caza and she is out of town for this week. Donor is black and thats a good point. I will need to check if patient is willing to pay ...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 21 hours ago

Thank you, Dr Rodby. Yes, MPO, PR3, ANTI GBM & ANA were negative. I failed to mention in the post that I started him on pulse dose steroids yeste...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 21 hours ago

PLA2R was positive on renal biopsy specimen. No h/o malignancy. Serum PLA2R is a send out lab and will take few days to come back. Trying to ...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 21 hours ago

Need to rule out RVT too i guess --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Treatment of MVI 21 hours ago

For obi / ritux you could use entecavir --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Treatment of MVI 21 hours ago

Thanks for case Can you get EM?from paraffin block ? Difficult for plex you would do it blindly as in nothing to measure You could change tac ...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 21 hours ago

Many thanks Serum Plar2 +ve how much ? And plar2 - ve on biopsy ? Any history of malignancy? Why did he have nephrectomy ? I would favour dr Nil...

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RE: GN in post transplant 22 hours ago

Dr. Pujari: Is your patient's third kidney donor African American? Arkana can identify APOL1 high risk variants in the kidney biopsy specimen. If p...

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RE: Rapidly progressive glomerulonephritis 23 hours ago

Dr Venturelli, hypocomplementemia is seen in 65-90 percent of patients in studies at least from india. However with such an acute presentation here...

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RE: GN in post transplant 23 hours ago

That's quite useful information. Let's see what an independent ARKANA pathologist (Dr. Caza says) particularly in regards to collapsing features, i...

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RE: Rapidly progressive glomerulonephritis 23 hours ago

Thanks Dr. Balan I agree but in the larger cohorts up to 30% of patients with IRGN (not necessarily IgA dominant) did not have hypocomplementemia...

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RE: GN in post transplant 1 day ago

I did reach out to Arkana earlier when Dr.Venkat mentioned about it. The pathologist who read it said she is very confident that its not pseudocres...

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RE: GN in post transplant 1 day ago

@Ashwini Pujari @K.K. Venkat @Tiffany Caza The story of CMV glomerulopathy was already addressed with references. The only way to establish w...

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RE: GN in post transplant 1 day ago

"CMV glomerulopathy" as originally described (pathologically, glomerular endotheliosis being the dominant finding) may be a questionable entity. Wh...

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RE: Treatment of MVI 1 day ago

assuming no viral infection- and no ability to get MMDx-would switch to tacroliomus maintaining target troutgh 5-8ng/ml, optimize MMF if no GI TOXI...

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RE: Treatment of MVI 1 day ago

Blood: BK negative, CMV <30 IU/ml (no IHC done on biopsy, but i0 and t0). ------------------------------ Christian Kuhn MD Kantonsspital St. Gall...

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RE: Treatment of MVI 1 day ago

assume BK and CMV pcr are not elevated? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Ki...

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RE: Treatment of MVI 1 day ago

dd-cfDNA is not covered by the insurance. CSA through target is 100-120 ug/l, which has always been reached the last months. Serum creatinine used ...

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RE: Treatment of MVI 1 day ago

do you have access to dd-cfDNA? CSA trough? what is serum creatinine ? CMV PCR? BK PCR? ------------------------------ [Mark] [Lerman] [MD,FASN...

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RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 1 day ago

By "Auto immune & viral serologies are negative" you included and ANCA - MPO and PR 3 (and anti-GBM)? Crescentic PLA2R MGN is not common. Generally...

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Treatment of MVI 1 day ago

A 37-year-old woman received a living-donor kidney transplant from her husband in the Middle East in January 2020. The underlying kidney disease re...

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RE: Type 1 Cryo proliferative GN without identifiable clone on treatment without improvement in proteinuria 1 day ago

Agreed. I often leave small amount of cryoglobulin alone if it is not causing proteinuria, renal dysfunction, uncontrolled hypertension or purpura....

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RE: Rapidly progressive glomerulonephritis 1 day ago

My own thoughts are in the opposite direction. With a transient petechial rash, rapidly progressive glomerulonephritis, impressive CRP, normal comp...

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Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 1 day ago

41 y/o AAM patient with PMH significant for HTN & left nephrectomy 10 yrs ago (he is unable to give diagnosis for nephrectomy ? non function kidney...

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RE: GN in post transplant 1 day ago

Due to his previous bx of abmr it did make me think if these crescents are from that. But having said that in my short experience in transplant I h...

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RE: GN in post transplant 1 day ago

Thank you so much for the detailed explanation. His previous biopsy was done in 2024. His diagnosis back then was suspicious for ABMR,c4d neg(g2+p...

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RE: Anticoagulation On Dialysis 1 day ago

It is important to point out that Enoxaparin is seldom used for anticoagulation in HD in the USA- for two reasons-it is not approved by the FDA for...

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RE: Anticoagulation On Dialysis 1 day ago

I think low single dose Enoxaparin is fine for anti-Coagulation of the dialysis circuit in hemodialysis , but I tend to avoid it for systemic antic...

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RE: GN in post transplant 1 day ago

"Given his 3rd kidney wanted to try to keep this kidney as long as possible for him" agree suspect cPRA is very high limiting chances for 4th cro...

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RE: Transplantation case 1 day ago

awaiting biopsy results ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas ...

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RE: Type 1 Cryo proliferative GN without identifiable clone on treatment without improvement in proteinuria 1 day ago

If I may ask a follow up question to the group weighing in on this case, how do we actually monitor disease progression? Renal function is stable a...

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RE: Rapidly progressive glomerulonephritis 1 day ago

Thank you everyone Clinically, I'm leaning more toward IgA dominant IRGN because of the age, the presentation with AKI in the absence of crescent...

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RE: Anticoagulation On Dialysis 1 day ago

No cause found prof glassock after work up --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Anticoagulation On Dialysis 1 day ago

Did this patient have a cardio embolic source of the CRAO (e.g. patent foramen ovale, aortic arch atheromatous placques? Just curious?) --...

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