RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 5 hours ago

Thank you Prof Glassock. ------------------------------ Payal Gaggar MD, DM Nephrology Asst prof Nephrology Nizams Institute of Medical Sciences ...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 6 hours ago

I would treat with RTX (cautiously with careful observation ) now, rather than waiting so see deterioration of kidney function. I do not think that...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 6 hours ago

Thanks Prof Glassock . In your opinion is "wait and watch " an option for this patient.? And if treated would she require prolonged therapy with ...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 6 hours ago

Thanks Prof Rodby. "Pearls of wisdom" as usual !!! ------------------------------ Payal Gaggar MD, DM Nephrology Asst prof Nephrology Nizams Inst...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 7 hours ago

If you choose to treat this patient with RTX be wary of passive serum sickness ,which can ocurr in this situation with devastating results. ----...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 7 hours ago

Furthermore, the absence of a T0 biopsy in this case, makes it impossible to exclude a donor derived IgAN , although this seem unlikely on the surf...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 8 hours ago

But "de novo" igAN has been associated with fairly 'benign" outcomes. I am not confident that this is de novo IgAN in an allograft.. ------------...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 8 hours ago

Forgive me for repeating this that I started a couple years ago "When in question, pronase digestion" ------------------------------ Roger Rod...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 8 hours ago

"no data on APRIlL/BAFF drugs as transplants were excluded in studies" I have seen some pretty bad outcomes in renal transplant with IgAN. We u...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 16 hours ago

I had a different take on Wagner's review. It was an excellent review of previous data and the history, but it really didn't add much to today's di...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 22 hours ago

Agree with the need to review unlabeled biopsy report. Allograft 27 yrs since transplant would be expected to have IFTA and possibly evidence of ch...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 22 hours ago

It should read that repeat gado dosing should be avoided. ------------------------------ Mark Perazella MD, MS, FASN Boynton Beach FL (203) 464-...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 22 hours ago

Any prior kidney transplant biopsies over the 27 years post-transplant? Were these free of findings suggestive of IgA nephropathy? Has SCr been sta...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

See Haas et al KI Reports 2025 for a recent study of recurrent vs de novo IgAN in Allografted kidneys. ------------------------------ Richard Gla...

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RE: Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

No personal experience with April- or April-BAFF inhibitors in this situation. De novo IgAN in renal allografts is pretty rare so no literature..Ho...

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Immunotherapy For De Novo IgA Nephropathy Post Transplant 1 day ago

62 year old with reflux nephropathy and LRD kidney transplant in 1999. De novo IgAN on biopsy. Currently on Envarsus, prednisone, sparsentan and da...

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

Thank you so much Dr.Lambeau for your valuable input, that was very useful! ------------------------------ Safa Nowrooz MD Dr. Governmental Hospi...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

Less gadolinium is better. But, you don't want to limit gado dose and not get adequate images. Also, avoiding repeat dosing within short time inter...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

Thanks for the input , agree for not only MRI but for all other tests to be done when only necessary One more question, is using a low dose gadoli...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

We were among the first to enlighten Gadolinium toxicity. Although small, the risk is never zero. I would organize to meet the radiologist and the ...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

Besides NSF, there is evidence of Gd deposition (mainly with linear, but with 2nd generation as well) in the brain. Not just in CKD but in patients...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 1 day ago

My 2 cents. Are the new gado agents completely safe. Nope. However, their benefit when used to diagnose serious illnesses far outweighs their relat...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 2 days ago

That would be highly unusual for Cryo GN Do you have EM available? You should try to look for masked deposits by protease digestion and IF on fo...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 2 days ago

@Mark Perazella Fell free to pipe in on this, clearly there is lot more to this, there is reported chronic gadolinium syndrome (not skin) that re...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 2 days ago

thank you-I read the review which is excellent. reinforcing the view that MRI with Gadolinium is not a zero risk especially in CKD/ESRD. NSF was an...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 2 days ago

I agree, mostly; however, I do think there is a risk associated with gadolinium (see Brent Wagner's recent CJASN review), and I do my best to avoid...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 3 days ago

No.. there was no restriction on biopsy.. Suprisingly.. the IF was negative for all deposits.. I presume the cryo nature of the deposits might have...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 3 days ago

Thanks for the response. Will try to get the cryocrit levels.. Is there any explanation for why a clone could not be identified, despite clear evid...

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RE: Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 3 days ago

How was the light chain IF of the kidney biopsy, any light chain restriction? I think a rituximab based therapy (either 375 mg/m^2 or 1 g q2weeks)...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

He has started plex one session but not had any yesterday . He had a new line yesterday Will get anti gbm level today tho might be reduced but wil...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

did you repeat ANTI-GBM as suggested? If remains high as before then even if biopsy IF is inadequate IMO nothing changes ------------------------...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

How many glomeruli in the DIF.. ? were the extensively sclerosed or disrupted. False negative DIF has been seen in antiGBM disease when the DIF sam...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

My reply “Sorry to hear that . I was hoping to have IF as differential remain and infectious process and full house staining might make think about...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

Thanks everyone for help From histopatholgist “just did the DIF. It's negative across the board. However, I do have slight misgivings about the qu...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

Dr. Soobadar: is the immunofluorescence result available yet? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 --------------...

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Management of Sjögren's syndrome with type II cryoglobulinemic MPGN in the absence of a confirmed lymphoproliferative disorder 3 days ago

I would greatly appreciate your opinion regarding the management of the following challenging case. A 42-year-old woman presented with fever, fat...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

Thanks , appreciate the advice --------------------------------- Aymen Al-Duajili MD Gulf Coast Nephrology Sugar Land TX (832) 526-1343 ------...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

let look at this from another perspective-agree with doing MRI with gadolinium using newer generations ( we all agree risk is low) but consequences...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

I assume linear IgG on biopsy. With oliguria , nearly 100% glomerular crescents and dialysis dependency his prognosis for recovery of useful renal ...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V 3 days ago

I basically agree with Dr. Rodby. For what it's worth, we have an institutional policy on this and we do not initiate dialysis on a patient to dial...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 days ago

Anti-GBM antibody disease can present with fever in the elderly patient with a poor prognosis. Will find a paper and post it. --------------------...

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RE: 3rd Generation Gadolinium Use In Pt With CKD IV/V Wednesday, August 5 @ 11:58 PM

The vast majority of the nephrology community does not believe that there is any appreciable risk to the newer Gad compounds. And while Gad is dial...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 7:48 PM

await IF and EM prior to stopping Plex. continue dialysis unless uo improves and evidence of intrinsic renal function. If any viable glomeruli (whi...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 7:40 PM

Thanks prof lerman You would not immunosuppress stop steroid and plex and plan for dialysis? --------------------------------- Muhammad Soobada...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 7:37 PM

"All renal screen negative . Cryoglobulin not sent ( complement normal )" per DR. Soobadar .IF REPEAT ANTI-GBM still high-then not likely infection...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 7:20 PM

C3/c4 normal Histopathologist felt inflammatory changes in glom leads to tin Not concerned about infection IF and degree of chronicity awaited to...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 7:15 PM

"significant glomerulitis": Does this mean endocapillary cellular infiltration ("exudative GN")? Especially, if there are abundant endocapillary ...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 6:42 PM

and is daily plex or alternate day plex? ------------------------------ Muhammad Soobadar MBChB UK ------------------------------

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 6:41 PM

patient had biopsy yesterday and plex today with octaplas and albumin. we need to remove femoral line tomorrow and insert temporary jugular line. ...

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RE: anti gbm serology postive with fever and raised inflammatory markers Wednesday, August 5 @ 6:09 PM

provisional histopathology report Notes LM- florid crescentic necotising GN almost all glomeruli glomerular tuff show significant glomeru...

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