RE: Membranous nephropathy 1 hour ago

I do not currently suggest enhanced screening (beyond routine age- and sex adapted screening ) for cancer in PLA2R positive MN. I occasionally wi...

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RE: FSGS conundrum 1 hour ago

I have no experience with combined OBI and DARA in treatment resistant FSGS. I suppose that this is a rational approach as CD20- Plasma Cells can b...

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RE: Membranous nephropathy 2 hours ago

Dr. Soobadar- Practical approach is to perform routine age-appropriate cancer screening and to escalate screening when clinical suspicion exists ev...

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RE: Pauci-Immune GN, Chronic, Minimally Active 2 hours ago

While I see no particular reason to spare steroid in this patient, I wonder if lower (LoVAS study) dose steroid can be enough in this particular ca...

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RE: FSGS conundrum 2 hours ago

Thank you, Drs Rodby and Glassock. A bit worrisome that in the series by Zand et al that only 40% reach full/partial remission with obinutuzumab in...

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RE: intra-operative CRRT 2 hours ago

At our institution, surgeons request intraoperative CRRT support mainly in patients already on dialysis preoperatively, significantly fluid overloa...

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RE: intra-operative CRRT 3 hours ago

@David Charytan As it has been pointed out, there is NO evidence whatsoever that the use of intra-operative dialytic modalities (continuous or in...

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RE: FSGS conundrum 3 hours ago

Addendum- in the Phase 2 trial of Zand, et . 60% of patients with treatment resistant presumed Primary FSGS failed to receive any benefits from O...

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RE: FSGS conundrum 4 hours ago

Dr. Rodby- you may be correct concerning your comments about "independence" of the beneficial effects of OBI and full peripheral CD19 Bcell depleti...

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RE: Pauci-Immune GN, Chronic, Minimally Active 4 hours ago

I would use a PEXIVAS based steroid regimen. I am not sure about concomitant use of Avacopan.. just not enough data in tgus kind of "smoldering " d...

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RE: Pauci-Immune GN, Chronic, Minimally Active 4 hours ago

Thank you all. In addition to Rituximab how low on steroids would you go. ------------------------------ Awais Nauman HMC Doha ---------------...

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RE: FSGS conundrum 6 hours ago

I'm not sure that CD19 depletion on rituximab means anything in terms of response to obi. In other words, obi may have improved effects over ritu...

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RE: AAV ? 6 hours ago

Do you have a rheumatoid factor in this case? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephr...

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RE: AAV ? 7 hours ago

Given diagnostic uncertainty and opinion-based initial therapy, too early to plan maintenance treatment. Will have to observe clinical course close...

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RE: AAV ? 8 hours ago

Thanks prof venkat What about maintenance what would you use ? And avacopan ? --------------------------------- Muhammad Soobadar MBChB UK ---...

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RE: AAV ? 11 hours ago

I wish to clarify: 1. I will replace rituximab with cyclophosphamide or use them in combination only if a RPGN-like course is evolving, and/or life...

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RE: AAV ? 12 hours ago

Thanks prof glassock Kind regards --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: AAV ? 16 hours ago

I have no opinions on how to interpret this auto p-antibody in light of the kidney pathology.-I agree with the use of RTX and steroids (as is being...

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RE: AAV ? 16 hours ago

https://pmc.ncbi.nlm.nih.gov/articles/PMC10167150/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10167150/ Attached is review of SSc and antibodies ...

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RE: AAV ? 16 hours ago

@ prof glassock what about the antibody for scl? Any educational point for non expert --------------------------------- Muhammad Soobadar MBChB U...

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RE: AAV ? 18 hours ago

Thanks prof glassock / prof venkat and other colleagues 26 February 0215 dr taam posted same post under different title ANA-Negative Lupus Nephr...

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RE: FSGS conundrum 18 hours ago

Thanks for your prompt response Dr Glassock. Much appreciated! ------------------------------ Donald Mitema MD Mississippi Baptist Medical Center...

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RE: AAV ? 18 hours ago

Agree with Dr. Glassock that the nature of the GN is not clear in this patient. If the initial SCr of (?) 3.1 mg/dL ("31 mg/L") is rapidly increasi...

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RE: FSGS conundrum 18 hours ago

I would treat with Obinutuzumab and document full peripheral B cell depletion. If non response in 3-4 months , I Would switch to PLEX or Lipid Aphe...

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FSGS conundrum 18 hours ago

Hi everyone, I would love your insight on this case. Young otherwise healthy patient of African ancestry develops fairly rapid edema and nephr...

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RE: AAV ? 19 hours ago

Dr. Soobadar - I really cannot draw any conclusions as to what is best therapy in this case. I think I would try RTX and steroids , but I have very...

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RE: AAV ? 19 hours ago

And your thoughts about anti pm scl antibody and scl? Kind regards --------------------------------- Muhammad Soobadar MBChB UK ---------------...

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RE: AAV ? 19 hours ago

Thanks prof glassock Is the ANA negative till we do another assay to confirm ? @ prof glassock I am interested to know how you would treat ? ...

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RE: AAV ? 19 hours ago

It is not possible to categorize this patient as having Lupus Nephritis with a negative ANA, none of thev published trials on treatment of LN are r...

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RE: Opinions plz 20 hours ago

Yes, I agree; IgAV; formerly Henoch-Schönlein purpura My bias: The triggers possibly midodrine + Velphoro use. Midodrin causing microcirculation ...

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RE: AAV ? 21 hours ago

I also note that there is a lot of fibrosis on kidney biopsy but it would not stop me from treating Kind regards ------------------------------...

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RE: AAV ? 21 hours ago

Many thanks for case Many thanks prof glassock for input Does patient have any symptoms of PMR or GCA?( rule out large vessel vasculitis ) Any ...

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RE: Pseudohypertension or true uncontrolled HTN 21 hours ago

HTN in Elderly 1. Old people have less ability to activate RAAS. They have Low Renin type hypertension and they do not respond to ACEi & BRB ...

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RE: intra-operative CRRT 1 day ago

We did that routinely with most liver transplant. However, after a regime change in the surgical side, we rarely do need it. The new team uses much...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Thank you all Pretransplant creatinine was 0.7 mg/dL with with an eGFR 97 mL/min and posttransplant eGFR 98 mL/min remained stable through July 20...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

This might be considered as a case of "smoldering " ANCA Vasculitis ( renal limited).: Uncommon, but deserving of therapy. She should respond to th...

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RE: intra-operative CRRT 1 day ago

We have done this in the past but surgeons have improved and demand this less and less. The main problem occurs with acidosis in the anhepatic phas...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

Dr. Nauman this is my opinion only this is most probably a slowly progressing microscopic polyangiitis (or MPO-ANCA associated GN) While it's ...

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RE: intra-operative CRRT 1 day ago

Thankfully this has not come up in years at our center bc it was a logistical nightmare when surgeons in the past demanded it. One reason was to he...

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RE: Opinions plz 1 day ago

He lost two transplants. Any idea what the biopsies showed on those? this is an impressive rash! Looks like leukocytoclastic but the DD if even t...

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RE: Membranous nephropathy 1 day ago

@ dr aleydan @ I would not do screening in mn plar 2 positive Do you mean you don’t do CT whole body or you don’t ask any questions ( history talk...

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RE: Membranous nephropathy 1 day ago

- avoid CNI due to poor eGFR and it not great to induce remission on its own vs ritux but maybe can be used as add on if eGFR preserved with ritux ...

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RE: Membranous nephropathy 1 day ago

Thanks for caseand discussion some learning points for me - kidney biopsy considered in eGFR 60 ml/ min or less to rule out 2nd pathology . (...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

Agree with Dr. Glassock about the need for IS therapy in this patients with low activity and documented chronicity. Given the history of breast c...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

I don't think hat a history of breast cancer is a contraindication to RTX therapy. Just an opinion. ------------------------------ Richard Glasso...

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RE: Opinions plz 1 day ago

Diagnosis first. What are the C3/C4, HBV/HCV serology, Rheumatoid Factor, CryoCrit, cardiac exam. WBC , Hemoglobin, ----------------------------...

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Opinions plz 1 day ago

65-yr-old white male with ESRD. Original renal Dz was non-proteinuric & was not a toxin or medication-induced as far as one could tell. Had advance...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

Important to keep in mind history of breast cancer in 2012 with recurrence in 2021 vis-a-vis immunosuppression in this patient. -----------------...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Her last bone marrow was still positive so it is not going to give us any more information. Did she have a baseline SAP scan? If so, it might be he...

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 1 day ago

Thanks everyone @ dr Leung what are your thoughts about SAP scan for monitoring disease activity ? What about repeat bone marrow ? Kind regards ...

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