RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 29 seconds ago

How is his muscle mass and fat mass. Please get combined eGFR for creatinine and cystatin C for better guessing his GFR. Renal echogenicity on US F...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 6 minutes ago

There is an obvious Strongyloidos stercoralis infection history. Alternative cause for eosinophilia which is a chronic challenging helminthic infec...

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RE: Avacopan 19 minutes ago

If you learned that something you are eating has the potential to poison you, would you continue to eat it? If you were to be poisoned, wouldn't yo...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 1 hour ago

a little confused post 2 days ago- "Eosinophilia is going on for at least 10 years, has minimal proteinuria on medication," now 4gms albuminuria, ,...

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RE: Recurrent CaPhos stones with low urinary citrate 2 hours ago

Sir, Thank you again for your detailed insight. Absent a low serum bicarbonate level, I hadn't considered the topiramate to be potential...

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RE: Avacopan 3 hours ago

I would not continue this drug; my (probably) naive view is that given potential risk for adverse events (with this or any drug), doing so may leav...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 3 hours ago

Thanks Dr Glassock Creatinine 2.4 GFR 24 for the last few years had albuminuria 4 Grams Prof My impression was that if it is eosinophilic intersti...

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RE: Atypical Anti-GMB? 9 hours ago

No data are available regarding albumin staining. Anti-GBM antibodies were assessed by ELISA and indirect immunofluorescence. Despite the patien...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 13 hours ago

Dr. Safdar. So you believe that the renal impairment (CKD4) is related to Diabetic Nephropathy and is stable on RASi and SGLT2i. The CKD is not dir...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 13 hours ago

Thanks appreciate all the input and help from respected members Sorry for delayed response briefly his creatinine has been stable for the last fo...

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RE: Resistant FSGS 14 hours ago

Dr. Lerman you are most welcome. The assay for these antibodies is not yet widely available (to my knowledge in the USA is only being done at the M...

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RE: Resistant FSGS 15 hours ago

Dr. Rubin thanks for sharing this very important paper. Given that the presence of anti-nephrin abs in these patients with presumed primary non-gen...

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RE: Resistant FSGS 15 hours ago

For medical students and fellows in Renal medicine: In clinical medicine in good old days we start by presenting the case with age race family ori...

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RE: Possible IgG4 Or Lymphocytic Hypereosinophilia Or Mast Cell Disorder 17 hours ago

In my opinion the entire clinical picture of Eosinophilic syndrome is related Strongyloides stercoralis infection. This unique human helminthic inf...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 19 hours ago

Many thanks, Professor Glassock and Muhammad, for your thoughtful replies and for taking the time to review this case. I have found your comments i...

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RE: Resistant FSGS 19 hours ago

Also let us know what you have decided with respect to further treatment of this patient and the results of the genetic testing , when you receive ...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 19 hours ago

Addendum- i see no reason to consider a repeat kidney biopsy In this patient. I think you have all of the information needed to make managemen...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 19 hours ago

It is incorrect to assume that positive PLA2R staining by IF is100% specific for "Primary "MN. Lupus nephritis, Sarcoidosis and HBV infection are w...

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RE: Resistant FSGS 20 hours ago

"he issue is whether kidney biopsy alone can verify a diagnosis of Primary (non-genetic or secondary) FSGS" I believe the answer is no as several...

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RE: Avacopan 20 hours ago

Today drug company which holds rights for Avcopan Advised not enroll new patients --------------------------------- Bajinder Reen MD Etobicoke O...

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RE: Resistant FSGS 20 hours ago

about 8 months apart ------------------------------ Hannah Tiu MD NKDHC Henderson NV (520) 626-9603 ------------------------------

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 20 hours ago

What is patient functional status ? With paraplegia ? Thanks --------------------------------- Muhammad Soobadar MBChB UK ----------------------...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 20 hours ago

Any history of UTI, delayed bladder emptying --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 20 hours ago

Many thanks for case Complex Humble thoughts How convincing do you find the diagnosis of primary PLA2R-associated membranous nephropathy given t...

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RE: Resistant FSGS 20 hours ago

Certainly the EM findings are consistent with the diagnosis of the so-called primary FSGS. Regarding the genetic aspects of FSGS, the following is ...

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RE: Resistant FSGS 21 hours ago

EM for first biopsy : 11/2024 EM for second biopsy :9/2025 ------------------------------ Hannah Tiu MD NKDHC Henderson NV (520) 626-9603...

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RE: Resistant FSGS 21 hours ago

I've sent for genetic studies already, I have also referred for kidney transplant at the same time. And at the same time have discussed dialysis op...

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RE: Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 21 hours ago

Can you resurrect the blocks from the KB and send them for EXT1/2 staining ? . This is very likely to be a Class V Lupus Membranous Nephropathy and...

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RE: Resistant FSGS 21 hours ago

Thanks- I look forward to the response from Drs. Cravedi and Riella, the issue is whether kidney biopsy alone can verify a diagnosis of Primary (no...

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RE: Resistant FSGS 22 hours ago

@Paolo Cravedi @Leonardo Riella Dr. Glassock, I respectfully disagree with your personal point of view that the conclusions reached by the larg...

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Management dilemma: PLA2R-positive membranous nephropathy, persistent dsDNA positivity and progressive CKD – would you re-biopsy? 22 hours ago

I'd be grateful for the community's thoughts on a challenging case. A middle-aged gentleman with CKD G3b A3 underwent a kidney biopsy in May 2025 ...

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RE: Avacopan 22 hours ago

Yes, it is now official. The authors of the ADVOCATE trial in the NEJM have now retracted the publication, removing all RCT evidence of efficacy ( ...

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RE: Resistant FSGS 22 hours ago

Dr.Rubin- Many thanks - while the TANGO registry study reveled some important aspects of recurrent FSGS in kidney allografts, it is fundamentally f...

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RE: Avacopan 22 hours ago

Looks like advocate trial has been retracted by New England journal of medicine --------------------------------- Bajinder Reen MD Etobicoke ON ...

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RE: Resistant FSGS 23 hours ago

Thank you Dr. Glassock. The retrospective analysis of 94 patients in the single center study you cited (attached), will not dissuade me to use a li...

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RE: Atypical Anti-GMB? 23 hours ago

What were the results of Albumin stains by IF. What methods were used to measure the serum anti-GBM antibodies? Was the patient on anti-coagulation...

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RE: Resistant FSGS 23 hours ago

Thanks Dr. Rubin - See Maas et al study (Maas RJ,et al BMC Nephrol 2013;14: 47. of predicting risk of recuttrent FSGS . They found a recurrence rat...

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RE: Resistant FSGS 23 hours ago

Dr. Lerman - Many thanks. Good citation source . I use the data of Miao et al (see Miao J. et al Mayo Clin Proceedings. 2021; 96:2342) as a sourc...

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RE: Resistant FSGS 23 hours ago

The best source of information that we have regarding the recurrence rate of FSGS is the Tango study (J Am Soc Nephrol. 2020;15(2):247) which showe...

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RE: Resistant FSGS 23 hours ago

I fully agree. I want to underscore that the publication in Kidney Int. 2024;106(4): 749–752 which I posted earlier is quite revealing in terms of ...

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RE: Resistant FSGS 23 hours ago

Why would you use a 30-50% recurrence risk in your patient discussions? . In my opinion, a risk of recurrence closer to 70% might be more realistic...

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RE: Resistant FSGS 1 day ago

Dr.Mohammed-there is no good evidence that starting plasma exchange plus anti-CD 20 therapy is reliably successful in steroid resistant disease. As...

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RE: Resistant FSGS 1 day ago

Thank you for sharing this case. We have a couple of similar cases of Focal Segmental Glomerulosclerosis (FSGS) with a very aggressive course that ...

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RE: Resistant FSGS 1 day ago

Dr.Glassock - found a study showing genetic FSGS may be higher. what do you think? https://www.kidney-international.org/article/S0085-2538%2...

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RE: Resistant FSGS 1 day ago

Dr. Hirsch - no - I would still refer for transplant still best option IMO given recurrence is not absolute and with early diagnosis some transplan...

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RE: Resistant FSGS 1 day ago

Time interval over which SCr increased to 4.4 mg? How far apart were the two biopsies? Serial renal ultrasound results? Longer the duration of fo...

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RE: Resistant FSGS 1 day ago

Your question is addressed in the attached study. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -------------...

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RE: Resistant FSGS 1 day ago

If the patient has anti-nephrin antibodies, would you insist on elimination of them (with CD20 or CD 28) prior to accepting a transplant? -------...

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RE: Resistant FSGS 1 day ago

Thanks Dr. Glassock, if genetic testing is negative would refer for LDKD or DDKD depending which could be done preemptively given eGFR [More]

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Atypical Anti-GMB? 1 day ago

Hello everyone, I would appreciate input on a 63-year-old man with diabetes (dx 30 years ago A1C 7-7,5), severe vascular disease (stent vertebral...

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