RE: Refractory membranous Nephropathy 18 minutes ago

The current standard of care monitoring includes an anti-PLA2R antibody of [More]

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RE: Membranous Nephropathy with Rapid Progression 29 minutes ago

I agree with the senior Dr. Rodby, except I might use a combination of standard dose RTX + low dose - short duration CYC ( Niles-Zonozi protocol )....

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RE: Membranous Nephropathy with Rapid Progression 5 hours ago

"Any response from the seniors would be appreciated." "Senior" is in the eye of the beholder This senior will keep it simple The clinical out...

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RE: Membranous Nephropathy with Rapid Progression 8 hours ago

SCr was already at 3.9 mg/dL by late 2025. Remnant nephron hyperfiltration may have kept SCr at 3.9 mg and this compensation may fail rapidly, and ...

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RE: Membranous Nephropathy with Rapid Progression 10 hours ago

Significance of a Single Fibrocellular Crescent: Even relatively low percentages of crescents in MN (median ~4–5% of glomeruli) are associated wit...

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RE: Membranous Nephropathy with Rapid Progression 11 hours ago

Thanks for case Did The biopsy findings suggest collapsing fsgs? ? There is no haematuria and if it’s bad crescentic case would expect microscopic...

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RE: Membranous nephropathy 12 hours ago

Currently, no large randomized trials directly testing routine combination CNI+rituximab versus rituximab monotherapy exist; most data derive from ...

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RE: Membranous nephropathy 13 hours ago

RE: Refractory membranous Nephropathy Thanks prof glassock - drop in proteinuria with weight loss / diabetes management - normal albumin - high ...

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RE: Refractory membranous Nephropathy 13 hours ago

@ prof glassock - I got confused with another case this case does not warrant CT The other case had improvement of proteinuria with weight loss a...

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RE: Refractory membranous Nephropathy 14 hours ago

https://doi.org/10.1016/j.ekir.2025.07.043 Elisa plar2 cut off at baseline and for disease monitoring --------------------------------- Muhamma...

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RE: Refractory membranous Nephropathy 15 hours ago

Thanks prof glassock -Negative serum plar2 with possible active immune disease tho initially positive - drop in proteinuria with weight loss / d...

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Membranous Nephropathy with Rapid Progression 15 hours ago

We had a patient, 20 yr old male, known case of Pla2r positive membranous (titer not known) in 2022, nephrotic range proteinuria, treated conservat...

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RE: Refractory membranous Nephropathy 17 hours ago

What is odd about this case- why would you obtain a CT (of what) ? Your reasoning is quite obscure to me- please try for greater clarity. Thanks. ...

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RE: Refractory membranous Nephropathy 18 hours ago

I think if I am allowed to guess your thought process prof glassock Is if Elisa plar2 2-14 then consider it positive I guess ( hope I am ok righ...

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RE: Refractory membranous Nephropathy 18 hours ago

< 2RU / ml is the lower limit of sensitivity of the ELiSA assay. The distinction at 14RU between a positive and a "negative" test is arbitrary and ...

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RE: Refractory membranous Nephropathy 19 hours ago

Thanks prof glassock Anything more than 2 in this case you would consider positive ? Can you explain your thinking please? -------------------...

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RE: Refractory membranous Nephropathy 19 hours ago

Negative is any value less than 14RU/ml. This is not not the same as<2RU/ml which is the lower limit of sensitivity of the ELISA method. An importa...

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RE: Refractory membranous Nephropathy 19 hours ago

Dr dastoor said plar2 Elisa is negative prog glassock Whether its shares epitope leading to false negative not sure . But iFA will be more sensitiv...

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RE: Refractory membranous Nephropathy 19 hours ago

First, we need ti know if the serum anti-PLA2R antibody (by ELISA) is less than 2RU /ml. Yes or no? ------------------------------ Richard Glasso...

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RE: Refractory membranous Nephropathy 20 hours ago

@ dr dastoor one thought came to mind . What about IFA assay? It would help in case it’s false negative plar2 --------------------------------- ...

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RE: Membranous nephropathy 20 hours ago

Thanks for help prof glassock and prof aledan --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 20 hours ago

Helpful input in case --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Management of persistent amyloidosis and nephrotic range proteinuria despite Very good partial response to BMT and prior chemo 20 hours ago

@dr Leung thanks for your helpful cases I would be interested to know due to lack of experience / knowledge -if you use SAP baseline and monitor...

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RE: Pauci-Immune GN, Chronic, Minimally Active 20 hours ago

Lower compared to higher dose steroids in the LoVas trial of anti-MPO Vasculitis treated with RTX were non-inferior in terms of efficacy but were a...

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RE: Membranous nephropathy 21 hours ago

Any proposal to link Prostate Cancer with PLA2R antibody induced MN is weak and unsubstantiated, in my opinion. ------------------------------ R...

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RE: Membranous nephropathy 1 day 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 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 ? 1 day 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 ? 1 day 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 ? 1 day ago

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

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RE: AAV ? 1 day 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 ? 1 day ago

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

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RE: AAV ? 1 day 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 ? 1 day 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 ? 1 day 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 ? 1 day 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 1 day ago

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

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RE: AAV ? 1 day 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 1 day 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 1 day 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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