RE: Lupus planning pregnancy, now with low C3/C4. 2 minutes ago

Agree you are playing with fire, The bigger issue is how DO you get her into remission tat will last longer that she can get through pregnancy. ...

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

Initially oliguric, now anuric. Any urinalyses available from either the peripheral hospital or your institution? Blood culture positive for coag...

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RE: Lupus planning pregnancy, now with low C3/C4. 4 hours ago

I too strongly feel this lady is likely to have adverse pregnancy outcomes due to worsening immunological activity which may predate a clinical rel...

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RE: anti gbm serology postive with fever and raised inflammatory markers 4 hours ago

Looking at this from the other side, how confident are you in the diagnosis of urinary tract infection? Your positive culture was for CONS which is...

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Applications for ASN ITE Committee Now Open 6 hours ago

Dear Kidney Educators, Thank you for your continued commitment to training in nephrology. The American Society of Nephrology (ASN) In-Training Ex...

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RE: Lupus planning pregnancy, now with low C3/C4. 7 hours ago

I asked my AI colleague (Claude) to opine on this case. He agreed that with the history of ClassIV LN and the the recent changes in serology implyi...

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RE: Lupus planning pregnancy, now with low C3/C4. 16 hours ago

YES, uncommon but anyone who sees cases of LN frequently can remember a case or two. If she becomes pregnant it will be difficult but a successful ...

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RE: anti gbm serology postive with fever and raised inflammatory markers 19 hours ago

probably not as its immunosuppression which increases risk with serious infection. Plex is not indicated in simultaneously dialysis-dependent at pr...

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RE: anti gbm serology postive with fever and raised inflammatory markers 20 hours ago

Thanks both Guess kidney biopsy will help us here . Is there harm to plasma exchange if this turned out to be infection related ? And if harm in ...

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RE: anti gbm serology postive with fever and raised inflammatory markers 20 hours ago

All renal screen negative . Cryoglobulin not sent ( complement normal ) Virology negative Methyl pred - biopsy and if delay for results start ple...

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RE: anti gbm serology postive with fever and raised inflammatory markers 20 hours ago

Dr. Lerman is correct bacterial sepsis, including urosepsis, can cause anti-GBM formation and possibly to glomerular disease. Rare, but I have seen...

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RE: anti gbm serology postive with fever and raised inflammatory markers 20 hours ago

AGREE WITH PLAN- but would repeat and confirm the anti-GBM titre on a fresh sample in a reference lab, and send MPO/PR3-ANCA, ANA, complements C3/C...

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RE: Lupus planning pregnancy, now with low C3/C4. 20 hours ago

This patient needs triple therapy for active LN and should avoid pregnancy. Contraceptives are indicated. ------------------------------ Richard ...

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RE: Latent TB and Membranous Nephropathy 21 hours ago

thanks prog glassock will bring it as paper in journal club for discussion hopefully can change practice. ------------------------------ Muham...

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RE: anti gbm serology postive with fever and raised inflammatory markers 21 hours ago

and if biopsy result delayed will start plex and wait for biopsy result to come back . does that sound ok? @prof glassock your input valued ---...

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anti gbm serology postive with fever and raised inflammatory markers 21 hours ago

74 m bg HTN and usually fit and well baseline egfr 56 m/min Admitted inextremis with aki 3, oliguria , hyperkalaemia ,acidosis and raised inflamm...

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ASN FIT Bowl 22 hours ago

We have 3/4 fellows from Harbor-UCLA hoping to participate in the FIT Bowl at ASN this year, we are looking for one more fellow to join so we can f...

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Lupus planning pregnancy, now with low C3/C4. 1 day ago

30 year old significant for Hypothyroidism, SLE with history dating back to 2015 ,Renal Biopsy done with results of lupus nephritis classs III and ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 1 day ago

Thanks. Good discussion. The current FDA endorsed pivotal Phase 3 Trial of Felzartamab in MN uses CNI as a comparative arm , not OBI so it will not...

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RE: PLA2R negative Membranous Nephropathy- Management Q 1 day ago

@Richard Glassock: Is there more information that you are aware off about the Trillini cohort. Few things are missing for me to make heads or tails...

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RE: PLA2R negative Membranous Nephropathy- Management Q 1 day ago

Trial of Felzartamab against Obinutuzumab has to be designed with non-inferiority endpoint. Companied do not like to conduct such trials. A double ...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 2 days ago

Thanks Dr. Lambeau for these fresh and important insight into the connection between PLA2R and Cancer!! ------------------------------ Richard Gl...

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RE: Latent TB and Membranous Nephropathy 2 days ago

In the MENTOR trial of RTX vs CsA NEJM) infectious complications were twice as frequent with CsA. My AI consultant (Claude) stTes very clearly that...

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RE: Latent TB and Membranous Nephropathy 2 days ago

Thanks dr dastoor for learning experience and sharing your experience @ prof glassock thanks for learning experience Can I ask if there is paper...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 2 days ago

I would suspect a link between MPN and PLA2R1-MN. PLA2R1 has been proposed as a tumor suppressor gene, and is involved in various types of cancer, ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

This discussion may be moot- as Felzartamab has no benefits in RTX resistant MN- see Trillini et al KI Reports, 2026 ---------------------------...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 3 days ago

I think this is a very reasonable approach, considering the clinical circumstances. Good luck. ------------------------------ Richard Glassock ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

We do not use CNI for membranous, at least I don't . However at the ERA 2026 , when the Obi trial was presented , the first and main question that ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

I see-it is all about access, not comparative efficacy and safety.. Do you really think that CNI are safe and effective for MN in an era of biologi...

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RE: Anti-PLA2R antibody +ve MN on a background of malignancy 3 days ago

Dear colleagues, As per the previous discussion, and after reading the article Dr.Rodby suggested, I repeated his anti-PLA2-R level, and decided...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

I agree but the Obi trial should have also been compared to Rituximab. I think it was compared to CNI for 2 reasons 1. Rituximab is not FDA appro...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

How can such a trial of Felzartamab show superiority to OBI-assuming that OBI is approved by the FDA for therapy of MN as a consequence of the MAJE...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

@Richard Glassock could you elaborate why Felzartamab would be a meaningless approval , if OBI was also compared to a CNI. ----------------------...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

In my opinion, CNIs (Tacrolimus or Cyclosporin + or - low dose steroids ) are no longer considered a standard of care for treatment of MN. If one a...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

Thank you, have put in for Obi prior Auth. Have a great weekend. ------------------------------ T. Kaur, MD FACP Nephrologist/HTN/Kidney Stones ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

Will Felzartamab gain approval for MN from FDA by comparison to a CNI ?. If so . the approval will be meaningless. The comparator will have to be O...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

Regardless of PLA2Ra positive or other. This is an antibody driven disease and therapy is targeting the antibody producing cells. I agree with abov...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

I fully agree with Dr. Rodby- a CR with RTX makes Cancer less likely but either way with NELL1 disease you have to look hard for triggers. Mercury ...

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RE: PLA2R negative Membranous Nephropathy- Management Q Friday, July 31 @ 2:04 PM

As you know, Nell1 MGN is Cancer, medications, herbals, Hg containing skin creams, lipoic acid, ask about everything... It is often segmental and...

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RE: PLA2R negative Membranous Nephropathy- Management Q Friday, July 31 @ 1:44 PM

Biopsy is NELL 1 positive. THSD7A negative. Does that change the management? Cancer screen was negative. still Ola to watch he proteinuria a...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 11:34 PM

Yes Quantiferon is part of screening in our hospital. I do it because , it avoids conflict with the infusion and ID teams who have created the prot...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 9:14 PM

Thanks Quantiferon is not part of pre rituxan screen in my centre --------------------------------- Muhammad Soobadar MBChB UK ----------------...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 9:10 PM

YES, especially when steroids are used n conjunction with a CNI. I would definitely avoid any CNI or steroid use in this patient ---------------...

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RE: pr3 +ve is it endocarditis ? Thursday, July 30 @ 7:25 PM

well PTH was not suppressed and urine calcium was borderline high so could be primary HPTX especially since serum phos low. eGFR 65 with creatinine...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 6:09 PM

Is Cni risk higher than rituxan for latent tb reactivation prof glassock --------------------------------- Muhammad Soobadar MBChB UK ---------...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 5:22 PM

I would not advise use of a CNI,especially with steroids, for MN in a patient with latent TB. Just an opinion. ------------------------------ Ri...

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RE: pr3 +ve is it endocarditis ? Thursday, July 30 @ 2:49 PM

Prior to cinecalcet --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 2:45 PM

Respiratory MDT Reviewed case Agree TB highly unlikely given reassuring CT, stability of bronchiectasis and only Sx weight loss Given product...

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RE: Latent TB and Membranous Nephropathy Thursday, July 30 @ 1:12 PM

Thanks Dr. Dastoor fir your commentary on this case.. It is not uncommon to see combinations of CNI and RTX used to "speed up" the trajectory towar...

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ASN Loan Mitigation Program Thursday, July 30 @ 12:39 PM

ASN is now accepting applications for the ASN Loan Mitigation Program as a part of its continued efforts to decrease the loan burden of those enter...

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