RE: FeNa 3 hours ago

Thank you for your response, Melanie. If it is still on the Steps, we must talk about it! ------------------------------ Anna Vinnikova, MD Assoc...

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RE: Refractory membranous Nephropathy 9 hours ago

Dr. Dastoor - From the descriptions you have provided, I would conclude that this is not immunologically refractory PLA2R mediated MN. Rather the...

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RE: Refractory membranous Nephropathy 10 hours ago

Thank you for the new information. So it looks like it is still a case of PLA2R1-MN, where anti-PLA2R1 antibodies may be the culprit of this pathog...

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RE: Refractory membranous Nephropathy 11 hours ago

My pathologist just called me , and he just had a conversation with @Samih Nasr at Mayo. It is an IgG4 and anti pla2r on biopsy is positive- done ...

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RE: Refractory membranous Nephropathy 13 hours ago

I just read all the above comments on an interesting and very unusual case of MN, which is at least initially PLA2R1-associated MN. I think that th...

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RE: AKI & Immune complex GN 16 hours ago

She was not on any meds. that's what I thought, no full house no lupus. What is it though!? ------------------------------ M. Samih, MD, FAC...

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RE: AKI & Immune complex GN 20 hours ago

Does the absence of full house ( ie IgM and IgA ) and seronegativitiy rule out Lupus ??? was the patient on any medications ?? ----------...

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RE: Refractory membranous Nephropathy 21 hours ago

We are sending this biopsy slides to the Mayo clinic for further investigations ..currently she is on max anti proteinuric therapy with ARB, SGLT2i...

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RE: AKI & Immune complex GN 1 day ago

She's on Bactrim. ------------------------------ M. Samih, MD, FACP, FASN, FASDIN Cayuga Medical Center Ithaca, NY, 14850 -----------------------...

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RE: Refractory membranous Nephropathy 1 day ago

Thank you , Dr Glassock . ------------------------------ Rochak Varma MD Oro Valley AZ (917) 459-0750 ------------------------------

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RE: AKI & Immune complex GN 1 day ago

What is the differential? c1q Nephropathy? IC GN 2/2 IE? IC GN 2/2 Serology negative Lupus? sounds good to me. Treat like Lupus Nephritis? Yes I ...

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RE: AKI & Immune complex GN 1 day ago

So yes UACR dropped but not sure how accurate was the 1100 mg/d nevertheless this happened over 1 week and after starting the combo prednisone and ...

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RE: Refractory membranous Nephropathy 1 day ago

See Giri, Glassock and Fervenza. KI Reports 2026; 11: 106416 for a discussion of defining refractory (resistant) MN. ----------------------------...

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RE: AKI & Immune complex GN 1 day ago

"UACR dropped 1,100--->60mg/d" Was this after starting prednisone + mycophenolate? Has SCr improved from peak of 2.4 mg over the last 10 days sin...

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RE: Refractory membranous Nephropathy 1 day ago

Great question. I wish I had a good answer. Electron lucent deposits are presumed to be a sign of inactive disease . Whether electron dense fresh d...

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RE: Refractory membranous Nephropathy 1 day ago

Dr Glassock , Does presence of deposits on EM indicate active disease ? Are there any Electron microscopy features which suggest active disease ...

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RE: C3G Or FSGS 1 day ago

Since genetic testing is not indicated in steroid-sensitive MCD, I would (probably) ignore these findings, unless there is a family history of CKD....

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RE: AKI & Immune complex GN 1 day ago

Yes Doc. RF was negative. C3, and IgG equal IgG (3+) C1q (3+) C3 (3+) Kappa (3+) Lambda (3+). No significant staining for IgA, IgM and fibri...

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RE: AKI & Immune complex GN 1 day ago

If a Rheumatoid Factor is normal I think you can stop the evaluation for Endocarditis. I might look for a viral lobby- Parvovirus or EBV.. how inte...

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RE: SGLT2 inhibitors in MCD 1 day ago

Probably yes, but long term FU data are largely lacking. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen Schoo...

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AKI & Immune complex GN 1 day ago

Hi all, sorry for the long post. Need your help --------------------------------------------- 38 YO WF Presentation: Gross hematuria (later Mi...

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RE: C3G Or FSGS 1 day ago

Just wanted to give an update and get some thoughts on the genetic profile of this patient . He responded well to steroids with complete resoluti...

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RE: SGLT2 inhibitors in MCD 1 day ago

can we say the same about statins, as some of this patients severe dyslipidemia is reversible once the immunologic process is reverse ----------...

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RE: Sarcoidosis? 1 day ago

Finding papers on GN in sarcoid was not hard. Finding papers on crescentic GN in sarcoid was harder. Finding papers on ANCA GN in sarcoid was much ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Since "interferon storm" has been implicated in causing podocyte injury in the setting of viral infections, use of interferon in this patient might...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Hi everyone, It has been a while since I posted this thread. It turns out that she has chronic parvovirus viremia with a relatively low titer (14...

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RE: FeNa 1 day ago

Hi Anna, yes, we are still teaching FENa to pre-clerkship students. Although FENa is flawed, it is helpful conceptually to teach about how fantasti...

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RE: cause of AKI 2 days ago

Did you stop the Ashgawanda as well? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCL...

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RE: cause of AKI 2 days ago

agree with avoiding infliximab but given persistent intense TIN with lymphocytes and apparent lack of IFTA-MMF seems worth a try unless leukopenia ...

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RE: cause of AKI 2 days ago

Personally, I would avoid Infliximab in this case due its propensity to induce vasculitis. ------------------------------ Richard Glassock MD, ...

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RE: Sarcoidosis? 2 days ago

Thanks prof rodby Sorry pred 60mg first and wean and then add mmf and continue for 12 month with low dose steroid and mmf rheumatologist prefer met...

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RE: cause of AKI 2 days ago

Thanks prof rodby worth exploring Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Sarcoidosis? 2 days ago

I would use moderate dose prednisone starting 60 and taper as response, I think that will give you the fastest response. then for maintenance I ...

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RE: cause of AKI 2 days ago

steroids didn't work and yet the kidney is not "dead" as i wold have predicted if on hd this long nd no recovery. Im not excited about MMF what...

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RE: cause of AKI 2 days ago

I have no opinions on this very difficult questions, Simply no data upon which to base an opinion. ------------------------------ Richard Glassoc...

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RE: Sarcoidosis? 2 days ago

Thanks prof glassock . I would do mmf and small dose pred Mmf 500 mg bd and pred 5 mg od for 12 month and review (opinion not ebm) Repeat biopsy ...

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RE: cause of AKI 2 days ago

@ prof glassock would you consider mmf as second line and if so at what dose and at what point ( how long would you call futility? --------------...

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RE: cause of AKI 2 days ago

I do not know of any comparative data concerning the risk of severe TIN is Ashgawanda vs PPI.this risk of developing AIN with PPI is estimated to b...

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RE: Sarcoidosis? 2 days ago

No evidenced based answer to your very good question. I do not know. It is so uncommon, nor real data. This spreads to be an ANCA negative Pauci- i...

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RE: Sarcoidosis? 2 days ago

IF neg except fibringen in the crescent. No deposits or foot process effacement findings on the EM. PLAR2 neg. didn't do the anti-GBM with the cre...

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RE: cause of AKI 2 days ago

Dr.Glassock- assuming myeloma excluded- wouldn’t PPI induced AIN/AKI be more likely vs ashwagandha ? How often does latter cause severe Tubuliinter...

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FeNa 2 days ago

Hi all, does anybody still teach FeNa at M2 level? Do we know if step 1 and step 2 still test it? ------------------------------ Anna Vinnikova,...

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RE: is it SIADH 2 days ago

How sad.Thanks for the follow-up. Pretty classical case.of SIADH and a lung malignancy. ------------------------------ Richard Glassock MD, FAS...

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RE: Sarcoidosis? 2 days ago

Crescentic glomerular lesions are an uncommon , but well recognized , finding in Sarcoidoisis. No reason to question the diagnosis in this case. Wh...

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Sarcoidosis? 2 days ago

The patient is clinically suspected to have sarcoidosis, but some atypical findings. He is a 77yo who began feeling unwell 2 mo prior and found to...

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RE: is it SIADH 2 days ago

unfortunately pt was found to have lung cancer for best supportive treatment ------------------------------ Muhammad Soobadar MBChB UK ----------...

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RE: SGLT2 inhibitors in MCD 2 days ago

The beneficial role for RASi and /or SGLT2i in classical MCD with nephrotic syndrome I has never been established. ------------------------------...

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RE: ICI induced IgAV 2 days ago

Overall GFR decline in crescentic GN, depends not only on the extent of crescentic involvement bit also on the extent of tubulo-interstitial injury...

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RE: cause of AKI 2 days ago

Thanks Would you consider mmf or any other agents prof glassock ? --------------------------------- Muhammad Soobadar MBChB UK ----------------...

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RE: ICI induced IgAV 2 days ago

Thanks prof glassock Hypothetical scenario If patient was also having macroscopic haematuria and was on anticoagulant too in above scenario I t...

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