RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 45 minutes ago

Since this is a triple positive APLA-associated TMA, I suggest the use of neonatal FC receptor antagonists, if the APLA antibodies are of the IgG t...

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RE: Pseudohypertension or true uncontrolled HTN 1 hour ago

I think the presenve of LVH on echo study would be consistent with hypertension rather than pseudohypertension, a differentisting point !! -------...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 1 hour ago

Asked Google's AI tool to comment on this patient and got the following response: "Based on the medical data provided and current U.S. Department...

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RE: Please help with a case of IGA nephropathy 2 hours ago

Thanks for the new information. Due to sampling issues for what is a focal process, it is very difficult to say that 4% is really different from 13...

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RE: Please help with a case of IGA nephropathy 2 hours ago

Just for more clarification. Initial biopsy in 2024 showed-3 out of 23 glomerulus with cellular crescents. 2 additional glomerulus with fibrous cre...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 3 hours ago

If the triple positivity for APLA persists beyond 6-12 weeks, this patient is at high risk for a thrombotic event and I think should be placed on W...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 4 hours ago

The low C4 and normal C3 suggests activation of the classic pathway probably by anti phospholipid antibodies !!! In that case there could be a rol...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 4 hours ago

The problem here is nothing has been shown to have a great effect on progressive CKD from APA syndrome, Rituximab, MMF, even anticoagulation. ...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 5 hours ago

His mother for sure has PKD but at 41 has nl GFR and relatively unimpressive CT scan genetically this is PKD 1 but seems to be acting more like P...

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RE: 20 year old with PKD1 mutation asking if he can join the Military. 6 hours ago

Is this a career decision or a-time limited engagement. ? So long as the military staff are aware of his condition and accept responsibility for hi...

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20 year old with PKD1 mutation asking if he can join the Military. 6 hours ago

I have a 20 year old male asking me if he can join the Military in the USA. He has a family history of PKD. His EGFr is 127, Normal UA. His ren...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

Does anyone know of any ongoing trials of Inebilizumab (anti-CD19 MoAB) or Felzartamab (anti-CD38 MoAB) in APLAS? -----------------------------...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

My enthusiasm for use of RTX or OBI in this case has been dampened by this (and other) study - but I acknowledge that it was primarily in Non Lupus...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

Thanks Dr Rodby and Dr Glassock and Dr Venkat - LDH 280 - Heptoglobins and ADAMTS pending at this time. But normal Hb of 15 on multiple CBC T...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

If MMF, steroids and Warfarin are not effective, C- inhibition (Pegcetacoplan or Ravulizumab) might be next choices, Is it possible to obtain a ser...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

the low amount of proteinuria makes me think that the Cr increase is more APAbs (TMA) than proliferative lupus GN. Bet there is evidence of sube...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

SLE with anti-phospholipid syndrome (triple positive) and TMA. Management,-probably Steroids, MMF and long term Warfarin. I would hold PLEX, IVIg i...

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RE: Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 1 day ago

Findings certainly suggest SLE-related TMA.?Slight decrease in SCr from its peak level and slight increase in platelet count are reassuring. LDH ,...

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RE: Full house with negative serolgy 2 days ago

Thanks so much Dr Glassock for the variable responses ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Full house with negative serolgy 2 days ago

Thank you so much Dr Zuckerman that was very insightful. ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Full house with negative serolgy 2 days ago

Dr. Zuckerman- great response. A good reason for discussants to be cautious regarding interpretation of kidney biopsy reports submitted as part of ...

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RE: Full house with negative serolgy 2 days ago

I don't have any direct experience with IHC for day to day clinical biopsies. These sorts of issues are also lab depended. So if weak C1q staining ...

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RE: Full house with negative serolgy 2 days ago

Based on the description of the report only it is difficult for me to come to a specific diagnosis as there may be other features in the biopsy not...

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RE: Please help with a case of IGA nephropathy 2 days ago

I agree with you 100% , I am not sure if AI condenses and presents all the available literature , or is making it's own biased assumptions . -...

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RE: Please help with a case of IGA nephropathy 2 days ago

Very interesting AI consult. Did your electronic consultant take into account the findings if the TESTING trial (with respect to biopsy lesions? If...

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RE: Full house with negative serolgy 2 days ago

Thanks Dr Zuckerman, I just want to say that this is on immunohistochemistry and not immunofluorescence, would it is still be as sensitive in detec...

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RE: Full house with negative serolgy 2 days ago

Thanks Dr Glassock. I will ask the pathologist is this is possible ------------------------------ Sara Ssa MBChB ------------------------------

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RE: Interesting GN case 2 days ago

Dr.Dastoor- look at the description of the patient eligibility for the PEXIVAS trial (NEJM)- the largest trial ever conducted concerning treatment ...

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RE: Full house with negative serolgy 2 days ago

Thanks Dr. Zuckerman. Based on the findings described in the Pathology Report, is sufficient evidence available to make a "diagnosis" rather than a...

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RE: Interesting GN case 2 days ago

Is a positive ANCA enough to diagnose the patient as an ANCA vasculitis of the kidney ( MPO MPA Anca vasculitis) The biopsy seems more like FSGS......

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RE: Please help with a case of IGA nephropathy 2 days ago

@Richard Glassock yes you are right about the low Kappa for E lesions . However these lesions are the earliest responders to therapy as well. It wo...

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RE: Full house with negative serolgy 2 days ago

yes, I think KM55 staining here would be helpful, a strong positive staining would favor IgAN. However, there are report of LN cases with KM55 posi...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 2 days ago

The major known risk with using complement inhibitors is for encapsulated bacteria. So vaccination is recommended against meningococcal, pneumococc...

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RE: Please help with a case of IGA nephropathy 2 days ago

The E lesion has the worst inter observer reproducibility among the MEST-C scores (Kappa about O.45) so i would not attach too much significance to...

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RE: Please help with a case of IGA nephropathy 2 days ago

She has C1 on both biopsy. I think its significantly indicative of active IgA nephropathy, particularly where E was 0 in the second biopsy. Dose th...

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RE: Interesting GN case 2 days ago

Interesting points. I think this patient would have met the entry criteria for the PEXIVAS trial of ANCA vasculitis without a kidney biopsy. ----...

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RE: Please help with a case of IGA nephropathy 2 days ago

I agree ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: Interesting GN case 2 days ago

I think having a proper biopsy is imperative in this context. Creatinine is only 1.2 and last one is 1.4 which is better than previous readings as ...

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RE: Please help with a case of IGA nephropathy 2 days ago

Since she has active IgA Nephropathy, and u plan to start her on Lisinopril, then why not increase steroids to control her disease . Once she has c...

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Friday afternoon Biopsy results - Lupus with TMA/Anti-Phospholipid Syndrome. 2 days ago

27-year-old male with CKD stage 3a (baseline Cr 1.7 mg/dL stable ×1.5 years) and HTN ×3 years (controlled on losartan 100 mg daily by PCP) but no w...

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RE: Full house with negative serolgy 2 days ago

With a non-specific nephritic-nephrotic presentation, lack of systemic features and a pattern of injury finding by kidney biopsy we fo not have a d...

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RE: Full house with negative serolgy 2 days ago

Seems it is a Non Lupus " Full House Pattern" with low specificity for Lupus Nephritis on biopsy. The Differential could include 1. IgA nephropat...

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RE: Full house with negative serolgy 2 days ago

To any renal pathologist- would KN55 stains (gdIgA) be indicated here? Dr. Zuckerman? Dr. Fogo? Dr. Caza? Dr. Haas? -----------------------------...

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RE: Full house with negative serolgy 2 days ago

Non-diagnostic Biopsy. So far. Hard to categorize as a non-lupus full house nephropathy with such weak IgM and C1q stains. Can you do a"rescue"?EM ...

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RE: Full house with negative serolgy 2 days ago

IgA antibody deposition is dominant or co-dominant, its non proliferative GN, Nephrotic syndrome is difficult to explain by the current findings on...

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RE: Full house with negative serolgy 2 days ago

Be sure to stain the biopsy for DNAJB9 (Fibrillary GN ) and for IgG subclasses (MGRS with masked LC monotypism ). What are serum FLC values? ----...

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RE: Interesting GN case 2 days ago

Just an opinion- I think you have enough information to pull the RTX -trigger now, rather than waiting -but it is a judgement call. -------------...

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RE: Be aware of the infectious consequences of therapy with complement inhibitors 2 days ago

@Anuja Java So , just to summarize infection prophylaxis ... What would be the recommedned prophylaxis with : 1. High dose steroids ie Prednisolon...

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RE: Interesting GN case 2 days ago

I agree - the RA could have been a missed ANCA vasculitis diagnosis. I have her on Prednisone 60 mg/d while awaiting the final biopsy results....

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RE: Interesting GN case 2 days ago

She is not. ------------------------------ Daniele Rios Leite MD University of Florida Jacksonville FL (864) 448-4781 ---------------------------...

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