RE: PLEX in Crescentic IgA Nephropathy 1 hour ago

These values make me more worried about an infection-related IgA dominant GN. Have you performed a TEE for cardiac valve vegetations? Do you have K...

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RE: Resistant Rejection 2 hours ago

A though case. I think second dose of rituximab or tocilizumab is unlikely going to work in this case. We have some experience with daratumumab in ...

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RE: PLEX in Crescentic IgA Nephropathy 4 hours ago

Rheumatoid factor was 88 IU/mL and 77 IU/mL, two days apart (Lab reference range: 0-14 IU/mL). C3 complement was 52 mg/dL (reference: 82-167) and C...

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RE: Iron replacement strategy in dialysis 4 hours ago

Thanks Dr Rodby, I really appreciate and respect your posts in general. Even though I've never met you, I consider you one of my better educat...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 5 hours ago

RItuximab in true steroid resistant Prinaryv FSGS with Nephrotic Syndrome , results in a complete or partial remission in about 20% of patients . T...

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RE: PLEX in Crescentic IgA Nephropathy 5 hours ago

Thanks. What were the levels of RF and C3/C4. If the RF is very high, you may want to start with a low dose of RTX to avoid a passive serum sicknes...

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RE: PLEX in Crescentic IgA Nephropathy 5 hours ago

Thank you all for the great inputs! Here are the answers to all the questions that were asked. Creatinine data - Baseline around 1 mg/dL...

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RE: Iron replacement strategy in dialysis 5 hours ago

im still not sure of the risk if clinically evident end organ damage from top From Open Evidence - "How often is iron overload by ferritin lev...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 7 hours ago

Dr. Dastoor very interesting It's quite unusual for me to see response with Rituximab in (true) steroid resistant patients Do you, or other pe...

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RE: Resistant Rejection 17 hours ago

If DSA is negative, the MVI element, provided recurrent GN and Hep C infection etc is ruled out, maybe it could be due to NK Cells and warrant CD38...

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RE: Resistant Rejection 23 hours ago

What are tacrolimus trough levels during this period. The August biopsy showed intimal fibrosis and prominent arteriolar hyalinosis which is not pr...

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RE: Iron replacement strategy in dialysis 1 day ago

Ferritin >500 μg/L is a red flag, especially if it's rising without clear inflammation. But the real signal is transferrin saturation (TSAT): once ...

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RE: Iron replacement strategy in dialysis 1 day ago

You're right, that's probably an unrealistic target goal. But I wonder if our ferritin protocols are too generous and I also wonder if some of the ...

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RE: Iron replacement strategy in dialysis 1 day ago

Not meaning to sound flippant but good luck keeping the ferritin 1-300. May I ask where this data comes from? Is it observational ? My guess is i...

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RE: Resistant Rejection 1 day ago

Dr Pineda is spot on about further tissue staining for markers of PTLD. Dr Aleydan I want to clarify what does "Late Active" signify in histopatho...

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RE: Iron replacement strategy in dialysis 1 day ago

Based on my personal experience a slightly higher ferritin target may be necessary and acceptable. Then the question becomes one of overruling th...

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RE: PLEX in Crescentic IgA Nephropathy 1 day ago

I do not think that this patient would qualify for the suggestion made by KDIGO CPG to treat with a combination of CYC + Steroids. I agree that the...

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RE: PLEX in Crescentic IgA Nephropathy 1 day ago

In this patient with crescentic IgA nephropathy/IgA vasculitis nephritis, routine PLEX is not recommended, as evidence for benefit in IgAV-associat...

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RE: PLEX in Crescentic IgA Nephropathy 1 day ago

Dr. Gharib- you raise some important issues. We do need to know the results of C3/C4 serum levels, Rheumatoud Factir levels, Cryoglobulin Aasays an...

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RE: PLEX in Crescentic IgA Nephropathy 1 day ago

It seems that the major contribution of very low GFR (serum creatinine 4 mg/dl) comes from ATI from RBC casts as suggested by Dr. Rodby especially ...

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RE: PLEX in Crescentic IgA Nephropathy 1 day ago

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: PLEX in Crescentic IgA Nephropathy 1 day ago

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: unexplained rhabdomyolysis 1 day ago

Yes multiple times --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh Shakhbout Medical Cit...

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Iron replacement strategy in dialysis 2 days ago

Based on the most recent evidence of iron overload contributing to liver cirrhosis, I am revising my own personal goals for iron replacement in dia...

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RE: IgA Nephropathy case 2 days ago

The notion that hematuria is an independent predictor of outcome is "all the rage" and could be targeted (as what prompted your post) I think yo...

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RE: CMNephritis 2 days ago

Long term CNI may have been doing well enough but it can lead to CKD, and you have an opportunity for remission with an anti-CD 20 drug. If you ...

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RE: CMNephritis 2 days ago

Thank you for responding: Patient 1 Patient 2 S. Albumin 3.7 4.0 Creatinine 3.7 2.76 (up from 1.86) U. protein 1.44 gmn 460 mg Tacrolimu...

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RE: unexplained rhabdomyolysis 2 days ago

I'm sure someone measured his thyroid function tests as hypothyroidism does cause mild non-traumatic rhabdo. ------------------------------ Da...

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RE: IgA Nephropathy case 2 days ago

Consistently in the 70s, no change over the 6 months since I have been seeing her. ------------------------------ Ritu Vyas MD Catonsville MD (4...

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RE: CMNephritis 2 days ago

I would taper (and stop) the CNI and treat both patients with RTX or Obinutuzumab . What is the current level of proteinuria, serum albumin snd eGF...

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RE: IgA Nephropathy case 2 days ago

What is her current eGFR- she might beca candidate fir moderate dose steroids + MMF or one of the anti- April-/ April/BAFF agents. --------------...

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IgA Nephropathy case 2 days ago

Hello, I have a 48 year female who I have been following for biopsy proven IgA. She is on Lisinopril 2.5 (unable to tolerate any higher due to lo...

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CMNephritis 2 days ago

I have two patients in their 60's with biopsy proved membranous nephritis. One has elevated Eliza PLA2R and the other does not. They have been doin...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Dr. Charytan- No direct comparator RCT of CYC vs RTX in IgA Vasculitus have been published- but three independent observational trials (one oroen...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

For me, it is more about this degree of crescentic IgAN not warranting CYC. This is based on the assumption that CYC is a superior drug for bad vas...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

There is no evidence-based indication for PLEX in IgA vasculitis or infection-related IgA-dominant vasculitis." ------------------------------ Sa...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Im curios about the evidence behind your recommendation that ritux is likely better than cytoxan here- can you summarize evidence --------------...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 2 days ago

Thanks for your extensive research - tell Claude I would like to meet him😂😂 ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] ...

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RE: unexplained rhabdomyolysis 2 days ago

I’m sure you can come up with other unifying narratives but here’s one, (sero-ve) SjD: - chronic lymphocyte-predom TIN - distal tubulopathy (with ...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 2 days ago

@Mark Lerman sorry I am on a plane , but was able to get Claude to research and answer ...and I think he/she has summarized it pretty well. The mai...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 2 days ago

if Renin is low - is it suppressed is the question-some articles suggest it is normal or high. if it is suppressed then how would you distinguish t...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 2 days ago

@Hormaz Dastoor-please see below regarding Obesity related Hypertension Clin Kidney J . 2025 Jul 9;18(8):sfaf218. doi: 10.1093/ckj/sfaf218 ...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

Thanks Dr. Dastoor for tgis clarification. I agree. Of late, I use less steroids and more Anti-CD20 MoAB for therapy of presumed MCD/FSGS . -----...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

The biopsy report suggested possible MCD of FSGS or perhaps just an podocytopathy. I don't think we are sure of the best treatment , but if the pa...

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RE: unexplained rhabdomyolysis 3 days ago

Yes ordered a whole panel beyond complement --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sh...

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RE: unexplained rhabdomyolysis 3 days ago

Have you done genetic testing for conditions beyond complement disorders? ------------------------------ Roger Rodby MD, FASN Professor of ...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

I am really moving toward rituximab alone as a primary therapy for a podocytopathy. The only issue is it may take some time to get approval. In tha...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

Dr.Dastoor- add or switch to RTX? What is the evidence that RTX + steroids is any better than RTX alone in Primary MCD ? I prefer monotherapy with ...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 3 days ago

@Mark Lerman I think obesity in relation to hypertension is defined as a hyperaldo state characterized high sodium retention , volume expansion, LO...

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RE: PLEX in Crescentic IgA Nephropathy 3 days ago

The bottom line is that this is not IgA Nephropathy and guidelines from IgA Nephropathy literature does not apply to this patient. This is either a...

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