RE: Case of SLN normal dsDNA high SSA/SSB 3 hours ago

There are cases of LN which are serologically persistently active without active inflammation. Increasing SCr and proteinuria can be the result of ...

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RE: Case of SLN normal dsDNA high SSA/SSB 3 hours ago

Isn't a low C3/C4, rising proteinuria and declining eGFR sufficient evidence of disease "activity" but a urine sediment exam is certainly appropria...

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RE: Case of SLN normal dsDNA high SSA/SSB 4 hours ago

Is the urine sediment active? Are C3 and C4 on a downward trend? Before subjecting this 74-year-old patient who has already had one opportunistic i...

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RE: Case of SLN normal dsDNA high SSA/SSB 8 hours ago

Dr. Abdalla. Your concerns about worsening proteinuria and declining kidney function are quite appropriate. The threshold for rebiopsy of patients ...

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RE: Case of SLN normal dsDNA high SSA/SSB 8 hours ago

pt does not have APS, platelets normal It seems like all roads lead to Vitamin R and her insurance seems to work only on Thursdays will need to s...

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RE: primary Membranous nephropathy and HBV infection 8 hours ago

Dear Pr. Glassock, the model system according to which HBV therapy (without the use of immunosuppressive drugs) induces PLA2R1-MN remission, would ...

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RE: Re: kidney biopsy findings in a young lady 9 hours ago

Its very odd, but they haven't described the intensity of staining in their report. ------------------------------ [Sriram] [Sriperumbuduri...

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RE: Case of SLN normal dsDNA high SSA/SSB 12 hours ago

Im not convinced a repeat biopsy would help but she seems to be getting worse despite MMF albeit at low dose I would like to escalate therapy ...

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RE: Re: kidney biopsy findings in a young lady 13 hours ago

The IF was done on glomeruli with extensive or global sclerosis so negative result does not help. The deposits by EM in multiple locations suggests...

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RE: Case of SLN normal dsDNA high SSA/SSB 13 hours ago

Worsening renal function and worsening proteinuria may indicate endothelial injury ..she has anemia and we don't know platlet count ..may be thromb...

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RE: Case of SLN normal dsDNA high SSA/SSB 14 hours ago

What features in her clinical and laboratory tests makes you think of a superimposed TMA? Renal limited TMA (wotput peripheral manifestations) is f...

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RE: Case of SLN normal dsDNA high SSA/SSB 15 hours ago

Renal biopsy was 1 year back --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ---------------------------------

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RE: Case of SLN normal dsDNA high SSA/SSB 17 hours ago

The pathology does not suggest a TMA, but an evaluation for anti phospholipid antibody is reasonable . Just an opinion, -------------------------...

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RE: Re: kidney biopsy findings in a young lady 17 hours ago

What is the staining intensity of C3 and IgG. Any Paraffin IF done after Pronase digestion. ? ------------------------------ Richard Glassock MD,...

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RE: Re: kidney biopsy findings in a young lady 18 hours ago

What was impression of Histopathologist. There is not much proliferation in intact gloms but to me it seems it is Primary/Idiopathic Immune Complex...

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RE: Case of SLN normal dsDNA high SSA/SSB 19 hours ago

Any thrombocytopenia ?? TMA ..APS should be excluded --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ---------------...

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Re: kidney biopsy findings in a young lady 20 hours ago

Hi everyone, I wanted to discuss this patient who was referred for advanced CKD 4 Young lady in her 20s with HTN since the beginning of this y...

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RE: Case of SLN normal dsDNA high SSA/SSB 22 hours ago

My impression of this case is that it is one dominated by SS manifestations, not SLE, and the dose of MMF tolerated is inadequate to prevent furthe...

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RE: primary Membranous nephropathy and HBV infection 23 hours ago

Thanks Dr Awais for the article, couldn't get access to full manuscript but found another publication from Chinese group supporting the idea that a...

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RE: primary Membranous nephropathy and HBV infection 1 day ago

This case, and others like it, raise the intriguing question of whether HBV infection itself is a driver of the Autoimmune phenomenon of anti-PLA2R...

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Case of SLN normal dsDNA high SSA/SSB 1 day ago

Im taking over a case of 74yo woman and hope to get some opinions from the community. Pt has a diagnosis on SLE since 1996 presented as rash and wa...

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RE: NELL-1 positive membranous 1 day ago

Sorry, Dr. Glassock it was misplaced Mawya Shocair MD

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RE: NELL-1 positive membranous 1 day ago

This post seems to bear no resemblance to the original (male) case in this thread. Is this post misplaced? I cannot respond to the question posed d...

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RE: NELL-1 positive membranous 1 day ago

Have u tested for syphilis --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ---------------------------------

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RE: primary Membranous nephropathy and HBV infection 1 day ago

Thanks for the Reference. I cannot acess the full article. Did they assess "reactivation" of HBV by serial measurement of circulating HBV virions ?...

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RE: cystatin C gfr 1 day ago

The answers to your question can be found in the paper by Bukabao JB, et al. Kidney Int 2019; 95:1181-1190. The prognostic utility of eGFR Cystatin...

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RE: cystatin C gfr 1 day ago

Recent studies showed combining eGFRcys-creat may have better prognostic value than eGFRcyst or eGFRcreat alone,is there any racial effect on eGFR ...

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RE: primary Membranous nephropathy and HBV infection 1 day ago

Seems no urgency for therpay but would take opinion of GI. The following article may be of help. Low risk of hepatitis B virus reactivation in me...

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RE: primary Membranous nephropathy and HBV infection 1 day ago

Appreciate your feedback Dr Glassock , Will watch for spontaneous remission and keep the community updated. ------------------------------ Abdal...

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RE: FSGS Tip Variant 1 day ago

Dr Mohamad, patient wanted to know how effective Ritux would be when I offered it to him. This followed discussion that one would be more certain a...

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RE: primary Membranous nephropathy and HBV infection 1 day ago

I think you have time to wait. Unfortunately, unlike HCV, it is very difficult to "cure" HBV with antiviral agents. The HBV can lurk in the liver i...

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RE: NELL-1 positive membranous 1 day ago

I am not aware of any strong data linking amphetamines or cannabis abuse to NELL1 MN, but I suppose that anything is possible, especially illicit H...

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RE: primary Membranous nephropathy and HBV infection 1 day ago

My only concern is that anti PLAR2R Ab level has been constantly above 200 ru/ml , otherwise kidney function is preserved and proteinuria < 4 g/24 ...

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RE: NELL-1 positive membranous 1 day ago

She had been on Colchicine almost all her life. She stopped it few months ago. Her baseline serum creatinine in July was 1.0.She came in with abdom...

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RE: Pregnancy in Transplant patients with aHUs and on complement inhibitors 1 day ago

Greetings Did she develop ESRD from an episode of aHUS prior to transplant? If so, that would worry me. That being said, people have used eculizu...

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RE: cystatin C gfr 1 day ago

The "improvement" in outcome prediction for eGFR-Cystatin C over eGFR-creatinine very likely has little to do with GFR itself, but ratherc is due t...

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RE: cystatin C gfr 1 day ago

Hi, I have no much experience with Cys based equations, but It's interesting what is mention in Kidney360 article about that in extremes situations...

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RE: FSGS Tip Variant 2 days ago

Thank you Dr. Nauman and congratulation on getting this patient into remission, great job! wonder why you restarted the steroids instead of just gi...

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RE: Tip variant FSGS 2 days ago

Very active maybe proteinuria will stabalize Has anyone had any luck with sglt2i and FSGS I haven't?I think they are less useful than ACEi/aRB bu...

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RE: Pregnancy in Transplant patients with aHUs and on complement inhibitors 2 days ago

Does she have pathologenic genetic variant ؟؟ Some variants have high risk of relapse others are low risk If no variant detected relapse are minma...

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RE: Tip variant FSGS 2 days ago

His mother may accept SGLT inhibitor --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ------------------------------...

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RE: IgA With ANCA Positivity 2 days ago

Total glomeruli: 41 Global sclerosis: 13 Segmental sclerosis: 7 --------------------------------- Kinjal Gosalia MD Dix Hills NY (516) 504-5279...

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RE: IgA With ANCA Positivity 2 days ago

Albumin 3.9. No edema. So no nephrotic syndrome just nephrotic range proteinuria. BMI 39. It could be secondary FSGS from IgA or Obesity --------...

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RE: IgA With ANCA Positivity 2 days ago

No hydrazine, allopurinol, PTU, methimazole, IVDU --------------------------------- Kinjal Gosalia MD Dix Hills NY (516) 504-5279 --------------...

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RE: IgA With ANCA Positivity 2 days ago

SAlb level? How much edema? Is "50% glomerulosclerosis" global? How obese is she? If this is a primary podocytopathy would expect significant hypoa...

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RE: Tip variant FSGS 2 days ago

"Very active fit kid." Some of the fluctuation in proteinuria may be the effect of heavy physical activity increasing it. ---------------------...

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RE: Tip variant FSGS 2 days ago

Yes I would not treat now at what point would you treat? Nephrotic range probably too late but > 1gm albumin/cr and lower serum albumin thank...

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RE: Pregnancy in Transplant patients with aHUs and on complement inhibitors 2 days ago

Not much experience with Eculizumab or Ravulizumab in Pregancey Several reports of their use in PNH and Pregnacy and PNH indicate tgat it may be sa...

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RE: IgA With ANCA Positivity 2 days ago

I would treat with oral systemic prednisone just as you would with a primary Podocytopathy . I do not know what to make of the serology. Has the pa...

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RE: Tip variant FSGS 2 days ago

With these findings I would just follow the patient with repeat values about every 3 months. ------------------------------ Richard Glassock MD,...

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