RE: Case of SLN normal dsDNA high SSA/SSB 5 hours ago

@K.K. Venkat she had controlled disease for 15 years until IS has been progressively decreased due to pts symptoms and kind of blossomed into curre...

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RE: Steroid dependent FSGS with "tip lesion" 6 hours ago

I don't think the 'tip lesion" characterization means a great deal in terms of therapy or prognosis . This course can often be seen with the NOS va...

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Steroid dependent FSGS with "tip lesion" 7 hours ago

Dear ASN members I would like to discuss an interesting case with you and request your valuable input. I have a 57 years old male with PMH of w...

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RE: Case of SLN normal dsDNA high SSA/SSB 9 hours ago

The dialogue in this thread has been very fruitful as it has exposed an area of deep controversy in management of LN- how to use serological "indic...

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RE: Case of SLN normal dsDNA high SSA/SSB 10 hours ago

We have a difference of opinion on this issue. Not easily resolved, but the recent paper from Italy tends to support my argument even if low serum ...

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RE: Case of SLN normal dsDNA high SSA/SSB 11 hours ago

The key question in this patient is whether hypocomplementemia is worsening progressively, or llow but stable. If over her long-term follow-up, hyp...

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RE: primary Membranous nephropathy and HBV infection 13 hours ago

All good points. HBV infection might be acting as an "adjuvant" like COVID. I am still concerned about giving RTX to a patient kniwn to be infected...

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

All good points- I am putting emphasis on the low complement and the likely inadequate intensity of therapy with MMF. If blood MPA levels are below...

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RE: Renal thrombotic microangiopathy 14 hours ago

Dr. Christian Kuhn: Can you please post an update on this patient --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt --...

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

This case is complicated but IMO Dr Venkat makes a very important broad point: anytime renal disease--esp proteinuria-- worsens five, ten, fifteen ...

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

Such cases of low serum C3/C4 in LN with no histological activity on KB must be uncommon. Do you have any literature citations that show how common...

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RE: Case of SLN normal dsDNA high SSA/SSB 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 2 days 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 2 days 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 2 days ago

Sorry, Dr. Glassock it was misplaced Mawya Shocair MD

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RE: NELL-1 positive membranous 2 days 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 2 days ago

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

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RE: primary Membranous nephropathy and HBV infection 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 3 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 3 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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