RE: Patient with ANCA positivity and no GN on biopsy 42 minutes ago

Is she is treated with steroids and Ritux, both bases will be covered. I wonder if steroid avoidance is sought then I think there is not much exper...

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first inflow alarm in peritoneal dialysis 1 hour ago

good day all, I requesting your expert opinion on one PD case. 54 years old ESRD due to DKD, started on PD 2 month back which was smooth at the...

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RE: Patient with ANCA positivity and no GN on biopsy 1 hour ago

The patient has a positive anti-MPO and has received Allopurinol. We all agree that Allopurinol must be stopped. Are you willing to ignore the ANCA...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 hours ago

Dr. Jabur- would it be possible for you to post a (deidentified) image of the global glomeruloscleroisis seen in this patients biopsy? ----------...

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RE: Patient with ANCA positivity and no GN on biopsy 3 hours ago

How does one tease out interstitial nephritis due to drugs from one due to ANCA. If it's the drug associated AIN, cessation of Allopurinol is cruci...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 3 hours ago

Obsolescent glomerulosclerosis is compatible with aging and ischemia- solidified glomeruloscleroisis is more compatible with an intrinsic Glomerulo...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 5 hours ago

Dr. Glassock, will you kindly elaborate on IgA/C3 and how its reliable in diagnosing IgA nephropathy? ------------------------------ Wael Jebur ...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 5 hours ago

Dr. Glassock. The global glomerulosclerosis was obsolescent type and immunoflorescent staining was performed on intact glomeruli. May I ask wha...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 6 hours ago

Thank you for all your replies. He records showed normal renal function and minimal proteinuria before gastric reduction surgery. He lost almost ...

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RE: Patient with ANCA positivity and no GN on biopsy 8 hours ago

Sound like acute interstitial nephritis from allopurinol or omeprazole and positive ANCA from allopurinol is a red herring. I would start small do...

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RE: Dialysis/Hemolysis 8 hours ago

Thank you for your input, I appreciate it! I should've added that the hemolysis resolved ina bout 2 days for all patients. The last patient had a f...

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RE: Patient with ANCA positivity and no GN on biopsy 8 hours ago

there can also be a sampling error, but to have a creatinine of .9 to 1.9 in a year without finding a segmental necrotizing lesion in a sample size...

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RE: Renal biopsy for low C4, and history of subacute cutaneous lupus, ANA positive 1: 320 and speckled but C3, urinalysis, double-stranded DNA antibody are normal , urine protein undetectable and creatinine stable > 1 year 8 hours ago

I will not put a needle in a kidney with stable CKD that is not excrete an access proteins and obvious not inflamed in a lupus patient (quiescent K...

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RE: Dialysis/Hemolysis 9 hours ago

I respect your diligence. I doubt I would have even noticed it, 3 patients in 1.5 years doesntseem possible to be a HD technical issue or it would ...

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Dialysis/Hemolysis 9 hours ago

Hi- over the last 1.5 years, we have had 3 patients who went to the ED after dialysis for various reasons who were noted to have hemolyzed labs. Th...

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RE: Renal biopsy for low C4, and history of subacute cutaneous lupus, ANA positive 1: 320 and speckled but C3, urinalysis, double-stranded DNA antibody are normal , urine protein undetectable and creatinine stable > 1 year 10 hours ago

What is lower limit of normal in your lab In our lab 17 c4 will be in normal range Perhaps labs doing different assays Does not look like c4 consu...

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RE: Patient with ANCA positivity and no GN on biopsy 12 hours ago

Allopurinol is a potent inducer of hypersensitivity Vasculitis . It should be stopped. I would treat this patient with steroids , in rapidly descal...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 13 hours ago

Thanks prof fogo. What does deposit being rarefied means? If you have electron lucent deposit does that mean MN is inactive ? And do we use stag...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 14 hours ago

If APOL1 risk allele, it will be a confounding factor but based on the are, it is possible. I do not know how easy for Dr. Jebur to get genetic tes...

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RE: Patient with ANCA positivity and no GN on biopsy 14 hours ago

I just talked to the pathologist, he had verbally told me it was more then 12 but forgot to put it in the final report. Will confirm the exact numb...

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RE: Patient with ANCA positivity and no GN on biopsy 14 hours ago

What is the full list of medications? How many glomeruli were in the kidney biopsy sample? ------------------------------ Richard Glassock MD, F...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 14 hours ago

Mesangial hypercellularity and Immune Complex deposition does not occur in APOL1 Nephropathy . I would be a bit surprised if this patient has two A...

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Patient with ANCA positivity and no GN on biopsy 16 hours ago

I have an 80-year-old Caucasian female with history of osteoarthritis, hypertension, discoid lupus diagnosed in early 2000's currently not on any t...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 16 hours ago

What about APOL1 status? --------------------------------- Hayder Aledan MD, FASN Assistant Professor Basra Nephrology and Transplantation Center ...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 17 hours ago

I agree with Dr. Venkat's questions and would also like to know if the global Glomerulosclerosis lesions were of the obsolescent " (ischemic) varie...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 18 hours ago

"Glomerulomegally of some glomeruli." What is his birth weight, full term vs premi, maternal exposure (father smoking is a factor)? What is his...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 22 hours ago

"Focal global glomerulosclerosis and focal glomerulosclerosis. in 28%" Was there both focal segmental and focal global glomerulosclerosis? Is he ...

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immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

I wanted to share with you this case, as I found it interesting and not straight forward. A 40-year-old patient presented to me with significant ...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

"For the time being , kidney biopsy is the only sure way to differentiate a chronically scarred lesion from a potentially treatable active inflamma...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 1 day ago

GBM reaction means a reaction of increased matrix extending out from the GBM, this is matrix made by podocytes in response to subepithelial deposit...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

We seem to have a major difference between Dr. Klein and Dr. Rodby concerning the utility of repeat biopsy in patients with advanced clinical forms...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 1 day ago

Thanks . What do you mean by gbm reaction prof fogo? --------------------------------- Muhammad Soobadar MBChB UK ------------------------------...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

Dear Dr Glassock I believe in surveillance biopsies at about 5 years in transplant patients doing well as that is only way to detect early calcin...

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RE: Calling All Nephrologists: What's Your Workflow Wisdom? 1 day ago

Dr Zapata: A few things about dialysis rounds I've picked up along the way, and I believe have helped me. First, Dialysis rounding is important so,...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

The biopsy findings would definitely change my treatment. eGFR 25 my treatment would depend on younger age, lesser fibrosis, more cellular crescent...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

Yes , but such single arm open labels trials are more like "compassionate use" as they have doubtful utility in effecting a change in labeling of t...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

Great suggestion or question rather . I know one study that’s going to do exactly that ( not just for low gfr pt ) I can’t reveal the details yet b...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

Yes that’s very correct But some trials are doing exploratory group as open label ( no placebo ) Sent from my iPhone

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 1 day ago

Thanks for the responses. To put the question in a different way - if you performed a kidney biopsy in a patient with known IgAN and an eGFR of 25m...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 2 days ago

She is very early in her pregnancy and it will be very difficult to get her through this But This is a life threatening disease and I would stron...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 2 days ago

@Satish Balan you bring up an interesting point, the relative intolerability of steroids in IgAN compared to eg lupus and vasculitis, but these a...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 2 days ago

Question- do participants in ASN Communities believe that a repeat kidney biopsy should be manadatiry for trials examining efficacy and safety of n...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 2 days ago

Of course, I agree with referral of patients fulfilling inclusion/exclusion criteria to trial sites nearby. But the patient must understand they ha...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 2 days ago

Tough question. I would probably use Steroids + AZA. If the DAH worsens, I would consider adding PLEX, which is quite safe and well tolerated in Pr...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 2 days ago

All valid points but this was smaller subset analysis from larger study . The broader point is that ongoing trials are including exploratory cohort...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 2 days ago

Thank you, prof Richard The IF and EM are still pending anti GBM negative CT chest not done she is pregnant ( 7 weeks now ) she is not de...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 2 days ago

When will IF and EM on the kidney biopsy be available? What is tge pO2 and O2 saturation.? What does the Chest CT show? did you do an antiGBM assay...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 2 days ago

Patients with non-RPGN and advanced chronic progressive GN represent a group unaddressed by the major "registration" trials of novel drugs for GN. ...

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active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 2 days ago

Dear all I need your kind expert opinion about the best approach for managing a challenging case, a 32 years old female with a background of Ty...

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RE: Tarpeyo use in IgA Nephropathy patients with Low GFR 2 days ago

Thanks for the post. Small study. No follow up eGFR, so we don't know of ESKD will be delayed. Kidney biopsy data not useful as they were performed...

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