follow up case 3 hours ago

Good morning, Apologies for all the detail. I would be grateful for feedback regarding this case. The original posting is as below from June l...

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RE: Mpo Vasculitis Case 4 hours ago

What medications are being used for treatment of hypertension. This might be a hydralazine induced positive MPO. What does the IF and EM show? -...

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Mpo Vasculitis Case 6 hours ago

Dear all, Would like an opinion on this case 80 male bg HTN Presented with lethargy and tiredness Crp raised mpo 70(0-20) creatinine 0.84 urine ...

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RE: Light chain deposition disease in transplant kidney allograft 7 hours ago

Are you asking what to do regarding the LCDD or C4d? The good news is that dara VD should take care of both assuming that this is a plasma cell clo...

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RE: High dose Rosuvastatin and non glomerular proteinuria 8 hours ago

Thanks Dr Rodby very helpful If no tubular damage then why increasing incidence of microhematuria and renal failure Thanks ---------------------...

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RE: Light chain deposition disease in transplant kidney allograft 9 hours ago

Transplanted kidneys are still kidneys and such a case is a great reminder of that. I would follow the same workup we do for a patient without tr...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 10 hours ago

I truly believe we are treating the PLA2R antibody, and that everything else will follow. One approach is to not even treat that, but to give An...

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RE: High dose Rosuvastatin and non glomerular proteinuria 12 hours ago

Rosuvastin increases tubular proteinuria , this is well established, but this is not tubular damage per se, it is blocking normally filtered normal...

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Using telenephrology and initiating new dialysis for urgent indication or otherwise 12 hours ago

I am assuming many of us do TeleNephrology for consultations in the hospitals especially in regional sites where we do not have in-person Nephrolog...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 12 hours ago

In my humble clinical practice with a patient with PLA2R +ve MN who achieve CR after 2 grams of RTX, I do the following: 1. Monitor serum creatinin...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 12 hours ago

Interesting discussion. I have the opportunity to repeat kidney biopsy in one case of MN. A 65-years-old woman with biopsy-proven MN at our center...

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MMF/Myfortic/cyclosprin/proton Pump Inhibitor 14 hours ago

Question for Transplant experts Cyclosporine inhibits the enterohepatic recirculation of mycophenolic acid (MPA), the active metabolite of MMF, red...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 15 hours ago

Dr. Balan- how would (or could ) you distinguish a spontaneous remission from a "response" to RTX in these situations., without a randomized trial....

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High dose Rosuvastatin and non glomerular proteinuria 15 hours ago

Have seen 3 pts with this last one year We’re on 40 mg with creatinine 1 EGFR 50 Improved after stopping or reducing the dose What is others exp...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 18 hours ago

A reasonable approach , Dr, Nauman, but not one that has been validated for more favorable patient outcomes. by prospective trials . Some might arg...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 19 hours ago

For patients in longterm remission, like a few I have been in remission for years, I do not measure ANtiPLA2R routinely, its just Urine PCR and che...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 21 hours ago

Dr. Balan- how would (or could ) you distinguish a spontaneous remission from a "response" to RTX in these situations., without a randomized trial....

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 21 hours ago

((Relapse without rising antiPLA2R titers does happen. In fact the reference below has collected data in that and carefully documented rituximab re...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Yes in that instance I would agree with you. But imagine we have a biopsy proven membranous nephropathy with IC deposits and significant IFTA. Seru...

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RE: Light chain deposition disease in transplant kidney allograft 1 day ago

DSA is negative. Sorry for not mentioning that earlier. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (8...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 1 day ago

Does diet, including food coloring, and medication history indicate unusual intake. The recovery is against the diagnosis of lymphoma. Did the pati...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

With all due respect for your valuable opinion -my opinion differs. If the anti-PLA2R antibody was undetectable ([More]

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Speaking for myself, I do not see a need to rebiopsy. As I see it, persistent proteinuria could be due to three reasons. Incomplete remission, rela...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

I would not, in general, but the specific detaiils of individual cases (e.g. RPGN or AKI) might warrant a rebiopsy. It depends! -----------------...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Dr Glassock, please clarify:if " the immunologic sink phenomenon is usually quite transient, so that it can often be recognized by serial measureme...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

This is an interesting but very timely question. Membranous nephropathy, like other 'primary' nephrotic syndromes follows a different trajectory in...

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RE: Light chain deposition disease in transplant kidney allograft 1 day ago

C4d deposition can be a feature of LCDD in the kidneys, I do not think that this minimal finding necessarily indicates the concomitant presence of ...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Dr. Hirsch. These phenomena are quite uncommon, so data that might answer your questions is scanty . However, the immunologic sink phenomenon is us...

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RE: Light chain deposition disease in transplant kidney allograft 1 day ago

Thank you for sharing this case . Seems that this is a case of denovo LCDD . However I would like to bring the attention of some findings in the bi...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

Dr Glassock, For the patient I described, do you suggest a repeat biopsy to distinguish "immunologic sink" (and need for yet more immunosuppression...

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RE: Light chain deposition disease in transplant kidney allograft 1 day ago

Thank you so much Dr. Glassock. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (843) 669-6694 -----------...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

These kind of patients are very uncommon, but have been described. A repeat kidney biopsy often shows extensive ( *? Irreversible) capillary wall c...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 1 day ago

There is phenomenon that I never understood well when a patients with PLA2R Membranous and in CR with negative PLA2R present with worsening protein...

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RE: Light chain deposition disease in transplant kidney allograft 2 days ago

We need to see the EM, Congo Red stain but this looks like de novo LCDD in a kidney allograft .An evaluation, involving complete blood cell count ,...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

Thanks Dr Hirsch. This is what make writing "Guidelines" and then applying them to individual patients so difficult. The more we know about "diseas...

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Light chain deposition disease in transplant kidney allograft 2 days ago

Seeking expert advice: This is a 55-year-old female with HTN, hyperlipidemia and ESRD due to IgA nephropathy and s/p DDKD in 2000 with good allog...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

In terms of "what is going on?", FWIW, I (n =1) have taken the PLA2R measurements seriously, based a lot on what I have learned from you guys in th...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

Thanks Dr. Rodby- the question as posted was very specific to PLA2R related MN in a complete clinical and immunological remission (anti-PLA2R antib...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

"Answer to Question posed by Dr Glassock is not really known" Don't you think that is why he asked It? I put my opinion out there, now you have t...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

Was Paraffin iF following Pronase digestion ever done in this case? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

Answer to Question posed by Dr Glassock is not really known --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 -----...

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RE: Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

If the remission was "spontaneous" bc something was done, stopping eg lipoic acid , Hg (Nell1) NSAIAs, treating syphillis, Hepatitis, cancer, etc t...

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RE: What is the etiology 2 days ago

I would give 2 grams now, separated by two weeks for each gram, assuming that achieved remission and was steroid free, then I would give another si...

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RE: What is the etiology 2 days ago

Thank You Drs. Rodby and Glassock. What is the duration of Rituximab you recommend? ------------------------------ Asma Qayyum MD West Houston...

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Rituximab for "maintenance " of a CR in PLA2R related MN 2 days ago

What role , if any , does therapy with RTX play in prevention of relapses following a spontaneous or RTX /CYC induced complete clinical and immunol...

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RE: Comparison of CVVHD vs CVVHF on Dialyzer life span 2 days ago

Thanks a lot Prof.Teixeira Regards, Yassin ------------------------------ Ahmed Yassin MD, FASN Saudi German Hospital Madina ----------------...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 3 days ago

follow up: Seen today in follow up. Her serum creatinine, that peaked at 6 4 weeks ago is now 1.1. ------------------------------ Victor Gur...

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RE: Comparison of CVVHD vs CVVHF on Dialyzer life span 3 days ago

Hey Dr. Yassin -- Very good (and certainly controversial question). As already alluded to in the discussion, if doing CVVH with 100% post-filter re...

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RE: Comparison of CVVHD vs CVVHF on Dialyzer life span 3 days ago

Not to be picky, but I was comparing pure HF (CVVHF) with pure HD (CVVHD) and pure HD would have no "predilution", so I suspect you are talking abo...

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RE: What is the etiology 3 days ago

It is hard to put this all together but it is acting like a very steroid responsive podocytopathy, so responsive that by the time you biopsy the FP...

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