#ECNeph @brammahin @Dilushiwijay @myadla @acssjr @dra_miliflores
pubmed.ncbi.nlm.nih....
pubmed.ncbi.nlm.nih....
☄️ More than few reported cases exist
ℹ️Turns out patient has hypogammaglobulinemia
❓MMF related/disease related
Ig A - 134 mg/dl ( 70-400)
⬇️Ig G - 669 mg/dL (700-1600)
⬇️⬇️Ig M - 38 mg/dL (40-230)
😏Does it explain all?
#ECNeph @brammahin @Dilushiwijay @myadla @acssjr @dra_miliflores
Agree #ECNeph
How to differeentiate flare from infection ? Any novel markers #ECNeph
#ECNeph
@brammahin @myadla @Dilushiwijay @acssjr @dra_miliflores
@Dilushiwijay @ISNkidneycare
Admitted with febrile illness
Flare vs infection
Any other DD ?
Thoughts plz !
Mild rise in creatinine
Kidney Bx : Now Class III LN
#ECNeph @brammahin @myadla @ISNkidneycare
@Dilushiwijay @acssjr @dra_miliflores
Class switching in LN
Bomback AS. Nonproliferative Forms of Lupus Nephritis: An Overview. Rheum Dis Clin North Am. 2018 Nov;44(4):561-569
Common diagnosis in this age group of rhematological category is lupus ..Need to see whether shes satisfying criteria #ECNeph
Let start the discussion!
23 YO women with Lupus and recurrent admissions
#ECNeph
@kidneying.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social @dramiliflores.bsky.social
Hi #ECNeph
Dr Manjusha From India
Eager to learn
#ECNeph
@brammahin @myadla @Dilushiwijay @acssjr @dra_miliflores
@Dilushiwijay @ISNkidneycare
Is the diagnosis obvious ?
Should we check labs?
ANA+VE/low C3/hemat /Musculo skeletal involvement /Kidney
Biopsy done in v/o proteinuria : Class 1
Can it be podocytopathy
Thank you for a good case prsentation
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Recent publication from CKJ
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
⚡️PLA2R antibody seropositivity doesn’t mean that we do not investigate for underlying malignancies.
Here is a Case Report showing PLA2rAb MN having Carcinoma Oesophagus
#ECNeph
@theisn.org @myadla.bsky.social @dramiliflores.bsky.social @arvindcanchi.bsky.social
KDIGO recommends Population and Age-appropriate Screening for malignancies irrespective of antigen status
#ECNeph
@theisn.org @myadla.bsky.social @dramiliflores.bsky.social @arvindcanchi.bsky.social
Yes, some tests came after biopsy #ECNEPh
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Check the distribution of solid malignancies in NS
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Differentiating between PMN and SMN @karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Final Diagnosis
#ECNeph
@dramiliflores.bsky.social @karnephro.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social
👉 🫣 Can IF differentiate from Primary and Secondary MN?
IgG 4 is the dominant class in primary MN
👉 IgG1,IgG2, IgG3 are dominant Immunoglobulins in Secondary MN
#ECNeph
@theisn.org @myadla.bsky.social @dramiliflores.bsky.social @arvindcanchi.bsky.social
Paraneoplastic glomerulopathies
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Some more info about PNS !
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Paraneoplastic glomerulopathy can occur before /sfter or simultaneously with the diagnosis of MN
Need for evaluation of cases of MN for underlying malignancy is suggested
Primary vs Secondary Membranous Nephropathy #ECNeph
http://springer.com/...
@dramiliflores.bsky.social @karnephro.bsky.social
🔬 The characteristic histopathologic features of MN, light microscopy, IF, EM, are falling into place.
So… where are we in this case? Granular IgG, GBM thickening, no crescents...
What do you think?
#ECNeph @dramiliflores.bsky.social @karnephro.bsky.social
www.ajkd.org/action/...
A positive anti-PLA2R antibody test is “virtually” diagnostic of a lesion of MN (but may not always be able to reliably distinguish primary and secondary forms) #ECNeph #MedSky #NephSky @kdjhaveri.bsky.social @dramiliflores.bsky.social @karnephro.bsky.social
Different types of tumor secrete different types of antigen.
Here is the proposed mechanism of malignancy associated MN. #ECneph
@dramiliflores.bsky.social @myadla.bsky.social @theisn.org
www.frontiersin.org/journals/med...
Great infographic about NS in elderly @karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
Genetic testing for elderly ?
Any lit supporting this ?
@karnephro.bsky.social #ECNeph @dilushiwijay.bsky.social @theisn.org
