ASN represents more than 21,000 kidney health professionals working to help people with kidney diseases and their families. Comprised of all of ASN's focus areas, the ASN Alliance for Kidney Health allows the society to continue its growth and work towards the goal of a world without kidney diseases.
The latest Nephrology Self-Assessment Program (nephSAP) issue, Volume 22: Issue 4 (Feb 2024): Pregnancy and Kidney Disease is now available online.
RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 51 minutes ago
Is there case for promise digestion in these cases of mgrs? And when to use it? Is fish routinely done on kidney biopsy? Is there any point of us...
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RE: Membranous nephropathy 1 hour ago
Obinutuzumab is definitely an option, if you can get it. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ...
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RE: Membranous nephropathy 2 hours ago
Appreciate the input. I spoke with Labcorp and Quest. None of them have standalone CD19 B cell test. It is a part of a panel testing for other CD...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 3 hours ago
Since the monoclonal protein studies are negative, we are looking for MRD (minimal residual disease) level of response. At Mayo, we typically start...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 4 hours ago
Very good points, Dr.Rodby. Serious consideration should be given to a deep started infection (? Peri-colonic abscess) perpetuating the immune inju...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 6 hours ago
strep fecalis endocarditis twice, separated by many years. Again I ask did ID comment on source, should a colonoscopy be done? This reminds me o...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 19 hours ago
Thanks, if the bacteremia has cleared and the ANCA remains strongly positive , I suppose that Kidney Biopsy deserves some consideration, despite th...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 20 hours ago
Dr. Leung. We don't have a recent flow cytometry (the hematologist thinks it will be low yield since the WBC is normal). The flow was from the b...
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RE: hyperaldosteronism without symptoms 21 hours ago
I thank Drs Goldfarb and Leiba for providing their cases.A few observations:1 It would appear one can be hypovolemic with normal or elevated BP. In...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 21 hours ago
CRP is 3.6 while the upper normal limit of the lab 0.99. Other results pending. ------------------------------ Sadeem Ali MD Bridgeport WV (612) ...
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RE: hyperaldosteronism without symptoms 1 day ago
In accordance with David Goldfarb's case, this is the case I mentioned, written as a quiz to fellows A 75-year-old woman, married +2, a retired...
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RE: hyperaldosteronism without symptoms 1 day ago
John, I'm attaching a series of Litholinks on a patient like this, whose PRA/aldo I have not measured, but I hope it answers your questions. I'm ...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago
Sounds good! I'll look into the FISH data as we get this show on the road- thank you ------------------------------ Kenneth Brand MD West Hartfor...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago
thank you for the insight i really appreciate it! I'll make sure to look into those options ------------------------------ Kenneth Brand MD West ...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 1 day ago
Thanks Dr. Leung for your careful review of tgis case and your suggestions for management . Always tough decisions in these cases. In CD19 + clones...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 1 day ago
is that flow recent? If it is, I would try Obinutuzumab plus venetoclax. ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN...
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RE: hyperaldosteronism without symptoms 1 day ago
Activated RAS is not the rule in CKD. RAS status depends on the cause of CKD and the associated conditions. Examples: Diabetic kidney disease may...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago
I would repeat a bone marrow biopsy. The plasma cells initially did not have a clear light chain restriction. While there was a kappa to lambda pre...
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RE: ICPI- AKI 1 day ago
Dr. Glassock, Yes, you are correct. As always, you are such a shining light for all of us! I am a proponent of kidney biopsy as the diagnostic te...
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RE: ICPI- AKI 1 day ago
Dr. Perazella- many thanks for your detailed analysis of this case. Very helpful and full of clinical logic from an esteemed clinician. If I unders...
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RE: ICPI- AKI 1 day ago
Hi all, This case represents the challenge of appropriately diagnosing and treating a patient with a single kidney on an ICPI that develops AKI/AK...
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RE: hyperaldosteronism without symptoms 1 day ago
Can anyone explain the cause or (patho)physiology of RAAS activation in CKD? I appreciate that it is manifestly present, but what is the mechanism?...
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RE: hyperaldosteronism without symptoms 1 day ago
Thank you
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 1 day ago
The ANCA profile was not repeated. Last urine analysis on 25 April found 62 red blood cells and no white cells, 20 mg/dL protein, 1+ mucus and 2+ ...
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RE: hyperaldosteronism without symptoms 1 day ago
Per above info, PRA was mid-nl range at 3.64 with aldo markedly elevated at 309 ng/dL. Unusual case. Dr. Yazdani: what were the other aldo and PR...
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RE: hyperaldosteronism without symptoms 1 day ago
https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030142 I think the colon at the end may have been the problem ---------------------------...
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RE: hyperaldosteronism without symptoms 1 day ago
@Sheldon Hirsch Can you please double-check the reference you provided? I get an error message when I try to retrieve it. Thank you. ----------...
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RE: hyperaldosteronism without symptoms 2 days ago
aldosterone is believed to have adverse effects on the myocardium and kidneys. Yes, one can counter the effects of aldosterone by long-term/lifelon...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 2 days ago
Thank you Drs. Glassock, Rodby and Leung for your suggestions. The patient received rituximab from 7/14-8/10/22 8/22/22 SIFE/UIFE showed Ig...
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RE: hyperaldosteronism without symptoms 2 days ago
Historically--the approach I've used and cited here-- the reason for screening was to find a possible adenoma to resect, and, I suspect most of us ...
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RE: hyperaldosteronism without symptoms 2 days ago
BP and potassium apart, aldosterone is believed to have adverse effects on the myocardium and kidneys. Yes, one can counter the effects of aldoster...
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RE: ICPI- AKI 2 days ago
It may be hard to interpret the urinary findings in this patient with a diagnosis of Stage 3B CKD and a hyperfiltrating single kidney. Ultrasound f...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 2 days ago
I must presume that the ANCA was secondary to the infective endocarditis. The serum levels of this auto-antibody should fall with control of the in...
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RE: hyperaldosteronism without symptoms 2 days ago
Spironolactone has multiple ways it can lower BP. Testing BP just screens for BP responsiveness. Sure those who respond likely represent an enriche...
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RE: hyperaldosteronism without symptoms 2 days ago
If his bowel is not so good at absorbing dietary Na as per Dr. Leiba, and he's on a low Na diet, he would reabsorb Na in the proximal tubule (renin...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 2 days ago
What was the light chain restriction on the CLL cells? What happened to the SIFE and UIFE after treatment with rituximab? BTK inhibitors are good a...
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RE: hyperaldosteronism without symptoms 2 days ago
What do you think of Dr. Funder's proposal for universal screening of hypertensive patients for hyperaldosteronism with a spironolactone therapeuti...
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RE: ICPI- AKI 2 days ago
Dr. Flickinger: urine sediment findings a d the sub-nephrotic proteinuria favor interstitial nephritis. You can do either UAlb/Cr + UPr/Cr on same ...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 2 days ago
Patient completed 6 weeks of intravenous ceftriaxone and ampicillin and now on amoxicillin 500 mg twice a day planned lifelong according to the con...
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RE: hyperaldosteronism without symptoms 2 days ago
I agree that depending on the population studied there is a 10-25% incidence of primary hyperaldosteronism. In resistant hypertension, it is closer...
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RE: ICPI- AKI 2 days ago
Thanks again, I will try a shorter, loer dose prednsione regimen and observe. Will provide followup over thext 1-2 months. -------------------...
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RE: ICPI- AKI 2 days ago
I prefer a shorter course and a lower dose of Prednisone, because of the immunosuppressed status of the patients in general. However, I do not thin...
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RE: hyperaldosteronism without symptoms 2 days ago
Thanks for this worthy contribution to the discussion. I am curious regarding your position on screening for hyperaldosteronism in hypertensive pat...
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RE: ICPI- AKI 2 days ago
Thank you Dr. Sungur. We will check Ultrasound as you've recommended. Based on Dr. Glassock, Venkat and your recommendations/opinions, I am incline...
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RE: ICPI- AKI 2 days ago
Thank you Dr. Venkat. UA showed 1 RBC and 13 WBC/HPF. Uprotein/Cr ration 0.99 g/g in this diabetic gentleman. I did not order UPE but will. Thank y...
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RE: ICPI- AKI 2 days ago
We have observed kidney enlargement (compared to baseline size) by ultrasound in 5 patients with ICPI-associated AKI. Urinalysis and urine microsco...
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RE: hyperaldosteronism without symptoms 2 days ago
Very interesting discussion. Certainly concur that with well controlled BP on minimal meds and no hypokalemia, I would not pursue invasive testing....
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RE: hyperaldosteronism without symptoms 2 days ago
I think at this time all we have is a high serum aldosterone subject to lab verification. Clinically it seems all is well and hence no further inte...
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RE: hyperaldosteronism without symptoms 2 days ago
Dr. Hirsch raises an important question. Is screening for hyperaldosteronism with a serum aldosterone level and plasma renin activity indicated in ...
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RE: hyperaldosteronism without symptoms 2 days ago
Dr Hirsch, primary hyperaldosteronism is not confirmed in this case to do adrenal vein sampling for lateralisation. If we considered the screening ...
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