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: Metformin toxicity 33 seconds ago
absolutely, and the ability to "tag" (@) someone you think may be an authority on the subject and get their response is such a plus. In this case...
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RE: Metformin toxicity 1 hour ago
This kind of dialogue is what makes the Open Forum so great. It is like witnessing a bedside consultation involving world renowned experts. More th...
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RE: Metformin toxicity 2 hours ago
Are you willing to be wrong, bc it will be too late once you figure that out. And even if the patient is unstable BP, the improvement in Acid bas...
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RE: Metformin toxicity 3 hours ago
Personally I don't, but it is case to case management there. I don't think you'll ever find good guidance. If the lactate is disproportionately e...
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RE: Metformin toxicity 3 hours ago
Thanks . What if the patient is clearly septic? Do you initiate dialysis right away on the basis (ie no other indication) that the patient had...
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RE: Metformin toxicity 4 hours ago
If you think there's a more likely than not chance it's metformin (no fever, no clear source of sepsis, hypothermia), personally I'd recommend HD. ...
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RE: Metformin toxicity 5 hours ago
opinion Metformin induced lactic acidosis has a high mortality Dialysis removes the Metformin and improves the acidosis For just about all po...
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Metformin toxicity 7 hours ago
Pt with previously normal GFR on Metformin presents with what seems like septic shock and severe lactic acidosis, requiring pressors. For the pur...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 19 hours ago
Here is the bone marrow biopsy report from 2018: Final Diagnosis: Bone marrow core biopsy: - Normocellular marrow with plasma cells compris...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 20 hours ago
Dr. Leung. I will remember this key advice. Do the FiSH results any bearing on CAR-T cell therapy? ------------------------------ Richard Glassoc...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 21 hours ago
Plasma cells with t(11;14) often do not have a very good response to bortezomib. Daratumumab increases the responsiveness, but resistance can be se...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 22 hours ago
Could you explain how the FISH results on a bone narrow biopsy will influence the treatment decisions in this case?. The answer to this question is...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 1 day ago
Here is another often missed association - staph lugdunensis bacteremia and infective endocarditis. It's not your ordinary coagulase-negative staph...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago
The FISH I was asking for is the myeloma FISH from the bone marrow biopsy. ------------------------------ Nelson Leung MD Mayo Clinic Rochester M...
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RE: Membranous nephropathy 1 day ago
Depending on what is happening with Anti-PlA2R antibody levels and (if available) CD19/CD20 B cell counts in peripheral blood, re-dosing with RTX (...
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RE: Membranous nephropathy 1 day ago
The patient received Rituxan x 2 dose with last dose 5 months back. Usually we give Rituxan after 6 months. I guess we can give it sooner at 5 mont...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 1 day ago
Following case report is relevant to the points made by Dr. Rodby regarding Streptococcus fecalis bacteremia and endocarditis complicating colon ca...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago
addendum- FISH us often done on kidney allograft biopsies (to identify viral infection, such as BK virus) and it has been done to identify mutant D...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago
The findings in this case clearly indicate a PGNMID. No need for Pronase digestion and paraffin IF or LD/MS , in my opinion. FISH is only done on b...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 days 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 2 days 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 days 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 2 days 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 2 days ago
Very good points, Dr.Rodby. Serious consideration should be given to a deep seated infection (? Peri-colonic abscess) perpetuating the immune injur...
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 3 days 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 3 days 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? 3 days 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? 3 days 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 3 days 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 3 days 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 3 days 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? 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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 3 days ago
Thank you
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 3 days 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 3 days 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 3 days 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 3 days 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 Sunday, April 28 @ 5:20 PM
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 Sunday, April 28 @ 5:04 PM
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 Sunday, April 28 @ 4:23 PM
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 Sunday, April 28 @ 3:55 PM
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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