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: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 2 hours 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 hours 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 hours 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? 4 hours 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 4 hours 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 4 hours 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 5 hours 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 6 hours 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 18 hours ago
Thank you
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RE: safety of Immunosuppression start for possibly GPA with history if bacteremia still in utine culture 18 hours 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 19 hours 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 19 hours 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 20 hours 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 20 hours 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 20 hours 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 21 hours 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 22 hours 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 22 hours 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 22 hours 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 23 hours 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 23 hours 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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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RE: LN not in remission 1 day ago
"In membranaous LN immune complex formation occur in situ and AutoAb targets are resident podocyte antigens . . . as opposed to . . ." Nauman...
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RE: hyperaldosteronism without symptoms 1 day ago
Dr Yazdani, should we understand your f/u post to mean two elevated aldosterone levels, with the first one preceding aldactone? Which would mean th...
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RE: ICPI- AKI 1 day ago
Is urine sediment consistent with interstitial nephritis? UPr/Cr and UAlb/Cr on same sample of urine or UPE (looking for tubular proteinuria)? Thes...
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RE: hyperaldosteronism without symptoms 1 day ago
ACE-I's, ARB agents and mineralocorticoid antagonists do have an effect on renin and aldosterone levels with the biologic effects exceeding the pre...
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RE: ICPI- AKI 1 day ago
Thank you Dr. Glassock . Your opinion carries alot of weight! ------------------------------ Allen Flickinger MD,PhD ------------------------------
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RE: ICPI- AKI 1 day ago
I favor #2 ( empiric steroids without a kidney biopsy. Opinion only. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (94...
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ICPI- AKI 2 days ago
Dear Colleagues: 51 year old man with Stage 3 B CKD with likely underlying diabetic nephropathy, s/p L nephrectomy for renal cell CA. Baseline Cr...
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RE: hyperaldosteronism without symptoms 2 days ago
Very interesting Maybe you should do a CTA adrenal protocol Three phasic - baseline, after contrast and after washout Sometimes better t...
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RE: hyperaldosteronism without symptoms 2 days ago
My error. Posted on the wrong patient. I meant to post it for the young patient with hypo kalemia and hypertension. . --------------------------...
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RE: hyperaldosteronism without symptoms 2 days ago
DR. Glassock: PRA and PRC are not suppressed in the the posted patient. Are you suggesting that this may still be glucocorticoid-remediable hyperal...
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RE: hyperaldosteronism without symptoms 2 days ago
------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------
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RE: hyperaldosteronism without symptoms 2 days ago
Plasma renin activity is not suppressed. If the patient did not receive spironolactone before the assay, 1ry hyperaldosteronism is less likely --...
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RE: hyperaldosteronism without symptoms 2 days ago
I have not ordered 24h urine sodium or urine aldosterone level. Your patient's case resembles mine in setting of colectomy, but he doesn't have hig...
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RE: hyperaldosteronism without symptoms 2 days ago
He was not on aldactone prior to lab being checked, been on medication for less than a month, and taken off for 2 weeks before repeating level. ...
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