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: hyperaldosteronism without symptoms 21 minutes ago
It has been speculated that elevation of aldosterone may antedate development of hypokalemia and/or hypertension by a long time (a la PLA2Rab anted...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 hour ago
I am not sure tgat a kidney or bone marrow biopsy is going to help make treatment decisions, , but if these are not contraindicated, why not. I thi...
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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 hours ago
Just one thing to add to Dr. Brand's case description is that with this last round of CyBor-D though we did not see the same response in renal func...
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IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 hours ago
-53-year-old lady with IgG kappa MGRS diagnosed in 2018. I believe her case was discussed here in 2021 -originally concern for fibrillary gn on EM ...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 4 hours ago
I want to ask about bone marrow response to the ritux, but it really doesn't matter if the renal disease is progressing. You need something "stro...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 6 hours ago
We receive a lot of traffic on the Open Forum regarding clone -directed therapy of PGNMID and its variants. It is a dynamic area, but with no RCT (...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 7 hours ago
Type 1 cryoglobulinemic GN or PGNMID- treatment will be virtually the same. I would prefer moving beyond RTX in this patient , but would defter to ...
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RE: hyperaldosteronism without symptoms 8 hours ago
Serum aldosterone concentration can not be interpreted in absence of plasma renin activity or concentration. What is the units of serum aldostero...
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RE: hyperaldosteronism without symptoms 10 hours ago
Curious to know Renin level with elevated aldo level but would not chase in a well controlled patient. ------------------------------ [Mark] [...
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RE: hyperaldosteronism without symptoms 10 hours ago
What is her renin levels ? Plasma bicarbonate ? What is 24 hour urine sodium ? 24 hours urine aldosterone? Some people after colectomy d...
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RE: hyperaldosteronism without symptoms 11 hours ago
Important also to appreciate the length of time patients must be off spironolactone, really at least 6 weeks or so. There is indeed a good amount o...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 13 hours ago
Thank you Dr. Glassock. There were not any rhomboid, grid-like structures on EM. ------------------------------ Eric Tong MD, FASN Woodland Hil...
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RE: LN not in remission 1 day ago
The optimum therapy for Lupus Membranous Nephropathy, with or without concomitant Class III or IV Lupus Nephritis is an unresolved enigma. We have ...
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RE: hyperaldosteronism without symptoms 1 day ago
Plasma aldosterone levels > 100 ng/ml are commonly seen in hypertensive patients receiving spironolactone therapy. When was the blood sample drawn ...
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RE: Hypertension in pregnant patient 1 day ago
It is essential to know the family history and whether blood pressure normalized after the first gestation. The most critical diagnosis to rule o...
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RE: Hypertension in pregnant patient 1 day ago
Following is a good review on PA in pregnancy and eplerenone (vs. spironolactone) use in this setting. https://link.springer.com/article/10.1007/...
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RE: Possible hydralazine associated ANCA vasculitis/lupus,/treat or not 1 day ago
Hi Dr. Rodby, We have a case with suspected hydral associated ANCA now. Pending biospy, s/p pulse + ritux, how often are you checking serologi...
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RE: Subacute to chronic thrombotic microangiopathy , what to do ? 1 day ago
Proliferative GN with MID .(lambda restriction) --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt -------------------...
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RE: hyperaldosteronism without symptoms 1 day ago
Does he have LV hypertrophy or hypertensive retinopathy? Renin level or activity? Home BP or ambulatory BP? Masked hypertension? ----------------...
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RE: hyperaldosteronism without symptoms 1 day ago
That aldo measurement seems like "TMI" (too much information). I would not chase an aldosterone level--especially not with an invasive procedure-- ...
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RE: LN not in remission 1 day ago
You "could" add RTX for the MN component but the evidence for efficacy is lacking. I do not believe that this approach is currently recommended by ...
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hyperaldosteronism without symptoms 1 day ago
I have a curious case of 66 yo with aldosterone level 300, no hypokalemia, mild hypertension, No adenoma, or hyperplasia on MRI adrenal. Has sig h/...
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RE: LN not in remission 1 day ago
Thanks . In our case we have chose mmf steroid/ hydroxychloroquine . Because of class v element could we add rituximab as part of induction togethe...
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RE: LN not in remission 1 day ago
I think in this case you just pick an induction NIH IV CYC (monthly CYC for many months) Eurolupus IV CYC (500 q 2 weeks for 3 months, 3 gm t...
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RE: LN not in remission 1 day ago
Ok thanks and why not rituximab? --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------
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RE: Hypertension in pregnant patient 1 day ago
I agree. I would pursue genetic testing in this patient, now. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 3...
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RE: LN not in remission 1 day ago
Wait and see. Slowly increase MMF to between 2 and 3gms per day.and be sure of compliance .Feasses in 3-6 months.? Add Belimumab. Just an opinion. ...
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RE: LN not in remission 1 day ago
Thanks . What would people treat with lupus nephritis class3/4 and class 5 in 67 male Egfr 40/80 , positive Ana, low c3/c4 positive Ds dna. Albumin...
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RE: Hypertension in pregnant patient 1 day ago
Renasight genetic testing by Natera is basically free and if more than $150, they will provide financial assistance program. --------------------...
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RE: Hypertension in pregnant patient 1 day ago
The history of early onset of hypertension in childhood suggests GRA.(as pointed out by Dr. Alhosaini) Do you know the sex of the fetus? In most ca...
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RE: Hypertension in pregnant patient 1 day ago
Would you use eplernone in pregnancy? My options r limited regarding genetic testing bc she is uninsured charity care. Refusing further imaging due...
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RE: Hypertension in pregnant patient 1 day ago
The elevated Plasma Aldosterone rules out Geller and Liddle syndrome, but Primary Aldosteronism, apparent excess meralocorticoidusm and glucocortic...
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RE: Subacute to chronic thrombotic microangiopathy , what to do ? 1 day ago
There is discrepancy between IF and EM results in terms of immune complex deposits. While EM showed rare electron dense deposits, IF revealed stron...
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RE: Hypertension in pregnant patient 1 day ago
This might be a very long shot but worth mentioning, glucocorticoid remediable hypertension present at early age and sometimes get worse with pregn...
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RE: Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 1 day ago
Tough case. The absence of detectable circulating cryoglobulins and extra-renal manifestations of Cryoglobulinemia are a bit atypical but the EM fi...
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Hypertension in pregnant patient 1 day ago
23 y/o F, G2P1001 at 9 weeks gestation, with pmhx of chronic HTN (since 13 years old) and pre-eclampsia in previous pregnancy ( 2016 ), presented t...
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Management of glomerulonephritis secondary to low grade non-Hodkin lymphoma/CLL 1 day ago
Dear all, I would like your opinion on managing this case of glomerulonephritis caused by cryoglobulin from a low-grade lymphoma/CLL. 60-year-ol...
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RE: Lupus, Albuminuria, and persistently positive serologies: 1 day ago
So fast forward, she's on MMF 250 mg BID, and steroids free. 2 questions: 1) At this level of Immune suppression, can she get a live attenuate...
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RE: NSAIDS and CKD 1 day ago
Thanks to this forum I have learned a great deal and become more open minded in the use of NSAIDS in kidney disease. I have utilized some of the ...
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RE: IgG4 related disease with slowly rising IgG4 levels 2 days ago
I would point you to the "IgG4-RD Responder Index" for guidance on disease activity: Development of an IgG4-RD Responder Index - PubMed PubMe...
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RE: Possible hydralazine associated ANCA vasculitis/lupus,/treat or not 2 days ago
Patience repeat complement now normal Creatinine down to 3 from 3.6 Repeat ANCA pending Asked pathologist look again if any if there was any evide...
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RE: IgG4 related disease with slowly rising IgG4 levels 2 days ago
If no contraindication to renal biopsy, maybe a repeat one can give more information about the ''activity'' of the interstitial nephritis. -----...
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RE: Refractory Hypercalcemia of Malignancy with hypophosphatemia (elevated 1,25-OH VitD and PTHrP) 3 days ago
Thank you, everyone, for your kind replies. I have two updates: I had ordered an FGF-23 level a few weeks ago, which has now just shown up...
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RE: Refractory Hypercalcemia of Malignancy with hypophosphatemia (elevated 1,25-OH VitD and PTHrP) 3 days ago
? Try a MAP Kinase inhibitor for palliation? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------...
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RE: IgG4 related disease with slowly rising IgG4 levels 3 days ago
See the data of Choi SJ et al PLoS One. 2023; 18: e0282852) - a rising level of IgG 4 can be associated with relapse, but no one has shown improved...
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RE: IgG4 related disease with slowly rising IgG4 levels 3 days ago
I don't think that anyone has a good evidence based answer to your Challenging question. I would watch and wait.. ------------------------------...
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RE: IgG4 related disease with slowly rising IgG4 levels 3 days ago
Another suggestion : Checking UAlb/Cr and UPr/Cr on same sample of urine or U-protein electrophoresis for tubular proteinuria. ------------------...
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RE: IgG4 related disease with slowly rising IgG4 levels 3 days ago
Doubling of IgG4 level is worrisome. You may want to check CRP and sedimentation rate (elevated in 40 - 50%of patients) and PET-CT scanning. If the...
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RE: Refractory Hypercalcemia of Malignancy with hypophosphatemia (elevated 1,25-OH VitD and PTHrP) 3 days ago
Here’s what may be considered plausible: -The recalcitrant Hypercalcemia is likely from a combination of elevated PTHrp (paraneoplastic), bone met...
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IgG4 related disease with slowly rising IgG4 levels 3 days ago
A 73 yr old male presented to me 2 years ago with an acute deterioration of renal function and his creatinine peaked at 4.5. His renal biopsy showe...
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