ASN represents more than 21,000 kidney health professionals working to help people with kidney diseases and their families. Created with input from all of ASN's constituencies, the new ASN logo allows the society to continue our growth and work toward a goal of a world without kidney diseases.
The latest Nephrology Self-Assessment Program (nephSAP) issue, Volume 22: Issue 1 (Apr 2023): Disorders of Divalent Ions, Renal Bone Disease and Nephrolithiasis is now available online.
RE: Alkaline urine in primary hyperaldosteronism 6 minutes ago
I believe that aldosterone mediated increase in pendrine abundance in distal tubules could help to explain the alkaline urine. There is good eviden...
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RE: Alkaline urine in primary hyperaldosteronism 14 minutes ago
IN Primary hyperaldosteronism , distal tubule Na+ for H+ exchange should generate enough urinary H+ to keep the urine on the acidotic side. Experim...
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RE: Alkaline urine in primary hyperaldosteronism 52 minutes ago
I suspect the renal HCO3 generation can persist as a consequence of H secretion regardless of the serum concentration of HCO3 or urine pH. This may...
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RE: Screening for CKD 1 hour ago
I am concerned that all this would do is identify more mild non-progressive CKD in older patients, that seem to be filling my clinic as a result of...
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Screening for CKD 1 hour ago
A lot of interest in screening asymptomatic subjects for CKD is being expressed on SoMe. Do you think that population -based screening of adults ) ...
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RE: Plasma Cell Rich TCMR 16 hours ago
Would it be worth trying Anti-plasma cell treatments like Bortizomib in this situation if the viral and drug induced causes have been ruled out? ...
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RE: Alkaline urine in primary hyperaldosteronism 22 hours ago
If K+ depletion effect on PCT cell pH dominates, intracellular acidosis leads to increased ammoniagenesis. Indeed, many pts with PA are hypocitratu...
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RE: Alkaline urine in primary hyperaldosteronism 22 hours ago
Thanks for these replies. I thought about this, but this would be incompatible with maintenance of the metabolic alkalosis (presuming the typical a...
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RE: Alkaline urine in primary hyperaldosteronism 23 hours ago
I think Dr. Rodby may be correct - the bicarbonaturia regularly seen in Primary Aldosteronism may be a phenomenon of increased filtered load of HCO...
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RE: Alkaline urine in primary hyperaldosteronism 1 day ago
well I think you should remove that table from your lecture. I am being a bit facetious, but the problem with teaching physiology often is just thi...
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Alkaline urine in primary hyperaldosteronism 1 day ago
I gave a lecture on urinalysis to medical students with a table listing causes of alkaline urine, including primary hyperaldosteronism. Many studen...
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RE: Undetectable FGF23 found when hypophosphatemia normalized 1 day ago
Just curious. I would like to hear from the experts concerning the indications for testing for the serum level of FGF23. Also, when ordering a FGF2...
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RE: Undetectable FGF23 found when hypophosphatemia normalized 1 day ago
This patient has CKD stage 3B- isn't the elevated IPTH the result of CKD? Akso, I thought that serum FGF23 was increased in primary Hyperparathyroi...
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RE: Undetectable FGF23 found when hypophosphatemia normalized 1 day ago
Inappropriately high phosphate excretion in this case Urinary phosphate excretion above 100 mg/day or a FEPO4 above 5 percent is indicative of rena...
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RE: Plasma Cell Rich TCMR 1 day ago
Rarely, IgG4-related disease can occur in the allograft. It can manifests as plasma cell rich inflammation and tubulitis. Plasma cells stain for Ig...
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RE: Plasma Cell Rich TCMR 1 day ago
If other causes of a plasma cell infiltrate as mentioned by Dr Rubin have been ruled out, then the prognosis for this type of rejection is usually ...
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RE: AKI after start of Tolvaptan for PKD 1 day ago
The effects of AVP peptide(vasopressin) includes activation of V2 receptors which stimulate the formation of cyclic AMP (cAMP) and phosphorylation ...
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RE: Lupus nephritis and Pregnancy 1 day ago
It is clear that this lady has active lupus nephritis and with a fairly advanced pregnancy. I find the thought that tacrolimus would cause abnormal...
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RE: AKI after start of Tolvaptan for PKD 1 day ago
in the discussion so far there has been no mention of the solute load generated by the patient that determines the amount of water the patient has ...
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RE: Plasma Cell Rich TCMR 1 day ago
It appears that this patient is months to years out from transplantation. Questions: 1. Current UAlb/Cr or UPr/Cr? 3. Has SCr been stable around 4...
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RE: AKI after start of Tolvaptan for PKD 2 days ago
Agree, but the question remains: Why or how does talvaptan cause a hemodynamic change big enough to lead to a significant drop in GFR? That seems u...
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RE: Plasma Cell Rich TCMR 2 days ago
This is the reference for the use of IVIG in this situation: Adrogue HE, Soltero L, Land GA, Ramanathan V, Truong LD, Suki WN. Immunoglobulin thera...
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RE: Plasma Cell Rich TCMR 2 days ago
As you know a plasma cell rich infiltrate can be seen in rejection (which tends to be very resistant to treatment) but also in viral nephropathy (s...
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Plasma Cell Rich TCMR 2 days ago
A 30 years old woman with kidney transplant (ESKD due to SLE). She is in TAC 1 mg bid, MMF 500 mg bid and prednisolone 5 mg od. Developed slowest i...
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RE: AKI after start of Tolvaptan for PKD 2 days ago
Agree- this is very likely not Acute Kidney "Injury" but "just" a hemodynamic adjustment . ------------------------------ Richard Glassock MD, F...
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RE: AKI after start of Tolvaptan for PKD 2 days ago
Acute drops in eGFR with tolvaptan has been previously described: One study looked at acute hemodynamic changes with tolvaptan. Median eGFR drop w...
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RE: Lupus nephritis and Pregnancy 3 days ago
Hi Gurwant, I don't think this is tacrolimus effect esp when it has been subtherapeutic. What were the earlier fetal growth scan. Does fetus have I...
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RE: AKI after start of Tolvaptan for PKD 3 days ago
Sheldon, let me "phone a friend" on the effect of tolvaptan on Na excretion @JuanCarlosVelez ------------------------------ Roger Rodby MD, ...
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RE: Treatment of Renal limited anti GBM disease 3 days ago
Thank you both for your valuable input. ------------------------------ Jaideep Hingorani MD Charlotte Nephrology Associates, P.A. Port charlotte ...
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RE: AKI after start of Tolvaptan for PKD 3 days ago
thank you and happy to let group know next BMP on Tolvaptan but off the thiazide ------------------------------ Alan Friedman MD Kidney Medical ...
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RE: AKI after start of Tolvaptan for PKD 3 days ago
To Dr Balan: Good point but may not apply to a patient on talvaptan (or those on forced water drinking) To Dr Rodby: That's the classic teaching an...
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RE: AKI after start of Tolvaptan for PKD 3 days ago
I was taught that diuretics are relatively contraindicated in adpkd due to the fact that progression of CKD is faster if a diuretic is used to cont...
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Lupus nephritis and Pregnancy 3 days ago
Seeking expert opinion on LN in pregnancy 30.2 w POG G1P0. Question: Is tacrolimus really needed esp. if remains sub-therapeutic? 27 F, adopted, ...
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RE: Proteinuria in IgA nephropahy 3 days ago
If I understand correctly from above discussion, since patient is already on Benazepril, next drug to add would be SGLT2i - Dapagliflozin Only if ...
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RE: Treatment of Renal limited anti GBM disease 3 days ago
I agree with Dr.Friedman that this is irreversible kidney disease so it would be futile to expect any recovery of kidney function with re-treatment...
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RE: Proteinuria in IgA nephropahy 3 days ago
The newer drugs ( sparsentan and budesonide) were studied on patients on RAASi alone not RAASi with SGLT2i, so it is unclear what effect they may h...
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RE: AKI after start of Tolvaptan for PKD 3 days ago
I suspect it is the thiazide more than anything. Water loss represents so little intravascular volume. If it were significant, you should see hype...
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RE: AKI after start of Tolvaptan for PKD 3 days ago
Some patients do not realize the water intake committment needed to be on Jynarque. Hopefully, you patient has reversible volume and hypotension re...
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RE: AKI after start of Tolvaptan for PKD Thursday, May 25 @ 10:12 AM
thank you ------------------------------ Alan Friedman MD Kidney Medical Associates Bronx NY ------------------------------
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RE: Proteinuria in IgA nephropahy Thursday, May 25 @ 10:09 AM
Dear Dr Glassock I thought mmf was studied in Chinese population Do you still suggest to use of mmf in Caucasian population --------------------...
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Lupus nephritis and Pregnancy Thursday, May 25 @ 9:59 AM
Seeking expert opinion on LN in pregnancy 30.2 w POG G1P0. Question: Is tacrolimus really needed esp. if remains sub-therapeutic? 27 F, adopted,...
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RE: Proteinuria in IgA nephropahy Thursday, May 25 @ 9:53 AM
I agree that this patient is a good candidate for SGLT2i therapy, if high-grade hematuria is also present I might consider MMF as well. I am uncert...
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RE: Psychiatric Patients and Dialysis Thursday, May 25 @ 9:09 AM
Privilege is a special right, advantage, or immunity granted or available only to a particular person or group: It is singular. A right may be inal...
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RE: AKI after start of Tolvaptan for PKD Thursday, May 25 @ 8:54 AM
yet to see it, but I must admit I have not always checked sCR/GFR, 2 weeks after starting Tolvaptan as diligently as you have. I will do it next ti...
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AKI after start of Tolvaptan for PKD Thursday, May 25 @ 7:42 AM
40 yo woman know PKD (no genetic testing) with strong +FH (mother, uncle) started on starting dose of Jynarque/Tolvaptan two weeks ago BP well cont...
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RE: Unusual GN with "full house" and Hepatitis D Thursday, May 25 @ 6:51 AM
Why don’t GI/ID offer to treat the HBV too with a renally-friendly/adjusted NA like entecavir despite suppressed HBV DNA (in blood; expected with H...
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RE: Psychiatric Patients and Dialysis Thursday, May 25 @ 6:44 AM
Dr. Salman's comments and questions are very important and germane. In response to his question about healthcare being a human right, I would sugge...
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RE: Unusual GN with "full house" and Hepatitis D Thursday, May 25 @ 1:23 AM
Thanks Dr Glassock. Her current creatinine is around 3, improving a bit from resolution of the ATN component. Currently around 3 g proteinuria. Yes...
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RE: Treatment of Renal limited anti GBM disease Wednesday, May 24 @ 11:12 PM
Given severe clinical/pathological initial presentation (creat 15, dialysis-requiring, > 90% crescents) with (therefore expected) ongoing dialysis-...
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RE: Psychiatric Patients and Dialysis Wednesday, May 24 @ 11:04 PM
I understand where you ate coming from, Dr Hirsch. As an immigrant from Post WWII , my family initially lived in an inner city community of Philade...
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