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 24: Issue 2 (May 2025): Hypertension is now available online.
RE: Bartter's syndrome vs primary hyperaldosteronism 6 minutes ago
If the actual anion gap is around 10 and the serum HCO3 of 30 is correct then it would appear to be a metabolic alkalosis with the serum Cl an erro...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 1 hour ago
Dr. Campese.- would a PRA of 5.1during the first trimester of a normal pregnancy be regarded a a 'suppressed " value since the PRA is reported to b...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 1 hour ago
Thank you for answering my inquery. Yes, we need to figure out what the urine can tell us Exactly what I was hoping for. We do depend too much on p...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 2 hours ago
normotensive hypokalemia metabolic alkalosis that develops in pregnancy? $$$ is it Gitelman I suppose you should check urine diuretics to...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 3 hours ago
Dr Balan You also use lower dose of mmf in your patients as compared to Caucasian population --------------------------------- Bajinder Reen MD ...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago
How does the stage of pregnancy (25 weeks) alter the evaluation in terms of ipper limits" for the renin levels and other parameters. If Barters is ...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 4 hours ago
I too agree with the excellent points made by Dr Hirsch. The treatment would be maximum dose of ARB with chlorthalidone and then SGLT2i both for an...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago
The serum magnesium values are low at .77 mmol/l which is in the normal range . The urine calcium excretion has also been provided in the spot urin...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 4 hours ago
See the full report ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------------...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 4 hours ago
Thanks to Drs. Glassock, Reen and Venkat for prompt comments. Patient has been getting MMF 500 mg twice daily for one year. This is a lower dose th...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 4 hours ago
Can you give us the complete biopsy report? What were the immunofluorescence findings? Did the EM show complete foot process effacement? Was a s...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago
Since both Primary Hyperaldosteronism and Barrter Syndrome cause Hypercalciuria (especially when a high NaCl diet is consumed) I doubt that a urine...
View Discussion
RE: 76 Y/O patient who develops Kaposi while on treatment for MCD 4 hours ago
Kaposis sarcoma has been reported in patients treated with rituximab in both HIV positive and negative individuals. I do not think that seems bette...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 4 hours ago
> Whether they increase proteinuria or not (there is other evidence that they do), they do not decrease proteinuria. IMO, in a proteinuric patien...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 5 hours ago
What is the current urine PCR? With initial urine PCR of 1.4 g/g, SAlb of 2.8 g/dL appears lower than what would be expected from urinary protein l...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago
Thank you for sharing this fascinating case and to everyone who has contributed such thoughtful input. I agree with many of the observations alread...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 5 hours ago
Reference provided by DoctorGlassock is actually Blish inCkJ on line on July 7, 2025 --------------------------------- Bajinder Reen MD Etobicok...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago
More likely than not this patient has Gitelman syndrome which, on occasion, can manifest itself for the first time during pregnancy . Check serum...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago
sorry, distal RTA less likely or at least confounded by the metabolic alkalosis here. but bartter-like from SLE tubulopathy with hyperaldo could st...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago
This patient does not have primary aldosteronism. Renin and aldosterone levels are both high which is normal during pregnancy. This increase is ...
View Discussion
RE: 76 Y/O patient who develops Kaposi while on treatment for MCD 5 hours ago
In this case, it is very likely that the MCD is secondary to the Thymoma. The role of RTX (or other CD20 antibodies ) for therapy is not well under...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago
I agree with Prof Glassock that true Bartter syndrome is very unlikely. The genetic form is usually apparent very early in life and requires massiv...
View Discussion
76 Y/O patient who develops Kaposi while on treatment for MCD 7 hours ago
A 76-year-old woman with a history of hypertension, bilateral mastectomies for breast cancer 20 years ago, and hemicolectomy for a polyp with high-...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 10 hours ago
See this recent report - very relevant to this case. Jia X, et al NDT 2025; 18, July 7, combined IS is highly effective in Class I/Ii Lupus Nephrit...
View Discussion
RE: Treatment of Lupus Nephritis Class II (PLUS) 12 hours ago
Is she taking the MMF? What is the prescribed dose of MMF? . Before starting additional IS, such as Belimumab, I would check a trough serum MPA lev...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 12 hours ago
Doe the increased proteinuria induced by DHP-CCBs is a theoretical concern and not clinically significant as this study showed no meaningful increm...
View Discussion
Treatment of Lupus Nephritis Class II (PLUS) 13 hours ago
27 y/o female presented for nephrology consultation with c/o swelling feet and proteinuria in March, 2024. She had earlier been diagnosed having SL...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 21 hours ago
I agree Barrter Syndrome seems very unlikely. Would a plasma renin concentration or a saline suppression test be of value. --------------------...
View Discussion
RE: Elevated BUN evaluation 23 hours ago
Using the data provided and making some simplified assumptions of urea transport and metabolism (which are crude approximations), the BUN in this s...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 23 hours ago
Thank you Dr. Awais. But usually the renin is very high in Bartters syndrome? The Renin is within normal limit, how may hyperaldosteronism be e...
View Discussion
RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago
With this BP and Renin at upper end of normal looks like Barrters. Urine Na and Cl are high too suggesting renal wasting rather than Aldosteronism ...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago
I agree with Dr Campese that the requirement for RASI is based on proteinuria (and I also agree with his excellent comments on BP). However, presen...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago
In patients with diabetic kidney disease and proteinuria> 0.5 g/d the evidence is in favor of using RASi as first line. In patients without signifi...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago
The combination of RAAi with DHP-CCBs lessen the increment of intraglomerular pressure observed with DHP-CCBs as it also decrease the pedal edema. ...
View Discussion
Bartter's syndrome vs primary hyperaldosteronism 1 day ago
Dear colleagues and professors, I would like to share with you this case which I found puzzling. 25 year 11 weeks pregnant lady, who is a known...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago
Complete agreement. Hypertension in DKD has a very prominent volume component which cannot be overlooked. Attached below is a comment by Dr Solei...
View Discussion
RE: Elevated BUN evaluation 1 day ago
The sarcopenia appears to be reflected by the Cr level of .4 mg/dl (presumed baseline). As mentioned by others, in the face of AKI, due to kidney h...
View Discussion
RE: Elevated BUN evaluation 1 day ago
If available, I would obtain a measured GFR in this patient. If not available, I would do a 24 hour urinary creatinine clearance. ---------------...
View Discussion
RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago
RASi ate always first choice for therapy of hypertension In DKD. I prefer to combine them with diuretics (chlorthalidone) if needed and try to av...
View Discussion
RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago
I think that OBI + MMF + hydroxychloroquine is the best option for this patient. Belimumab probably will not do much with this degree of proteinuri...
View Discussion
DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago
2022 KDIGO guidelines recommend dihydropyridine calcium channel blockers (DHP-CCBs) or diuretics as second-line antihypertensive agents in diabetic...
View Discussion
RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago
Thank you for your responses: Dr Abra: I actually like this option, between Rituxilup and the Nobility trial Dr Campese: The patient was p...
View Discussion
RE: Diffuse proliferative GN 1 day ago
Agree for infective endocarditis related proliferative GN and new 2023 criteria including PCR for microbiological diagnosis, CT scan and even FDG P...
View Discussion
RE: Elevated BUN evaluation 2 days ago
My assumption was both volume depletion with high protein. wondering why the sarcopenia adds to the situation. wouldn't this contribute to less end...
View Discussion
RE: Elevated BUN evaluation 2 days ago
"But I see that there is tripling in serum creatinine from baseline (0.4 to 1.1) and if this couple with high serum cystatin-c, doesn't this indica...
View Discussion
RE: Elevated BUN evaluation 2 days ago
Agree with the quintuple whammy to explain this scenario. But I see that there is tripling in serum creatinine from baseline (0.4 to 1.1) and if th...
View Discussion
RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 2 days ago
The information provided that this is a case of class III/V LN and not pure class V and so my choice would be MMF plus Belimumab if non-nephrotic a...
View Discussion
RE: Elevated BUN evaluation 2 days ago
I have also been a big proponent of FE UN as an index of kidney status in acute situations (both for renal perfusion and catabolic rate). In this c...
View Discussion
RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 2 days ago
The patient was admitted with anasarca and AKI. I presume UACR was high and sAlb very low. In this contest, I would like to know more about the r...
View Discussion
RE: Elevated BUN evaluation 2 days ago
I assume this patient is not on steroids or a tetracycline which can increase BUN level. Doxycycline is the only tetracycline with lesser effect of...
View Discussion