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 2 (Aug 2023): End-Stage Kidney Disease is now available online.
RE: Collapsing FSGS post transplant 49 minutes ago
A 2.4 year gap between COVID and onset of Collapsing FSGS makes COVAN very unlikely, as well. Still a puzzle. ------------------------------ Rich...
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RE: Collapsing FSGS post transplant 1 hour ago
Collapsing lesions are quite common in viral and drug-induced FSGS, but seldom seen in maladaptive FSGS, I suppose that the long term consequence o...
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RE: Collapsing FSGS post transplant 2 hours ago
If SAlb is not very low and if FPE is not extensive, donor-recipient size-mismatch with chronic hyperfiltration causing secondary FSGS is a possibi...
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RE: Collapsing FSGS post transplant 5 hours ago
Thanks for the clarification. This is very late for recurrence of Primary FSGS, but I suppose it is possible. The normal Scr and lack of IFTA make ...
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RE: Collapsing FSGS post transplant 11 hours ago
This is unknown. ------------------------------ Pablo Garcia MD Albuquerque NM (732) 925-5825 ------------------------------
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RE: Collapsing FSGS post transplant 11 hours ago
Yes, that is what I meant. We did genetic testing on the patient and on the patient's kidney transplant. ------------------------------ Pablo...
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RE: Collapsing FSGS post transplant 11 hours ago
No vascular changes to go along with chronic CIN. Another piece of information, the creatinine is 0.95 mg/dl ------------------------------ Pabl...
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RE: Collapsing FSGS post transplant 11 hours ago
Was the Donor of West African ancestry? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------...
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RE: Collapsing FSGS post transplant 11 hours ago
You mean Kidney transplant tissue was sent for APOL1genetic analysis and was found to be G0/G0? ------------------------------ Richard Glassock M...
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RE: Collapsing FSGS post transplant 12 hours ago
Since no etiologic factors for de novo were uncovered & late for recurrent (not sure if NS vs NRP), were there any accompanying vascular changes to...
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RE: Collapsing FSGS post transplant 16 hours ago
Thank you. Donor tissue biopsy was analyzed with no APOL1 risk alleles. ------------------------------ Pablo Garcia MD Albuquerque NM (732) 925-...
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RE: Collapsing FSGS post transplant 16 hours ago
Do you know the APOL1 risk alleles of the Donor ? Would give consideration to high dose steroids first and then PLEX , probably with RTX as well, i...
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Collapsing FSGS post transplant 17 hours ago
36 year old Hispanic male with history of ESRD due to tip lesion variant FSGS (biopsy proven) around 20 years ago. Now s/p DDKT 2016 with no compli...
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Nephrology Quiz and Questionnaire 2023 18 hours ago
Calling all nephrology fellows and program directors-we need your help with the Nephrology Quiz and Questionnaire. Fellows, try to outsmart the Nep...
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Nephrology Quiz and Questionnaire 2023 18 hours ago
Calling all nephrology fellows and program directors-we need your help with the Nephrology Quiz and Questionnaire. Fellows, try to outsmart the Nep...
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RE: Non-resolution of proteinuria of native kidney origin during primary non-function of first kidney transplant and prompt resolution of native proteinuria with immediate graft function of second transplant 1 day ago
Dr. Brezin: Thanks for your comments. In our 2005 paper, we discussed whether acute CNI-nephrotoxicity selectively affecting the already chronicall...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 2 days ago
One (obvious) addendum to the above: As u osm reaches the low levels of beer potomania or "tea and toast" then the treatment surely is to provide o...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 2 days ago
That all makes great sense to me, and the only quibble I would add is that I try to avoid salt pills, they taste terrible and you need about six pi...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
I definitely teach the treatment of SIADH as a hierarchy. Obviously, step 1 is remove the inciting agent/pain/nausea is possible but it often isn't...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
Other psychiatric medications have been tried but we're not effective. She was previously taking 300 mg of trileptal twice dialy. We decreased it t...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
She seems like a challenging patient. I would offer the following observations: (1) Oxcarbazepine is the most likely culprit drug. Hyponatremia...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
Thanks. Where are Diet and CRRT in this algorithm.? It suggests that Tolvaptan, Urea and SGLT2 are equivalent in effucacy and safety. Has this been...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
The EFFUSE fluid trial failed to see benefit in fluid restriction + salt tablets + furosemide alone or in combination (although low dose furosemide...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
The hierarchical arrangement of diet, water restriction , oral urea, salt tablets/Furosemide , SGLT2i, Tolvaptan (generic or private label ), Hyper...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
I agree with a trial of SGLT2. I've used it in two patients with acceptable results. Re diet, here in West LA Bev Hills I rec treatment at a spec...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
Thanks for clarifying the exact findings of lower dose Tolvaptan in sIADH disorders.. Rulings by the FDA ate not the nd all of "truth". When in dou...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
I think a better comparison is a Big Mac (or equivalent) which has 25 gms protein and a gram of salt. That alone should prompt quite a bit of free ...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
Nice analysis -thanks. so 3 high-protein "bars" containing about 15 gms. Protein each would add about 250mOSM to the daily osmolal excretion and re...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago
nice discussion, lots here all good points the only solution I dont like is fluid restriction, urea works great. 'If the patient ha...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Sunday, September 24 @ 9:06 AM
Thank you all for your recommendations. I'll pursue the urea route, see how palatable it is and vaptan if all else fails (if insurance willing to p...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Sunday, September 24 @ 8:49 AM
This is a perfect case for UreaAide tablets. They are tasteless and currently 2.5 grams each . You could start her on 3 twice a day and that will p...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 8:59 PM
Yes, a glucose osmotic diuresis might improve hyponatremia in this case, but will it be any better than increase of protein (and salt) in the diet ...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 7:13 PM
If the patient had an extra 15 gram protein bar daily, what are the calculations regarding urea nitrogen generation and how much additional obligat...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 6:32 PM
It seems to me that it is chronic hyponatremia (medication induced SIAD). One approach tested both outpatient and inpatient is iSGLT2 inhibitors. ...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 4:47 PM
This chronic condition patient will continue his psychiatric medication for long time Because of potential hepatotoxicity, tolvaptan should not be...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 2:53 PM
Thank you Dr. Glassock! ------------------------------ Ralph Mohty MD, MPH Fellow Stanford Paradise Valley AZ (602) 509-4310 --------------------...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 2:49 PM
I have seen over correction with 7.5 in the hospital, (see attached link my fellow put this together a few years back) but I think we are really ta...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 2:07 PM
Dr Hirsch, I have seen rapid correction with 15 mg but so far not with 7.5. Unfortunately the other side of the coin is that anyone can prescribe a...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 12:50 PM
I concur with Hirsch and Kirsch (has a nice ring to it). She has isosthenuria and her U Na + K is < P Na, meaning she can excrete free water. T...
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RE: Hypotension In CKD patients With HFrEF or HFpEF Saturday, September 23 @ 12:27 PM
The first questions I have are: is the patient symptomatic; does he have orthostatic hypotension; does he have autonomic dysfunction? If the patien...
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RE: Hypotension In CKD patients With HFrEF or HFpEF Saturday, September 23 @ 11:36 AM
Another perspective on this very thought provoking question - progressive CKD and morality from CVD are "competing risks ". Patients with Non-dialy...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 10:54 AM
Thanks- interesting twist. No generics yet in the USA. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 --...
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RE: renal effects of Nivolumab Saturday, September 23 @ 10:51 AM
Dr. Rodby Agree with your assessment. Sometimes it is better care to step back and not push, particularly in the elderly. Id the Bicarb is under,...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 10:43 AM
Dr, Balan . Reading many of the discussions, it seems that in India, you have more generics and develop hem more quickly than we do here in the s...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 10:41 AM
Gosh I wish we could get talvaptan here in the US, esp for severe hyponatremia with high U osm/ADH levels. In this case, with the Na near 130 and...
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RE: Hypotension In CKD patients With HFrEF or HFpEF Saturday, September 23 @ 8:39 AM
I have found that the BP lowering of the renal and cardio protective agents you have listed to be variable and some better tolerated than others ...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 8:34 AM
Multiple generic brands of tolvaptan are available in our country at around 0.5$ for a tablet of 15 mg. We routinely prescribe this for chronic hyp...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 7:09 AM
Remember - the prescription should be for Samsca, not Jynarque. Same drug (Tolvaptan) but for different indications. ----------------------------...
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RE: C3 glomerulopathy ? Saturday, September 23 @ 5:29 AM
Definitely. Will post the biopsy results once I get them. ------------------------------ Adi Leiba MD Assuta Ashdod University Hospital Kiryat O...
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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 1:56 AM
Would you use the 1/2 FDA dose of 7.5 to start? or 15? ------------------------------ Ralph Mohty MD, MPH Fellow Stanford Paradise Valley AZ (602...
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