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 23: Issue 5 (Dec 2024): Transplantation is now available online.
FSGS and primary Hyperparathyroidism 2 hours ago
I would like to have your kind advice on this case, 40 year old male patient was diagnosed earlier to have steroid resistant primary FSGS with ne...
View Discussion
RE: Nephrotic syndrome and VEGFR inhibitors 2 hours ago
Any ref on TKI interfere with nepherin synthesis --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 ---------------...
View Discussion
RE: Primary Hyperparathyroidism 3 hours ago
Mild hypercalcemia , I think the adjusted ca overestimates hyoercalcemia. Pth while not totally suppressed is not impressive either if it were ...
View Discussion
RE: GN question 3 hours ago
@Richard GlassockThank you very much for the input. What was also confusing is that he developed purpuric rash on dorsum of one hand which looked l...
View Discussion
Primary Hyperparathyroidism 4 hours ago
63 female ckd 4 ( single functioning kidney ) , obstructive uropathy, puj - reflux nephropathy Dec 21 creatinine 1.36 eGFR 36 Adj ca 2.75(2.20-2...
View Discussion
RE: Kfre 4 hours ago
Thanks . And in rapidly varying creatinine ? Someone had dropped 15 ml in 2 years but low kfre and no proteinuria that’s why I asked the questions ...
View Discussion
RE: Nephrotic syndrome and VEGFR inhibitors 8 hours ago
TKI can also interfere with Nephrin synthesis and produce a MCD like lesion. TMA is typically seen with VEGF inhibition -------------------------...
View Discussion
RE: Nephrotic syndrome and VEGFR inhibitors 11 hours ago
This question was discussed recently at rush biopsy rounds on jan 16 You can visit their YouTube channel It was an excellent discussion and may he...
View Discussion
RE: Nephrotic syndrome and VEGFR inhibitors 11 hours ago
Urine sediment and serum lipids? Very heavy proteinuria and hypoalbunemia suggest a podocytopathy (MCD/FSGS/collapsing glomerulopathy) +/- AIN. V...
View Discussion
RE: secondary IgA? 11 hours ago
"His serum Na 132 meq/L, BP was 111/67 Mm Hg". Since he be has history of hypertension, this may be relative hypotension and there is hyponatremi...
View Discussion
Nephrotic syndrome and VEGFR inhibitors 12 hours ago
The patient is a pleasant 55-year-old male with a history of hypertension and metastatic renal cell Ca to the lung/status post lt side nephrectomy ...
View Discussion
RE: secondary IgA? 12 hours ago
Thank you all. His serum Na 132 meq/L, BP was 111/67 Mm Hg. Urine Na came out 71 . Urine protein/creat shows "Normal dilute" -----------------...
View Discussion
RE: Re-Biopsy in LN 1 day ago
My guess is that will not have an answer to this issue question anytime in the near future. ------------------------------ Richard Glassock MD, F...
View Discussion
RE: Gibbs-Donnan effect on potassium bath 1 day ago
While what you say is correct, the system is complicated because of the presence of other ions such as Na and of course more importantly Cl. Albumi...
View Discussion
RE: Re-Biopsy in LN 1 day ago
A question I keep asking my colleagues is when will we move on from cyc/pred in crescentic LN? What will it take? In the modern era for ln, it seem...
View Discussion
RE: secondary IgA? 1 day ago
What is the urine PCR? Because this better for assessment of proteinuria than urine dipstick which is subjected to false positive and negative res...
View Discussion
Gibbs-Donnan effect on potassium bath 1 day ago
I wonder if it is possible to calculate the Gibbs-Donnan effect on dialysate potassium. For example, if a dialysis patient has normal serum albumin...
View Discussion
RE: GN question 1 day ago
Good questions Dr. Venkat , as usual. IgA Vasculitis is not a histopathogical diagnosis, but the absence of capillary wall necrosis/crescents make ...
View Discussion
RE: secondary IgA? 1 day ago
Very good point Dr. Venkat. What is his serum sodium and current BP values? ------------------------------ Richard Glassock MD, FASN Laguna Woods...
View Discussion
RE: Re-Biopsy in LN 1 day ago
The inclination to use CYC based regimens (IV or oral) in the uncommon forms of LN with clinical RPGN and "extensive" crescents (variously defined)...
View Discussion
RE: secondary IgA? 1 day ago
Dysmorphic RBCs and RBC casts, if present currently will favor GN. Decrease of proteinuria may be due to falling GFR. Maintained BP and if hypona...
View Discussion
RE: GN question 1 day ago
@Richard Glassock: Does the lack of subepithelial and/or subendothelial deposits, and PMNs in glomeruli make IgA nephropathy or IgA vasculitis more...
View Discussion
RE: Re-Biopsy in LN 1 day ago
There is crescentic LN with rapidly worsening renal function and crescentic GN with mild/moderate and stable renal dysfunction. One can treat the f...
View Discussion
RE: secondary IgA? 1 day ago
Thank you all for your input. Appreciate it. HRS is in my differential. Checking urine Na. Type 2 is possible. His BP is stable, good urine output ...
View Discussion
RE: secondary IgA? 1 day ago
I fully agree with Dr. Rodby. Thus is very likely secondary IgA deposit disease (not Primary IgAN) in a patient with advanced cirrhosis and HRS. Tr...
View Discussion
RE: Membranous case 1 day ago
This is an early first relapse after successful therapy of PLA2R+ MN, not 'refractory MN.". There is no compelling reason to treat with agents like...
View Discussion
RE: Membranous case 1 day ago
I know it is hard to get anti-CD38 for MN in USA, hopefully the company can get accelerated approve. When patient fails everything including Cyc, m...
View Discussion
RE: secondary IgA? 1 day ago
you have to wonder if his elevated creatinine has more to do with his cirrhosis (HRS?) than his IgAN, to have that creatinine from IgAN without pro...
View Discussion
RE: Membranous case 1 day ago
Dara in SLE papers attached ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associate...
View Discussion
RE: Membranous case 1 day ago
" would try an anti-CD38 both Daratumumab and Isatuximab are approved in Europe." wow, although I have no idea why just bc something is hard to g...
View Discussion
RE: Re-Biopsy in LN 1 day ago
The ALMS trial that found MMF to be equal to CYC, was no powered for RPGN with crescentic lupus nephritis. I would be inclined to use CYC in this...
View Discussion
RE: Membranous case 1 day ago
IF Obinutuzumab not available, would try an anti-CD38 both Daratumumab and Isatuximab are approved in Europe. Felzartamab likely to come soon with ...
View Discussion
RE: secondary IgA? 1 day ago
You can ask to stain the biopsy with KM55, positive and high intensity suggestive of primary IgAN and negative of weak staining suggestive of other...
View Discussion
RE: Re-Biopsy in LN 1 day ago
Agrew with Dr. Venkat that when have LN/RPGN presentations, most of the time, the biopsy will lot change the treatment plan (pulse MPD plus either ...
View Discussion
secondary IgA? 1 day ago
Dear all, need your help in treatment decision making I have a 53 y/o male with HTN and alcoholic liver cirrhosis started raising creatinine sin...
View Discussion
RE: Re-Biopsy in LN 2 days ago
That was Dr Edmund Lewis' approach, (For those of you that dont know, Ed literally wrote the book on lupus nephritis and was the editor of htt...
View Discussion
RE: Re-Biopsy in LN 2 days ago
While I generally agree with Dr. Rodby that management of LN is an art influence by science, the great heterogeneity of LN demands a very personali...
View Discussion
RE: inexplained highly positive CEA antigen 2 days ago
Thank you for your remarks. Concerning ascites, it was transudate. We are now starting the diagnostic procedure for the possibility of chronic lymp...
View Discussion
RE: Membranous case 2 days ago
obi for refractory MGN has good results. see attached; but obi is not that readily available and certainly perhaps not in Portugal? The patie...
View Discussion
RE: Re-Biopsy in LN 2 days ago
@K.K. Venkat I ask myself this question all the time. It used to be that to justify cyclophosphamide (CYC) you really needed the histology. Thing...
View Discussion
RE: GN question 2 days ago
first biopsy "and only mild tubulointerstitial scarring (TO). " second biopsy "There is mild interstitial fibrosis and tubular atrophy invo...
View Discussion
RE: GN question 2 days ago
Thank you very much for the response. There are mesangial deposits. On the first biopsy there was focal interstitial inflammation composed pre...
View Discussion
RE: GN question 2 days ago
Thank you very much for your input. Complement levels are within normal range. From first biopsy the findings were Microscopic Description:...
View Discussion
RE: GN question 3 days ago
As others have said, this is not IgA nephropathy. Was this biopsy read by a renal pathologist? moat people are calling this "staphylococcus-assoc...
View Discussion
RE: Standard of care for nephrology consultation prior to acute hemodialysis 3 days ago
Seeing Dr. Hirsch's comment made me smile. One of my first dialysis nurses was a savant at dialyzing really sick ICU patients. 'Chuck' could dialyz...
View Discussion
RE: inexplained highly positive CEA antigen 3 days ago
@Richard Glassock, the CEA in this patient is higher than expected for CKD alone but given very extensive negative work up assuming Ascites has bee...
View Discussion
RE: inexplained highly positive CEA antigen 3 days ago
I did not realize that CKD alone could produce serum CEA levels > 500ng/ml. In the quoted paper the elevation in CEA was quite modest, not approach...
View Discussion
RE: Re-Biopsy in LN 3 days ago
Dr. Venkat - thanks for your excellent question-ones that have been asked, but not answered for over 50 years. We lack the RCT that examines the ou...
View Discussion
RE: Re-Biopsy in LN 3 days ago
I believe that following are the scenarios wherein initial or repeat kidney biopsy is most useful in LN patients: 1. Slowly increasing SCr, slowly ...
View Discussion
RE: Re-Biopsy in LN 3 days ago
@Richard Glassock @Roger Rodby: in a patient presenting with acute nephritic or RPGN features (+/- nephrotic range proteinuria), normal sized kidne...
View Discussion