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 2 (Jun 2024): Electrolytes and Acid-Base Disorders is now available online.
RE: Glomerular Proteinuria now? 56 minutes ago
The quote by Hippocrates simply says do no harm. This is a vague statement, subject to individual interpretation, but it does not say do nothing. ...
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RE: Glomerular Proteinuria now? 1 hour ago
I'm not saying this applies here, but Primum non nocere does not alway mean Primum do nothing. Sometimes doing nothing can be equally harmful. I...
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RE: isolated. vit d 1,25 elevated 1 hour ago
My gut tells me you are going to do testing and still not have a definitive diagnosis and you will be left with empiric treatment I would still giv...
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RE: proteinuria and pyuria in Chron's pt on JAKi 1 hour ago
Chrons, I would add Secondary AA amyloid. I should biopsy but also hold on steroids pending results. ------------------------------ Roger Rodb...
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RE: To biopsy or not to biopsy 1 hour ago
nice discussion as usual but I would never biopsy this patient with no hematuria. I dint see the answer of whether or not on Hydralazine, might ...
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RE: To biopsy or not to biopsy 1 hour ago
> It was a long time ago, a different world, but not only did we not have RAASIs but the benefits of both tight BP and glycemic control were disp...
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RE: To biopsy or not to biopsy 3 hours ago
Excellent question. The decision about performing a kidney biopsy of native kidney in patients with advanced CKD (e.g. Stage IV CKD ) is influenced...
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RE: To biopsy or not to biopsy 3 hours ago
Did the recent repeat US show further increase in echogenicity/cortical thinning? Regarding GFR cutoff vis-a-vis non-utility of biopsy: rather th...
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RE: To biopsy or not to biopsy 4 hours ago
ANCA panel was negative too Dr Glassock ------------------------------ Mohamed Anwar Abdus Samad MD WellSpan Medical Group York PA --------------...
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RE: To biopsy or not to biopsy 4 hours ago
Thanks for your input Dr Hirsch. I tried ACEi with thiazides but he ended up having hypovolemia and hyponatremia as well. I haven't attempted oral ...
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RE: To biopsy or not to biopsy 4 hours ago
Thank you so much Dr Glassock for your input. I did not know about the differences in antidsDNA specificity with different assays. Good to know. Yo...
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RE: To biopsy or not to biopsy 5 hours ago
Also agree, and noting absence of hematuria. Plus, there is a noticeable lack of acuteness or acceleration to this CKD, arguing against a superimpo...
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RE: To biopsy or not to biopsy 15 hours ago
Thanks. Though case but I agree with your decision not to biopsy. It is a fairly common issue. Anti-ds -DNA antibodies vary in terms of specificity...
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To biopsy or not to biopsy 18 hours ago
Dear community members, I would appreciate your input on this patient of mine on whom I am debating whether or not to do a kidney biopsy. I f...
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RE: proteinuria and pyuria in Chron's pt on JAKi 22 hours ago
Thank you Dr Venkat. Yes, I thought of Ig A but for the same reason as you mentioned was not convinced. If it is Ig A , With improved inflammation ...
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RE: proteinuria and pyuria in Chron's pt on JAKi 1 day ago
Two possibilities come to mind: 1. IgA nephropathy because of its known association with IBD. However, lack of hematuria recently is atypical. 2. S...
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RE: isolated. vit d 1,25 elevated 1 day ago
I am curious when your patient last had a colonoscopy and/or if he had diarrhea. Crohn's disease is a reported cause of an elevated 1.25 dihydroxy ...
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RE: proteinuria and pyuria in Chron's pt on JAKi 1 day ago
Thank you for your input , Dr Glassock. --------------------------------- Asad Riaz Indianapolis IN ---------------------------------
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RE: Glomerular Proteinuria now? 1 day ago
"Do no harm" (primum non nocere, or ὠφελέειν ή μὴ βλάπτειν from Hippocrates). I would treat conservatively. ------------------------------ J...
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RE: proteinuria and pyuria in Chron's pt on JAKi 1 day ago
The UACR/UPCR ratio is more suggestive of a glomerular disease. I would do a kidney biopsy and not use empiric steroid therapy. Opinion only. -...
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proteinuria and pyuria in Chron's pt on JAKi 1 day ago
30 YOF with hx of chron's disease, on upadacitinib ( JAK 2 inhibitor) , CKD 2 with biopsy proven AIN/CIN in 2007 ( presumed to be 2/2 mesalamine) w...
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RE: Glomerular Proteinuria now? 1 day ago
Plenty of room on this site for a diversity of opinions on an obviously very difficult, largely philosophical question . I think that those who adv...
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RE: isolated. vit d 1,25 elevated 1 day ago
will order it via mayo with his followup in 9/2024, but renal function cr now 2, vit d active and calcium are now normal on pred 20mg daily this we...
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RE: isolated. vit d 1,25 elevated 1 day ago
Would anyone do a serum 25 hydroxy vitamin D to 24,25 dihydroxy Vitamin D ratio in this case to evaluate the possibility of an acquired auto-immune...
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RE: isolated. vit d 1,25 elevated 1 day ago
damm it, sorry i missed it. as level was 51 but didnt realize ace level 51 post steroids, i had ordered labs on 6/7 but pt pt got started on steroi...
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RE: Glomerular Proteinuria now? 1 day ago
I agree that there is no proven cure for AA amyloidosis once developed. The question is, would you tell the patient that they have incurable diseas...
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RE: Glomerular Proteinuria now? 1 day ago
I think you are being realistic, and I agree with you. ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 ----------------...
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RE: Glomerular Proteinuria now? 1 day ago
I find it difficult to understand how knowing that one has an untreatable disease will help the patient cope with the disabilities that accompany t...
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RE: isolated. vit d 1,25 elevated 1 day ago
ACE was 2 on and <14 one repeat before steroid use (Normal range 14-82) afterwards, 12 and 10. best, ------------------------------ Jin...
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RE: Glomerular Proteinuria now? 1 day ago
spastic quadriplegic with possible osteo , likely chronic decubuti, Creatinine is 0.8 but this is likely severe CKD given muscle mass, This is...
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RE: isolated. vit d 1,25 elevated 1 day ago
What was the ACE level before starting steroids? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Med...
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RE: isolated. vit d 1,25 elevated 1 day ago
Hi, Dr. Glassock, I did not exclude 24 hydroxylase deficiency yet since the patient started to have kidney stones in 40s, no family history. Howe...
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RE: Glomerular Proteinuria now? 2 days ago
Subjecting this quadriplegic patient to a kidney biopsy can be justified ONLY if the treating physician and the patient agree upfront that he is an...
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RE: Glomerular Proteinuria now? 2 days ago
Labial salivary gland biopsy is more sensitive than fat pad and is also minimally invasive. I would biopsy the kidney if not contraindicated, this ...
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RE: isolated. vit d 1,25 elevated 2 days ago
I would think the genetic mutation x 2 from different gene lab would have picked it up, will try to send as miscellaneous. ---------------------...
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RE: isolated. vit d 1,25 elevated 2 days ago
I didn't check , but will do, thank you, that is easy to be get then petscan ------------------------------ Shivangi Patel Nephrology Morristo...
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RE: isolated. vit d 1,25 elevated 2 days ago
yes will keep you posted petct is only thing i have not done, shivangi ------------------------------ Shivangi Patel Nephrology Morristow...
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RE: isolated. vit d 1,25 elevated 2 days ago
Has 24 hydroxylase deficiency been excluded fir diagnostic possibilities? ------------------------------ Richard Glassock MD, FASN Laguna Woods C...
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RE: isolated. vit d 1,25 elevated 2 days ago
Hi, Dr. Patel, I am the author of the paper Dr. Aledan attached in his reply. I am taking care of a patient similar as yours. He is currently...
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RE: Glomerular Proteinuria now? 2 days ago
How about fat pad Bx Or rectal gingival Bx Believe SAP SCAN NOT available in USA although management will not change as mentioned by Dr Glassock...
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RE: Glomerular Proteinuria now? 2 days ago
The UACR value is simply to high to be explained by anything over than glomerular disease, unless the urine is frankly liipiduruc and full of chylo...
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RE: IgA nephropathy with active disease 2 days ago
The EM findings are not at all suggestive of a COLIV Glomerulopathy. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (94...
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RE: IgA nephropathy with active disease 2 days ago
When there is a discrepancy between the clinical and the histopatholigical picture like this case . Shall we think of co occurring of another patho...
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RE: PLA2R Associated Membranous Nephropathy With No Clinical Remission 2 days ago
Thanks --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt ---------------------------------
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RE: Glomerular Proteinuria now? 2 days ago
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RE: PLA2R Associated Membranous Nephropathy With No Clinical Remission 2 days ago
Yes- i know- if you want to avoid steroids, RTX is preferred for therapy of MN. Thanks. ------------------------------ Richard Glassock MD, FASN ...
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RE: PLA2R Associated Membranous Nephropathy With No Clinical Remission 2 days ago
Iv Cyclophosphamide was with steroid --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt -----------------------------...
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RE: PLA2R Associated Membranous Nephropathy With No Clinical Remission 2 days ago
By the way, no studies exist, that I am aware of, that have demonstrated efficacy of IV CYC regimens (without steroids ) in therapy of PLA2R or non...
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RE: PLA2R Associated Membranous Nephropathy With No Clinical Remission 2 days ago
Thank u 💓 @Roger Rodby @Richard Glassock --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt -------------------------...
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RE: PLA2R Associated Membranous Nephropathy With No Clinical Remission 3 days ago
If the Anti-PLA2R antibody is 50RU / ml (by ELISA) I would be inclined to give RTX at 6 months. If the -PLA2R is > 2[More]
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