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 3 (Aug 2024): Acute Kidney Injury and Critical Care Nephrology is now available online.
RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 5 hours ago
There is not a lot of data on RItux for IgAN, or IgA vasculitis, BUT, I would want to add something besides steroids And I think Cresentic IgAN...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 6 hours ago
Please post the outcome in a few weeks. I hope that RTX works. Curiously, RTX does not work in IgAN but does seem to work in IgAV. --------------...
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RE: Membranous Nephropathy 6 hours ago
We do not have a KB , but based on a + antiPLA2R this is most likely a primary PLA2R associated MN, not idiopathic MN --------------------------...
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RE: HBV Viremia 6 hours ago
Mycophenolate salts have not been implicated in reactivation or susceptibility to incident HBV infection. Some evidence exists that Mycophenolate s...
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HBV Viremia 6 hours ago
Dear All Would appreciate your inputs on the following patient, A 50 yr female , c/o LRDT recipient ( unrelated donor ) /ATG-TMS/ primary disease...
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RE: Membranous Nephropathy 9 hours ago
Since the RVT was L-sided (L already more common than R because of its greater length) & he’s very slim & ‘small’, I assume that’s what you meant b...
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RE: Membranous Nephropathy 9 hours ago
Yes very unusual presentation as never saw patient of MN presented with thromboembolism and on work found to have MN ----------------------------...
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RE: Membranous Nephropathy 9 hours ago
Thanks for input regarding thrombophilia testing but he never has family history of any thrombotic event ------------------------------ Samee Kha...
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RE: Membranous Nephropathy 9 hours ago
Sir his albumin is 3.4g/dl ,very smart and having smoking as risk factor now on anticoagulants , biopsy not performed as hi Anti PLA2R found to be ...
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RE: Membranous Nephropathy 9 hours ago
He has smoking as risk factor very slim and smart age in thirtees having serum albumin 3.4g /dl ------------------------------ Samee Khan MBBS...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 11 hours ago
thank you Dr Glassock! will do! --------------------------------- Mohammed Ashraf MD, FASN MD Lynchburg Nephrology Physicians Lynchburg VA (43...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 11 hours ago
I would add RTX and taper steroids, based on observational studies. With 25% crescents the prognosis is poor. ------------------------------ Ric...
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RE: Membranous Nephropathy 12 hours ago
Dear if he is not having any other risk factor for dvt and pulmonary embolism,it's very unusual to have thrombosis with 1002 mg /24hrs protienurea ...
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IG A Vasculitis with diffuse profoliferative crecentivrabout 12 hours ago
dear all I would appreciate comment about my patient, regarding manageme of IGA vasculitis and kidney biopsy showing diffuse proliferative glomerul...
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RE: Membranous Nephropathy 14 hours ago
Maybe genetic testing for Factor V Leiden mutation would be reasonable. ------------------------------ Richard Glassock MD, FASN Laguna Woods C...
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Tolvaptan for PCKD 14 hours ago
wondering about dose titration with Tolvaptan for PKD I have had a patient that I have kept on the lowest dose (45mg am 15mg pm) because her urin...
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RE: Membranous Nephropathy 15 hours ago
Good morning, I also agree with treating this patient with Rituximab and, for managing both hypertension and proteinuria, I'd suggest considering A...
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RE: Membranous Nephropathy 16 hours ago
Does he have other risk factors for hypercoagulability? Obesity, immobilization, smoking, trauma? Having recent thrombotic event and being on antic...
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RE: TRANSPLANT QUESTION: mycophenolate dosing 19 hours ago
Thank you very much for your comments! Charite spent quite a lot of energy in building up a tool for measuring mycophenolate exposure. Attach...
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RE: A middle aged lady with IgA Nephropathy 1 day ago
The rationale of a suggested conversion to Sparsentan is very reasonable, but we lack supportive evidence (RCT or Observational) in patients with a...
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RE: TRANSPLANT QUESTION: mycophenolate dosing 1 day ago
Because of excessive multi-factorial variation of pharmaco- kinetics of MMF and MPA should monitoring of blood MPA levels orAUC become a routine pa...
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RE: TRANSPLANT QUESTION: mycophenolate dosing 1 day ago
Given risk of nephrotoxicity/diabetogenicity/ cosmetic and neurological adverse effects/hyperkalemia/hypomagnesemia/hyperlipid-emia/hypertension, e...
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RE: Choice of therapy - or none - for IgA nephropathy 1 day ago
Anything but oral steroids, Budesonide , MMF, Azathioprine, Cyclophosphamide, Tacrolimus, Cyclosporin, ACTH, Leflunomide, Mizoribine, Tonsillectomy...
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RE: Membranous Nephropathy 1 day ago
I don't think that a kidney biopsy has been done, but MN (PLA2R+ ) is highly likely. (> 95%) I think I would probably treat him with RTX now. ---...
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RE: Membranous Nephropathy 1 day ago
RVT and PE with 1 gram of proteinuria would be very unusual indeed! What are his serum albumin and creatinine? Even if this were resolving MGN, ...
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RE: Choice of therapy - or none - for IgA nephropathy 1 day ago
I will not disagree with anything above, his proteinuria is low but clearly he has progressed. Speaks volumes about what we are learning about the ...
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Membranous Nephropathy 1 day ago
Dear all i want guidance regarding a case of 36 years old male who presented with sudden onset of dry cough and increased blood pressure of 170/100...
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RE: Choice of therapy - or none - for IgA nephropathy 1 day ago
In my opinion, Budesonide (or oral systemic steroids) have a low likelihood of being beneficial in the absence of hematuria and with the biopsy fin...
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RE: Choice of therapy - or none - for IgA nephropathy 1 day ago
Pentoxyphylline is an interesting suggestion. So far as I know the Reno -protective effect of this old drug has never been tested in IgAN. It does ...
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RE: Choice of therapy - or none - for IgA nephropathy 1 day ago
Perhaps another gestalt consideration for this unfortunate young with marked and progressive decline in his renal function, from an inflammatory GN...
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RE: A middle aged lady with IgA Nephropathy 1 day ago
Dear All Thank you for your suggestions . The goal is to have a better BP control and delay the progression to ESKD. Will share and empower the f...
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RE: Choice of therapy - or none - for IgA nephropathy 1 day ago
Insufficient sample is problematic. Especially that we are leaning to dismiss the old diagnosis of IgAN, which is a possibility. What was his bi...
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RE: A middle aged lady with IgA Nephropathy 1 day ago
Two very atypical "IgAN" cases in a row, what are the odds for this. I agree that with a MPGN pattern of injury (very uncommon in IgAN) one must se...
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RE: TRANSPLANT QUESTION: mycophenolate dosing 1 day ago
Agree! With higher dose unless side effects ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Directo...
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RE: TRANSPLANT QUESTION: mycophenolate dosing 1 day ago
Hi Christian, The MMF dosing is not universal as the individuals response is not. Some centers tend to start with MMF doses up to 1250 or 1000 mg...
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RE: Tablo dialysis 1 day ago
I am currently a Nephrologist and Division Chief + Medical Director of local program in rural Hospital Based inpatient and outpatient (including ho...
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TRANSPLANT QUESTION: mycophenolate dosing 1 day ago
Dear experts, some transplant centers tend to limit MMF/MPA doses to 500-0-500 mg / 360-0-360 mg „due to concerns about viral infections", even in...
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RE: A middle aged lady with IgA Nephropathy 1 day ago
Agree with Dr. Venkat that this is advanced IgAN and will relay on neohroprotective strategy with good BP control. Probably switch Sparsentan if in...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 2 days ago
I agree I think TIO is very unlikely and would as I mentioned earlier pursue 24 vit D. I was just commenting based on the other case that was menti...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 2 days ago
Doesn't the unequivocally elevated 1,25 dihydroxy Vitamin D leveks make TIO very unlikely and serve as an indication to measure 1,24 dihydroxy Vita...
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RE: A middle aged lady with IgA Nephropathy 2 days ago
The description also fits MPGN pattern of injury and there are sub-endothelial deposits on EM. I would discuss the potential of C3 GN with the path...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 2 days ago
It is sometime very difficult to find such a tumor, I had a case several years ago which took almost 2 years to find the tumor, it was very small o...
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RE: A middle aged lady with IgA Nephropathy 2 days ago
Given evidence of TMA, BP control is obviously critical. What is her heart rate? She is on 3 medications which might cause significant bradycardia ...
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RE: A middle aged lady with IgA Nephropathy 2 days ago
Dr. Narinder Singh: My impression is that there is too much chronicity in the biopsy to be enthusiastic about immunosuppression. As commented by th...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 2 days ago
SCr- and cystatin C-based eGFR are identical (90 and 91 mL/min). BUN 17 mg but affected by dietary protein intake. Serum uric acid and BNP (or proB...
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RE: Choice of therapy - or none - for IgA nephropathy 2 days ago
1. Agree with Dr. Glassock that the diagnosis of IgA nephropathy is soft on the latest biopsy. Do you have access to the 2014 biopsy (or at least t...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 2 days ago
Yes, inappropriately non-suppressed FGF23 for the measured serum phosphate levels. FGF23 could be a red herring here, but a clear answer is not exp...
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RE: Choice of therapy - or none - for IgA nephropathy 2 days ago
In order to add to the generic renal protection, would consider off label use of pentoxifylline ------------------------------ Mitchell Kirsch MD...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 2 days ago
By high FGF23, do you mean inappropriately non-suppressed? Observed secondary biochemical changes don’t always agree with what’s expected like norm...
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RE: Choice of therapy - or none - for IgA nephropathy 2 days ago
No IS for reasons already given but also, would budesonide be expected to benefit where pred/MMF did not? Switch lisinopril to sparsentan if avail...
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