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: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 2 hours 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 hours 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 hours 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 hours 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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RE: High urea reduction ratio during hemodialysis 2 hours ago
With her HD intensity (K/V) being high, at least 0.67/hr, you can bet she’ll have a high post-HD BUN rebound. --------------------------------- Od...
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A middle aged lady with IgA Nephropathy 3 hours ago
Dear All, I wish to seek the best course of action for this 37 year old lady with IgA nephropathy struggling to achieve remission and BP contr...
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RE: Elevated Biotin in ESKD 5 hours ago
Dr Glassock, Thanks. It seems like multiple renal vitamins for dialysis patients contain 150-300mcg Biotin as well. We will be making changes at ...
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RE: Choice of therapy - or none - for IgA nephropathy 6 hours ago
My "gestsalt" tells me to be suspicious of the "diagnosis " of IgAN in this case - "focal" deposition of IgA and IgM without IgG and no deposits by...
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RE: Choice of therapy - or none - for IgA nephropathy 7 hours ago
I fully concur with Dr. Hirsch's comments about adding a diuretic (mainly chlorthalidone ) to the regimen to see if a further decrease in proteinur...
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RE: Choice of therapy - or none - for IgA nephropathy 8 hours ago
In terms of non-immunologic rx: Several older studies showed that instead of increasing ACEi from 20 to 40 mg, adding or increasing thiazide/lasix ...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 8 hours ago
Pizza, Chinese food, salted Chicken Soup! Fascinating menu for treatment of hyponatremia. What about a Taco with Salsa or a good old American Hot D...
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RE: Choice of therapy - or none - for IgA nephropathy 8 hours ago
Kind of an unusual case of "IgAN". No deposits by LM and EM but "focal" deposits of IgA without IgG. Progression of nephron loss with persistent hi...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 8 hours ago
Giving NS to a hyponatremic patient with a low urine na who appears to be euvolemic, about 100ml /hr for 6 hrs can be a diagnostic tool. If volume ...
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RE: Tablo dialysis 9 hours ago
Appreciate the discussion so far. The efficiency of the machine seems to be OK with some limitation for clearance of low mol wt toxins based on wha...
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RE: Choice of therapy - or none - for IgA nephropathy 9 hours ago
From an old and very conservative corner: " I do not give immunosuppression for scar tissue". Conservative management with acei/arb +/- MRA's will ...
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Choice of therapy - or none - for IgA nephropathy 10 hours ago
Dear all, My patient and I welcome your opinion regarding therapy. This 33 year old had a kidney biopsy done elsewhere in 2014 which showed I...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 10 hours ago
Your patient sounds like a case of FGF23 Tumor Induced Osteomalacia. I was actually hoping to find TIO but no luck on the Ga68-DOTATATE scan. It co...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 11 hours ago
Intact FGF23 performed by Mayo Clinic in Rochester, C-Terminal testing in progress now. eGFR ranges from 70 to 80. Vitamin D intake investigated an...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 11 hours ago
Patient total daily calcium intake averages around 1500mg to help compensate for the lost urine calcium. No suspicious CYP24A variants seen (see at...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 11 hours ago
To be clear, by "ADH -induced disease", or "ADH related etiology", I mean ADH from some other source than low volume. ---------------------------...
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RE: hypomagnesemia 11 hours ago
Dr. Hootkins. Thanks for raising the important issue of variable bioavailability of commercial preparations of Magnesium supplements. This needs to...
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RE: hypomagnesemia 12 hours ago
I am jumping on late here, so my apologies, but also remember that when replacing with oral Mg++, not all agents are equivalent. Some, such as the ...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 12 hours ago
By fiat, you can not diagnose an ADH related etiology when the U Na is low. However, patients with "SIADH" in the chronic state are in Na balance a...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 13 hours ago
I recall seeing a patient almost 30 years back with acquired hypophosphatemia (serum Phosphorus 1.3 mg/dl). Do not recall more details of the case ...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 21 hours ago
I agree- some salted chicken soup will do the trick . ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ---...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 22 hours ago
What assay for FGF23 was used- N terminal (active ) or COOH terminal (inactive fragments ). What is tge patients eGFR. Any source of exogenous Vita...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 23 hours ago
hyponatremia with a low urine Na on lasix and every other medication known to man.' Why is this not hypovolemic hypoNa? I suppose the measured...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 23 hours ago
very interesting case. Is he taking significant calcium supplements? Could be Cyp24A defect, especially with marked hypercalciuria, however, would ...
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RE: Tablo dialysis 1 day ago
Hi Dr. Shah I am in rural southeast Iowa. We are using Tablo for Home Hemodialysis and patients love it. We have good support from Outset Medical...
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RE: chronic Hyponatremia, now hypo osmolar , euvolemic , asymptomatic, and undetsctable urine Na 1 day ago
Cystatin C 0.9 and EGR based on that 91 ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 ------------------------------
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 1 day ago
No, but was planning to check iron levels as a next step. Thanks. ------------------------------ Michael Lavacot MS UCI Irvine CA (949) 378-7866 ...
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RE: Elevated Biotin in ESKD 1 day ago
Addendum- True biotin deficiency is quite uncommon and mainly seen in GI malabsorption states. CKD, even with dialysis therapy, is not a recogniz...
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RE: hypomagnesemia 1 day ago
As best as can be determined your patient does not have a renal magnesium wasting syndrome. Extra-renal losses, probably from the GI tract, are the...
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RE: Elevated Biotin in ESKD 1 day ago
Biotin deficiency does not occur consequent to CKD or dialysis therapy. There is no need for regular supplementation. Biotin is very safe and has n...
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RE: hypomagnesemia 1 day ago
On Amiloride and Slow Mag bid says likely underlying hypomagnesemia possible Mag loosing nephropathy.Serum Mag may not be an accurate estimate of d...
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Elevated Biotin in ESKD 1 day ago
One of HD patients part of dermatological w/u noted to have serum Biotin >3600.He is on renal vit/daily with biotin 300mg/d. Unable to find target ...
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Closing TODAY - Nephrology Quiz and Questionnaire Survey 1 day ago
Today is your last chance to help with the Nephrology Quiz and Questionnaire. Fellows, try to outsmart the Nephrology Program Directors by taking t...
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Closing TODAY - Nephrology Quiz and Questionnaire Survey 1 day ago
Today is your last chance to help with the Nephrology Quiz and Questionnaire. Nephrology Program Directors, challenge your fellows by taking the 16...
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RE: Tablo dialysis 1 day ago
Tablo is an excellent resource for small hospitals. Small foot print. Inbuilt RO system and really easy to learn and use. We have extensive exper...
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RE: Tablo dialysis 1 day ago
Good afternoon Dr. Shah, I'm Dr. Jimmy Thomas. I'm a nephrologist and currently, the Chief Medical Officer at Renasolve Inc. Renasolve focuse...
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RE: High urea reduction ratio during hemodialysis 1 day ago
Well said Dr. Hirsch. I fully agree tgat KT/V or URR are not sufficient Biomarkers for "adequate" dialysis. Volume control is at least of even more...
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RE: High urea reduction ratio during hemodialysis 1 day ago
In terms of the possibility of 2x/wk HD, we all know there is much more to dialysis than urea removal; in particular, volume and BP control as well...
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RE: High urea reduction ratio during hemodialysis 1 day ago
Very common issue in elderly patients, especially female, with low weight and V and well recognized and reported in the dialysis literature with co...
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RE: High urea reduction ratio during hemodialysis 1 day ago
We havent done a delayed BUN in her. I will get one next month-will keep one needle in after dialysis for 5 more minutes for a draw and see if ther...
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RE: High urea reduction ratio during hemodialysis 1 day ago
Is there a significant rebound in the BUN, say 5 minutes post HD? ------------------------------ Philip Goldwasser MD New York NY (646) 322-3303 ...
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RE: Hypophosphatemia - Renal Leak, FGF23, or PTH issue? 1 day ago
Is pt getting IV iron/Injectafer --------------------------------- Shahzad Safdar MD MD Mt. Auburn Nephrology, Inc. Cincinnati OH (513) 841-02...
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RE: Hypokalemia without an obvious cause and Urine potassium appropriately low 1 day ago
Did the patient have polyuria after the urinary retention resolved? it is possible that he depleted the potassium stores before and during the admi...
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RE: High urea reduction ratio during hemodialysis 1 day ago
I would do 2/week dialysis if she still make some urine and UF is not too high. You can estimate the weekly kt/v from 2/week dialysis then add the ...
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RE: High urea reduction ratio during hemodialysis 1 day ago
I know your point Anand. I agree with you. However, Rodby's discussion is probably true for achieved Kt/V of ~ 1.3 not for ~ 2.0. Higher level ...
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RE: High urea reduction ratio during hemodialysis 1 day ago
I was more curious about the unusually high URR for a very modest dialysis prescription and was wondering how it was possible. Low Vd of urea as Dr...
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