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: HBV Viremia 11 minutes ago
Dear All, Thank you very much for your reviews and suggestions. In a way I am happy that it generated lots of discussion and as Prof Glassock sum...
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RE: Hypokalemia without an obvious cause and Urine potassium appropriately low 4 hours ago
you cannot evaluate K wasting when the K is normal Disregard that K/Cr ration of 78 ------------------------------ Roger Rodby MD, FASN P...
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RE: Hypokalemia without an obvious cause and Urine potassium appropriately low 6 hours ago
Spot urine K value not much help since K deficit largely replaced. Everything is quite compatible with extra-renal K depletion, but the posts all p...
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RE: Hypokalemia without an obvious cause and Urine potassium appropriately low 6 hours ago
Today as outpatient, Spot urine potassium 73.1 million mole per litter and spot urine Creatinine 93.9 mg/dL so looks like potassium to creatinine r...
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RE: HBV Viremia 8 hours ago
You are right sir Original post had 2 questions hbv issue we all agreed dosing issue was independent of hbv viremia -----------...
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RE: HBV Viremia 9 hours ago
Great discussion- very divided opinions- mainly on MMF/MPA dosing, not so much on the HBV issues. No real consensus emerged (so far). -----------...
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RE: HBV Viremia 9 hours ago
I think I would agree with Dr Singh in terms of reducing mycophenolate dose but not for the HBV infection. There was a study from Vellore where the...
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RE: HBV Viremia 10 hours ago
Cyclosporine reduces mycophenolic acid exposure by 40% while other calcineurin inhibitors such as Tacrolimus and Voclosporin don't. There is ...
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RE: HBV Viremia 10 hours ago
Hi all, this is only based on my limited experience in renal transplant medicines. Looking through the 'Viral hepatitis: guidelines by the Ame...
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RE: Membranous Nephropathy 21 hours ago
@Richard Glassock Dear Dr. Glassock, why do you prefer RTX now over observation of PLA2R trend over few months? ------------------------------ M....
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RE: Membranous Nephropathy 22 hours ago
Nothing mention to show that this was provoked PE ? Was hypercoagulability workup done? Not sure if we a have a clear picture or one disease t...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 22 hours ago
Thanks a lot! Such gut feeling is very valuable!
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RE: Tolvaptan for PCKD 1 day ago
thank you yes it was the first AM urine will review the predicted gfr decline based on Mayo classification and may consider going up to next d...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 1 day ago
No data on safety/efficacy of MMF +RTX. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 1 day ago
I would definitely try RTX, but I recognize rhat it is not a suggestion based on RCT. To my knowledge there are no comparator trials of MMF vs RTX ...
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RE: HBV Viremia 1 day ago
This is not an outcome based study , and I do not know if the findings were ever independently confirmed. ------------------------------ Richard ...
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RE: HBV Viremia 1 day ago
Thanks a lot for this paper! I will keep it in mind, especially for the rare cases of slim Western Europeans which may match the slim Asians.
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 1 day ago
Do you see any role for MMF? Currently, I`m treating a 82 year old Caucasian lady diagnosed with IgAV in August. She came to the outpatient clini...
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RE: HBV Viremia 1 day ago
Will defer to my transplant colleague ,await his reasoning but I did find this https://academic.oup.com/ndt/article-abstract/22/12/3638/19...
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RE: HBV Viremia 1 day ago
I concur with Dr. Glassock. I would keep the MPA doese at 1440 mg. She`s in the first year of an unrelated kidney transplant, with a probably rathe...
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RE: Tolvaptan for PCKD 1 day ago
Please see attached a slide that Vicente Torres presented at the 2018 ASN meeting in San Diego. Tolerance (= coping with aquaresis) and effect (def...
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RE: HBV Viremia 1 day ago
Standard use of MMF or MPA is a fixed dose independent of body weight. Tacrolimus .but not CsA , affects PK of MPA. What is the evidence that using...
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RE: HBV Viremia 1 day ago
I checked with our transplant neph ( 2 of them ) They both said to reduce MMF based on weight everything else you are doing , they concur ...
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RE: HBV Viremia 1 day ago
Tough call mycoohenolate PI says caution in HBV ------------------------------ Arvind Madan MBBS, MD Partner Central Florida Kidney ...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 1 day ago
I agree-PEXIVAS steroid dosing Protocol, but without any PLEX. Interestingly,CYC is without demostrated benefit in IgAV -------------------------...
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RE: Tolvaptan for PCKD 1 day ago
Tough question- I suspect that there are no good answers. What is subtly included in your question is if any dose dependent off-target effects if T...
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RE: IG A Vasculitis with diffuse profoliferative crecentivrabout 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 3 days 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 3 days 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 3 days 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 3 days ago
Anything but oral steroids, Budesonide , MMF, Azathioprine, Cyclophosphamide, Tacrolimus, Cyclosporin, ACTH, Leflunomide, Mizoribine, Tonsillectomy...
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RE: Membranous Nephropathy 3 days 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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