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Sri Lekha Tummalapalli, MD, MBA, Nephrology Fellow, UCSF On March 27, 2018, members of American Society of Nephrology (ASN) and the American Association of Kidney Patients (AAKP) joined together in Washington, D.C. for Kidney Health Advocacy Day.  Patients and physicians joined together to meet with Senate and House Congressional Offices in Capitol Hill to support innovation in kidney health.  Months of efforts by ASN staff culminated on April 26, 2018, when ASN signed a Memorandum of Understanding with the Department of Health and Human Services to establish the Kidney Innovation Accelerator, KidneyX We had a lively discussion on ASN Communities on ...
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Introduction and Background A 59-year-old with long-standing diabetes and end-stage liver disease secondary to NASH is being evaluated for a liver transplant. The patient’s baseline serum creatinine was 1.4-1.8 mg/dl but developed an acute increase in creatinine to 2.7 with worsening ascites and a decrease in urine output. After paracentesis, withholding diuretics, and the administration of IV albumin with octreotide, the urine output increased and creatinine decreased to 2.4 mg/dl. The urine sodium was low and both a renal ultrasound and urinalysis were unremarkable for obvious parenchymal renal disease. Query Should this patient receive a liver ...
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By Hayder Aledan, MD, FASN Introduction and background This Communities discussion compared the results of two randomized clinical trials (SMART and SALT-ed) reported on in the New England Journal of Medicine that compared the effects of normal saline and a “balanced solution” in preventing AKI. Isotonic saline (0.9% NS) is the main crystalloid solution used for resuscitation of hypovolemic critically or non-critically ill patients. The SMART trial in which 7,942 critical care patients were randomized to either 0.9% NS or a more balanced electrolyte fluid preparation (Lactated Ringers or Plasma-Lyte A) showed a higher rate of composite of death ...
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by Roger Rodby, MD Query and Hypothesis Is the risk of ODS the same at all levels of starting PNa levels? And if not, perhaps we do not need to re-lower the PNa if starting in the mid-120s? Discussion The discussion focused on several points: The relative change in serum osmolality (and therefore shifting of brain water) is not the same with a 12 meq/L PNa change when you consider, for example, starting at a PNa of 110 vs. 125. Thus, you would not expect the risk of ODS to be the same in those two patients. This is confirmed by the fact that most cases of ODS have been reported at lower starting PNa levels. Other ODS risk factors should ...
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By Rebecca Rojas, MD Introduction and Background Acceptance of Hepatitis C donor kidneys is a big topic of conversation today.  Are we underutilizing these donor organs for kidney transplantation?  With our ever-expanding wait list, more advanced testing (nucleic acid testing (NAT)) and newer hepatitis C medications able to be used now in our kidney population, we should be reconsidering how best to utilize these donor organs.  Risk of transmission and current treatment options need to be weighed against the risk of waiting on the wait list.  Primary Query Can we safely utilize hepatitis C Virus seropositive non viremic ...
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Thin Basement Membrane Disease ASN Communities Weekly Rewind Beatrice Concepcion, MD, FASN Introduction and Background A 45 year old white male wishes to donate a kidney. He has a history of persistent hematuria with no proteinuria and a normal blood pressure. Kidney biopsy revealed thin basement membrane nephropathy (TBMN). He has no family history of kidney disease, hearing loss or lenticonus. Query Would you allow this man to donate a kidney? Discussion The discussion focused on two issues: How does one definitively exclude Alport syndrome (including carrier states) in this potential donor? There was an enlightening discussion regarding ...
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Ovarian Hyperstimulation Syndrome ASN Communities Weekly Rewind Silvi Shah, MD, FASN, FAC Introduction and Background An 18  year old female  presented with a 4 day history of  non oliguric acute kidney injury (AKI), creatinine of  7.5 mg/dl,  severe anemia (hemoglobin of 5.8 g/dl), and generalized edema following ovulation induction therapy. Corrected reticulocyte count was 0.15%.  Platelet and leukocyte counts were normal.  Other laboratory workup was as follows: albumin 1.9 g/dl, uric acid 6.5 mg/dl, and LDH 330 U/L. C3 levels were low, and C4 was normal. Antinuclear antibody serology,  ANCA, and viral studies were negative. Urinalysis showed ...
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In February 2018 @Kelly Hyndman of ASN's Media and Communications Committee interviewed new JASN Editor in Chief Josephine Briggs, MD. Below is a transcript of their conversation, lightly edited for clarity and length. If you have other questions for Dr. Briggs, you can ask them here . Kelly Hyndman, PhD Dr. Briggs, you have been intimately involved in nephrology research for many years, in both academia and government at the NIH. What attracted you to a life in the lab and what would you tell potential young investigators about why they should pursue work in the nephrology sphere? Josephine Briggs, MD First, let me say, I am a fan of the ASN Communities. ...
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Donor Evaluation ASN Communities Weekly Rewind Scherly Leon, MD Introduction and Background While living kidney donation provides great potential benefits to kidney disease patients donor evaluation practices, policies and thresholds vary considerably, and importantly, long waiting lists have stimulated non-directed altruistic donation and paired exchange programs, which present their own unique legal and ethical challenges, controversies and complex psychosocial implications. Although living kidney donation offers the recipient better outcomes than deceased kidney donation, live donors face the risks of surgical complications, long-term ...
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Confusing Acid Base Disorder ASN Communities Weekly Rewind  Roger Rodby, MD, FACP, FASN Introduction and Background A woman with type-1 DM who was 31 weeks pregnant presented for the second time in about a month with vomiting and a severe metabolic acidosis. The first time she had a pH of 7.3 with an HCO3 of 10 but an anion gap (AG) of only 12. Her blood glucose (BG) was 171, her betahydroxybutyrate (BHB) was 39 and she was assumed to have diabetic ketoacidosis (DKA), was treated as such and the acidosis resolved. Then 20 days later she developed a similar metabolic acidosis, HCO3 13, AG 16, BHB again elevated at 55, but her BG this time ...
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In January 2018 @Silvi Shah of ASN's Media and Communications Committee interviewed new ASN President Mark Okusa. Below is a transcript of their conversation, lightly edited for clarity and length. If you have other questions for Mark Okusa, you can ask them here .  Silvi Shah, MD, FASN I am very excited to kick off the Leadership Spotlight Series. As a member of the Media and Communications Committee, I have the honor of interviewing Mark Okusa. How did you became interested in nephrology and who inspired you to pursue nephrology? Mark Okusa, MD, FASN Early in medical school, I wandered through various courses including biochemistry and microbiology. ...
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2017 is drawing to a close, marking the end of a year that saw ASN Communities hit its stride within the nephrology social media landscape. Providing an interactive learning experience for nephrologists around the world has become the primary strength of ASN Communities. Interacting on Communities reminds many practicing nephrologists of the iterative case conferences they had in residency. Both complicated and mundane discussions provide a springboard for nephrologists to finding their own answers and improving their own knowledge base. None of these conversations would be possible without you.  During 2017, 1,109 kidney care professionals contributed ...
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Philadelphia. November, 2014. I was a second-year medicine resident who had cashed in my vacation time to attend my first Kidney Week. I clutched my badge with pride: it was the first time my name had been associated with Nephrology.   Flipping through pages upon pages of presentations, posters, and abstracts, I thought: “What am I supposed to do now?” A little help from my friends. In August, I was fortunate to be part of the #askASN Twitter chat about this very topic. Novices and experts alike discussed the upcoming meeting and recalled lessons learned from meetings past. I shared my humble experience but mostly listened. A little ...
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Kidney Week will be here in less than a month, and, once again, will feature some of the most innovative basic science. Topics will encompass cell biology, physiology, tissue engineering, cutting-edge microscopy and sequencing, genetics, targeted therapies and much more.  One of the highlights of every Kidney Week are the morning plenary lectures , which feature topics of broad, general interest in the basic and translational sciences delivered by highly accomplished presenters. Notably, this meeting brings four outstanding plenary speakers.  This begins with Dr. Laura Niklason, whose lung and blood vessel engineering was recognized among the top 50 inventions ...
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Brought to you by #askASN and NSMC Internship  1. Pace yourself! You don't have to go to a lecture in every time block 2. Bring a phone charger, really 3. Go to as many alumni dinners as possible 4. If you see a poster you are interested in, don’t be timid, talk to the author 5. Use the mobile app . It's easier than the handbook 6. Wear comfortable shoes 7. Listen to the daily ASN KidneyNews Podcast daily wrapups 8. The president's address is a must 9. Make it to the morning plenary sessions, you will be inspired 10. Visit the ASN Communities Lounge Have more tips to add? Share them on this threa
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