American Society of Nephrology

RE: Covid-19 and CKD 1 hour ago

Thanks.   Very helpful. —————————— Richard Sterns MD Professor of Medicine, Emeritus University of Rochester School of Medicine…

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RE: Unexplained AIN 3 hours ago

The reason to determine whether this is from a drug exposure vs autoimmune is the maintenance.  If it is an exposure, no maintenance is necessary b…

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RE: Medically Creating Anuria 3 hours ago

Thanks-just curious why is wife refusing to do intermittent catherization? —————————— [Mark] [Lerman] [MD,FASN,FACP,FAST] [Past…

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RE: Covid-19 and CKD 4 hours ago

>  There is a shortage of ventilators to care for patients infected with Covid-19 and this may require the terrifying prospect of rationing resourc…

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RE: covid 19 beyond chloroquine 4 hours ago

We have implemented similar practice in our intensive care unit , One attending who does the exam, every other consultant can do it as you describe…

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CVVHD retrofitted as an ECMO 5 hours ago

I was struck by the discussion re use of cvvhd as an ECMO device and its limitations due to blood flow by a magnitude of 10 ( 400 vs 4000 ml/min) I…

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RE: Vascular access 6 hours ago

Under ordinary times, the scheduling of AVFs and AVGs are essential, and removal of CVC s highest priority when no longer in use. However, as pract…

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RE: Covid-19 and CKD 6 hours ago

Maybe this can help; from (https://doi.org/10.1016/j.kint.2020.03.001): There are 7184 patients on hemodialysis (HD) in 61 treatment centers in Wuh…

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Covid-19 and CKD 7 hours ago

There is a shortage of ventilators to care for patients infected with Covid-19 and this may require the terrifying prospect of rationing resources….

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RE: Medically Creating Anuria 8 hours ago

The circumstances under which this 85 yr old was initiated on dialysis was post a complicated CABG and valvular heart disease about 18 months ago. …

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RE: Medically Creating Anuria 10 hours ago

Thank you for sharing this interesting case. 85 year old hemodialysis dependent patient., I wonder how much urine output he is  making ?, whether s…

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RE: COVID -19 and positive MPO 11 hours ago

Can I piggy back onto this case?  I have a young lady (50’s) with acute renal failure, Cr up to 3 (from baseline of ~ 0.8 over 1 year ago), 3 grams…

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RE: Unexplained AIN 15 hours ago

Pjp prophylaxis is supposed to be used at prednisone of 20 mg/d or more, I have not been that cautious but on the doses you are using, I would. As …

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RE: Unexplained AIN 15 hours ago

I was only thinking of MMF for steroid-sparing purposes. If she has IgG4 related disease, which seems possible- then I would use RTX, as she will r…

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RE: Unexplained AIN 15 hours ago

Thanks Dr. Rodby. I agree–so far on steroids with a slow taper as noted above. Given no other IS at this time, would you add PJP prophylaxis with …

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RE: Unexplained AIN 16 hours ago

Hi Dr. Leung, No obvious concern for uveitis based on history and routine exam. I did check ACE level, it was 11 (lower limit of reference range). …

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RE: Unexplained AIN 16 hours ago

Thank you so much for the feedback Dr. Glassock. I have asked the pathologist again for specific IgG4 staining. No CT chest or abdomen done–should…

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RE: Vascular access 16 hours ago

Thank you for the joint statement on the issue of vascular access surgeries. Hopefully this will help our patients get the procedures they need in …

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RAAS and covid19 18 hours ago

I am interested in learning from the community on two issues:  1) In patients in normal health, would suppressing RAAS by volume expansion decrease…

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RE: Unexplained AIN 18 hours ago

Good point. If there are lots of Plasmablasts (CD20+) that are also positive for IgG4, I would taper steroids quickly and give RTX. Sent from my iPad

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RE: Unexplained AIN 19 hours ago

While mildly elevated serum IgG4 can be seen in many conditions, markedly elevated serum IgG4 (>5 g/L) is approximately 90% specific for IgG4-RD. T…

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RE: Unexplained AIN 20 hours ago

Any eye findings or history?  The uveitis can occur months in advance or even afterward.  Did you check an ACE level?  Renal limited sarcoidosis co…

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RE: Vascular access 22 hours ago

At SSMVAC in STl, MO it is an outpatient department of the hospital. We have continued treating patients with malfunctioning AV Access. We have con…

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covid 19 beyond chloroquine 23 hours ago

Just wanted to make some comments about covid 19 and also ask some questions which I have not been able to find the answers to. I work in Southern …

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RE: In Center and PD dialysis visits via telemedicine 23 hours ago

i think we are adding the 02 modifier and have an indicator that the note was done as telemed – my billing department is doing this —————…

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RE: AKI in COVID 19 and CRRT 23 hours ago

Thank you very much, Dr. Rodby and Dr.Gura for explaining significant points I was not aware of. The US machine was invented by Britts during WW2 b…

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RE: Vascular access 23 hours ago

The limiting factor appears to be the shortage of PPE. —————————— Michael Allon MD University of Alabama at Birmingham Birmingh…

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RE: Vascular access 1 day ago

At our hospitals we are working very closely with our vascular surgeons who in turn navigate these new restrictions on elective surgeries with the …

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RE: AKI in COVID 19 and CRRT 1 day ago

I agree with Dr. Rodby. It would be lovely to turn a CRRT machine into an ECMO but the differences seem, for now, insurmountable. The main challeng…

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RE: Hydroxycloroquine 1 day ago

Thanks for the info! This is the way to go. — Dr. Antonio R. Vilches Fellow del American College of Physicians- FACP Fellow de la American Society…

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RE: Hydroxycloroquine 1 day ago

Here is an ongoing RCT from Minnesota using a slightly different (higher) dose of hydroxychloroquine c/w the study from France. According to the PI…

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RE: AKI in COVID 19 and CRRT 1 day ago

In my country we have more than 1000 reported positive cases for COVID-19. But we have not yet seen kidney failure in ICU patients in my city. Howe…

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RE: HOME DIALYSIS FACE-TO-FACE ENCOUNTERS 1 day ago

ASN supports telephonic waivers and has made the recommendation in multiple phone conversations with CMS and HHS as part of the society’s COVID-19 …

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

So, if one is doing all 4 visits via telemedicine and submitting 90960, it negates the fact that comp was done under telemedicine? Are you submitti…

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes LIST OF MEDICARE TELEHEALTH SERVICES  CY 2020 …

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RE: HOME DIALYSIS FACE-TO-FACE ENCOUNTERS 1 day ago

can you share the waiver request? I am part of 25 doctor group, san Antonio Texas, we are moving as much as we can to telemedicine —————-…

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RE: SIADH 1 day ago

Sorry to respond so late. I don’t recall the time course of her improvement. Tom

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RE: Vascular access 1 day ago

ASDIN and VASA are preparing a joint statement outlining the special concerns around dialysis access, it will hopefully go online later today. The …

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RE: AKI in COVID 19 and CRRT 1 day ago

Extracorproeal oxygenation using a CRRT machine is not a new concept. basically you dialyze against O2 and the “dialysate” rate is the O2 liters/mi…

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

I believe the incenter comprehensive visit must still be done in person and face to face as it is not yet reimbursed under Telemedicine. RPA and al…

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

Let me put these two threads together https://community.asn-online.org/communities/community-home/digestviewer/viewthread?GroupId=37&MessageKey=19d…

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

Yes, we have been doing it at our practice. —————————— Sandeep Magoon MD Nephrology Associates of Tidewater, LTD Virginia Beach…

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RE: Vascular access 1 day ago

​The widespread unavailability of dialysis access procedures is a big deal, and, in communications with nephrologists across the country, is a nati…

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RE: Question on Preemptive Kidney Transplant 1 day ago

Transplantation has been shown to have a mortality benefit compared to staying on dialysis, and incremental time on dialysis has been shown to be a…

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RE: Question on Preemptive Kidney Transplant 1 day ago

Hello everyone, I am a kidney transplant fellow at a transplant center that performs high rates of preemptive and living kidney transplants. I am n…

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RE: Vascular access 1 day ago

At our hospital, not only have placements of AVFs, AVGs and PD catheters been canceled, even removal of CVCs in patients with a mature AVF or AVG h…

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RE: HYDROXYCHLOROQUINE IN COVID PATIENTS 1 day ago

This manuscript addresses the issue of safety of the combination hydroxychloroquine + azithromycin in pregnant patients. It is reassuring, although…

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RE: AKI in COVID 19 and CRRT 1 day ago

This study in pregnant patients gives some reassurance. Of couse, non of them had myocarditis. —————————— Maurizio Gallieni MD,…

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RE: Unexplained AIN 1 day ago

Excellent case. Excellent evaluation. We must remember that a small fraction of Idiopathic Granulomatous Interstitial Nephritis remain “Idiopathic”…

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RE: AKI in COVID 19 and CRRT 1 day ago

I suggest we turn CRRT or SLED into ECMO MACHINES by using oxygenated dialysates! We can turn dialysis machines into ECMO MACHINES. This may save m…

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