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Articles by A. Brent Alper
Fast Five Quiz: IgA Nephropathy Presentation and Diagnosis
Immunoglobulin A (IgA) nephropathy is one of the leading causes of renal failure. Disease management typically involves an interprofessional team to evaluate and treat patients with this condition. Data indicate that many patients with IgA nephropathy are asymptomatic on presentation and have an unremarkable physical exam.
Fast Five Quiz: IgA Nephropathy
Immunoglobulin A (IgA) nephropathy is caused by deposits of glomerular mesangial IgA. This deposition can result in glomerulosclerosis and interstitial fibrosis. IgA nephropathy is the most common primary glomerular disease worldwide; it accounts for about 10% of kidney biopsies in the United States, with higher biopsy prevalence reported in East Asia and Europe. It affects both sexes equally in East Asia. However, a male predominance has been shown in Western populations and Europe.
Fast Five Quiz: Chronic Kidney Disease and Cardiovascular Disease
Cardiovascular disease remains a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), with risk increasing well before progression to advanced stages. Contemporary guidelines emphasize CKD-specific risk prediction models and tailored prevention strategies to better address this elevated risk.
Quiz: Diabetes und Nieren – was wirklich zählt bei Prävention, Früherkennung und Therapie der CKD
Chronische Nierenerkrankungen zählen zu den häufigsten und zugleich schwerwiegendsten Folgen eines Diabetes mellitus. Wird die Erkrankung frühzeitig erkannt und konsequent leitliniengerecht behandelt, lässt sich ihr Fortschreiten verlangsamen, das Risiko für Komplikationen senken und die langfristige Prognose der Betroffenen deutlich verbessern.
Rapid Review Quiz: Immunoglobulin A Nephropathy
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerular disorder worldwide and a significant contributor to progressive kidney disease. Its clinical presentation is highly variable, ranging from asymptomatic hematuria or mild proteinuria to more aggressive forms with rapid loss of renal function. Management strategies focus on preserving kidney function, controlling proteinuria, and achieving remission.
Fact or Fiction: Immunoglobulin A Nephropathy
Immunoglobulin A (IgA) nephropathy is a complex and heterogeneous kidney disease that is a leading cause of chronic kidney disease worldwide. Its presentation, natural history, and prognosis vary widely, influenced by factors such as age at presentation, degree of proteinuria, ethnic background, urinary findings, and histopathologic features.
Fast Five Quiz: IgG4-Related Disease
Immunoglobulin (Ig)G4-related disease is understood as a systemic disease characterized by multi-organ lesions, dense lymphoplasmacytic infiltrates, storiform fibrosis, and often elevated serum IgG4 levels. IgG4-related disease most commonly affects the pancreas, salivary and lacrimal glands, kidneys, retroperitoneum, and eyes. Pancreatic symptoms can include autoimmune pancreatitis and exocrine pancreatic failure with or without complicated diabetes.
IgG4-RD Presentation
IgG4-related disease is a chronic, immune-mediated condition that can involve nearly any organ system and often masquerades as malignancy, infection, or other inflammatory disorders. Patients might present with subacute organ enlargement, mass-like lesions, or unexplained organ dysfunction discovered incidentally on imaging, potentially making timely recognition a diagnostic challenge. Histopathology is considered the gold standard for IgG4-related disease diagnosis.
Fast Five Quiz: CKD and CVD
Cardiovascular disease remains a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), with risk increasing well before progression to advanced stages. Contemporary guidelines emphasize CKD-specific risk prediction models and tailored prevention strategies to better address this elevated risk.
Fast Five Quiz: Diabetes and Chronic Kidney Disease
Chronic kidney disease (CKD) remains one of the most common and consequential complications of diabetes. Early detection and evidence-based management can slow progression, reduce complications, and improve long-term outcomes. The American Diabetes Association (ADA) maintains specific guidance on CKD in diabetes to guide clinicians in managing this major comorbidity.
CKD Screening in Primary Care
Chronic kidney disease (CKD), defined as abnormality in kidney structure or function, has a global median prevalence of 9.5%, and its incidence continues to increase. Screening in primary care is essential for early detection because many patients are asymptomatic in early stages of the disease. Regular screening enables early intervention and can improve clinical outcomes. As part of CKD screening in primary care, eGFR and albuminuria (a marker of glomerular damage) must both be measured.
Fast Five Quiz: aHUS Management
Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy that represents about 10% of HUS cases. It most often arises from dysfunctions in the complement mediation pathway and can be familial (primary) or nonfamilial (sporadic). This syndrome might result in renal failure, extrarenal morbidities, and death. In recent decades, there has been a paradigm shift in aHUS therapy due to the introduction of certain treatments. How much do you know about the treatment and management of aHUS?
Fast Five Quiz: Atypical Hemolytic Uremic Syndrome
Hemolytic uremic syndrome (HUS) is typically characterized by the triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury (AKI). The prevalence of atypical HUS (aHUS), sometimes called secondary HUS or nonenteropathic HUS, is estimated at about 10% of HUS cases. aHUS affects both children and adults and can result in renal failure as well as extrarenal morbidities of the nervous and gastrointestinal systems, for example. How much do you know about aHUS?
CKD Hyperphosphatemia
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Hyperphosphatemia, or abnormally high serum phosphate levels, has been identified as a key factor associated with cardiovascular complications and increased mortality risk among patients with chronic kidney disease (CKD).
Rapid Review Quiz: Immunoglobulin A Nephropathy Prognosis
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A (IgA) nephropathy is a common cause of glomerulonephritis that can progress to chronic kidney disease. A major challenge in treating the condition is the inability to identify patients at high risk for progression, as many patients are asymptomatic and diagnosis is often delayed.
Emerging Treatments for Immunoglobulin A Nephropathy
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A (IgA) nephropathy, the most common primary glomerular disease, is a leading cause of progressive kidney disease and kidney failure. It is characterized by the presence of IgA-containing immune complexes in the kidney and has a variable clinical presentation.
IgA Nephropathy Management
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. IgA nephropathy is a chronic, lifelong disease associated with several extrarenal manifestations and catastrophic complications if left untreated. Fortunately, it can be effectively managed through supportive care and medical interventions when necessary.
Don’t Miss the Dx: A 24-Year-Old Man With Sudden-Onset Hematuria, Proteinuria, Edema, and Hypertension
Presentation A 24-year-old man with no significant past medical history presents to urgent care with a 1-week history of sudden-onset dark urine, leg swelling, and unusually high blood pressure readings, with recent values around 160/100 mm Hg. Physical examination reveals pitting edema up to the mid-shins and mild periorbital edema, with an elevated blood pressure of 158/98 mm Hg. Past medical history was significant for frequent upper respiratory tract infections over the past year.
Don’t Miss the Dx: A 24-Year-Old Man With Sudden-Onset Hematuria, Proteinuria, Edema, and Hypertension
Presentation A 24-year-old man with no significant past medical history presents to urgent care with a 1-week history of sudden-onset dark urine, leg swelling, and unusually high blood pressure readings, with recent values around 160/100 mm Hg. Physical examination reveals pitting edema up to the mid-shins and mild periorbital edema, with an elevated blood pressure of 158/98 mm Hg. Past medical history was significant for frequent upper respiratory tract infections over the past year.
Fast Five Quiz: aHUS Management
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy that represents about 10% of HUS cases. This syndrome might result in renal failure, extrarenal morbidities, and death. aHUS most often arises from dysfunctions in the complement mediation pathway and can be familial (primary) or nonfamilial (sporadic).
Fact or Fiction: Complement 3 Glomerulopathy
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Complement 3 (C3) glomerulopathy is a rare disease marked by inflammation of the glomerular kidney filters and the prototypical complement-mediated kidney disease. The complement dysregulation that gives the condition its name occurs in the fluid phase and the glomerular microenvironment.
Rapid Review Quiz: IgA Nephropathy
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A nephropathy (IgAN) is a progressive autoimmune disease that is caused by predominant IgA deposition in the glomerular mesangium and can lead to kidney failure. It primarily affects young adults (ages 16-35), with a predominance in males.
Fact or Fiction: Immunoglobulin A Nephropathy
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A (IgA) nephropathy, an autoimmune condition also known as Berger disease, is the most common type of primary glomerular disease that can lead to end-stage renal disease. IgA nephropathy varies in prevalence worldwide but is more common in Pacific countries, such as Japan.
Fast Five Quiz: Atypical Hemolytic Uremic Syndrome
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Hemolytic uremic syndrome (HUS) is characterized by the triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury (AKI).
Fast Five Quiz: C3 Glomerulopathy Presentation and Diagnosis
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. C3 glomerulopathy (C3G) is a rare group of glomerular diseases characterized by dysregulation of the alternative complement pathway, leading to complement C3 deposition in the kidney, progressive chronic damage and, ultimately, kidney failure.
Fast Five Quiz: IgA Nephropathy Overview
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A (IgA) nephropathy is caused by deposits of glomerular mesangial IgA. This deposition can result in glomerulosclerosis and interstitial fibrosis. Globally, IgA is the most common cause of primary glomerulosclerosis.
Woman With Pitting Edema of Bilateral Extremities
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. A 53-year-old Black woman presents with shortness of breath, pruritus, and pitting edema of bilateral extremities. She has a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia, and a 35–pack-year history of smoking.
Fast Five Quiz: Chronic Kidney Disease Complications
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Chronic kidney disease (CKD) is an increasingly prevalent global public health problem. Estimates suggest that up to 13% of the worldwide population (approximately 846 million people) is affected by CKD stages I-V, with the majority of patients in stage III disease.
Fast Five Quiz: IgA Nephropathy Presentation and Diagnosis
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A (IgA) nephropathy is one of the leading causes of renal failure and is a common type of glomerulonephritis that is caused by the deposition of IgA immunoglobulins in the glomerular mesangium. This results in damage to the basement membrane that manifests as hematuria and renal insufficiency.
Fast Five Quiz: IgA Nephropathy Causes
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Immunoglobulin A (IgA) nephropathy is characterized by IgA deposition in the glomerular mesangium and is one of the most common causes of glomerulonephritis and renal failure. The prevalence of IgA nephropathy is lower in the United States and in Europe, with higher rates in Asian countries.
Fast Five Quiz: C3 Glomerulopathy Causes
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. C3 glomerulopathy (C3G) refers to a group of rare kidney diseases known as membranoproliferative glomerulonephritis. The group is distinguished by complement dysregulation in the glomerular microenvironment in the fluid phase, which results in complement C3 deposition in the kidney tissue.
Fast Five Quiz: Living Donor Kidney Transplantation
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel End-stage kidney disease (ESKD) is a significant and rapidly increasing global health burden.
Fast Five Quiz: Preemptive Kidney Transplantation
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Preemptive kidney transplantation (PKT), or a kidney transplant performed prior to the start of maintenance dialysis, is recognized as the most beneficial form of renal replacement therapy for patients with end-stage kidney disease (ESKD).
A Man With IgA Nephropathy and Frothy Urine
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.
Fast Five Quiz: C3G Management
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Complement 3 glomerulopathy (C3G) is a group of extremely rare kidney diseases characterized by complement dysregulation in the alternative pathway and is classified into two major subgroups: C3 glomerulonephritis (C3GN) and dense deposit disease (DDD), both of which have overlapping clinical and pathologic features.
Fast Five Quiz: Workup for Hyperkalemia
Authors and Disclosures Author(s) A. Brent Alper, Jr, MD Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana Disclosure: A. Brent Alper, Jr, MD, has disclosed no relevant financial relationships.
Fast Five Quiz: Hyperkalemia Management
Authors and Disclosures Author(s) A. Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana Disclosure: A. Brent Alper, Jr, MD, MPH, has disclosed no relevant financial relationships.
Fast Five Quiz: Hyperkalemia Signs and Symptoms
Authors and Disclosures Author(s) A. Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana Disclosure: A. Brent Alper, Jr, MD, MPH, has disclosed no relevant financial relationships.
Fast Five Quiz: Chronic Kidney Disease (CKD) Management
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Chronic kidney disease (CKD) is defined as a persistent abnormality in kidney structure or function (ie, persistent estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 or persistent urine albumin-to-creatinine ratio (ACR) ≥30 mg/g) for more than 3 months.
Fast Five Quiz: Hyperkalemia
Authors and Disclosures Author(s) Vecihi Batuman, MD Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine, New Orleans, Louisiana; Chief, Renal Section, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana Disclosure: Vecihi Batuman, MD, has disclosed no relevant financial relationships. A.
Diabetic Nephropathy Presentation/Diagnosis
Authors and Disclosures Author(s) A. Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine Disclosure: A. Brent Alper, Jr, MD, MPH, has disclosed no relevant financial relationships.
Fast Five Quiz: Diabetic Nephropathy
Authors and Disclosures Author(s) A. Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine Disclosure: A. Brent Alper, Jr, MD, MPH, has disclosed no relevant financial relationships.
Fast Five Quiz: Diabetic Nephropathy Management
Authors and Disclosures Author(s) A. Brent Alper, Jr, MD, MPH Associate Professor of Medicine, Section of Nephrology and Hypertension, Department of Medicine, Tulane University School of Medicine Disclosure: A. Brent Alper, Jr, MD, MPH, has disclosed no relevant financial relationships.
Chronic Kidney Disease
Authors and Disclosures Vecihi Batuman, MD Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine, New Orleans, Louisiana; Chief, Renal Section, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana Disclosure: Vecihi Batuman, MD, has disclosed no relevant financial relationships.
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