For the past 5 years, alloantibody measurement has become a standard of practice in recipients of kidney transplants experiencing worsening allograft function. This week, I admitted a patient who had a rising creatinine and on biopsy mild-moderate interstitial…
Monoclonal gammopathies generally arise from an abnormal clone that has developed from a single cell of B-cell lineage. The monoclonal protein can be intact immunoglogulin (often associated with free light chain), free light chain (FLC) in isolation, or…
Almost every transplant clinic I have, one of my patients will ask about reducing his or her immunosuppression. This happened again this week. Needless to say that this is one of the most frustrating area in transplantation where…
Historically – before CHOIR and CREATE – Goals for anemia management were Hb level of 11-13 g/dl Iron saturation > 20% Ferritin >200. CREATE changed the tide which was followed by CHOIR. CREATE (Epo-β) had intent to treat…
I saw a patient in clinic in follow up this week who was interesting. A 90 year old thoroughly delightful woman who presented last July with acute renal failure, creatinine rising from normal to 4.4 within a period…
Spironolactone has long been favored in the setting of decompensated liver disease; the effective control of “secondary aldosteronism” is usually given as the reason for this in textbooks. However, this is like saying you should open a new…
Nephrologists for many years have been able to accurately measure kidney function, a measure termed the glomerular filtration rate or GFR. To this end we have been the envy of many other specialties. However the GFR can be…
I recently saw a patient in clinic who has type I diabetes and received a kidney transplant from a sibling ~15 yrs ago. His allograft function remains excellent, but recently his diabetic control has been more difficult, despite…
I recently saw a patient in my outpatient clinic who was referred for management of chronic kidney disease presumed to be caused by chronic lithium-induced nephrotoxicity. The patient presented with a serum creatinine ranging from 1.4-1.5 mg/dL over…
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