Linking up nicely with Nate’s rituximab post from this Tuesday, I wanted to mention a patient with lupus nephritis whom I saw in clinic this week. She had had horrendous renal disease, as seen on the three kidney…
IgA nephropathy (IgAN) is an unpredictable beast, and identifying patients who will go on to develop progressive disease can be challenging. The classic predictors of progression, namely heavy proteinuria, CKD, glomerular sclerosis and tubulointerstitial fibrosis, are themselves just…
Bortezomib is a proteosome inhibitor used primarily in the treatment of relapsed myeloma. However, it is increasingly being used in the management of myeloma cast nephropathy (MCN). Bortezomib binds to, and inhibits the function of, the 26S proteosome…
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the gradual enlargement of multiple fluid filled cysts in both kidneys, which compress and destroy normal adjacent nephrons, typically resulting in ESRD by the fifth decade of life. Management…
I was recently asked the mechanism by which insulin resistance causes sodium retention and hypertension, and had to lie. Here’s what I should have said. Serum and glucocorticoid-inducible kinase 1 (SGK1) is an enzymatic central orchestrator of many…
As acute rejection rates continue to fall, causes of late allograft loss, such as transplant glomerulopathy (TG), become increasingly important. TG should spring to mind when you encounter a renal transplant recipient who develops heavy proteinuria and progressive…
Hypovitaminosis D is implicated in a wide variety of disease states, including insulin resistance and diabetes, cancer and cardiovascular disease. A new new study in JASN suggests it may also influence the development of de-novo renal disease. The…
A promising new class of oral hypoglycemic agents for type 2 diabetes, the SGLT inhibitors, are on the horizon. As they work on the kidney, and potentially have renal side effects, it may be helpful to review them….
I was taught the rule of 6’s when it came to using opiates in dialysis patients: they’re metabolized by hepatic glucuronidase to 6-glucurinides (e.g. morphine 6 glucuronide or M6G) these metabolites are renally excreted, increasing the half-life to…
In my experience, it’s unusual to perform a transplant nephrectomy in a patient who has returned to dialysis in the absence of a ‘hard’ indication such as macroscopic hematuria or severe symptoms suggestive of rejection or infarction. There…
