The Cryocrit
Whenever you recommend that “cryoglobulins” be drawn on a patient, it is important to realize that the specimen must be collected in a very specific way. It cannot be simply “added on” to a specimen already drawn. Cryoglobulins…
ANCA Madness
ANCA-positive vasculitides are a not uncommon cause of rapidly progressive glomerulonephritis. When we send off an ANCA test, what are we actually measuring? ANCAs (anti-neutrophil cytoplasmic antibodies) are a type of IgG autoantibodies that are directed against antigens…
Side-Effects of Cytoxan
Welcome to Cytoxan (cyclophosphamide), one of the most versatile (albeit toxic) medications in the nephrology world. Its mechanism of action is as an alkylating agent; it induced alkylation of DNA in actively proliferating cells, which explains its use…
Acquired GBM Disease
An interesting scenario of “acquired” anti-GBM disease can occur when a patient with Alport’s Syndrome gets a renal transplant. Patients with Alport’s Syndrome–a cause of hematuria with progressive renal failure and hearing loss–have mutations in genes encoding certain…
Hepatitis B Virus & Renal Disease
Hepatitis B–a disease which in the U.S. is on the decline due to regular childhood vaccinations–has a variety of interesting associations with renal disease. There are three distinct glomerular diseases with which the hepatitis B virus is associated….
Hereditary Amyloidosis
I saw a patient in Transplant Clinic today with a strong family history of chronic kidney disease requiring dialysis and periodic fevers. She was coming to the Transplant Clinic because she wants to be considered for a potential…
The Ponticelli Protocol
When one is just beginning as a nephrology fellow, it may seem as if all the major glomerular diseases (e.g., membranous nephropathy, FSGS, lupus, etc) are all treated with the same protocols and same immunosuppressive agents: steroids, Cytoxan,…
Tonsillectomy for IgA Nephropathy?
IgA Nephropathy is the most common cause of glomerulonephritis globally. It is especially common in Japan, although some of this prevalence may be due to increased screening (all school children undergo a screening urinalysis as part of their…
Primary versus Secondary FSGS
We all know that FSGS can exist in both primary and secondary forms. In both cases light microscopy identifies partially (“segmental”) sclerotic glomeruli in a variable (“focal”) distribution in the biopsy. How can you tell the different between…
Fibrillary Glomerulonephritis
Friday we did two biopsies on the Consult Service…one of which turned out to be a fairly interesting diagnosis of fibrillary glomerulonephritis. The case in brief: a 71 yo woman with a history of HTN and no diabetes…