Acute humoral or antibody-mediated rejection (AMR) is attributed to the presence of alloantibodies against the graft, which could be either antibodies against human leukocyte antigens (HLAs) Class I and/or II , non-HLA antigens or endothelial antigens. Diagnosis of…
A 50 yo male with non-ischemic cardiomyopathy with ejection fraction of 15% presented with worsening dyspnea and renal failure (Cr 3 mg/dl). He was started on inotropes and was evaluated for heart transplantation. Nephrology was called since the…
The pharmacokinetics of a drug refers to the study of the absorption, distribution, metabolism and elimination of that drug (often referred to as ADME). Each of these characteristics can be greatly altered in a patient presenting with acute…
Six months after a kidney transplant, a patient developed a rising creatinine, significant proteinuria (~2g/day), hematuria and low C3 levels. A kidney graft biopsy showed severe glomerulonephritis with mostly occluded capillary loops with immunofluorescence staining negative for immunoglobulins…
Kidney biopsy is considered the most invasive procedure nephrologists are involved. Though complication rates are small, bleeding requiring surgery has been reported to occur in 1 in 1,000 kidney biopsies. More commonly, patients may develop a decrease in…
Winter season arriving and you might see a couple of transplant patients with colds… Immunosuppressants have the potential to interact with OTC meds used to treat common colds and coughs, which can lead to alterations in the degree…
Multiple myeloma (MM) is the most common malignancy causing ESRD. Renal disease is frequently related to the characteristics of the monoclonal immunoglobulin produced, which can lead to 3 general pathological findings: “cast nephropathy’, light chain deposition disease or…
We are frequently faced with patients on multiple anti-hypertensives still with poorly controlled BP levels. I learned some very interesting points on an article at CJASN from Dr Townsend on how to approach the management of those patients:…
Hepatitis C virus (HCV) infection affects more than 180 million people globally, may lead to renal disease and is prevalent in 11-49% of patients with end-stage renal disease, depending on geographical location. With that picture in mind, we…
I would like to direct your attention to a landmark paper in transplantation just published on the NEJM two weeks ago. We have previously discussed the terms used to characterize sensitized patients and the most common protocols to…
