the MEPEX Trial
When you are called at 5pm to start pheresis on a patient with Wegener’s granulomatosis who is already on dialysis…there is a certain part of the renal fellow which wants to say, “Come on–the dude is already on…
Recurrent FSGS after Transplant
There are many diseases which can recur following renal transplant: examples include IgA Nephropathy (which has a very high rate of recurrence on follow biopsy but is rarely clinically relevant in that it does not cause significant allograft…
Fattest Dialysis Patient Ever
There is an interesting paper in the literature which just came out–I have to admit that I’m a little biased since the senior author is my father, also a nephrologist–describing the dialysis of the most obese patient ever…
Diarrhea & common immunosuppressants
Did you know that diarrhea increases the absorption of Prograf (tacrolimus, FK506)? Drug levels must be monitored closely in this setting to avoid tacrolimus-induced allograft toxicity. Tacrolimus is even considered a cause of diarrhea by some, though its…
Aristolochic acid
Aristolochic acid is an herb used in many varieties of Chinese herbs and health supplements. Interestingly, it also can cause a severe form of interstitial nephritis which has been known by several names, most notably “Chinese herb nephropathy”…
What’s in a crescent?
What are the cells that make up crescents, the histopathologic hallmark of rapidly progressive glomerulonephritis (RPGN)? Classically these have been thought to be the parietal epithelial cells which make up Bowman’s capsule. However there is now some thought…
Leflunomide
Leflunomide is a drug I’ve seen used with increasing frequency in the renal transplant world. Marketed under the trade name “Arava”, it is an immunomodulatory agent which works by inhibition of the enzyme dihydroorotate dehydrogenase, one of the…
Avastin-induced kidney injury
Avastin (bevacizumab) is one of the commonly used VEGF (vascular endothelial growth factor) inhibitors used to inhibit vascular neogenesis, a process which is required for growth of tumor. It has proven to be a valuable agent in a…
Wearable Artificial Kidney
The man on the left is Victor Gura, one of the authors on a 2007 Lancet paper demonstrating the efficacy of the wearable artificial kidney (WAK). The machine (which can perhaps be likened to deluxe version of Batman’s…
Neuraminidase-associated TMA
A rare but interesting (and potentially fatal) type of thrombotic microangiopathy (TMA) called neuraminidase-associated TMA occurs with severe pneumococcal pneumonia or meningitis. Neuraminidase is a protease which cleaves off a specific antigen (Thomsen-Friedreich) on the surface of platelets…