One of the largest controversies in the field of proteinuria/nephrotic syndrome research derives from a 2007 Kidney International paper published by Russo et al. Briefly stated, the authors suggest the paradigm-shifting idea that the glomerulus filters massive amounts…
In the past I’ve struggled to get my head around the question of the role of statins in CKD. On the one hand they appear to slow progression, and people with lots of proteinuria often show some reduction…
Keeping with our recent theme of “numerical rules in Nephrology”, let’s briefly discuss the “Rule of Thirds” for Membranous Nephropathy. The “Rule of Thirds” is frequently taught in medical school and a useful way of thinking about the…
A landmark paper on membranous nephropathy was published by Beck et al in the most recent issue of NEJM. Ultimately we will have to see if the finding is reproducible, but based on the data presented this represents…
I recently had to look up the differential diagnosis of nodular glomerulosclerosis: we had recently sent a clinic patient to undergo a renal biopsy based on a history of nephrotic-range proteinuria (urine protein to creatinine ratio of about…
Clinical trials evaluating the efficacy of various therapies of membranous nephropathy is a tricky business, given the natural history of the disease: because about 1/3 of patients spontaneously remit, it is often difficult to say that a patient’s…
An article by van de Velde et al in this month’s JASN describes the results of the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, a cohort study in which the ability to predict the need for…
Orthostatic proteinuria occurs in between 2-5% of all adolescents–it is primarily a pediatric condition, rarely occurring after age 30. Orthostatic proteinuria refers to the condition of an individual having proteinuria only while upright; the urine protein level returns…
The thiazolidinediones (a.k.a. “the glitazones”) are widely used in the treatment of of hyperglycemia. Although they have their side effects (an increased risk of cardiac events according to some epidemiologic studies, plus the possibility of fluid overload or…
The ONTARGET trial was on the major trials looking at the potential benefits of dual ACE-inhibitor (ACE-I)/angiotensin receptor blocker (ARB) therapy. Although it was not intended to specifically examine the effects of dual blockade of the renin-angiotensin system…
