Pathology Image of the Month
A 47 year old man with ESRD secondary to a chronic TMA presented 3 months following a renal transplant with a rising creatinine (1.44 mg/dl from a baseline of 0.9 mg/dl). His prograf level had ranged from 5-7….
Enteric Hyperoxalosis following Roux-En-Y Bypass
Recently, I evaluated an older gentleman with diabetic nephropathy who had undergone a living related kidney transplant from a family member. He underwent Roux-en-Y bypass with an approximate 80 lbs. weight loss prior to his transplant to achieve…
Allowing Altruistic Donors to be Altruistic
If you were embarking on a search to find and interview the healthiest individuals on the planet, speaking with kidney donors would be a great place to begin. People who have donated one of their kidneys share many…
Diagnosis and Management of Post-Transplant Fluid Collections
We were evaluating a kidney transplant recipient three weeks after surgery who presented with a rise in creatinine. We obtained an ultrasound which showed a large fluid collection and mild hydronephrosis. Prograf level was at goal. Peritransplant fluid…
Still mysterious: the elusive circulating factor for FSGS
Important new findings were recently published in relation to proteinuria and FSGS, which are definitely of interest to our community. First, the punch line: There is new evidence for a “circulating factor” in recurrent FSGS in a fascinating…
Acute rejection: what do the circulating cells have to say about it?
One of the frequent situations that we face in the renal transplant clinic is the patient in otherwise good condition who presents with a slight rise in serum creatinine. Although this is sometimes due to reversible causes, such…
To transplant or not to transplant: That is the question
A young woman presented for altruistic kidney donor evaluation. She had no significant past medical history other than two normal prior pregnancies. Physical examination was unremarkable. A CT angiogram revealed bilateral irregularities of the renal arteries and a…
Antibody-Mediated Rejection: Choose your weapons
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…
Combined heart-kidney transplant – when less is enough
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…
Cold and OTCs in Transplantation
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…