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The renal services were consulted on a man in his late 70s with a distant history of colon cancer, recent pneumonia and NSTEMI, for investigation of worsening renal function. He had sub-nephrotic range proteinuria (2-3 g/24 hours) and…

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Beads on a String

A 41 year old gentleman with no past medical history presented to ER for nausea, vomiting and abdominal pain. Abdominal CT showed bilateral renal infarcts. His labs were notable for a Cr of 1.4, LDH 500 ESR 102….

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Mmm, let’s try rituximab

Mixed cryoglobulinemia (MC) is a systemic vasculitis in which B cell clones produce IgM with rheumatoid factor activity. The disease can range in severity from isolated skin lesions to full blown renal and neurological involvement. Most patients are…

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Classification of Cryoglobulins and MPGN

Cryoglobulinemia is characterized by the presence of circulating antibodies which precipitate at cooler temperatures, and not infrequently leads to renal failure/glomerulonephritis. The stereotypical histologic lesion of cryoglobulinemia is membranoproliferative glomerulonephritis, which takes the appearance on light microscopy of…

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Lyme Nephritis??

I included two question marks in the title, since the existence of Lyme Nephritis remains controversial.  However, somebody presented a case of alleged Lyme Nephritis in a recent Renal Grand Rounds which was interesting. In brief, the case…

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Empiric Management of Suspected RPGN

RPGN is a nephrologic emergency, and one of the more exciting consult cases for nephrologists to participate in.  Much like dealing with a stroke or heart attack, delays in initiating therapy can lead to substantially worsened outcomes.  Prompt…

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