Great @mgh_transplant path rounds with Veronica π§ββοΈ 38M with ESRD due to MPGN, s/p kidney transplant 1 year ago, presents with rising creatinine and 1g of proteinuria.
Biopsy: No rejection but segmental β cellularity & mesangial expansion. Whatβs on your differential? π§΅π
True vs. Pseudo-Crescents
Differentiating crescents in kidney transplant biopsies:
β’ True crescents: Breaks in GBM with fibrin deposition.
β’ Pseudo-crescents: No fibrin, no break in GBM. Fewer inflammatory cells.
Recurrent GN post-transplantoften mirrors the native disease. Here, mesangial IgA/IgG, C3+,C1qβ, & EM mesangial deposits fit crescentic IgA-dominant immune complex GNβa known recurrence.Treatment decision: steroid pulse and iptacopan. Hopefully new B-cell targets soon @AlJurdi
1/3. Hair-straightening products containing glyoxylic acid may cause acute kidney injury (AKI)! A recent NEJM article reports cases of calcium oxalate nephropathy linked to these products. Murine models confirm kidney damage after skin exposure. https://www.nejm.org/doi/full/10.1056/NEJMc2400528
3/3: β οΈGlyoxylic acid, marketed as a safer alternative to formaldehyde in hair products, may be nephrotoxic. The study suggests discontinuing such products to prevent kidney injury. Public health implications! Thanks @MegSise for presenting it + https://www.sciencedirect.com/science/article/pii/S2468024924017698#:~:text=Hair%2Dstraightening%20procedures%20are%20potential,and%20prevent%20chronic%20kidney%20disease.
One more recent evidence here: https://www.kidney-international.org/article/S0085-2538%2824%2900619-7/fulltext
Obesity affects kidney health, with severe obesity nearly doubling in prevalence over 20 years. Weight loss improves kidney outcomes, but lasting results require lifestyle changes + new tools like anti-obesity meds & surgery. Multidisciplinary care isπ #KidneyHealth #Obesity
Great review @JASN_News https://pubmed.ncbi.nlm.nih.gov/39292519/ from @AlpIkizler et al.
Kidney transplants from HIV+ donors to HIV+ recipients. A new study @Dorry_Segev w/ participation @mgh_transplant shows no difference in 3-year survival or graft loss vs. non-HIV donors. Data convincing to move this to routine practice #Transplantation #HIV
Even better news came out today... Historic ruling from the Secretary of the Health and Human Services has determined that clinical research is no longer required for HIV kidney and liver transplantation in the US. β¬οΈEquity with supported safety data. ππ https://www.federalregister.gov/documents/2024/11/27/2024-27410/organ-procurement-and-transplantation-implementation-of-the-hiv-organ-policy-equity-hope-act
π¦ππ©π π§ππ πππ§π for the ISN Webinar: "Pioneering Xenotransplantation: The Worldβs First Genetically-Edited Pig Kidney Transplant in a Living Recipient"
π£οΈ @LVRiella, Winfred Williams
π€ @LiLiHsiao1
ποΈ November 15
π 2 pm CET
π Free registration: https://ow.ly/eUS450U0nRm
Great case presentation at Renal Grand Rounds by Ashima Chadha @MGHKidneys @BWHKidney π©Ί Scleroderma Renal Crisis:A rare but life-threatening complication of systemic sclerosis.Early signs include sudden high blood pressure & acute kidney injury+/- TMA. Low-risk of tx recurrence
Β© 2024 Leo Riella
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