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Novel strategy to decide on meaningful benefits with regard to examination throughout clinical trials.
Kidney transplantation has indisputably revamped renal medicine and restored hope among patients coming across fatal end-stage renal disease. However, sensitization of human leukocyte antigen (HLA) triggers extensive immunological fences to successful kidney transplantation and henceforth, transplant candidates are frequently demoted to the ever-growing waiting list owing to preformed donor specific antibodies (DSAs). Over the past few years, the advent of desensitization protocols has significantly overpowered the immunological barriers and enhanced the outcomes of kidney transplant recipients with DSAs against HLA. Those desensitization protocols include combination of plasmapheresis, high-dose intravenous immunoglobulin (IVIG), low-dose IVIG, rituximab, and/or bortezomib. These immunomodulatory treatments either eliminate DSAs or prevent their production. Lately, our transplant center developed and used a desensitization protocol (Two sessions of plasmapheresis on day 1 and 2 → injection rituximab on day 2 after plasmapheresis →no plasmapheresis on day 3 → eight sessions of plasmapheresis after day 3 and IVIG 100 mg/Kg/dose after each session of plasmapheresis → repeat HLA antibody detection test to confirm if DSAs are present against HLA with median fluorescence intensity (MFI)values less then 1000 and complement dependent cytotoxicity (CDC) crossmatch is negative for both T and B lymphocytes; if NO then continue plasmapheresis sessions with IVIG 100 mg/kg/dose till MFI values are less then 1000 and CDC crossmatch is negative for both T and B lymphocytes or if YES then proceed for transplantation → repeat dose of rituximab post-transplantation) to evaluate its effectiveness in improving kidney function in patients post-desensitization and kidney transplantation.Dosage adjustment of meropenem is usually recommended in hemodialysis (HD) patients and about 30% of meropenem is cleared during regular HD sessions. However, most of the published trials excluded patients on regular HD. Little is known about the accurate dosage of meropenem needed to avoid central nervous system toxicity. Herein, we report a 65-year-old Saudi female, a known case of end-stage renal disease on regular HD, who was admitted because of pyelonephritis and started on meropenem in the recommended dose according to cultures and sensitivity. She developed tonic-clonic convulsions after the 7th dose. Seizures were completely aborted after discontinuation of the offending drug. The recommended dosage of 500 mg daily in HD patients may still be too high particularly in Asian patients owing to their relatively small body mass index.A 69-year old male patient attended our clinic with fatigue, fever, anuria, nephritic syndrome and severe renal failure. Kidney biopsy showed pauci-immune crescentic glomerulonephritis with an unusual association of suppurative interstitial nephritis. Though most patients with renal involvement linked to antineutrophil cytoplasmic antibodies associated vasculitis (AAV) have pauci-immune glomerulonephritis, only a few patients were identified to have atypical renal pathology. In most cases, mononuclear tubulointerstitial infiltrate may be a feature of AAV, suppurative interstitial nephritis is very rare. In the literature, we found only one case reported associated with suppurative interstitial nephritis without glomerulonephritis who later developed classic pauci-immune necrotizing glomerulonephritis. Here, we report a case diagnosed as AAV, presenting with pauci-immune crescentic glomerulonephritis and suppurative interstitial nephritis. MEK inhibitor It is not clear whether suppurative interstitial nephritis is a severe disease variant in AAV-associated renal disease. As described in the first case the lack of improvement in renal functions in spite of intense immunosuppressive treatment leads to the conclusion that suppurative interstitial nephritis is a marker of poor prognosis.Membranous nephropathy (MN) is the major cause of nephrotic syndrome in adults and may be secondary to systemic lupus erythematosus or malignancy in 25% of patients. Without any etiology, it is called primary MN, which is usually associated with phospholipase A2 (PLA2) receptor antibodies. Secondary MN can appear months before a secondary cause is identified. Here, we report a case of MN, that was found to be secondary to pancreatic adenocarcinoma and positive for PLA2 receptor antibodies.Melioidosis is an emerging infectious disease in many countries including Bangladesh. Patients with diabetes mellitus are at increased risk for infection by Burkholderia pseudomallei, the causative agent for melioidosis. Here, we report an autochthonous case of septicemic melioidosis occurring in a middle-aged non-diabetic Bangladeshi farmer who presented with prolonged pyrexia and splenomegaly. Diagnostic workup revealed splenic micro-abscesses, previously undetected chronic kidney disease (CKD) and beta-thalassemia minor. This case stresses the importance of searching for less common risk factors for melioidosis such as CKD and hemolytic anemia.We report on a patient presenting with persistent chyluria due to filariasis, whose clinical course was complicated by massive proteinuria and severe hypoalbuminemia. Treatment with dietary manipulation, antifilarials, and sclerotherapy resulted in successful reversal of the above abnormalities. It has been reported that chyluria is not associated with massive proteinuria, or that even in cases of massive proteinuria, hypoalbuminemia is not seen and implies a glomerular pathology. We argue that chyluria is always associated with proteinuria, which may be massive, and does not warrant a kidney biopsy unless proteinuria persists despite resolution of chyluria.Anticoagulant-related nephropathy (ARN) is a recently described disease entity which is an underdiagnosed complication of anticoagulation. Despite widespread usage of anticoagulants, ARN is not commonly reported. We report a case of a 64-year old man with biopsy-proven ARN who presented with over anticoagulation and acute chronic kidney injury while on warfarin therapy for his left lower limb deep-vein thrombosis. Various investigations were performed and renal biopsy confirmed the diagnosis of anticoagulant-related nephropathy.
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