ASN 2011: West Nile Nephropathy

An oral abstract presented at the ASN 2011 session talked about an interesting new entity that we should now consider in our diagnosis - West Nile associated Nephropathy presented by Dr. Podoll.
West nile is a zoonotic infection that infects horses and humans and bird as the vector. WN is an arbovirus, sRNA and there are 3.8 million infected cases in the USA.
There are many neurological sequelae that we have read about that can come from WN. Apparently, many also develop chronic neurological damage. Bird autopsies have shown that the virus can also live in the kidney and usually in the tubules. The Hampster model has shown that it can have peri tubular damage.
Of 208 patients with chronic WN neuropathy, 70 were found to have been shedding WN RNA in their urine.  Most of them were male and 47% had proteinuria.  28% had GFR < 60 and the urine sediment showed predominant monocytes, epithelial cells.  6 biopsies found chronic tubular interstitial disease with predominantly monocytes. Glomeruli were normal.  EM showed virion particles within the tubules. Immuno was negative in all cases.  There was chronic interstitial fibrosis and tubular atrophy.  


This is interesting - chronic TI disease from West Nile Nephropathy- keep this in your differential in the endemic areas of USA and the world


Ref
http://www.ncbi.nlm.nih.gov/pubmed/16102323
http://www.ncbi.nlm.nih.gov/pubmed/15772329
http://www.sochinf.cl/sitio/templates/sochinf2008/documentos/persistenciavirusdelnilo.pdf

ASN 2011: MPGN revisted

MPGN classically has been associated with Type 1, II and III variant and divided based on electron microscopic(EM) findings.
This ASN, a paradigm shift of thinking was mentioned.

The thinking now is to think of it more like a pattern of injury and classify based on immunofluorescence (IF) rather than EM.

The four major categories are:

Immune complex :  chronic infection related or auto immune 

Complement dysregultion : familial and acquired, the c3 glomerulopathies

Chronic tma:  atypical hus, other TMAs, APLAS

Paraprotein.  Any variant can come here, that is monoclonal

Old classification:  Based on extent of deposits on EM and where they are

New classification: Based on pathophysiology and IF findings more

So If you have IgG and C3 on IF:- then think more immune complex based

If you have Ig G monoclonal:- think monoclonal disease 

If you have C3 only:- think C3 glomerulopathies  or Dense Deposit Disease

If you have No C3 or IgG:- then think TMA

Idiopathic MPGN in an adult is a diagnosis of exclusion, more common in children and its usually polyclonal and C3 positive. 

So think differently when thinking about MPGN from now on. Always a tough disease to battle

take a look at a prior concept map on this

http://www.nephronpower.com/2011/08/concept-map-of-mpgn-pattern-of-injury.html

NSLIJ - Lengthening Kidney Dialysis Treatments Could Reduce Mortality

NSLIJ - Lengthening Kidney Dialysis Treatments Could Reduce Mortality

NSLIJ - When Doctors Turn to Google for Diagnosis Help

NSLIJ - When Doctors Turn to Google for Diagnosis Help

E Journal Club:- CJASN feature

CJASN is doing live journal clubs or e journal clubs of the articles published in CJASN.

Take a look at this new and innovative feaure

http://ejc.cjasn.org/phpBB3/

Nephrology Crossword- from World Kidney Day

Kidney F by Dr. Malvinder S Parmer, From Univ of Ottawa

Answers provided after ASN Kidney Week 2011

eAJKD, the official blog of AJKD

I would like to introduce to the blogsphere:- eAJKD: the official blog of American Journal of Kidney Diseases.
http://ajkdblog.org/

The American Journal of Kidney Diseases (AJKD) is the official journal of the National Kidney Foundation and is recognized worldwide as a leading clinical kidney journal. AJKD is pleased to now offer eAJKD, the official blog of the journal. A central goal ofeAJKD is to highlight selected journal content in an engaging, timely format.  The blog will have interviews with authors, educational material, as well as podcasts and video. We are looking forward to bringing AJKD into the future and offering engaging new means for authors and readers alike to interact with the journal!

It's also a landmark as this is the first time all prominent Nephrology bloggers or e-nephrologists are uniting for a single mission:- Education and sharing of knowledge. Please welcome: Matt Sparks, Tejas Desai, Vinay Nair, Joel Topf, Sidharth Sethi, Kellie Calderon and Jordan Weinstein to this. 

Come visit us all at the eAJKD and we shall show you many new things in the coming months.