Check out this interesting cartoon video on The Nephron
http://www.khanacademy.org/video/the-kidney-and-nephron
Sunday, August 29, 2010
Friday, August 27, 2010
CMV infection in Kidney Transplantation
Here is a brief presentation by Arun Chawla, MD on CMV in Kidney Transplantation.
CMV in Organ Transplantation
View more presentations from Nephrology, NSLIJ.
Thursday, August 26, 2010
IN THE NEWS: LIVER induced erythropoietin production
As we all know that the kidney is a major site for erythropoietin production. We deal with complications of ESRD and patients needing EPO as a result. Apparently, liver controls production of this hormone in the fetal life. Hypoxa inducible factor of HIF inhibits this function of the liver by three hydroxylases PHD1,2 and 3.
This recent study listed below showed that in mice if all three PHD1,2,3 are inhibited, the liver can started producing erythropoietin again. This might make way for some clever drug creations for future treatment of anemia. The concern might be if the body chose to shut down liver mediated Epo, perhaps it might not be that active or perhaps not a safe form. No one knows.
Is liver produced epo as effective and safe as the kidney produced epo?
Regardless, worth a read!
Reference:
http://www.ncbi.nlm.nih.gov/pubmed/20651146
JOURNAL CLUB: RITUXIVAS Trial
We discussed the recent NEJM trial called RITUXIVAS
( Linked below)
Take home points
1. Randomized controlled double blinded trial that was comparing IV Cytoxan induction arm to IV Rituximab + low dose IV cytoxan arm and follow up for up to 12 months.
2. It was a random assignment via a 3:1 ratio ( rituximab to cytoxan)
3. everyone got steroids
4. Primary end points were sustained remission
5. Result: A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events.
Plus points:
1.First study to compare SEVERE anca vasculitis in a randomized fashion that involves Rituximab
2. Patients included elderly as well which is where the choice of treatment becomes an issue.
Minus points:
1. Sample size
2. The Rituximab arm was sicker( more patients on dialysis)
3. The Rituximab arm received cytoxan as well ( unclear why they chose to do this, perhaps ethical reasons)
4. Net immunosuppresion was likely higher in the Rituximab arm ( dialysis , likely had TPE, and also cytoxan) making more infectious risks.
5. Data on IV cytoxan itself is poor in ANCA vasculitis.
6. Didn't really answer the question if Rituximab alone is good enough when compared to Cytoxan, and less toxic
http://www.ncbi.nlm.nih.gov/pubmed/20647198
( Linked below)
Take home points
1. Randomized controlled double blinded trial that was comparing IV Cytoxan induction arm to IV Rituximab + low dose IV cytoxan arm and follow up for up to 12 months.
2. It was a random assignment via a 3:1 ratio ( rituximab to cytoxan)
3. everyone got steroids
4. Primary end points were sustained remission
5. Result: A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events.
Plus points:
1.First study to compare SEVERE anca vasculitis in a randomized fashion that involves Rituximab
2. Patients included elderly as well which is where the choice of treatment becomes an issue.
Minus points:
1. Sample size
2. The Rituximab arm was sicker( more patients on dialysis)
3. The Rituximab arm received cytoxan as well ( unclear why they chose to do this, perhaps ethical reasons)
4. Net immunosuppresion was likely higher in the Rituximab arm ( dialysis , likely had TPE, and also cytoxan) making more infectious risks.
5. Data on IV cytoxan itself is poor in ANCA vasculitis.
6. Didn't really answer the question if Rituximab alone is good enough when compared to Cytoxan, and less toxic
http://www.ncbi.nlm.nih.gov/pubmed/20647198
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