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Since the completion of the Human Genome Project in 2003, an expanding understanding of the genetic basis of diseases has allowed us to target disease mechanisms at the molecular level. One example of the application of precision medicine in nephrology targets the mammalian target of rapamycin (mTOR) complex in the multisystem disease of tuberous sclerosis (TSC). Affecting roughly 1 in 6000 live births, TSC is a rare but significant cause of kidney disease in children (
Once the decision to pursue peritoneal dialysis (PD) is made, two primary modalities are available from which patients can choose: continuous ambulatory PD (CAPD) and ambulatory PD (APD). CAPD involves manually performed exchanges using gravity to fill and drain the peritoneal cavity, and APD involves exchanges that are performed using a cycler over several hours, typically during the night. The selection of a PD modality is dependent on an individual's lifestyle because there is no difference in patient and technique survival (
Subtypes of APD include continuous cycling PD (CCPD), nightly intermittent PD (NIPD), and tidal PD (TPD)
Kidney involvement is a major complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), manifesting clinically as rapid decline in glomerular filtration rate and histologically by Pauci-immune crescentic (
Cellular crescents
Glomerular fibrinoid necrosis at Jones methenamine silver (JMS) staining
C3 glomerulonephritis (C3GN) and dense deposit disease (DDD), collectively known as C3 glomerulopathy (C3G), are rare glomerular diseases presenting with microscopic hematuria, proteinuria, and often, abnormal kidney function. Low serum C3 is present in 70%−80% of patients with DDD and 50% with C3GN (
C3G is characterized by dysregulation of the alternative complement pathway and defined by C3-dominant staining on immunofluorescence
As the coronavirus infectious disease 2019 (COVID-19) pandemic unleashed through the world, we found that patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) had a wide range of direct and indirect effects culminating in a variety of end-organ injuries. Acute kidney injury (AKI) was found in as many as 80% of patients admitted to the intensive care unit with severe illness.
The most common histopathologic equivalent of clinical AKI was acute tubular injury or necrosis in biopsy and autopsy studies in these patients. However, COVID-19 can affect all compartments of the kidney parenchyma, including the glomerulus, interstitium, and vasculature.
Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerular disease worldwide. Despite being initially described over 50 years ago by Dr. Jean Berger, there remains no disease-specific treatment. Its underlying pathogenesis is a dysregulation of the IgA immune system, which is characterized by elevated circulating levels of polymeric IgA1 that lack terminal galactose residues within the hinge region (termed “poorly galactosylated IgA1”) and the presence of IgA1-specific IgG and IgA antibodies (
Fibrillary glomerulonephritis and immunotactoid glomerulonephritis represent two of the kidney diseases characterized by organized fibrillar deposits. In 1977, the first case of fibrillary glomerulonephritis was described in a patient with nephrotic syndrome whose kidney biopsy showed amyloid-like deposits that did not stain with Congo red (
Drugs cause approximately 20% of community- and hospital-acquired episodes of acute kidney failure (
A growing body of literature highlights the potential for drugs to induce not only AKI but also glomerular diseases, termed drug-induced
Minimal change disease (MCD) is one of the major causes of idiopathic nephrotic syndrome, accounting for up to 70%−90% of cases in children and approximately 15% of cases in adults (
Membranous nephropathy (MN) is a common cause of nephrotic syndrome, attributed to approximately 25% of adult patients with nephrotic-range proteinuria or nephrotic syndrome (
MN is classified as primary,
