Nephrology Quiz and Questionnaire

Abstract

T he Nephrology Quiz and Questionnaire returns to the pages of CJASN after an absence of 3 years, but it still remains one of the most popular sessions at the annual meeting of the American Society of Nephrology. The meeting in 2009 in San Diego was no exception, with a full-house attendance, estimated at more than 800 eager nephrologists. Eight challenging and educational cases were presented and discussed by four able and skilled experts. The discussants were asked to prepare vignettes of puzzling cases, each illustrating some topical, challenging, or controversial aspect of diagnosis or management of ESRD and dialysis (Dr. Bargman), fluid and electrolytes (Dr. Palmer), kidney transplantation (Dr. Samaniego), and glomerular disease (Dr. Fervenza). One or two single best answers questions followed each case presentation, which were addressed by the audience in a live electronic response system. In addition, several weeks before the meeting, the cases and questions (without the answers) were sent to all of the US nephrology training program directors as a questionnaire. Their responses to the questions were tallied and presented after the audience response but before the answers to the quiz and the analyses of the cases were given by the discussants.Each discussant prepared a manuscript summarizing his or her discussion of the cases, an edited version of which serves as the main text of this article. We hope that this "distillate" from San Diego will serve the subscribers to CJASN well and provide some fresh insights into the complexity and vibrancy of clinical nephrology for those who were unable to attend (Richard J. Glassock, MD, Moderator).

Understanding the complement‐mediated glomerular diseases: focus on membranoproliferative glomerulonephritis and C3 glomerulopathies

“…Immune-complex-mediated MPGN is typically a consequence of chronic antigenemia, and the continuing presence of immune complexes in the circulation, a phenomenon usually associated with a certain condition (6,8,9). The most frequent underlying disorders associated with immune complex MPGN (10) include chronic infections, autoimmune diseases, and monoclonal gammopathies.…”

“…The use of cyclophosphamide in the treatment of MPGN is not clearly documented, although it is the most widely used, as the use of other agents is very limited . There is only one randomized trial, in which, 59 patients with MPGN were assigned to cyclophosphamide, warfarin, and dipyridamole or to no therapy . Entry criteria were according to the older classification and included MPGN type I or type II (DDD) plus an eGFR < 80 mL/min/1.73 m 2 and/or a 24‐h proteinuria >2 g/day.…”

“…Entry criteria were according to the older classification and included MPGN type I or type II (DDD) plus an eGFR < 80 mL/min/1.73 m 2 and/or a 24‐h proteinuria >2 g/day. Two years later, no difference was found in the renal survival or the rate of decline of renal function and proteinuria, between treatment and control groups . Another study, reported results in 19 patients with MPGN, who were treated with a regimen consisted of an inductive phase with intravenous pulse of methyl‐prednisolone plus oral cyclophosphamide, and a maintenance phase with oral prednisone, given every other day with daily oral cyclophosphamide .…”

Clinical and Pathophysiological Insights Into Immunological Mediated Glomerular Diseases in Childhood

“…Immune complex-mediated MPGN is typically caused by a chronic antigen stimulus with persistence of CICs (11,16,69,70). The most frequent underlying disorders include chronic infections (hepatitis B/C, streptococcal and mycoplasma infections), autoimmune diseases (SLE, scleroderma, Sjögren syndrome) (60, 71-79), while monoclonal gammopathies are exceptional in children (80,81).…”

Two Cases of Membranoproliferative Glomerulonephritis With Severe Proteinuria

“…Kötü prognostik bulguları içermeyen olgular (non-nefrotik proteinüri, normal tansiyon, kreatinin normal, kresent yok) kan basıncını kontrol etmek ve proteinüriyi azaltmak için tek başına anjiyotensin inhibitörleri ile konservatif olarak tedavi edilebilirler (9) . İdiopatik immün kompleks aracılı MPGN için optimal immünosupresif tedavi bilinmemektedir, çünkü az sayıda randomize çalışma vardır (10)(11)(12) . Sıklıkla glukokortikoidlerin tek başına veya diğer immünsüpresif ajanlarla birlikte (sitotoksik ilaçlar, MMF, kalsinörin inhibitörleri) kullanımı önerilmektedir (13)(14)(15) .…”