Focal Segmental Glomerulosclerosis, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrolog скачать в хорошем качестве

Focal Segmental Glomerulosclerosis, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrolog

A 44-year-old woman with a history of progressive kidney disease marked by collapsing glomerulopathy is now preparing for a living-donor kidney transplant. She previously had negative infectious and autoimmune workups, extensive genetic testing, and nephrotic-range proteinuria prior to anuria. What factors in her clinical history and pre-transplant evaluation highlight the risk of disease recurrence, and what unique peri-operative challenges must clinicians consider to minimize early graft complications? VIDEO INFO Category: Focal Segmental Glomerulosclerosis, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Prevention - Preventive measures and screening Case Type: Typical Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 44-year-old Black woman in the United States is completing living-donor kidney transplant evaluation 4 weeks before surgery. Eighteen months ago, a native left-kidney core biopsy read by a renal pathologist using the Columbia classification reported a collapsing glomerulopathy pattern of injury on light microscopy, with no immune-complex deposition on immunofluorescence and diffuse podocyte foot-process effacement on electron microscopy.... OPTIONS A. Therapeutic plasma exchange 1.0-1.5 plasma volumes every other day for five inpatient sessions beginning postoperative day 1, combined with rituximab 375 mg/m2 IV once on postoperative day 1; performed on the inpatient transplant unit with on-site apheresis and infusion monitoring B. Abatacept 10 mg/kg IV on postoperative day 1 and again on day 15 without peri-operative therapeutic plasma exchange; administered on the inpatient transplant infusion service C. Ofatumumab 300 mg IV on postoperative day 1 followed by 2000 mg IV on postoperative day 15 without therapeutic plasma exchange; administered on the inpatient transplant unit D. Intravenous immunoglobulin 2 g/kg total divided over postoperative days 1-2 without therapeutic plasma exchange; administered on the transplant ward with standard infusion monitoring CORRECT ANSWER A. Therapeutic plasma exchange 1.0-1.5 plasma volumes every other day for five inpatient sessions beginning postoperative day 1, combined with rituximab 375 mg/m2 IV once on postoperative day 1; performed on the inpatient transplant unit with on-site apheresis and infusion monitoring EXPLANATION Therapeutic plasma exchange 1.0-1.5 plasma volumes every other day for five sessions starting postoperative day 1, paired with a single rituximab 375 mg/m2 infusion on postoperative day 1, is the only option that reflects small peri-operative, uncontrolled attempts to blunt very-early recurrence of presumed primary podocytopathy after kidney transplantation. The mechanistic aim is immediate removal of circulating permeability factors that can trigger hour-to-day recurrence, plus early CD20+ B-cell depletion to reduce autoantibody generation. In this patient, estimated plasma volume by the Kaplan formula is 0.065 x 84 x (1 - 0.31) = 3.77 L; a 1.5-volume exchange is 5.65 L per session.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------