Blog entry by Meguid El Nahas

Anyone in the world

Adam from Paris for GKA 2010

The Theme of this 1st Episode: 

Back to Old drugs: Aza, MTx, Hydroxychlorquene.
Less Corticosteroids still do the same action with less S/Es.
Cr Nadir is earlier than Albumin one.

Date: Thursday May 24th 2012
08:30 - 12:30 CME Courses
Rheumatology for nephrologists 46
Peritoneal Dialysis Workshop 47

Title: Rheumatology for nephrologists
Chair: Hans-Joachim Anders, Munich, Germany
David Jayne, Cambridge, UK
i. Welcome and introduction
Hans-Joachim Anders, Munich, Germany
David Jayne, Cambridge, UK

ii. Joint pain in CKD patients: When do we need a joint aspirate?
Hendrik Schulze-Koops, Munich, Germany
1) Sodiumaurate Crystals in Gout is different that those of CPPD crystals in Pseudo gout which may occur in the dialysis population.
2) The Take Home message in unclear monoarthrits; Do Not Wait; and do Aspirate; however;
3) Synovial fluid aspirate is a sterile procedure; however; the risk of complication by sepsis is 1/10,000; which cost a famous German athelet his career by causing septic arthritis for a procedure which is considered in his case may not be justified.

iii. Proteinuria in the patient with arthritis
Volker Vielhauer, Munich, Germany

4) Proteinuria in patients with arthritis include these following 5 main Topics: either Association, Complication, Manifestation, Toxicity and the fifth and the Last but not the least is Co-morbidity. 

5) This need Reply: A 34 yrs old male diagnosed as Behcet and was on CsA and CS. Developed proteinuria 2.8 g/24hrs, Cr 88um/L, with Dysmorphic RBCs, Hence referred to the Nephrologist; with a Bx showed IgA in A Behcet Disease with eGFR 60 ml, with no Cresents and no Fibrosis. How to manage? Opinions so to tell you what happen and what they did?

6) Assoicated Renal Disease in Behcet include mainly Amyloidosis 69/156, and GN in 51/152 cases. IgA deposition was found in 22% of GN with Behcet.

7) Associated Renal Disease in RA include: Mesangial GN 40/110, Renal Amyloidosis 33/110 and MN 19/110 cases.

8) The 2012 “standard of care” in lupus nephritis – referral,
drugs and monitoring
Frédéric A. Houssiau, Brussels, Belgium

8) LN is a very heterogenous disease which varies from single shot, or relapsing 1/3 or refractory 1/5 of the cases.
9) Poor prognostic factors include many; but on the top of the lists are Race (AA), non-observance to Rx, Absence of primary response to IS.

10) Poor prognostic factors in the pathology; beyond Roman numerals include fibrinoid necrosis, partial cresents and circumferential cresents.
11) Renal Bx is not a routine procedure in all SLE patients. However; Low C3, High Anti-DNA, or renal involvements include Pr > 0.5 g/24hrs and/or Active sediment are red flagged.
12) You may need Renal Bx so as not to miss APL-related Disease.
13) Which LN patients should be immunosuppressed? Class I, II NO ---, III & IV (both have Endo/extra capillary cellularity and sub-endo ID: YES ---, V in Selected Cases. However; wait for

my 2nd Episode from the EDTA concerning ISN/RPS 2003 Classification for more Info and critic by Ian Roberts.
14) LN: Towards no Steroid regimen? By Imperial College of Kidney and Tx Institute in London UK; by Liz Lighstone et al. Giving on Day 1 and 15th : 500 mg MPS + 1g RTx. Then only use MMF with no steroids. Claiming optimal renal protection.
15) Euro Lupus Nephritis Trial showed LD is equivalent to HD of CYP for induction in LN.
16) The cost of MMF is more than 10 times that of CYP for induction of Rx in LN.
17) Both AZA and MMF have similar effect as maintenance Rx for LN as proved by two trials ALMS (David Wafsy; especially if the two arms were induction with IV CYP) and MAINTAIN.
18) Never forget Plaquanil (Hydrochlorequene) in LN not only in SLE. Nephrologists are reluctant to consider it.
19) This need Reply: A Pregnant Lady with Acute flare of SLE; which IS Rx you recommend? Either with or without LN? and Do you recommend Abortion to save the mother from being ESRD or more complication?

v. Non-renal flares in lupus nephritis patients – new options
Falk Hiepe, Berlin, Germany

20) Bortezomib can cause clinical improvement in severe and refractoy SLE. This proteasome inhibition markedly reduced plasmablasts and plasma cells from the peripheral blood and bone marrow.

vii. B cell targeted therapy in nephritis, all hype and no substance?

David Jayne, Cambridge, UK

viii. ANCA-associated vasculitis - an update on therapeutic
Alan Salama, London, UK

Wait for my 2nd Episode of the Pathology.
The Theme is:
New Pathological Dx with still invalid clinical Significance.
Recent pathological classification of LN 2003 are more confusing than older one and may be wrong.
Criteriae necessary for Dx may not be necessary anymore. (ABMR with C4d –ve).

Wait for my 3rd Episode of the Opening Cermony and Pioneers in European Nephrology .
The Theme is:
There are two "REFRAINS" in the opening Cermony: Continuity and Memory.
Modesty and The Patient is what Kept the Pioneers so Pioneers.

[ Modified: Thursday, 1 January 1970, 1:00 AM ]