Living Donation in the Family Ethical and Medical Problems Dr Umberto Maggiore
|
|
- Peregrine Townsend
- 6 years ago
- Views:
Transcription
1 Living Donation in the Family Ethical and Medical Problems Dr Umberto Maggiore SS Trapianti Rene-Pancreas UO Nefrologia (Dir Prof C Buzio) Az. Ospedaliero-Universitaria di Parma Parma, ITALY
2 CATEGORIES OF DONATION BY LIVING PERSONS 1. DIRECTED DONATION TO A LOVED ONE 2. NONDIRECTED DONATION 3. DIRECTED DONATION TO A STRANGER Truog N Engl J Med 2005;353:5
3 ETHICAL ISSUES IN DONATION IN THE FAMILY 1. PRESSURE TO DONATE WITHIN THE FAMILY 2. WILLING TO DONATE REGARDLESS OF THE RISKS Spital Ethics of Organ Transplantation 2001;7:89
4 PRESSURE TO DONATE WITHIN THE FAMILY 1. EXTERNAL: ONE PERSON TRIES TO CONVINCE ANOTHER TO DONATE (eg spouse) 2. INTERNAL: FEELING OF OBLIGATION AND GUILT (eg sibling) Gordon Am J Transplant 2012, May 17
5 EXTERNAL PRESSURE UNUSUAL MORE AGAINST DONATION THAN IN FAVOUR OF DONATION Smith Am J Kidney Dis 1986;8:223
6 Spital Ethics of Organ Transplantation 2001;7:89 Gordon Am J Transplant 2012, May 17 INTERNAL PRESSURE FEAR OF FAMILY OSTRACISM FEAR OF LIFELONG GUILT SOCIOCULTURAL AND FINANCIAL DIFFERENCES o Europe o Asia o Developing Countries EXTENT: LIVER vs KIDNEY DONORS
7 Live Organ Donor Consensus Group JAMA 2000;284:2919 Steel Am J Transplant 2012, May 1 INTERNAL PRESSURE: SAFEGUARDS TRAINED MENTAL HEALTH PROFESSIONAL ie, clinical social worker, psychologist, psychiatrist, or psychiatric nurse experienced in transplantation INDEPENDENT DONOR ADVOCATE (TEAM) o not a transplant team member: conflict of interest o transplant center might engage a mental health professional who is not a member of the recipient care team
8 PLAUSIBLE MEDICAL EXCUSE FOR UNWILLING DONORS MEDICAL EXCUSE: BOW OUT GRACEFULLY NOT A FALSIFIED MEDICAL CONDITION o Undesired consequences of medical insurance o May still act as a donor in the future eg for their own children STANDARD OPTIONS o Borderline hypertension, glucose level o general contraindication Live Organ Donor Consensus Group JAMA 2000;284:2919
9 SOME DEGREE OF INTERNAL PRESSURE IS ACCEPTABLE INTERNAL PRESSURE: WRONG TO AUTOMATICALLY CONCLUDE DONATION IS NOT VOLUNTARY EXAMPLE: MOTHER TO CHILD DONATION o Emotional ties to their child o Sense of moral obligation COERCITIVE SITUATION (NOT COERCION) o Coercion requires that the decision is being forced by another person o Coercitive situation: feeling of obligation gives voice to mother autonomy Crouch Cambridge Quarterly Healthcare Ethics 1999;8:275 Spital In: Living Donor Organ Transplantation (Gruessner Benedetti) 2008; 51
10 ETHICAL ISSUES IN DONATION IN THE FAMILY 1. PRESSURE TO DONATE WITHIN THE FAMILY 2. WILLING TO DONATE REGARDLESS OF THE RISKS Spital Ethics of Organ Transplantation 2001;7:89
11 Fellner Am J Psychiat 1970;126:1245 Nuffield Council of Bioetics Human Tissue Ethical and Legal Issues 1995; 45 RAPID CONSENT FROM DEEP AFFECTION IS VALID DONORS MAY IMMEDIATELY VOLUNTEER UPON HEARING OF THE NEED, IN THE FACE OF LIMITED UNDERSTANDING OF RISKS: CONSENT MAY NOT BE FULLY INFORMED THE ETHICALLY SIGNIFICANT REQUIREMENT IS NOT THAT CONSENT BE COMPLETE, BUT THAT IT BE GENUINE : DONATION STILL REGARDED AS AUTONOMOUS CHOICE
12 DO DONORS HAVE A RIGHT TO DONATE AN ORGAN? NO: AUTONOMY OF THE RESPONSIBLE PHYSICIAN MUST ALSO BE RESPECTED THE PHYSICIAN DECIDES WHETHER HE IS MORALLY JUSTIFIED IN HELPING THE DONOR ACCOMPLISH IT IT MAY BE NOT ALWAYS REASONABLE FOR THE PHYSICIAN TO ACCEPT VOLUNTEERS WHO STRONGLY WISH TO DONATE DESPITE ADDED RISK Elliot J Med Ethics 1995;21:91
13 BALANCE BETWEEN RISK AND BENEFIT: DONOR S BENEFIT DONOR BENEFIT IS THE KEY TO JUSTIFIED LIVING ORGAN DONATION For physicians to recommend their patient as an acceptable organ donor they must first believe that the benefits for the potential donor are sufficient to offset the risk for the donor Spital Cambridge Quarterly Healthcare Ethics 2004;13:105
14 PSYCHOLOGICAL BENEFIT FOR THE DONOR CAN BE LARGE AND AT LEAST AS IMPORTANT AS PHYSICAL ONE o eg mothers who see their loved child returned to normal life o eg spouses having their cherished person available for sharing the joys of life UNJUSTIFIED REJECTION OF A SPOUSE/MOTHER MAY HAVE NEGATIVE CONSEQUENCES FORTHE DONORS THEMSELVES Gaston Am J Transplant 2010; 10:2574
15 ESTIMATES OF ANTICIPATED PSYCHOLOGICAL BENEFIT BEST EXPERTS ABOUT THE EXPECTED PSYCHOLOGICAL BENEFIT ARE THE DONORS THEMSELVES PHYSICIANS SHOULD INCORPORATE THE DONOR S VISION INTO THEIR DECISION MAKING PROCESS Kassirer New Engl J Med 1983;308:898
16 DONATION FROM MINORS AND NOT MENTALLY DEVELOPPED LACK OF DONOR BENEFIT IS THE STRONGEST POINT AGAINST DONATION TO SIBLINGS FROM MINORS AND FROM PEOPLE NOT MENTALLY DEVELOPED o may fail to understand the important role they played in the care of sibling o may not receive any psychological benefit as a result of their donation Crouch Cambridge Quarterly Healthcare Ethics 1999;8:275
17 DISCLOSURE OF INFORMATION THE PERSON WHO GIVES CONSENT TO BE A LIVE DONOR SHOULD BE COMPETENT, WILLING TO DONATE, MEDICALLY AND PSYCHOSOCIALLY SUITABLE, FULLY INFORMED OF THE RISKS AND BENEFIT AS A DONOR, AND FULLY INFORMED OF THE RISKS, BENEFIT, AND ALTERNATIVE TREATMENT AVAILABLE TO THE RECIPIENT Live Organ Donor Consensus Group JAMA 2000;284:2919
18 RISK ESTIMATES ESSENTIAL FOR DONOR ACCEPTANCE POLICY IF THE RISKS ARE TRULY UNKNOWN, OR ONLY A CURSORY ESTIMATE IS PROVIDED OVER A WIDE LOW TO HIGH RANGE, DECISION MAKING IS INDEFENSIBLE o donors faced with truly unknown risk cannot rationally decide o the transplant team cannot balance the risk and benefit of living donation Steiner Am J Transplant 2008;8:230
19 THE BURDEN OF FAMILY HISTORY OF ESRD A SIGNIFICANT PROPORTION (ie >20%) OF PATIENTS WITH ESRD WILL HAVE A FAMILY HISTORY (FH) OF RENAL DISEASE A NEGATIVE FAMILY HISTORY DOES NOT EXCLUDE PRIMARY RENAL GENETIC DISEASE ESRD, End-Stage Renal Disease BTS-RA UK Guidelines Transplantation 2012;93:666
20 FH OF ESRD IN LIVING RELATED KIDNEY TRANSPLANTATION: RISKS RISK FOR THE DONOR: MAY DEVELOP THE DISEASE AFTER DONATION FH, Family History ESRD, End-Stage Renal Disease Niaudet Nat Rev Nephrol 2010;6:736
21 YOUNG DONOR AGE: LONG-TERM LARGE RISK ESTIMATES THE YOUNGER THE DONOR, THE GREATER THE REMAINING BASELINE LIFETIME RISK FOR ESRD, AND THE LESS A NORMAL FOR NOW MEDICAL EVALUATION CAN FORESEE ESRD ESRD, End-Stage Renal Disease Steiner Am J Transplant 2010;10:737
22 YOUNG DONOR AGE: LONG-TERM LARGE RISK ESTIMATES EXAMPLE 25-year old donors have on average more than 50 years to live. Overt renal disease or medical findings that are risk factors for renal disease may well not be apparent 30 or 40 years before ESRD ensues: a normal for now medical evaluation in a young donor may provide little assurance of reduced baseline lifetime risk of ESRD Steiner Am J Transplant 2010;10:737
23 YOUNG DONOR AGE: LONG-TERM LARGE RISK ESTIMATES Lifetime Risk Risk left to be predicted for a 60-yr-old donor Risk left to be predicted for a 25-yr-old donor Steiner Am J Transplant 2010;10:737
24 YOUNG DONOR AGE & FH OF ESRD IN NON-MENDELIAN DISEASES FH, Family History ESRD, End-Stage Renal Disease Freedman Am J Nephrol 2005;25:529
25 FAMILIAL CLUSTERING OF IgA NEPHROPATHY at least 14% of IgAN pts in Brescia (Italy) Scolari Am J Kidney Dis 1999;33:857
26 YOUNG LIVING-RELATED DONOR CANDIDATES YOUNG DONOR CANDIDATES DESERVE THE SAME CONCEPTUAL (AND ETHICAL) APPROACH AS DONORS WITH AN ISOLATED MEDICAL ABORMALITY, DESPITE A NORMAL MEDICAL EVALUATION Steiner Am J Transplant 2010;10:737 BASELINE LIFETIME RISK MAY BE FURTHER INCREASED BY A FH OF RENAL DISEASE FH, Family History
27 PERSISTENT NON VISIBLE HEMATURIA IN RELATED DONORS Koushik Transplantation 2005;80:1425 kidney biopsy frequently reveals glomerular pathology which precludes donation, with the possible exception of thin basement membrane disease BTS-RA UK Guidelines Transplantation 2012;93:666
28 Niaudet Nat Rev Nephrol 2010; 6:736 BTS-RA UK Guidelines Transplantation 2012;93:666 MENDELIAN RENAL DISEASES IN LIVING RELATED KT: X-linked DISEASE Alport syndrome Fabry Disease Dent s Disease IS LIVING RELATED DONOR KT APPROPRIATE?, but heterozygous females, only if: >45yrs, no renal abnormality, no hearing deficiency if donor does not carry the mutation. Incrased risk in heterozygous females if donor does not have LMW proteinuria KT, Kidney Transplantation
29 MENDELIAN RENAL DISEASES IN LIVING RELATED KT: Aut Recessive DISEASE SRNS -Finnish Type (NPHS1) Aut Rec SRNS (NPHS2) Aut Rec SRNS (NPHS3) Pierson Syndrome Schiemke dystrophy Nephronophtisis Cystinosis ARPKD Alport syndrome Atypical HUS IS LIVING RELATED DONOR KT APPROPRIATE? except for carriers of Arg229Gln(q.R229Q) No* No SRNS, Steroid-Resistant Nephrotic Syndrome; HUS, Hemolytic-Uremic Syndrome; ARPKD, Autosomal Recessive PKD Niaudet Nat Rev Nephrol 2010; 6:736 *BTS-RA UK Guidelines Transplantation 2012;93:666
30 MENDELIAN RENAL DISEASES IN LIVING RELATED KT: Aut Dominant DISEASE ADPKD type 1 ADPKD type 2 Atypical HUS IS LIVING RELATED DONOR KT APPROPRIATE? UMOD associated nephropathy (normal FE ur ) Nail Patella Syndrome Tuberose sclerosis complex Von Hippel Lindau FSGS MYH9 var (e.g Epstein Dis.) : for unaffected relatives and/or for not carrying the mutation ARPKD, Autosomal Dominant PKD; HUS, Hemolytic-Uremic Syndrome; UMOD, UroMODulin No Niaudet Nat Rev Nephrol 2010; 6:736 *BTS-RA UK Guidelines Transplantation 2012;93:666
31 LIVING RELATED KIDNEY DONATION IN ADPKD Ultrasound, CT, or MRI Defer donation Imaging Defer donation 3 cysts (uni- or bilateral)? Genetic Linkage No 3 family members with ADPKD? No Recipient DNA sequencing Age<40 Age Age 60 Equivocal Imaging Study*** 2 cysts per kidney? 4 cysts per kidney? Defer donation No*** Proceed With Donation Genetic Testing Pathogenetic variant identified? Donors ADPKD mutation? No Defer donation No Defer donation Proceed With Donation Huang Transplantation 2009;87:133
32 LIVING RELATED DONATION IN ahus LIVING RELATED TRANSPLANTATION SHOULD BE AVOIDED IN ahus UNLESS ALL KNOWN MUTATIONS HAVE BEEN EXCLUDED IN THE DONOR ahus, Atypical Hemolytic-Uremic Syndrome BTS-RA UK Guidelines Transplantation 2012;93:666
33 GENETIC RENAL DISEASES CAUSED BY ALTERNATIVE COMPLEMENT PATHWAY DYSREGULATION C3 GLOMERULOPATHIES o Dense Deposit Disease (DDD) o MPGN Type I with isolated C3 deposition o Non-MPGN C3 Glomerulonephritis o Familial MPGN Type III o CFH-R5 Nephropathy MPGN, MembranoProliferative GlomeruloNephritis CFH, Complement Factor H Sethi Kidney Int 2012;81:434 Fakhouri Nat Rev Nephrol 2010;6:494
34 PROGRESSION FROM MPGN TO ahus MPGN ahus Fakhouri Nat Rev Nephrol 2010;6:494 Gnappi Pediatr Nephrol 2012; Jun 5 MPGN MPGN (1st KT) ahus (2nd KT) Lorcy Nephrol Dial Transplant 2011;26:3811 MPGN, MembranoProliferative GlomeruloNephritis ahus, Atypical Hemolytic-Uremic Syndrome KT, Kidney Transplant Manenti, Licht N Engl J Med 2012;367:86
35 RISK OF CLINICALLY RELEVANT RECURRENCE IN THE GRAFT disease recurrence (%) graft loss at 5-10 yrs (%) risk modifiers ahus MCP mutation risk, except LRD DDD Age onset; severity; LRD better # MPGN Type I & LRD worse: risk of recurrence?; C3 glomerulopathy 60 NA severity; recur. in a previous KT NPHS2 FSGS low if any low if any LRD better regardless etiology* FSGS Recur. in a previous KT: >75% risk IgA Nephropathy LRD worse: inconsistent evidence Prim hyperoxaluria High Risk High Risk KT only if Gly170Arg mutation LRD, Living-Related Donation; KT, Kidney Transplantation; graft loss at 5-10yrs refers to risk due to recurrence ahus, Atypical Hemolytic-Uremic Syndrome; DDD Dense Deposit Disease; MPGN, MembranoProliferative GlomeruloNephritis; FSGS, primary Focal Segmental GlomeruloSclerosis; NPHS2 pdocin gene mutation # Angelo Am J Kidney Dis 2011;57:291, Servais Kidney Int 2012, Mar 28 *Jungraithmayr J Am Soc Nephrol 2011;22:579
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT. J. H. Helderman,MD,FACP,FAST
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT J. H. Helderman,MD,FACP,FAST Vanderbilt University Medical Center Professor of Medicine, Pathology and Immunology Medical Director, Vanderbilt Transplant
More informationRaDaR Newsletter. Issue Four, Winter 2016
RaDaR Newsletter Issue Four, Winter 2016 The National Registry of Rare Kidney Diseases (RaDaR) is a Renal Association initiative designed to pull together information from patients with certain rare kidney
More informationPathology of Complement Mediated Renal Disease
Pathology of Complement Mediated Renal Disease Mariam Priya Alexander, MD Associate Professor of Pathology GN Symposium Hong Kong Society of Nephrology July 8 th, 2017 2017 MFMER slide-1 The complement
More informationC3 Glomerulopathy. Jun-Ki Park
C3 Glomerulopathy Jun-Ki Park 03.08.11 For the last 30 years classification MPGN is based on glomerular findings by light microscopy with further specification on EM and staining for Ig and complement
More informationRaDaR Inclusion and Exclusion Criteria. Diagnosis Inclusion Criteria Exclusion Criteria. Alport Syndrome definite or probable
Alport Syndrome and Type IV collagenopathies APRT Deficiency Alport Syndrome definite or probable Alport carrier definite or probable Thin basement membrane nephropathy APRT Deficiency confirmed Abolished
More informationFrom MPGN to C3G. F Fakhouri, Nantes, France. «Membranoproliferative» is a pathological feature. Mesangial expansion «Doubles contours»
From MPGN to C3G F Fakhouri, Nantes, France Conflits d intérêt: consultant auprès d Alexion Pharmaceuticals «Membranoproliferative» is a pathological feature Mesangial expansion «Doubles contours» Immune
More informationCase Presentation Turki Al-Hussain, MD
Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory
More informationRECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT HISTOPATHOLOGIC DISORDERS AFFECTING THE ALLOGRAFT OTHER THAN REJECTION RECURRENT DISEASE DE NOVO DISEASE TRANSPLANT GLOMERULOPATHY Glomerular Non-glomerular
More informationGlomerular pathology-2 Nephritic syndrome. Dr. Nisreen Abu Shahin
Glomerular pathology-2 Nephritic syndrome Dr. Nisreen Abu Shahin 1 The Nephritic Syndrome Pathogenesis: inflammation proliferation of the cells in glomeruli & leukocytic infiltrate Injured capillary walls
More informationC3 Glomerulonephritis versus C3 Glomerulopathies?
Washington University School of Medicine Digital Commons@Becker Kidneycentric Kidneycentric 2016 C3 Glomerulonephritis versus C3 Glomerulopathies? T. Keefe Davis Washington University School of Medicine
More informationC3 GLOMERULOPATHIES. Budapest Nephrology School Zoltan Laszik
C3 GLOMERULOPATHIES Budapest Nephrology School 8.30.2018. Zoltan Laszik 1 Learning Objectives Familiarize with the pathogenetic mechanisms of glomerular diseases Learn the pathologic landscape and clinical
More informationGenetics of Steroid Resistant Nephrotic syndrome. Velibor Tasic University Children s Hospital Skopje, Macedonia
Genetics of Steroid Resistant Nephrotic syndrome Velibor Tasic University Children s Hospital Skopje, Macedonia Nephrotic syndrome - definition Oedema Massive proteinuria (> 50mg/kg/d or> 40mg/m2/h Hypoalbuminemia
More informationRaDaR Inclusion and Exclusion Criteria. Diagnosis Inclusion Criteria Exclusion Criteria. Alport Syndrome definite or probable
Alport Syndrome and Type IV collagenopathies APRT Deficiency Alport Syndrome definite or probable Alport carrier definite or probable Thin basement membrane nephropathy APRT Deficiency confirmed Abolished
More informationGlomerular diseases mostly presenting with Nephritic syndrome
Glomerular diseases mostly presenting with Nephritic syndrome 1 The Nephritic Syndrome Pathogenesis: proliferation of the cells in glomeruli & leukocytic infiltrate Injured capillary walls escape of RBCs
More informationProposed Scope of Work for KDIGO Clinical Practice Guideline for the Evaluation and Management of Candidates for Kidney Transplantation
Proposed Scope of Work for KDIGO Clinical Practice Guideline for the Evaluation and Management of Candidates for Kidney Transplantation Introduction Transplantation is the renal replacement therapy of
More informationGenetic Testing of Children with Steroid Resistant Nephrotic Syndrome
The 5 th Global Congress For Consensus in Pediatrics & Child Health Genetic Testing of Children with Steroid Resistant Nephrotic Syndrome Fang Wang Peking University First Hospital Nephrotic Syndrome (NS)
More informationFamilial DDD associated with a gain-of-function mutation in complement C3.
Familial DDD associated with a gain-of-function mutation in complement C3. Santiago Rodríguez de Córdoba, Centro de investigaciones Biológicas, Madrid Valdés Cañedo F. and Vázquez- Martul E., Complejo
More informationChapter 8: ESRD Among Children, Adolescents, and Young Adults
Chapter 8: ESRD Among Children, Adolescents, and Young Adults The number of children beginning end-stage renal disease (ESRD) care decreased by 6% in 2014, totaling 1,398 (Figure 8.1.a). 9,721 children
More informationEvaluation of Genetic Renal Diseases in Potential Living Kidney Donors
Curr Transpl Rep (2015) 2:1 14 DOI 10.1007/s40472-014-0042-5 LIVE KIDNEY DONATION (KL LENTINE, SECTION EDITOR) Evaluation of Genetic Renal Diseases in Potential Living Kidney Donors S. Kuppachi & R. J.
More informationmicrorna Therapeutics Harnessing the power of micrornas to target multiple pathways of disease
microrna Therapeutics Harnessing the power of micrornas to target multiple pathways of disease January 2018 Safe Harbor Statement Statements contained in this presentation regarding matters that are not
More informationRaDaR Inclusion and Exclusion Criteria
Cohort Inclusion Criteria Exclusion Criteria Adenine Phosphoribosyltransferase Deficiency (APRT-D) APRT Deficiency APRT Deficiency confirmed Abolished APRT enzyme activity or confirmed disease-causing
More informationUSRDS UNITED STATES RENAL DATA SYSTEM
USRDS UNITED STATES RENAL DATA SYSTEM Chapter 8: Pediatric ESRD 1,462 children in the United States began end-stage renal disease (ESRD) care in 2013. 9,921 children were being treated for ESRD on December
More informationM.Weitz has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve.
M.Weitz has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve. Prophylactic eculizumab prior to kidney transplantation for atypical hemolytic uremic
More informationCHAPTER 2. Primary Glomerulonephritis
2nd Report of the PRIMARY GLOMERULONEPHRITIS CHAPTER 2 Primary Glomerulonephritis Sunita Bavanandan Lee Han Wei Lim Soo Kun 21 PRIMARY GLOMERULONEPHRITIS 2nd Report of the 2.1 Introduction This chapter
More informationRenal Cystic Disease. Dr H Bierman
Renal Cystic Disease Dr H Bierman Objectives Be able to diagnose renal cystic disease Genetic / non-genetic Be able to describe patterns of various renal cystic disease on routine imaging studies Be able
More informationLiving Kidney Transplantation: Ethical Approaches to Enhance and Evaluate Donations
Living Kidney Transplantation: Ethical Approaches to Enhance and Evaluate Donations Center for Health Care Ethics Lakehead University September 19, 2012 Fabrice Jotterand, PhD, MA Senior Researcher Institute
More informationHasan Fattah 3/19/2013
Hasan Fattah 3/19/2013 AASK trial Rational: HTN is a leading cause of (ESRD) in the US, with no known treatment to prevent progressive declines leading to ESRD. Objective: To compare the effects of 2 levels
More informationDr Ian Roberts Oxford. Oxford Pathology Course 2010 for FRCPath Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust
Dr Ian Roberts Oxford Oxford Pathology Course 2010 for FRCPath Present the basic diagnostic features of the commonest conditions causing proteinuria & haematuria Highlight diagnostic pitfalls Nephrotic
More informationRENAL EVENING SPECIALTY CONFERENCE
RENAL EVENING SPECIALTY CONFERENCE Harsharan K. Singh, MD The University of North Carolina at Chapel Hill Disclosure of Relevant Financial Relationships No conflicts of interest to disclose. CLINICAL HISTORY
More informationCHAPTER 2 PRIMARY GLOMERULONEPHRITIS
CHAPTER 2 Sunita Bavanandan Lim Soo Kun 19 5th Report of the 2.1: Introduction This chapter covers the main primary glomerulonephritis that were reported to the MRRB from the years 2005-2012. Minimal change
More informationPreimplantation Genetic Diagnosis for inherited renal diseases
Preimplantation Genetic Diagnosis for inherited renal diseases 54th ERA-EDTA Congress Madrid, Spain June 3-6, 2017 Nine Knoers Department of Genetics Chronic kidney disease frequently has genetic aetiology
More informationGlomerular Pathology- 1 Nephrotic Syndrome. Dr. Nisreen Abu Shahin
Glomerular Pathology- 1 Nephrotic Syndrome Dr. Nisreen Abu Shahin The Nephrotic Syndrome a clinical complex resulting from glomerular disease & includes the following: (1) massive proteinuria (3.5 gm /day
More informationChapter 7: ESRD among Children, Adolescents, and Young Adults
Chapter 7: ESRD among Children, Adolescents, and Young Adults The one-year end-stage renal disease (ESRD) patient mortality among the 0-4 year age group has declined approximately 41.6% over the past decade.
More informationC3G An Update What is C3 Glomerulopathy Anyway? Patrick D. Walker, M.D. Nephropath Little Rock, Arkansas USA
C3G An Update What is C3 Glomerulopathy Anyway? Patrick D. Walker, M.D. Nephropath Little Rock, Arkansas USA C3 Glomerulopathy Overview Discuss C3 Glomerulopathy (C3G) How did we get to the current classification
More informationC1q nephropathy the Diverse Disease
C1q nephropathy the Diverse Disease Danica Galešić Ljubanović School of Medicine, University of Zagreb Dubrava University Hospital Zagreb, Croatia Definition Dominant or codominant ( 2+), mesangial staining
More informationIndex. electron microscopy, 81 immunofluorescence microscopy, 80 light microscopy, 80 Amyloidosis clinical setting, 185 etiology/pathogenesis,
A Acute antibody-mediated rejection (Acute AMR) clinical features, 203 clinicopathologic correlations, 206 pathogenesis, 205 206 204 205 light microscopy, 203 204 Acute cellular rejection (ACR) clinical
More informationCase Presentation Turki Al-Hussain, MD
Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory
More informationSpectrum of complement-mediated thrombotic microangiopathies after kidney transplantation
Spectrum of complement-mediated thrombotic microangiopathies after kidney transplantation Marius Miglinas Vilnius university hospital: Nephrology center, Center of Rare Kidney Diseases Vilnius university
More informationESRD Dialysis Prevalence - One Year Statistics
Age Group IL Other Total 00-04 12 1 13 05-09 5 2 7 10-14 15 1 16 15-19 55 2 57 20-24 170 10 180 25-29 269 14 283 30-34 381 9 390 35-39 583 14 597 40-44 871 20 891 45-49 1,119 20 1,139 50-54 1,505 35 1,540
More informationFIBRILLARY GLOMERULONEPHRITIS DIAGNOSTIC CRITERIA, PITFALLS, AND DIFFERENTIAL DIAGNOSIS
FIBRILLARY GLOMERULONEPHRITIS DIAGNOSTIC CRITERIA, PITFALLS, AND DIFFERENTIAL DIAGNOSIS Guillermo A. Herrera MD Louisiana State University, Shreveport Fibrils in bundles 10-20 nm d Diabetic fibrillosis
More informationAccepted Manuscript. No more thrombotic thrombocytopenic purpura/hemolytic uremic syndrome please. Yeong-Hau H. Lien MD, PhD S (18)
Accepted Manuscript No more thrombotic thrombocytopenic purpura/hemolytic uremic syndrome please Yeong-Hau H. Lien MD, PhD PII: S0002-9343(18)30965-3 DOI: https://doi.org/10.1016/j.amjmed.2018.10.009 Reference:
More informationMonoclonal Gammopathies and the Kidney. Tibor Nádasdy, MD The Ohio State University, Columbus, OH
Monoclonal Gammopathies and the Kidney Tibor Nádasdy, MD The Ohio State University, Columbus, OH Monoclonal gammopathy of renal significance (MGRS) Biopsies at OSU (n=475) between 2007 and 2016 AL or AH
More informationMembranes basales glomérulaires minces: une lésion courante.
Membranes basales glomérulaires minces: une lésion courante. Marie Claire Gubler/ Laurence Heidet INSERM U574 / MARHEA Hôpital Necker-Enfants Malades Université Paris Descartes Paris Actualités Néphrologiques
More informationSecondary IgA Nephropathy & HSP
Secondary IgA Nephropathy & HSP Anjali Gupta, MD 1/11/11 AKI sec to Hematuria? 65 cases of ARF after an episode of macroscopic hematuria have been reported in the literature in patients with GN. The main
More informationElevated Serum Creatinine, a simplified approach
Elevated Serum Creatinine, a simplified approach Primary Care Update Creighton University School of Medicine. April 27 th, 2018 Disclosure Slide I have no disclosures and have no conflicts with this presentation.
More informationC3 Glomerulopathy. Rezan Topaloglu, MD Hacettepe University School of Medicine Department of Pediatric Nephrology Ankara, TURKEY
C3 Glomerulopathy Rezan Topaloglu, MD Hacettepe University School of Medicine Department of Pediatric Nephrology Ankara, TURKEY Journey in history Some diseases have journey Diagnoses may change during
More informationLong-term Non-ESRD Kidney Donor Risks. Arthur Matas Dept Surgery University of Minnesota
Long-term Non-ESRD Kidney Donor Risks Arthur Matas Dept Surgery University of Minnesota Conflict of Interest Disclosure I have no relevant financial relationships to disclose No off label use will be discussed
More informationGenetic Diseases Of The Kidney READ ONLINE
Genetic Diseases Of The Kidney READ ONLINE Genetic Diseases of the Kidney offers expert insight into the role of genetic abnormalities in the pathogenesis of abnormal kidney function and kidney disease.
More informationFebruary 20, 2019 MANAGEMENT CALL TO DISCUSS PHASE 2 PHOENIX RESULTS AND CKD PROGRAM UPDATES
February 20, 209 MANAGEMENT CALL TO DISCUSS PHASE 2 PHOENIX RESULTS AND CKD PROGRAM UPDATES Forward-Looking Statements This presentation contains certain forward-looking statements that are made pursuant
More informationIt is important upfront to realize and believe that, like many adults,
Kids With Kidney Disease Can Realize Their Dreams and Live Long, Normal, Productive Lives By Gordon Lore It is important upfront to realize and believe that, like many adults, children with kidney failure
More informationA clinical syndrome, composed mainly of:
Nephritic syndrome We will discuss: 1)Nephritic syndrome: -Acute postinfectious (poststreptococcal) GN -IgA nephropathy -Hereditary nephritis 2)Rapidly progressive GN (RPGN) A clinical syndrome, composed
More informationEuropean Society for Organ Transplantation Council
This response was submitted to the consultation held by the Nuffield Council on Bioethics on Give and take? Human bodies in medicine and research between April 2010 and July 2010. The views expressed are
More informationGenetics in Pediatric Nephrology. S Alexander J Fletcher Children s Hospital at Westmead National Kidney Transplant Institute
Genetics in Pediatric Nephrology S Alexander J Fletcher Children s Hospital at Westmead National Kidney Transplant Institute OBJECTIVES 1 2 3 To understand the basis of inheritance of genetic diseases
More informationAtypical IgA Nephropathy
Atypical IgA Nephropathy Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA XXXIII Chilean Congress of Nephrology, Hypertension and Transplantation Puerto Varas, Chile October 6, 2016 IgA
More informationFor more information about how to cite these materials visit
Author(s): Silas P. Norman, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Noncommercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
More informationACCME/Disclosure. Case #1. Case History. Dr. Bracamonte has nothing to disclose
Case #1 ACCME/Disclosure Dr. Erika Bracamonte Associate Professor of Pathology University of Arizona, College of Medicine Banner University Medical Center, Tucson Dr. Bracamonte has nothing to disclose
More informationOverview of glomerular diseases
Overview of glomerular diseases *Endothelial cells are fenestrated each fenestra: 70-100nm in diameter Contractile, capable of proliferation, makes ECM & releases mediators *Glomerular basement membrane
More informationThe ERA-EDTA database on recurrent glomerulonephritis following renal transplantation
Nephrol Dial Transplant (2014) 29: 15 21 doi: 10.1093/ndt/gft299 Advance Access publication 27 August 2013 NDT Perspectives The ERA-EDTA database on recurrent glomerulonephritis following renal transplantation
More informationNephrotic Syndrome NS
Nephrotic Syndrome NS By : Dr. Iman.M. Mudawi Pediatric Nephrology Unit Gaafar Ibn Auf Hospital Definitions: In children NS is applied to any condition with a triad of: Heavy proteinuria (UACR ratio >200
More informationKidney Transplant Outcomes In Elderly Patients. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Kidney Transplant Outcomes In Elderly Patients Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Case Discussion 70 year old Asian male, neuropsychiatrist, works full
More informationPatient with factor H deficiency associated hemolytic uremic syndrome looses fourth renal allograft What comes next?
Patient with factor H deficiency associated hemolytic uremic syndrome looses fourth renal allograft What comes next? Anja Lehnhardt 1, Andreas Richterich 2, Dirk E. Mueller-Wiefel 1, Markus J. Kemper 1
More informationThe evolution of the classification of nephrotic syndrome Laura Barisoni, MD
The evolution of the classification of nephrotic syndrome Laura Barisoni, MD Department of Pathology and Medicine, Division of Nephrology New York University Old classification schemes: Proteinuria and
More informationglomerular capillary wall Pathogenic Mechanisms of Glomerular Diseases General Outline General Trend General Concepts
General Outline Pathogenic Mechanisms of Glomerular Diseases Patrick H. Nachman, MD Professor University of North Carolina UNC Kidney Center Chapel Hill, NC USA Overview of Pathogenetic Mechanisms For
More informationClinical pathological correlations in AKI
Clinical pathological correlations in AKI Dr. Rajasekara chakravarthi Director - Nephrology Star Kidney Center, Star Hospitals Renown clinical services India Introduction AKI is common entity Community
More informationReview Article Kidney Diseases Caused by Complement Dysregulation: Acquired, Inherited, and Still More to Come
Clinical and Developmental Immunology Volume 2012, Article ID 695131, 6 pages doi:10.1155/2012/695131 Review Article Kidney Diseases Caused by Complement Dysregulation: Acquired, Inherited, and Still More
More informationSigns and symptoms of thin basement membrane nephropathy: A prospective regional study on primary glomerular disease The Limburg Renal Registry
Kidney International, Vol. 66 (2004), pp. 909 913 Signs and symptoms of thin basement membrane nephropathy: A prospective regional study on primary glomerular disease The Limburg Renal Registry PIETER
More informationTHE KIDNEY AND SLE LUPUS NEPHRITIS
THE KIDNEY AND SLE LUPUS NEPHRITIS JACK WATERMAN DO FACOI 2013 NEPHROLOGY SIR RICHARD BRIGHT TERMINOLOGY RENAL INSUFFICIENCY CKD (CHRONIC KIDNEY DISEASE) ESRD (ENDSTAGE RENAL DISEASE) GLOMERULONEPHRITIS
More informationGenetics in Nephrology. Saeid Morovvati Associate Professor of BMSU Director of Biogene Laboratory
Genetics in Nephrology Saeid Morovvati Associate Professor of BMSU Director of Biogene Laboratory Genetics in: A. Congenital Anomalies of the Kidney and Urinary Tract B. Cystic Diseases of the Kidney C.
More informationRenal Pathology 1: Glomerulus. With many thanks to Elizabeth Angus PhD for EM photographs
Renal Pathology 1: Glomerulus With many thanks to Elizabeth Angus PhD for EM photographs Anatomy of the Kidney http://www.yalemedicalgroup.org/stw/page.asp?pageid=stw028980 The Nephron http://www.beltina.org/health-dictionary/nephron-function-kidney-definition.html
More informationWhat s hiding behind IgA nephropathy?
What s hiding behind IgA nephropathy? Bauerova L. Department of Pathology, the First Faculty of Medicine and General Hospital, Charles University Prague (nephropathology training: Department of Clinical
More informationMany patients receiving renal allografts become identified simply
Recurrent Disease in the Transplanted Kidney Jeremy B. Levy Many patients receiving renal allografts become identified simply as recipients of kidney transplantation. All subsequent events involving changes
More informationCase 3. ACCME/Disclosure. Laboratory results. Clinical history 4/13/2016
Case 3 Lynn D. Cornell, M.D. Mayo Clinic, Rochester, MN Cornell.Lynn@mayo.edu USCAP Renal Case Conference March 13, 2016 ACCME/Disclosure Dr. Cornell has nothing to disclose Clinical history 57-year-old
More informationCommonly Asked Questions about Kidney Transplants
Commonly Asked Questions about Kidney Transplants Should I consider having a kidney We encourage you to get as much information as possible. Ask questions. Talk with other transplant patients and talk
More informationPATIENT SELECTION FOR DECEASED DONOR KIDNEY ONLY TRANSPLANTATION
PATIENT SELECTION FOR DECEASED DONOR KIDNEY ONLY TRANSPLANTATION This policy has been created by the Kidney Advisory Group on behalf of NHSBT. The policy has been considered and approved by the Organ Donation
More informationComplement in vasculitis and glomerulonephritis. Andy Rees Clinical Institute of Pathology Medical University of Vienna
Complement in vasculitis and glomerulonephritis Andy Rees Clinical Institute of Pathology Medical University of Vienna 41 st Heidelberg Nephrology Seminar March 2017 The complement system An evolutionary
More informationProposal form for the evaluation of a genetic test for NHS Service Gene Dossier
Proposal form for the evaluation of a genetic test for NHS Service Gene Dossier Test Disease Population Triad Disease name Polycystic Kidney Disease, Autosomal Dominant OMIM number for disease 173900 Disease
More informationChapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
More informationNEXT GENERATION SEQUENCING: A TOOL FOR THIS GENERATION OF NEPHROLOGISTS
NEXT GENERATION SEQUENCING: A TOOL FOR THIS GENERATION OF NEPHROLOGISTS Lea Landolt, Philipp Strauss, Hans-Peter Marti, *Øystein Eikrem Department of Clinical Medicine, University of Bergen, Bergen, Norway
More informationPATTERNS OF RENAL INJURY
PATTERNS OF RENAL INJURY Normal glomerulus podocyte Glomerular capillaries electron micrograph THE CLINICAL SYNDROMES 1. The Nephrotic Syndrome 2. The Acute Nephritic Syndrome 3. Rapidly Progressive Glomerulonephritis
More informationKidney Summary. Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA
Kidney Summary Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Key Issues to Address re: the Classification 1. Incorporation of i-ifta + tubulitis into the TCMR classification - Defining
More informationMembranoproliferative Glomerulonephritis
Membranoproliferative Glomerulonephritis MPGN is characterizedby alterations in the GBM and mesangium and by proliferation of glomerular cells. 5% to 10% of cases of 1ry nephrotic syndrome in children
More informationClinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review
Clinical and pathological characteristics of patients with glomerular diseases at a university teaching hospital: 5-year prospective review KW Chan, TM Chan, IKP Cheng Objective. To examine the prevalence
More informationCase # 2 3/27/2017. Disclosure of Relevant Financial Relationships. Clinical history. Clinical history. Laboratory findings
Case # 2 Christopher Larsen, MD Arkana Laboratories Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to influence or control the content
More informationRecent advances in pathogenesis & treatment of ahus
Recent advances in pathogenesis & treatment of ahus Miquel Blasco Pelicano Nephrology and Kidney Transplant Unit Hospital Clínic, Barcelona Atypical Hemolytic Uremic Syndrome (ahus) Ultra-rare disease:
More informationDisclosure. Agenda. I do not have any relevant financial/non financial relationships with any proprietary interests
Luis Rohena, MD Chief, Medical Genetics San Antonio Military Medical Center Assistant Professor of Pediatrics USUHS & UTHSCSA 15JUNE2014 51st Annual Teaching Conference Pediatrics for the Practitioner
More informationNephrotic syndrome in children. Bashir Admani KPA Nephrology Precongress 24/4/2018
Nephrotic syndrome in children Bashir Admani KPA Nephrology Precongress 24/4/2018 What is Nephrotic syndrome?? Nephrotic syndrome is caused by renal diseases that increase the permeability across the glomerular
More informationOrgan Donation The Gift of Life?
Irish Council for Bioethics Organ Donation The Gift of Life? MATT MEADOWS / PETER ARNOLD INC. / SCIENCE, PHOTO LIBRARY Q 1 What is organ donation? Q2 Who can be a donor? Organ donation takes healthy organs
More informationFocal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s. Part 1: Clinical
Focal Segmental Glomerulosclerosis and the Nephro6c Syndrome Dr. A. Gangji Dr. P. Marge>s Part 1: Clinical Pa#ent DM 18 year old McMaster student Back pain, severe fa#gue Oct 2006 Leg swelling to ER Nov
More informationFinal Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List
OPTN/UNOS Minority Affairs Committee Descriptive Data Request Final Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List Prepared for: Minority Affairs Committee Meeting
More informationNew Ideas. Better Medicines. Third Quarter Financial Results Conference Call
New Ideas. Better Medicines. Third Quarter 2018 Financial Results Conference Call Forward-Looking Statements 2 This presentation contains forward-looking statements that involve substantial risks and uncertainties.
More informationA Guide to Better Living
Transplantation What Is a Kidney Transplant? Kidney transplantation is placing a kidney from one person (donor) into a patient with kidney failure (recipient). This is done by surgery where the donated
More informationMembranoproliferative glomerulonephritis type II
Recurrence of Membranoproliferative Glomerulonephritis Type II in Renal Allografts: The North American Pediatric Renal Transplant Cooperative Study Experience Michael C. Braun,* Don M. Stablein, Lorraine
More informationGlomerular pathology in systemic disease
Glomerular pathology in systemic disease Lecture outline Lupus nephritis Diabetic nephropathy Glomerulonephritis Associated with Bacterial Endocarditis and Other Systemic Infections Henoch-Schonlein Purpura
More informationUEMS & EBS: DIVISION OF TRANSPLANT SURGERY
CURRICULUM AND SYLLABUS TRANSPLANTATION Module 1: Multi-organ retrieval Ability to evaluate donor suitability Ability to retrieve abdominal organs for transplantation Evaluation of donor/ organs suitability
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2010 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE I INTRODUCTION 1 II
More informationSteroid Resistant Nephrotic Syndrome. Sanjeev Gulati, Debashish Sengupta, Raj K. Sharma, Ajay Sharma, Ramesh K. Gupta*, Uttam Singh** and Amit Gupta
Steroid Resistant Nephrotic Syndrome Sanjeev Gulati, Debashish Sengupta, Raj K. Sharma, Ajay Sharma, Ramesh K. Gupta*, Uttam Singh** and Amit Gupta From the Departments of Nephrology, Pathology* and Biostatistics**,
More informationHUS-MPGN-TTP. & related disorders
ES-PCR 4 th International Conference HUS-MPGN-TTP & related disorders Current diagnosis and therapy of hemolytic uremic syndrome (HUS), membranoproliferative glomerulonephritis (MPGN), thrombotic thrombocytopenic
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section
More informationThe Evaluation of Kidney Transplant Candidates and Potential Living Donors
The Evaluation of Kidney Transplant Candidates and Potential Living Donors Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Case #1 37 yo male, ESRD due to FSGS Living-related
More information