IgM nephropathy - Successful treatment with rituximab.

Immunoglobulin M nephropathy (IgMN) is a primary glomerulonephritis which is characterized by variable degrees of morphological features ranging from minimal glomerular involvement to segmental or global sclerosis. No specific treatment is known to date for this disease because of uncertainties in etiopathogenesis. The mainstay treatment for this disease has been corticosteroids, which has varying degrees of resistance ranging from 0% to 50%. We present the case of a 59-year-old Caucasian male who was referred to the outpatient nephrology clinic for the evaluation of proteinuria and was diagnosed with IgMN. We successfully treated the patient with rituximab with resolution of his proteinuria.

Kidney Disease in Elderly: Importance of Collaboration between Geriatrics and Nephrology.

The population in the United States is aging and presents many challenges in the healthcare world. According to the report released by United States Census Bureau in June 2017, there are around 50 million residents aged 65 years and over as of 2016. Among the multiple healthcare challenges, kidney disease is a significant one because of its high burden, high cost and low awareness. Medicare spending on chronic kidney disease for 65 plus aged patients exceeded $ 50 billion in 2013. Different studies based on different calculations have estimated that at least one-third of chronic kidney disease patients are aged above 65 years. Most of the chronic kidney disease patients have multiple medical co-morbidities but geriatric syndromes are added factors that may be challenging for nephrologists. There is scarcity of well-trained geriatricians and in most instances, nephrologists take over the role of internist or geriatrician. This article outlines the need and importance of collaboration and coordination between geriatrics and nephrology for the best patient care and better healthcare outcomes.

Decision-Making in Geriatric Patients with End-Stage Renal Disease: Thinking Beyond Nephrology.

Compared to younger individuals, the prevalence of end-stage renal disease (ESRD) in elders is notably higher. While renal replacement therapy, usually with hemodialysis, is accepted therapy in younger patients with ESRD, decisions regarding the treatment of advanced kidney disease in the elderly population are more complex, secondary to the physiologic changes of aging, concurrent geriatric syndromes, and varying goals of care. Evaluation for possible initiation of dialysis in geriatric patients should be multidisciplinary in nature and patient-focused, including a consideration of physical, cognitive, and social function. If renal replacement therapy is not pursued, optimization of medical management or symptom management needs to be the goal of care.