Bijin Thajudeen

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Scholarly Contributions

Chapters

• Thajudeen, B. (2020). ECMO and AKI. In Practices and Principles of ECMO. Nova.
• Thajudeen, B. (2020). Emerging therapies. In Chronic kidney disease second edition. Elsevier publishers.
• Thajudeen, B. (2016). Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy. In Extracorporeal Membrane Oxygenation. www.intechopen.com: Intech. doi:10.5772/64164
• Thajudeen, B. (2016). Introduction and Disease Overview. In Managing diabetic nephropathy in clinical practice.
• Thajudeen, B. (2015). Chronic Kidney Disease. In Ultrasound Approach to Chronic Kidney Disease and it's Complications.

Journals/Publications

• Al-Obaidi, M. M., Gungor, A. B., Murugapandian, S., Thajudeen, B., Mansour, I., Wong, R. C., Tanriover, B., & Zangeneh, T. T. (2023). The Impact of Nirmatrelvir-Ritonavir in Reducing Hospitalizations Among High-Risk Patients With SARS-CoV-2 During the Omicron Predominant Era. The American journal of medicine, 136(6), 577-584.
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  The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality in high-risk populations. Several therapeutics have been developed to reduce the risk of complications related to COVID-19, hospitalizations, and death. In several studies, nirmatrelvir-ritonavir (NR) was reported to reduce the risk of hospitalizations and death. We aimed to evaluate the efficacy of NR in preventing hospitalizations and death during the Omicron predominant period.
• El-Achkar, T. M., Eadon, M. T., Kretzler, M., Himmelfarb, J., & , K. P. (2023). Precision Medicine in Nephrology: An Integrative Framework of Multidimensional Data in the Kidney Precision Medicine Project. American journal of kidney diseases : the official journal of the National Kidney Foundation.
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  Chronic kidney disease (CKD) and acute kidney injury (AKI) are heterogeneous syndromes defined clinically by serial measures of kidney function. Each condition possesses strong histopathologic associations, including glomerular obsolescence or acute tubular necrosis, respectively. Despite such characterization, there remains wide variation in patient outcomes and treatment responses. Precision medicine efforts, as exemplified by the Kidney Precision Medicine Project (KPMP), have begun to establish evolving, spatially anchored, cellular and molecular atlases of the cell types, states, and niches of the kidney in health and disease. The KPMP atlas provides molecular context for CKD and AKI disease drivers and will help define subtypes of disease that are not readily apparent from canonical functional or histopathologic characterization but instead are appreciable through advanced clinical phenotyping, pathomic, transcriptomic, proteomic, epigenomic, and metabolomic interrogation of kidney biopsy samples. This perspective outlines the structure of the KPMP, its approach to the integration of these diverse datasets, and its major outputs relevant to future patient care.
• Mansour, I., Murugapandian, S., Tanriover, B., & Thajudeen, B. (2023). Contemporary Monoclonal Antibody Utilization in Glomerular Diseases. Mayo Clinic proceedings. Innovations, quality & outcomes, 7(4), 276-290.
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  Therapeutic monoclonal antibodies (MAbs) have been one of the fastest growing drug classes in the past 2 decades and are indicated in the treatment of cancer, autoimmune disorders, solid organ transplantation, and glomerular diseases. The Food and Drug Administration has approved 100 MAbs between 1986 and 2021, and MAbs account for 20% of Food and Drug Administration's new drug approval every year. MAbs are preferred over traditional immunosuppressive agents because of their high specificity, reduced number of drug-drug interactions, and low toxicity, which make them a prime example of personalized medicine. In this review article, we provide an overview of the taxonomy, pharmacology, and therapeutic applications of MAbs in glomerular diseases. We searched the literature through PubMed using the following search terms: , and limited our search to years 2018-2023. We selected peer-reviewed journal articles with an evidence-based approach, prioritizing randomized control trials in specific glomerular diseases, if available. Advances in the MAb field have resulted in a significant paradigm shift in targeted treatment of immune-mediated glomerular diseases, and multiple randomized control trials are currently being conducted. Increased recognition is critical to expand their use in experimental research and personalized medicine.
• Stavas, J., Thajudeen, B., Coca, S., Silva, A., Butler, E., Detwiler, R., & Burgner, A. (2023). Renal Autologous Cell Therapy in Type 2 Diabetes with Late Stage 4 Diabetes-Related Chronic Kidney Disease: Trial Design and Early Analysis. Blood purification, 1-8.
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  Cell-based therapies potentially delay the trajectory toward end-stage kidney disease (ESKD) in late stage 4 diabetic chronic kidney disease (DKD). We describe the trial design, baseline patient characteristics, and early results of an IRB-approved phase II multicenter clinical trial, utilizing Renal Autologous Cell Therapy (REACT) in adults with pre-ESKD due to type 2 DKD. The trial objectives were safety and tolerability of REACT by assessment of the procedure, product administration, and renal-specific adverse events in addition to evaluate the impact on renal function following injection.
• Thajudeen, B. (2023). Effectiveness of casirivimab-imdevimab and sotrovimab monoclonal antibody treatment among high-risk patients with sars-cov-2 infection: a real-world experience. medRxiv.
• Thajudeen, B., Issa, D., & Roy-Chaudhury, P. (2023). Advances in hemodialysis therapy. Faculty reviews, 12, 12.
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  End-stage renal disease (ESRD) continues to be a disease process with a high rate of hospitalization and mortality. There has been little innovation in nephrology over the last few decades compared to revolutionary high-tech advancements in other areas like oncology and cardiovascular medicine. Kidney transplantation, the only available alternative to renal replacement therapy, is limited in its availability. It is essential to have advances in this field to improve the efficiency of currently available treatments and devise new therapies. The current description of renal replacement therapy is inappropriate as it only replaces the filtration function of the failed kidney without addressing its other vital metabolic, endocrinologic, and immunologic roles and portability. Hence, it is critical to have newer therapies focusing on total replacement and portability, not just clearance. This review will address the developments in hemodialysis therapy. Advances in hemodialysis therapy include hemodiafiltration, portable machines, wearable artificial kidneys, and bioartificial kidneys. Although promising, newer technologies in this direction are still far from clinical application. Several organizations and enterprises including the Kidney Health Initiative and Kidney X: The Kidney Innovation Accelerator, as well as The Advancing American Kidney Health Initiative, are working in tandem to develop new therapies that could customize the treatment of ESRD.
• Akilesh, S., Nast, C. C., Yamashita, M., Henriksen, K., Charu, V., Troxell, M. L., Kambham, N., Bracamonte, E., Houghton, D., Ahmed, N. I., Chong, C. C., Thajudeen, B., Rehman, S., Khoury, F., Zuckerman, J. E., Gitomer, J., Raguram, P. C., Mujeeb, S., Schwarze, U., , Shannon, M. B., et al. (2021). Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria. American journal of kidney diseases : the official journal of the National Kidney Foundation, 77(1), 82-93.e1.
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  Kidney biopsy data inform us about pathologic processes associated with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a multicenter evaluation of kidney biopsy findings in living patients to identify various kidney disease pathology findings in patients with coronavirus disease 2019 (COVID-19) and their association with SARS-CoV-2 infection.
• Chertow, G. M., Pergola, P. E., Farag, Y. M., Agarwal, R., Arnold, S., Bako, G., Block, G. A., Burke, S., Castillo, F. P., Jardine, A. G., Khawaja, Z., Koury, M. J., Lewis, E. F., Lin, T., Luo, W., Maroni, B. J., Matsushita, K., McCullough, P. A., Parfrey, P. S., , Roy-Chaudhury, P., et al. (2021). Vadadustat in Patients with Anemia and Non-Dialysis-Dependent CKD. The New England journal of medicine, 384(17), 1589-1600.
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  Vadadustat is an oral hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor, a class of drugs that stabilize HIF and stimulate erythropoietin and red-cell production.
• Florea, A., Jacobs, E. T., Harris, R. B., Klimentidis, Y. C., Thajudeen, B., & Kohler, L. N. (2021). Chronic kidney disease unawareness and determinants using 1999-2014 National Health and Nutrition Examination Survey Data. Journal of public health (Oxford, England).
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  Although chronic kidney disease (CKD) affects 15% of the United States (US) population,
• Kapp, M. E., Fogo, A. B., Roufouse, C., Najafian, B., Radhakrishnan, J., Mohan, S., Miller, S. E., D'Agati, V. D., Silberzweig, J., Barbar, T., Gopalan, T., Srivatana, V., Mokrzycki, M. H., Benstein, J. A., Ng, Y. H., Lentine, K. L., Aggarwal, V., Perl, J., Salenger, P., , Koyner, J. L., et al. (2021). Renal Considerations in COVID-19: Biology, Pathology, and Pathophysiology. ASAIO journal (American Society for Artificial Internal Organs : 1992), 67(10), 1087-1096.
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  Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged into a worldwide pandemic of epic proportion. Beyond pulmonary involvement in coronavirus disease 2019 (COVID-19), a significant subset of patients experiences acute kidney injury. Patients who die from severe disease most notably show diffuse acute tubular injury on postmortem examination with a possible contribution of focal macro- and microvascular thrombi. Renal biopsies in patients with proteinuria and hematuria have demonstrated a glomerular dominant pattern of injury, most notably a collapsing glomerulopathy reminiscent of findings seen in human immunodeficiency virus (HIV) in individuals with apolipoprotein L-1 (APOL1) risk allele variants. Although various mechanisms have been proposed for the pathogenesis of acute kidney injury in SARS-CoV-2 infection, direct renal cell infection has not been definitively demonstrated and our understanding of the spectrum of renal involvement remains incomplete. Herein we discuss the biology, pathology, and pathogenesis of SARS-CoV-2 infection and associated renal involvement. We discuss the molecular biology, risk factors, and pathophysiology of renal injury associated with SARS-CoV-2 infection. We highlight the characteristics of specific renal pathologies based on native kidney biopsy and autopsy. Additionally, a brief discussion on ancillary studies and challenges in the diagnosis of SARS-CoV-2 is presented.
• Batra, A., Herz Allah, S., & Thajudeen, B. (2020). Focal Segmental Glomerulosclerosis in Waldenström's Macroglobulinemia. Case reports in nephrology, 2020, 8895705.
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  Renal involvement in Waldenström's macroglobulinemia is a rare manifestation. Although most renal involvement is due to monoclonal immune deposits, pathology can also be unrelated to it. Here, we describe a 68-year-old female with a history of Waldenström's macroglobulinemia who presented with generalized edema and nephrotic range proteinuria. A renal biopsy showed findings consistent with focal segmental glomerulosclerosis. Treatment with oral prednisone leads to the resolution of proteinuria. This case highlights the importance of identifying pathology that might not be directly related to monoclonal gammopathy, which could have implications on the management.
• Kaur, G., Bijin, B., Saleem, K., Sarsah, B., & Thajudeen, B. (2019). Leukocyte Cell-Derived Chemotaxin 2-Associated Renal Amyloidosis: A Case Report. Case reports in nephrology and dialysis, 7(2), 121-129.
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  Amyloidosis is a disorder characterized by the deposition of abnormal protein fibrils in tissues. Leukocyte cell-derived chemotaxin 2-associated amyloidosis is a recently recognized entity and is characterized by a distinctive clinicopathologic type of amyloid deposition manifested in adults by varying degrees of impaired kidney function and proteinuria. There are only a limited number of cases reported in the literature. We present a 64-year-old Hispanic female with a history of hypertension who was referred for chronic kidney disease management. The review of her laboratory tests revealed a serum creatinine of 1.5-1.8 mg/dL and microalbuminuria (in the presence of a bland urine sediment) in the past year. She denied any history of diabetes, rheumatologic disorders or exposure to intravenous contrast, nonsteroidal anti-inflammatory drugs, herbals, and heavy metals. Serological workup was negative. A renal biopsy showed diffuse infiltration of glomerulus with pale eosinophilic material strongly positive for Congo red stain and a similar eosinophilic material in the interstitium, muscular arteries, and arterioles. Electron microscopy showed marked infiltration of the mesangium, capillary loops, and interstitium with haphazardly arranged fibrillary deposits (9.8 nm thick). Liquid chromatography tandem mass spectrometry confirmed leukocyte cell-derived chemotaxin 2 (LECT2) amyloid deposition. LECT2 amyloidosis (ALECT2) should be suspected in renal biopsy specimens exhibiting extensive and strong mesangial as well as interstitial congophilia. Individuals with LECT2 renal amyloidosis have a varying prognosis. Therapeutic options include supportive measures and consideration of a kidney transplant for those with end-stage renal disease.
• Dill, J., Bixby, B., Ateeli, H., Sarsah, B., Goel, K., Buckley, R., Finkelshteyn, I., Thajudeen, B., Kadambi, P. V., & Bime, C. (2018). Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study. International journal of nephrology and renovascular disease, 11, 249-257.
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  Patients with acute respiratory distress syndrome (ARDS) who develop acute kidney injury have increased mortality and frequently require renal replacement therapy (RRT). The optimal timing for initiation of RRT after onset of ARDS to improve survival is not known.
• Howlader, A., Thajudeen, B., Kodali, L., Martin, D., Harland, R., & Roy-Chaudhury, P. (2018). Page Kidney Following Nephroureteral Stent Placement in a Renal Transplant Allograft. Progress in transplantation (Aliso Viejo, Calif.), 1526924818817014.
• Sardar, A., Thajudeen, B., & Kadambi, P. V. (2018). Peritonitis: An Extremely Rare Complication of Peritoneal Dialysis. Case reports in nephrology, 2018, 8015230.
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  Bacterial peritonitis is a common complication of peritoneal dialysis, but fungal peritonitis is unusual and is mostly due to species. Peritonitis due to is rare and we report one such case. A 63-year-old female presented with progressively worsening abdominal pain, fever, and altered mental status. She had end-stage renal disease and had been on peritoneal dialysis for 4 years. She had abdominal tenderness without rebound or guarding. Laboratory studies and CT of abdomen were significant for leukocytosis and peritoneal membrane thickening, respectively. Peritoneal dialysis fluid study was consistent with peritonitis and culture of the fluid grew . Treatment recommendations include removal of catheter and initiation of antifungal therapy. With the availability of newer antifungals, medical management without removal of PD catheter is possible, but at the same time if there is no response to treatment within a week, PD catheter should be removed promptly.
• Howlader, A., Thajudeen, B., Sussman, A. N., Bracamonte, E., Krahl, L., & Nasr, S. H. (2017). Proliferative Glomerulonephritis With Masked Monoclonal Deposits Responsive to Myeloma Therapy. Kidney international reports, 2(6), 1233-1237.
• Kaur, G., & Thajudeen, B. (2017). Asymptomatic bilateral giant angiomyolipoma. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 28(3), 675-677.
• Bakhtar, O., Thajudeen, B., & Sussman, A. (2016). Decreasing After-Hours Hemodialysis in Hospitals. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 20(1), 87-8.
• Balamuthusamy, S., Kannan, A., Thajudeen, B., Ottley, D., & Jalandhara, N. (2016). Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion. Seminars in dialysis, 28(3), 293-8.
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  Renovascular hypertension is a syndrome which encompasses the physiological response of the kidney to changes in renal blood flow and renal perfusion pressure. Such physiological changes can occur with renal artery occlusion irrespective of the severity of the lesion. We have analyzed hypertensive patients with mild renal artery stenosis and compared them to patients with no stenosis. Renal vein renin sampling from catheterization of the renal vein was performed in all these patients. Patients with mild stenosis had higher renal vein renin ratio (3.01 ± 1.5) than the patients with no stenosis (1.10 ± 0.29; p = 0.002). Patients with mild stenosis were also found to have higher diastolic blood pressure and renal artery resistive indices when compared to patients with no stenosis. We therefore conclude that mild stenosis can precipitate renin-mediated hypertension in renovascular stenosis and also emphasis that parameters pertinent to renal physiology need to be evaluated before considering treatment options in patients with renal artery stenosis and medical management with RAAS blockade is the preferred modality of therapy for patients with renin-mediated hypertension.
• Kamel, M., Thajudeen, B., Bracamonte, E., & Madhrira, M. (2016). Idiopathic Nonviral Cryoglobulinemia Treated Successfully With Rituximab. American journal of therapeutics, 23(2), e617-20.
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  Cryoglobulinemia is a systemic inflammatory syndrome that generally involves small-to-medium vessel vasculitis due to cryoglobulin-containing immune complexes. The therapeutic management of idiopathic cryoglobulinemic vasculitis has yet to be defined because no study has evaluated the best strategies. However, treatment of severe vasculitis is traditionally based on a combination of corticosteroids and immunosuppressants or plasmapheresis, and more recently rituximab. We report a case of 77-year-old female patient diagnosed with idiopathic cryoglobulinemia, treated successfully with 6 months prednisone tapering and 2 doses of rituximab (1 g each dose). After receiving the above-mentioned treatment, her creatinine went back to normal with resolution of proteinuria and hematuria, normalization of serum complements, and significant improvement in her clinical picture. We conclude that rituximab could be an effective treatment for idiopathic cryoglobulnemia.
• Moinuddin, I., Madhrira, M., Bracamonte, E., Thajudeen, B., & Sussman, A. (2016). Membranous nephropathy with crescents associated with levamisole-induced MPO-ANCA vasculitis. Pathology, research and practice, 212(7), 650-3.
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  ANCA-associated vasculitis (AAV) is the most common cause of crescentic rapidly progressive glomerulonephritis (GN). Levamisole used as an adulterant in cocaine is increasingly recognized as a cause of AAV. We report the case of a 50 year old woman with atypical anti-MPO AAV associated with cocaine use and exposure to levamisole. In addition to the clinical and pathologic findings of crescentic GN, the patient also had biopsy evidence of secondary membranous nephropathy (MN). Although AAV and MN have been reported previously in the same patient and both have been induced by drug exposures, this is the first report of MN in a patient with AAV likely induced by levamisole. We suggest that MPO can cause both pauci-immune vasculitis and secondary membranous nephropathy in some cases, as in cases of levamisole-adulterated cocaine use.
• Moinuddin, I., Thajudeen, B., Sussman, A., Madhrira, M., Bracamonte, E., Popovtzer, M., & Kadambi, P. V. (2016). Early Posttransplant Isolated v1 Lesion Does Not Need to Be Treated and Does Not Lead to Increased Fibrosis. Case reports in transplantation, 2016, 4603014.
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  Acute vascular rejection (AVR) is characterized by intimal arteritis in addition to tubulitis and interstitial inflammation. It is associated with a poorer prognosis compared to tubulointerstitial rejection (AIR) and AVR is associated with a higher rate of graft loss than AIR. The prognosis and treatment of arteritis without tubulitis and interstitial inflammation (isolated v1 lesion) are still controversial. We report a case of a patient who had a biopsy of the kidney allograft for evaluation of slow graft function. The biopsy revealed an isolated v1 lesion. However, we chose not to augment immunosuppression. The patient's kidney allograft function improved over time with close monitoring. Repeat biopsy a year later showed no evidence of endothelialitis and relatively unchanged fibrosis and no other abnormalities. Although it is suggested that most cases of isolated v1 lesions will respond to corticosteroids or T cell depleting therapies, some cases will improve with conservative management. Further studies are needed to determine which cases could be managed conservatively.
• Murugapandian, S., Mansour, I., Hudeeb, M., Hamed, K., Hammode, E., Bijin, B., Daheshpour, S., Thajudeen, B., & Kadambi, P. (2016). Epidemiology of Glomerular Disease in Southern Arizona: Review of 10-Year Renal Biopsy Data. Medicine, 95(18), e3633.
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  Glomerulonephritis stands third in terms of the etiologies for end-stage kidney disease in the USA. The aim of this study was to look at the patterns of biopsy-proven glomerulonephritis based on data from a single center.Kidney biopsy specimens of all patients above the age of 18 years, over a 10-year period, who had diagnosis of nondiabetic glomerular disease, were selected for the study.The most common histopathological diagnosis was focal and segmental glomerulosclerosis (FSGS) (22.25%, 158/710) followed by membranous nephropathy (20.28%, 144/710) and immunoglobulin (Ig)A nephropathy (19.71%, 140/710). There was male preponderance in all histological variants except IgA nephropathy, lupus nephritis, and pauci-immune glomerulonephritis. The race distribution was uneven, and all histological variants, except minimal change disease and lupus nephritis, were more commonly seen in whites. In a separate analysis of the histological pattern in Hispanics, lupus nephritis was the most common pathology (28.70%, 62/216) followed by FSGS (18.05%, 39/216). In American Indian population, the most common pathology was IgA nephropathy (33.33%, 8/24) followed by FSGS (16.67%, 4/24).This study highlights the histopathological patterns of glomerular disease in southern Arizona. The data suggest regional and ethnic variations in glomerular disease that may point towards genetic or environmental influence in the pathogenesis of glomerular diseases.
• Thajudeen, B., & Salahudeen, A. K. (2016). Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives. Cancer management and research, 8, 105-14.
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  Hyponatremia is the most frequently observed electrolyte abnormality in clinical practice, and its frequency is almost double in hospitalized cancer patients. As a subset of cancer, hyponatremia is quite common in lung cancer patients, and it is often coupled with the diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The presence of hyponatremia is consequential in that its presence adversely affects cancer patients' prognosis and outcomes. Limited data suggest that correcting hyponatremia in lung cancer patients can increase response to anticancer treatment, may help reduce length of hospital stay and cost, and reduce morbidity and mortality. The type of treatment for hyponatremia depends on several factors; the key factors are the duration and severity of neurological symptoms of hyponatremia and the status of extracellular volume. When hyponatremia is caused by syndrome of inappropriate antidiuretic hormone, hypertonic saline is indicated for acute symptomatic cases, whereas fluid restriction is recommended in chronic asymptomatic hyponatremia. The latter allows a slower rate of correction, thus avoiding the dreaded complication of osmotic demyelination syndrome. Fluid restriction is, however, insufficient or impractical, and often the use of pharmacological therapy such as antidiuretic hormone receptor antagonists becomes necessary. Availability of these antagonists as an effective treatment in the management of hyponatremia has been a major breakthrough, and furthermore, its clinical or investigational use in cancer-related hyponatremia may offer a potential opportunity to gain further insights into the prognostic impact of hyponatremia correction on cancer patients' outcomes. Tolvaptan is a prototype of ADH receptor antagonists that acts at renal tubular levels to increase free water excretion without inducing major systemic electrolyte abnormalities such as hypokalemia or alkalosis. The aim of this paper is to provide a brief review while focusing on cancer hyponatremia; (1) of the epidemiology of hyponatremia and its pathophysiology and diagnostic approaches and (2) of the pharmacokinetics of tolvaptan and its clinical efficacy, safety, and compliance.
• Thajudeen, B., Madhrira, M., Bracamonte, E., & Cranmer, L. D. (2016). Ipilimumab granulomatous interstitial nephritis. American journal of therapeutics, 22(3), e84-7.
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  Drug-induced interstitial nephritis is a recognized cause of acute and chronic renal failure. Some of them lead to the formation of granulomata. T-cell-mediated immune response is implicated in the pathogenesis. Here, we describe the case of a 74-year-old male patient with metastatic melanoma who was referred to our clinic with a history of rash and worsening renal function. Because of subacute onset, progressively worsening renal function in the presence of skin rash, elevated liver enzymes, and in the background of exposure, medication-induced interstitial nephritis was suspected. He received 3 doses of ipilimumab, a novel drug used in the treatment of metastatic melanoma within 3 months before the onset of renal failure. A renal biopsy was done, which showed granulomatous interstitial nephritis. Renal biopsy findings, temporal relation between renal failure and exposure to medication, and review of the literature supported a diagnosis of ipilimumab-induced renal failure. He was started on steroids, and renal function recovered in the next 1 month. Immune-related adverse reaction is one of the common side effects of ipilimumab. Ipilimumab-induced hepatitis and colitis has been previously reported in the literature. This is the first ever case report of ipilimumab-induced granulomatous interstitial nephritis.
• Kamel, M., & Thajudeen, B. (2015). A case of acute kidney injury and calcium oxalate deposition associated with synthetic cannabinoids. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 26(4), 802-3.
• Moinuddin, I., Bracamonte, E., Thajudeen, B., Sussman, A., Madhrira, M., & Costello, J. (2015). Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram. Case reports in medicine, 2015, 250530.
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  Allergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is suspected if AKI is temporally related to the initiation of a new drug. However, patients with bland sediment and normal urinalysis can also have AIN. Currently, a definitive diagnosis of AIN is made by renal biopsy which is invasive and fraught with risks such as bleeding, infection, and hematoma. Additionally, it is frequently unclear when a kidney biopsy should be undertaken. We describe a biopsy proven case of allergic interstitial nephritis which manifested on contrast enhanced Magnetic Resonance Imaging (MRI) as a striated nephrogram. Newer and more stable macrocyclic gadolinium contrast agents have a well-demonstrated safety profile. Additionally, in the presentation of AKI, gadolinium contrast agents are safe to administer in patients who demonstrate good urine output and a downtrending creatinine. We propose that the differential for a striated nephrogram may include AIN. In cases in which the suspicion for AIN is high, this diagnostic consideration may be further characterized by contrast enhanced MRI.
• Murugapandian, S., Bijin, B., Mansour, I., Daheshpour, S., Pillai, B. G., Thajudeen, B., & Salahudeen, A. K. (2015). Improvement in Gemcitabine-Induced Thrombotic Microangiopathy with Rituximab in a Patient with Ovarian Cancer: Mechanistic Considerations. Case reports in nephrology and dialysis, 5(2), 160-7.
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  Gemcitabine is a potent and widely used anticancer drug. We report a case of gemcitabine-induced thrombotic microangiopathy (GCI-TMA), a known but not widely recognized complication of gemcitabine use, and our experience of treating GCI-TMA with rituximab. A 74-year-old woman was referred to our clinic for an evaluation of worsening renal function. She has recently been treated for ovarian cancer (diagnosed in 2011) with surgery (tumor debulking and bilateral salpingo-oophorectomy) along with cisplatin chemotherapy in 2012, followed by carboplatin/doxorubicin in 2013 and recent therapy for resistant disease with gemcitabine. Laboratory tests showed anemia, normal platelets and elevated lactate dehydrogenase. A peripheral smear revealed numerous schistocytes, and a kidney biopsy showed acute as well as chronic TMA. The patient continued on gemcitabine therapy, and treatment with plasma exchange was started. Since there was no response to treatment even after 5 sessions of plasma exchange, one dose of rituximab was given, which was associated with a drop in the creatinine level to 2 mg/dl. The pathogenesis of renal injury could be the effect of direct injury to the endothelium mediated by cytokines. Usual treatment includes withdrawing the drug and initiation of treatment with plasmapheresis with or without steroids. In cases resistant to plasmapheresis, treatment with rituximab can be tried. The mechanism of action of rituximab might be due to the reduced production of B-cell-dependent cytokines that drive endothelial dysfunction by depleting B cells. Patients receiving gemcitabine chemotherapy should be monitored for the development of TMA, and early treatment with plasma exchange along with rituximab might benefit these patients who already have a bad prognosis.
• Thajudeen, B., Budhiraja, P., Meister, E., & Popovtzer, M. (2015). Improvement in glomerular filtration rate may decrease mortality among type-2 diabetics with chronic kidney disease lacking proteinuria: A retrospective study. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 26(4), 702-7.
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  Twenty percent of patients with type-2 diabetes mellitus without albuminuria progress to chronic kidney disease (CKD). The various factors related to development of CKD, the natural course of renal dysfunction as well as mortality in this sub-group of diabetics has not been studied in detail. The medical records of 121 patients (all males) above the age of 40 years with type-2 diabetes mellitus and CKD, and without proteinuria, were reviewed in this retrospective study. The outcomes measured included: (a) all-cause mortality, (b) need for hemodialysis (HD), (c) appearance of proteinuria and (d) trend in kidney function. The all-cause mortality was 33%, with mean age at death being 75.9 years. Sixty-three percent of the patients had improvement in estimated glomerular filtration rate (eGFR) at the end of the follow-up period. The mortality was higher in patients with worsening eGFR compared with those with improvement in eGFR (61% vs 39%, P = 0.040). 5.8% of the patients ended up on HD and 16.51% developed proteinuria at the end of the follow-up period. Patients who developed proteinuria showed a higher tendency for progression of renal failure. Multivariate logistic regression for trend toward improving versus worsening of the eGFR revealed no statistically significant predictors. This observational study suggests that in type-2 diabetic patients with CKD, a substantial number of patients will have improvement in eGFR over time. Careful search for potential reversible causes of kidney damage could help in reducing mortality.
• Thajudeen, B., Kamel, M., Arumugam, C., Ali, S. A., John, S. G., Meister, E. E., Mosier, J. M., Raz, Y., Madhrira, M., Thompson, J., & Sussman, A. N. (2015). Outcome of patients on combined extracorporeal membrane oxygenation and continuous renal replacement therapy: a retrospective study. The International journal of artificial organs, 38(3), 133-7.
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  Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used in the management of cardiopulmonary failure. Continuous renal replacement therapy (CRRT) is often added to the treatment for the correction of fluid and electrolyte imbalance in patients with acute kidney injury. Most of the literature on the use of combined ECMO and CRRT has been on pediatric patients. There are limited outcome data on the use of these combined modalities in adult patients.
• Bakhtar, O., Thajudeen, B., Braunhut, B. L., Yost, S. E., Bracamonte, E. R., Sussman, A. N., & Kaplan, B. (2014). A case of thrombotic microangiopathy associated with antiphospholipid antibody syndrome successfully treated with eculizumab. Transplantation, 98(3), e17-8.
• John, S. G., William, P., Murugapandian, S., & Thajudeen, B. (2014). Outcome of Patients with Infective Endocarditis who were Treated with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy. Clinics and practice, 4(3), 670.
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  Infective endocarditis is a potentially life threatening condition. It is associated with high mortality and morbidity resulting mostly due to cardiorespiratory failure. Extracorporeal membrane oxygenation is a modality of treatment used to support hypoxic respiratory failure especially in patients who are already on mechanical ventilation. Continuous renal replacement therapy is added mainly for maintaining fluid and electrolyte balance. Here we report a case series of patients diagnosed with infective endocarditis who were treated with combined extracorporeal membrane oxygenation and continuous renal replacement therapy. Three patients in the age group 20-60 years were admitted with clinical features suggestive of infective endocarditis. During the course of hospital stay they developed cardiorespiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation support for refractory hypoxia. It was complicated by heart failure, renal failure and fluid overload which required initiation of continuous renal replacement therapy. All the three patients succumbed in spite of the aggressive treatment. In addition to the role played by each complication, delayed start of continuous renal replacement therapy might have also contributed to the high mortality. Early initiation of continuous renal replacement therapy for management of fluid overload needs to be considered in the management of these critically ill patients.
• Kamel, M., Thajudeen, B., Bracamonte, E., Sussman, A., & Lien, Y. H. (2014). Polyuric kidneys and uveitis: an oculorenal syndrome. The American journal of case reports, 15, 530-3.
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  Tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) is a diagnosis of exclusion based on the presence of uveitis and acute tubulointerstitial nephritis in the absence of other disease entities known to cause both of these disorders. The proximal tubule is frequently affected by this syndrome, resulting in a wide range of presentations that vary from proteinuria to full picture of Fanconi syndrome. However, distal tubular involvement is not common.
• Kamel, M., Thajudeen, B., Bracamonte, E., Sussman, A., & Lien, Y. H. (2014). Polyuric kidneys and uveitis: an oculorenal syndrome. The American journal of case reports, 15, 530-533.
• Sharda, N., Bakhtar, O., Thajudeen, B., Meister, E., & Szerlip, H. (2014). Manual urine microscopy versus automated urine analyzer microscopy in patients with acute kidney injury. Laboratory medicine, 45(4), e152-5.
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  To examine whether a significant difference exists between the reported ranges of granular and muddy brown casts in urine specimens using manual microscopy compared with an automated urine analyzer in a cohort of patients with acute kidney injury (AKI).
• Thajudeen, B. (2014). Continuous renal replacement therapy in a patient with pulmonary embolism receiving extracorporeal membrane oxygenation. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 18(5), 515-6.
• Thajudeen, B., & Sussman, A. N. (2014). Case of peritoneal dialysis-related peritonitis and associated tunnel infection due to group G streptococcus. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 18(6), 643.
• Thajudeen, B., John, S. G., Ossai, N. O., Riaz, I. B., Bracamonte, E., & Sussman, A. N. (2014). Membranous nephropathy with crescents in a patient with Hashimoto's thyroiditis: a case report. Medicine, 93(8), e63.
• Thajudeen, B., John, S. G., Ossai, N., Riaz, I. B., Bracamonte, E., & Sussman, A. N. (2014). Membranous nephropathy with crescents in a patient with Hashimoto's thyroiditis: a case report. Medicine, 93(8), e63.
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  Membranous nephropathy is a common cause of nephrotic syndrome in adults. It usually occurs secondary to underlying disease processes such as autoimmune disorders, malignancy, infection, and drugs. The presentation of nephrotic syndrome with concomitant precipitous decline in renal function warrants investigation of a coexistent disorder.We report the case of a 30-year-old male who presented with symptoms and signs of hypothyroidism.A diagnosis of Hashimoto's thyroiditis was contemplated based on the presence of high serum levels of antithyroglobulin and antithyroid peroxidase antibodies. Upon initiation of treatment with levothyroxine, patient symptomatology improved; however, the laboratory studies demonstrated continued elevated creatinine, hematuria, and proteinuria, which had not been addressed. Two months following treatment initiation, he had progressive deterioration in renal function and proteinuria. A renal biopsy revealed coexistent necrotizing and crescentic glomerulonephritis and membranous nephropathy.The final diagnosis was necrotizing, crescentic glomerulonephritis with superimposed membranous nephropathy likely secondary to Hashimoto's thyrodiitis.Induction treatment with oral cyclophosphamide and prednisone was started.At the end of 6 months of treatment, there was improvement in renal function and proteinuria and maintenance treatment with azathioprine and low-dose prednisone was initiated. This case highlights the importance of precise and detailed evaluation of patients with autoimmune diseases such as Hashimoto's thyroiditis particularly in the presence of active urine sediment. Proper evaluation and diagnosis of such patients has implications on the prognosis and response to treatment.
• Thajudeen, B., Murugapandian, S., & G, J. S. (2014). Outcome of Patients with Infective Endocarditis who were Treated with Extracorporeal Membrane Oxygenation and continuous Renal Replacement Therapy. Clinics and Practice.
• Thajudeen, B., & Rubin, M. F. (2013). Hemodynamic acute kidney injury in immunoglobulin A nephropathy: nephrosarca theory revisited. The American journal of medicine, 126(12), e13-4.
• Thajudeen, B., Budhiraja, P., & Bracamonte, E. R. (2013). Bilateral renal artery thrombosis secondary to acute necrotizing pancreatitis. Clinical kidney journal, 6(5), 503-6.
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  Renal artery thrombosis is a rare, but serious and often under-diagnosed condition. We report a case of bilateral renal artery thrombosis secondary to acute necrotizing pancreatitis. A 66-year-old female presented with abdominal pain and acute kidney injury (AKI). A renal biopsy showed organized intraluminal thrombi and a computer tomography scan of the abdomen showed bilateral renal artery thrombosis. Emergent laprotomy showed necrosed pancreas. Doppler studies showed deep vein thrombosis of the lower extremities and internal jugular vein thrombosis. Workup for hypercoagulability was unremarkable. The final diagnosis was AKI secondary to bilateral renal artery thrombosis probably due to hypercoagulability of acute necrotizing pancreatitis.
• Thajudeen, B., Sussman, A., & Bracamonte, E. (2013). A case of atypical hemolytic uremic syndrome successfully treated with eculizumab. Case reports in nephrology and urology, 3(2), 139-46.
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  Atypical hemolytic uremic syndrome (aHUS) is a rare thrombotic microangiopathy (TMA) characterized by the triad of hemolytic anemia, thrombocytopenia, and acute renal failure. Eculizumab, a monoclonal complement C5 antibody which prevents the induction of the terminal complement cascade, has recently emerged as a therapeutic option for aHUS. We report a case of aHUS successfully treated with eculizumab. A 51-year-old male was admitted to the hospital following a mechanical fall. His past medical history was significant for rheumatic valve disease and mitral valve replacement; he was on warfarin for anticoagulation. A computed tomography scan of the head revealed a right-sided subdural hematoma due to coagulopathy resulting from a supratherapeutic international normalized ratio (INR). Following treatment with prothrombin complex concentrate to reverse the INR, urine output dropped and his serum creatinine subsequently increased to 247.52 μmol/l from the admission value of 70.72 μmol/l. Laboratory evaluation was remarkable for hemolytic anemia, thrombocytopenia, elevated lactate dehydrogenase (LDH), low haptoglobin, and low complement C3. A renal biopsy was consistent with TMA, favoring a diagnosis of aHUS. Treatment with eculizumab was initiated which resulted in the stabilization of his hemoglobin, platelets, and LDH. Hemodialysis was terminated after 2.5 months due to improvement in urine output and solute clearance. The interaction between thrombin and complement pathway might be responsible for the pathogenesis of aHUS in this case. Eculizumab is an effective therapeutic agent in the treatment of aHUS. Early targeting of the complement system may modify disease progression and thus treat aHUS more effectively.

Presentations

• Thajudeen, B. (2014, November/Fall). Improving Quality of Life in Elderly Hemodialysis Patients: A Single Center Prospective Study. American Society of Nephrology National Conference. Philadelphia, PA: ASN.
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  Poster presented at ASN

Poster Presentations

• Thajudeen, B. (2016, April/Spring). A Case Of Yellow Filter. National Kidney Foundation. Boston, MA: NKF.
• Thajudeen, B. (2016, April/Spring). Cinacalcet Treatment For Primary Hyperparathyroidism Following Bone Marrow Transplant. National Kidney Foundation. Boston, MA: NKF.
• Thajudeen, B. (2016, April/Spring). Hypercalcemia Induced Metabolic Alkalosis Due To Primary Hyperparathyroidism: A case report. National Kidney Foundation. Boston, MA: NKF.
• Thajudeen, B. (2016, April/Spring). Immune Complexes In Pauci-Immune Glomerulonephritis-A Clinicopathologic Outcome Study. National Kidney Foundation. Boston, MA: NKF.
• Thajudeen, B. (2016, April/Spring). Symptomatic Sporadic Bilateral Giant Angiomyolipoma: A Case Report. National Kidney Foundation. Boston, MA: NKF.
• Thajudeen, B. (2015, april). Clinic-pathologic correlation of crescentic glomerulonephritis in patients with lupus nephritis and ANCA glomerulonephrits. NKF.

Other Teaching Materials

• Kutob, R. M., Sam, A., Thajudeen, B., Pritchard, G., Matika, R. W., Combs, D. A., Plitt, J., Ebert, V., Desoky, S. M., Winegar, B., Thienhaus, O. J., & Theodorou, A. (2021. Professionalism: Communicating with the Health Care Team. Virtual Lecture Hall.
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  Collaborated with University of Arizona College of Medicine Continuing Medical Education committee on development of this online, case-based, interactive course accredited for 1.5 CME credits, available to physicians nationwide on Virtual Lecture HallAvailable from: https://www.vlh.com/shared/courses/course_info.cfm?courseno=1807 (accessed September 16, 2021).