June 2013


I just saw a link shared by The Living Kidney Donors Network on its Facebook page. The link was to a press release by Donate Life California. In it is a very clever video by David Goldman called “David Got a Kidney.” It is worth a view.

DavidGotAKidney

Video still from “David Got a Kidney” Courtesy David Goldman

David is a kidney patient who was one of the participants of a very long kidney chain (28 patients at 19 different transplant centers over a span of about six weeks) facilitated by the National Kidney Registry.

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David has an earlier video entitled “David Needs a Kidney” that was featured in a Jan 2013 blog post.

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Reading through the press release, I notice that Donate Life California operates a service called Living Donation California. Living Donation California is an information and referral service that promotes living organ donation. It was created as a result of California SB 1395, the “Altruistic Living Donor Registry Act of 2010.” The bill was championed by then Gov. Arnold Schwarzenegger and the late Apple founder Steve Jobs. For more about the bill, read this Jun 2010 blog post.

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by George Taniwaki

Reproduced below is what I hope to be the final email I received from Alex, the scam artist who responded to a Craigslist ad I posted. A complete description of the attempted scam is reported in a Jun 2013 blog post.

This email is a follow up to a check she mailed to me for an amount far in excess of the price of the item I was selling. I did not deposit her check (it is obviously a counterfeit) and did not send a requested MoneyGram to her “movers”.

Her email starts off with a plaintive call for a reply followed by a threat of legal action. (Ha ha. Somehow, I doubt she will follow through on that threat.) The letter ends with a couple of misspelled words and closes with a friendly “Good day.”  I like it.

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From: alexisbr2@gmail.com
Sent: Friday, June 14, 2013 8:11 AM
To: George Taniwaki
Subject: Re: Beautiful Mission-style cupboard

Hey,

What is going on? The check has been delivered to you and you never get back to me regarding the movers money and the pick up schedule.

Are you trying to run away with my hard earned money? Remember i am a Marine and my friend works with the FBI you will be tracked down and arrested. I will also contact my lawyer now for a legal process.

To safe all this troubleyou better get back to me now.

Good day.

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Alex sent the email to me twice, a few hours apart. She has done this before. I guess it must be hard to remember whether you’ve sent a particular email when you have dozens of scams going on at once. Hey, maybe Alex should invest in a CRM email tracking system.

by George Taniwaki

Modern medical therapies often include the use of drugs, many of which have strange-sounding names. I noticed that various drugs used by kidney transplant patents have similar sounding names like tacrolimus and sirolimus or daclizumab and basiliximab. All four drugs are used to reduce the incidence and severity of acute organ rejection. Just from the sound/spelling of their names, I assumed the first two were similar to each other, the last two are similar to each other and that each pair is different from the other.

Similarly, if you read articles about advances in healthcare, you will often come across the name of a new drug. For instance, I recently saw a Reuters article mentioning ichorcumab, an experimental anticoagulant that may start clinical trials soon. The name of this drug ends in -mab. I wondered if it was related to the kidney transplant drugs I was familiar with and how.

Generic drug names

These sometimes difficult to pronounce words are called generic drug names. Unlike the names of simple chemical compounds like titanium dioxide (TiO2), drug names do not describe the arrangement of atoms in the molecule. Instead, they describe the pharmaceutical origins or uses of the molecules.

There is a single organization called the United States Adopted Names Council (USAN) that reviews and approves all generic drug names used in the U.S. The USAN includes representatives from the American Medical Association (AMA), the United States Pharmacopeial Convention (USP), and the American Pharmacists Association (APhA). A liaison from the U.S. Food and Drug Administration (FDA) also participates.

Whenever a pharmaceutical company develops a new biologic agent, it submits an application to the USAN for a generic name for it. The company can suggest a name. The USAN will approve it, or if it rejects it, will suggest an alternative. The process usually moves quite smoothly, though on occasion there is a disagreement that can lead to a court case (C&EN Jan 2012).

Separately, the company that has developed the drug is free to create a brand name for it and register the brand name as a trademark. This is a completely different process. There need not be any connection between the generic name and the brand name. In fact, the FDA will reject any brand names that are too close to the generic name. An article with some details appeared in the J. Am. Pharm Assoc. 2004.

The USAN works with the International Nonproprietary Name (INN) program of the World Health Organization (WHO) to ensure that generic drug names are standardized worldwide. About 60 percent of all new drugs are developed by U.S. pharmaceutical companies, so the USAN heavily influences the INN program.

Specific naming rules

The USAN follows specific nomenclature rules. The USAN’s guidelines for naming new drugs are available here. Summarizing them, a new generic drug name should be:

  1. Unique – reducing confusion and enhancing safety when prescribing
  2. Nonproprietary – can be referred to without violating intellectual property rights or being specific to the product of a single company or source
  3. Informative – Useful for healthcare practitioners and medical education
  4. Short and easy to pronounce – can be used worldwide, a single word with preferably no more than 4 syllables with up to one modifier, also with no more than 4 syllables

Names are based on prefixes and stems. Prefixes are the unique identifiers for a drug. The stems are letter sequences common to a group of drugs that share pharmacologic actions. A complete list of rules for creating new prefixes and stems is available here. Some general naming rules are listed in the table below.

Rule Reason
Do not begin with rac, dex. lev-, ar-, and es These are reserved for racemic mixture, dextro- [R(+)] or levo- [S(-)] rotating enantiomers, and for R(-) and S(+) isomers of the levorotatory and dextrorotatory forms respectively
Do not begin with h, j, k, or w These letters either do not exist in some of the 130 countries that use USANs, or have different sounds in various languages
Do not begin with x or z X and z often sound alike at the start of words
Do not use ph, th, ae, oe, or y Different sounds in different languages, use f, t, e, and i instead
Avoid prefixes and stems like brev, vel, mal, or mor These stems imply other things (brevity, velocity, bad, or death, respectively)
Avoid stem name based on a drug or agent’s target indication Indications often change; mechanism of action is a better basis for names

There are hundreds of approved stem names under the USAN and new ones are added regularly. A complete list is provided here. A few common stems and their meanings are shown in the table below.

Stem Meaning
-anib angiogenesis inhibitors
-ase enzymes
-bufen non-steroidal anti-inflammatory agents, fenbufen derivative
-caine local anesthetics
-cept receptor molecules, native or modified (a preceding infix should designate the target)
-coxib selective cyclooxygenase-2 inhibitors
-erg ergot alkaloids
-imus immunosuppressives
subgroup: –rol-imus immunosuppressant, rapamycin derivatives
-kin interleukins
-mab monoclonal antibodies or fragments
-stat enzyme inhibitors
-tide peptides
-a-, -e-, -i-, -o-, -u-, -xi-, -zu- animal source, rat = a; hamster = e; primate = i; mouse = o; human = u; chimera (from proteins or genes of two different species) = xi; humanized = zu
-vir-,bac-, -li- or –lim-, les-, –cir-, tu target disease or condition: viral = vir; bacterial = bac; immunomodulator = li or lim; infectious lesion = les; cardiovascular or circulatory = cir; tumor = tu

To assist those unfamiliar with drug names, a guide to pronouncing generic drug names is available here.

Examples of generic names

Going back to our example of antirejection drugs prescribed to kidney transplant patients, one common drug is sold under the brand name Prograf by Astellas, a name that is intended to sound like it supports organ grafts. The generic name for this drug is tacrolimus. The prefix or unique identifier of the name is tac-. The stem –rol-imus means it is a rapamycin (a type of fungus) derivative immunosuppressant. This drug reduces the activity of T-cells and thus reduces the chance of acute rejection of the grafted kidney.

A similar drug is Rapamune sold by Pfizer and has the generic name sirolimus. As you may guess by looking at both its commercial name and generic name, it is also a rapamycin derivative immunosuppressant.

Another immunosuppressant drug often prescribed just prior and after surgery is  Zenapax, sold by Roche. The generic name is daclizumab. The identifier prefix is dac-. The stem –li-zu-mab indicates this is a humanized monoclonal antibody targeted at the immune system. Monoclonal antibodies are highly specific. Daclizumab will only bind with the CD25 receptors of T-cells. It does not suppress other T-cell activity and so does not increase the incidence of opportunistic infections like other immunosuppression medications.

A similarly prescribed drug is basiliximab, sold as Simulect by Novartis. The identifier prefix is basi-. The stem -li-xi-mab indicates this is a chimeral (meaning it made by combining bits from two different species, in this case mouse and human) monoclonal antibody. It also binds to the CD25 receptor of T-cells.

Some more examples are shown below.

DrugName

Drug naming convention. Image from C&EN

As a final case, let’s look at the new anticoagulant drug, ichorcumab mentioned earlier. The prefix is ichorc-. The stem –u-mab indicates this is a human derived monoclonal antibody. In Greek mythology, ichor is the golden ethereal fluid in the blood of the gods and other immortals. A nice description of the discovery of a patient who naturally produced the antigen that resulted in the development of ichorcumab is described in Fierce Biotech Jun 2013.

To learn more about drug naming conventions, there is an online app at Quizlet that includes flash card training, a scatter game, and a race game.

by George Taniwaki

I recently became the target of a Craigslist check fraud scam. I was cautious, so I caught it before I lost any money. However, the scam was cleverly designed. A careless or more trusting person could easily be fooled and lose money.

There were a few surprising lessons from my experience. First, my interaction with the criminal didn’t raise any flags until very late in the process. The emails I received were a lot less obviously fraudulent than the offers of money in Nigerian widow emails.

Second, a regular Craigslist user may become complacent about the chances of becoming a victim of fraud. Because I am remodeling my house, I use Craigslist frequently both as a buyer of tools and supplies and as a seller of used kitchen appliances, fixtures, and furniture. I also buy and sell used cars this way. I haven’t bought a new car from a dealer in over 30 years. (Yes, I know this is way before the inception of Craigslist.) In all, I’ve never had a problem with any transaction, until this incident.

Further, in order to use Craigslist you need to have some trust in the other party, or you can’t complete a transaction. Thus, a potential victim is primed to be taken advantage of through emails in the context of a Craigslist transaction that does not occur when receiving an unsolicited email offer from a stranger.

Finally, even though I have kept detailed evidence of this attempted fraud, including names and addresses, and reported my incident  to a variety of law enforcement groups, I believe it is unlikely that any of the criminals involved will be caught or prosecuted. More on the reasons why I believe this later in this blog post.

CraigslistLogo

Description of events

On May 31, I posted an antique cupboard (shown below) on seattle.craigslist.org.

CraigslistPosting

Figure 1. The Craigslist posting that attracted a criminal’s attention

Within a few hours I received an email inquiry. It was from a woman named Alex who said she was in the Marines and temporarily stationed in Georgia.

This seemed odd, but not suspicious. There are lots of military families in the Seattle area.

I did a web search for the woman’s name and found that she had profiles on LinkedIn and Facebook. Both indicated she lived in Shoreline, a suburb of Seattle. Both said she was employed as an instructor at a local beauty school. Neither profile mentioned the Marines, but I reasoned if she was in the reserves, perhaps she wouldn’t mention it.

Alex asked some basic questions about the cupboard, which I answered. The questions were oddly generic and most of the answers were already in my ad. We settled on a price. On Monday, she wrote that she would mail me a cashier’s check and that someone would pick up the cupboard and hold it until she got back. She asked for my full name, address, and phone number.

This seemed odd and a bit suspicious. But I agreed since the risk seemed low.

On Tuesday, she sent another email saying that she had sent the check via USPS priority mail. The tracking number was 9405501699320004099027. I went to the USPS website and found the tracking information.

It looked legitimate to me.

On Thursday I received the package. The return address was for a TRH Construction of Brunswick, GA. This seemed odd, but not entirely suspicious. Maybe Alex was busy and had a friend mail it for her.

Inside was a company check (not cashier check) for $1,850.00 with payor name of Commercial Truck Sales & Export of Sanford, FL drawn from RBC Centura Bank of Lake Mary, FL. There is an illegible signature printed on it.

CraigslistCheck

Figure 2. A suspected counterfeit check, the account number and ABA routing numbers have been obfuscated

OK, now I was finally suspicious. The check appeared to be real. It was printed on one of those check forms you can buy mail order and run through your inkjet printer.  I did web searches for both the payor name and the bank name. Both seemed to be legitimate. But it was pretty obvious that these firms had no connection to this woman. The check was very likely a forged counterfeit.

I received another email from Alex. She wrote that the check amount included our agreed upon price plus an extra $30 for me for my troubles to cash the check and do her a favor. Because I was a trustworthy seller, she wanted me to send the remaining amount of money to her moving company via MoneyGram. She provided the contact name and address where the MoneyGram should be sent. It was a woman named Ychantiz of Rock Hill, SC. Once the money was sent, Alex wanted me to reply back with the MoneyGram reference number, date, address, and dollar amount sent, which she would forward to the movers.

Aha. Here is the scam. I receive a counterfeit check (the bad money) from a forger and deposit it. The check is drawn from a real account at a bank, so it clears. I feel confident and send a MoneyGram (the good money) to the forger’s confederate. Later, the payor on the check discovers money has been stolen from their checking account. Their bank reverses the transaction. My bank also reverses the transaction. I now have lost money and cannot get it back from the forger who is now long gone.

In fact, if I deposit the check now, I could be charged with bank fraud by the local police. It would be the ultimate indignity, the victim accused of being a criminal.

I noticed that my name was misspelled on the check. So to stall for time while I contacted law enforcement groups, I sent Alex an email stating that I received her check, but my name was misspelled and that the bank would not cash it. I asked her to mail me another check.

A day passed without any response. Then on Saturday she replied that she would send a replacement check on Monday. On Tuesday, I sent a follow-up email to Alex to see if she was still interested in the antique cupboard, but she didn’t respond.

Unexpectedly, I received a replacement check on Thursday. It was also sent via priority mail, tracking number 9405501699320004370294. The return address was Waddell Realty of Columbus, GA. The check was for the amount of $2,500.00. (Apparently, the larger amount will compensate the scammer for the additional effort my transaction is taking.) The payor on the check is A Mar Group (sic) of Masfield (sic), TX and drawn from Regions Bank, of Mansfield, TX. The check has the same signature as the first one. At this point, I decided I have collected enough evidence and stopped my conversations with Alex.

As shown in the Bing map, if a single scammer is involved, she is doing a lot of driving. The towns of Brunswick, Columbus, and Rock Hill form a triangle over 200 miles to a side. However, if the criminal organization is sophisticated, there may be a person in each city whose activities are overseen by a single mastermind. More on that next.

CraigslistMap

Figure 3. Map showing physical locations of the scammer(s)

Anatomy of a criminal enterprise

There are two roles being played by the criminal(s) involved in this scam. The mastermind and the dummy. Both roles can be played by the same person, but I suspect they are separate. The mastermind gains access to checking account information for businesses in order to create the phony checks. Perhaps she buys a list off the internet. Or she compiles the list themselves by bribing people who provide services to businesses, such as janitorial service providers, lawn maintenance companies, office suppliers, caterers, etc. to provide copies of checks from clients. Or since this is all about scams, the mastermind approaches a small janitorial business and says she is from the bank investigating fraud and ask for copies of all checks received from businesses. It may not be a coincidence that the two checks I received both have auto dealerships as the payor.

The mastermind also finds the names of innocent people with unique names, like Alexis of Shoreline, and creates fake gmail accounts with those names. The mastermind also has a computer program designed to quickly find new Craigslist postings and automatically send inquiries to the seller with generic questions about the product (e.g., how old is this antique, who was the manufacturer, where was it made, what kind of wood is used, has it been refinished, etc.).

I believe my email communications have been with this mastermind. For all I know, this person actually is the woman named Alexis who lives in Shoreline. But more likely, this person is a man, doesn’t live in the U.S. at all, and can’t be located, much less arrested and prosecuted.

I went back and found one of the emails I received from Alex. Her email address is alexisbr2@gmail.com. I opened up the header information and noted her email IP address was 209.85.214.193. A whois search locates the IP address in Mountain View, CA and lists the owner as Google. That’s not very helpful.

The dummy in this fraud scheme does the grunt work. This person may actually have been duped into participating and doesn’t even realize she is a criminal. This is similar to my belief that many of the scam artists I encountered in Paris (blog post Mar 2011) may be criminals but are also victims.

One task of the dummy is to forge checks. Forgery does not take special skills like you see in the movies. It simply requires the person to own a computer with an inkjet printer. Whenever the mastermind gets a live lead she tells the forger to print a check and mail it to the address requested. The forger gets paid (or is promised to be paid) a piecemeal rate for doing this work. But perhaps she is told to pay the priority mail postage out of her own pocket and doesn’t gets reimbursed (if at all) until the victim’s MoneyGram arrives. The use of priority mail allows the mastermind to monitor the work activity of the forger over the internet. If the forger takes too long to mail out checks or makes mistakes like misspelling the victim’s name, she is fired.

The other task of the dummy is to act as a drop box for receiving the MoneyGram payments and deposit them into the mastermind’s bank account, probably outside the U.S. She is also probably paid piecemeal (or told she will be). Her work activity is monitored by the mastermind using the MoneyGram reference number and dollar amount data that the scam victim kindly provides. If the dummy steals any of the money, the mastermind turns her over to the police. Since this person uses her real name and address for the drop box, she is also likely to get arrested if any of the victims pursue a case. She may also be sued by victims to recover funds. She is in a really high risk, low payout position.

(This arrangement seems similar to that between the mortgage brokers in boiler rooms selling zero money down home loans to unqualified buyers and the investment bankers on Wall Street selling the resulting CMOs to pension funds. Guess which ones got caught and went to jail.)

A good mastermind could probably manage a dozen dummies scattered around the country. So, how does the mastermind find these gullible underlings to do the dirty work and take enormous risk in getting caught in the scam? My guess is by running ads in Craigslist! The ad may have looked something like this:

NOW HIRING! WORK FROM HOME

Great opportunity as a document expeditor.

• Prepare and print checks, invoices, other shipping documents
• Package and ship completed documents
• Accept payments from customers and make deposit to bank accounts
• Track packages and payments and issue reports
• Perform other office tasks as assigned

Job Requirements:
• Must have own computer and color inkjet printer
• Must have own car for trips to post offices and banks
• Proficient in Microsoft Office, Word, Excel, Outlook

Yes, Craigslist is a wonderful tool for recruiting victims for criminal enterprises.

Contacting law enforcement

Had I fallen prey to this scam, I would have been out about $1600. This is a felony, so I want to report this crime. But to whom? The local Bellevue police can’t do anything about this crime. Even the Washington state attorney’s office can’t do anything. The scope of this crime is national or international.

I look for information on check fraud scams. There’s a lot. There is even a blog dedicated specifically to Craigslist scams, though it hasn’t been updated in a long time. Going to the Craigslist site, there is some advice on how to avoid scams and who to report them to.

Following craigslist’s advice, I report my incident to the Federal Trade Commission (FTC) using its online complaint form at https://www.ftccomplaintassistant.gov/

I also report it to the FBI’s Internet Fraud Complaint Center using its online complaint form at http://complaint.ic3.gov/update

Then I call RBC Centura Bank, the bank that the first check I received was drawn against. I explain to a bank employee that I have a counterfeit check and want to report it. She thanks me and says the bank is already aware of the problem. She notes that it is impossible for them to stop this type of criminal activity. (If you think about it, you can see why. The checks are being deposited by innocent victims all around the country. As long as the payor’s account is still open, the depositing banks have no way to know that the checks are counterfeit. Even after the check is returned to the payor bank, it has no way to recognize the check as counterfeit. It isn’t until the payor complains that the fraud is discovered and the bank account is closed. By this time the forger, directed by the mastermind, is writing checks from a different account.)

The bank employee asks me if I received the check by mail. I reply yes, and she tells me to report it to the post office as mail and wire fraud. I report the incident to the US Postal Inspection Services using its online complaint form at http://ehome.uspis.gov/fcsexternal/default.aspx

As a last step, I report the email fraud to Google phishing incident report at https://support.google.com/mail/contact/abuse?hl=en&rd=1. This wasn’t really a phishing scam, but there are not other methods of contacting the gmail team. Hopefully, if the police serve Google with a search warrant, the company can identify the location of the miscreant posing as Alex.

After filing these reports, I don’t have much confidence that anything will be done. Catching Ychantiz, the woman running the drop box, should be easy. She willingly provided her name and address. But she probably doesn’t know she is a criminal. Same thing for the person who is mailing out the checks, if it is a different person. She probably shows up at the post office every day with priority mail packages. The time stamps on the packages can easily be compared with video surveillance footage to identify her. But it is doubtful that either of these people has ever met the mastermind or know that person’s real name or location. Once caught or tired of the scam, these underlings are on their own. The mastermind will just find new underlings, find new checking account data, create new email addresses, and find new Craigslist sellers to target.

Why Craigslist is hard to use

The fine folks at Craigslist is very aware of the problem of scams. Their website strongly urges sellers to only deal with local buyers and to not send money by wire or by mail.

In order to make it difficult for buyers and sellers who are not local to meet, the Craigslist database is filtered by location. There is no easy way for a seller in one city to let buyers nationwide see their wares. Similarly, there is no easy way for a buyer in a city to see all the sellers of a particular trinket across the U.S. One can only do this by running a query on each local Craigslist site.

The best way of running multiple queries to use a computer program and display the results in your own custom web page, a process called a mashup. Lots of websites encourage this and publish an application programming interface (API) that helps developers to automate the query and populate their own database.

However, to deter criminal programmers, Craigslist does not publish an API. Most craigslist mashups are created using screenscraping. That is, a programmer has to tediously hardcode the requests to the Craigslist database and then figure out how to extract the data they want from the web page that is returned. It is easy for a human to read a webpage, but It’s a lot of work to program a computer to do it. Yet some honest people have done this. And apparently some criminals have found the effort worthwhile  too.

by George Taniwaki

I was surfing the web when I noticed a pop-under window appear on my second monitor. Check it out.

Warning

I clicked OK and got this pop-under window.

FakeFlashPage

Very nicely done. This is a spoofed website designed to make the visitors think they are at the official Adobe Flash Player download website. There are only a few problems I see. First, the criminals who want me to download their software didn’t bother to register a domain name and just point users to the IP address of their server. You can see the IP address in the address bar. They could fool a lot more people if they registered a domain name like flash.ly. They they could have a server name like www.adobe.com.flash.ly If you don’t look carefully, then you might think you were actually on Adobe’s site.

Second, the software product name is Adobe Flash Player, not Flash Player. Again they could fool a few more people if they included the correct product name in their pop-up window.

Finally, they misspelled “Uinstall” in the footer navigation.

Anyway, I didn’t have to see this second pop-up to know there was a problem. I knew there was something amiss as soon as I saw the message in the first pop-up window. The phrase “WARNING!” in all caps and with an exclamation point is an amateurish flourish.

All of the problems should raise flags to the user. They are obvious and sloppy errors on the part of the criminals. But I guess the type of person that would click “Install” is not very careful.

by George Taniwaki

The 2013 American Transplant Congress was held in Seattle two weeks ago. Two papers were presented that are of interest for kidney donors. Both of them discuss the issue of lower renal function after donation.

Recent kidney donors are experiencing greater declines in eGFR than in past

In the first paper entitled “First-Year Renal Function Changes among Living Kidney Donors (LKD) in the United States”, researchers led by Emily Heaphy at the Cleveland Clinic compared the short-term (one-year) change in renal function of donors. They compared results by race (white/Caucasian, Hispanic, African-American, Asian, and Native American), age, gender, obesity (as measured by body mass index), blood pressure, and by year of donation (from 2004 to 2011).

The findings are that all donors have higher creatinine levels and lower estimated glomerular filtration rate (eGFR) post-surgery. This is not a surprise. They also found differences by demographic characteristics. African-American, Asian, and Native American donors had bigger increases in creatinine than white/Caucasian or Hispanic donors.

Older donors, especially over 50, had greater increases than younger ones. Men had greater increases than women. There were no differences based on BMI or BP. The one-year decline in eGFR has been getting bigger over time. Donors in 2004 had an average 24.9ml/min drop while donors in 2011 had a 29.9ml/min drop.

The study was retrospective and was based on the data from over 31,000 living kidney donors in the Scientific Registry of Transplant Recipients (SRTR). As mentioned in previous blog posts (for example Nov 2009), donors are not tracked, so data beyond one or two years past donation is generally not available. Thus, it is not possible to say what the long-term consequences of low eGFR will be. That is, we don’t know if low eGFR after surgery is an indicator of any adverse health effects in the future. Also, there is no explanation why the decrease in eGFR is greater today than in the past.

The results of this study are of special interest to me, since I  am Asian, male, and was  51 years old when I made my donation in 2010.

Low eGFR after donation does not lead to kidney disease

On the positive side, a second paper entitled “Low GFR after Kidney Donation Is Not Chronic Kidney Disease” provides evidence to an idea I posited in an Apr 2011 blog post.

The abstract of the study says, “Many kidney donors have an estimated GFR<60 mL/min/1.73m early post-donation and thus meet with criteria of chronic kidney disease stage 3 (CKD3). However, the prognosis of a low GFR with one healthy kidney may not be equivalent to the prognosis of the same GFR with two diseased kidneys.”

A study led by Laura de Vries and colleagues at University Medical Center Groningen in the Netherlands followed two groups, patients with early stage CKD and recent donors, for an average of 4.7 years. At the start of the study the CKD patients had an average GFR of 67 ml/min compared to 71 for the donors. By the end of the study, the patients’ average GFR had fallen to 63ml/min (slope of –1-4ml/min/yr) while the donors had risen to 73 (slope of +1.8).

The results are based on a small prospective study of 57 post-donation kidney donors and 57 CKD patients who were matched for age, gender, GFR, and time of follow-up. GFR was measured rather than estimated, using 125I-iothalamate tracer rather than creatinine. Kidney function slope was calculated as (GFR follow-up – baseline GFR)/duration of follow-up, giving a slope in ml/min/year.

GFRstudy

Change in GFR for patients and donors over four years

by George Taniwaki

Unlike many of the other blog posts regarding the home remodel, this one is rather short. In a few hours you can build a desk from a slab of wood and metal angle bars.

Make the desktop

Actually, I didn’t make the desktop. Sue bought a single slab piece of walnut 2″ x 23″ x 53″ with an interesting live edge and a large check (split) on one end. The desktop is already planed, sanded, stained and varnished. She purchased it from elpis&wood of Marysville, WA. The desktop is smooth but not flat on top. It even has one depression large enough to hold paper clips (Fig 1).

OfficeDesk_01

Figure 1. Smooth but uneven top can be used as a paper clip holder

Make the desk legs

Sue wanted an industrial look to the desk. Thus, I decided to make the legs from 1-1/2″ x 1-1/2″ x 36″ steel angle bar from Home Depot. Cut the angle bars to 25-1/2″ long. This will result in a desktop that is still a little high for a computer desk, so we will add a keyboard tray to this desk.

We don’t want metal legs to sit directly on the hardwood floor or on the rug, since it could cut or ruin them. Take 3/8″ PVC tubing, and cut four pieces, each about 3″ long. Cut each piece open lengthwise. Using clear silicone sealant, attach one piece to the bottom of each leg (Fig 2). After the sealant cures, trim off any excess tubing and clean off any excess sealant.

OfficeDesk_02

Figure 2. PVC tubing makes the pad on the desk leg

Make the brackets

Normally, when constructing a table, the table legs are attached to an apron and the apron attached to the table. However, a desk generally sits much lower than a table and you don’t want an apron since it will make it difficult for you to slide your legs under the desktop, especially if you also have a keyboard tray.

Also, since the tabletop is a single slab 23″ wide, it will experience a lot of seasonal movement. A metal apron in the cross grain direction could cause damage to the desktop.

Thus, instead of an apron, we will make two brackets for each leg of the desk using 2-1/4 x 1-1/2″ x 48″ steel angle bar, also from Home Depot. This wider bar has two sets of holes on one side which will allow more bolts in the connection, making it more rigid and ensuring the legs don’t wobble. Each bracket will be 4-1/2″ long, for a total of 8 pieces.

Assemble the desk

Using two 1/4″ x 1/2″ hex bolts and nuts, attach a bracket to the inside of one side of the leg. Repeat on the other side of the leg (Fig 3). Do this for the other three legs. There will be 16 bolts total.

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Figure 3. Bracket attached to the inside of a leg

Flip the desktop so the bottom is facing up. Place the four legs upside down on the desktop so that the brackets are resting on the desktop. Arrange them in a nice pattern. Since the desktop is not square the legs may not line up on a rectangular grid. Using a pencil, mark the location of the end holes on each bracket on the desktop. You will end up with four marks per leg or 16 overall.

Using a hand-held drill with a 5/32″ bit, make pilot holes 1″ deep into the desktop at each pencil mark. Be careful to make the holes vertical. And be very careful to only go 1″ deep. You don’t want to go through the desktop and ruin it. Attach the brackets to the desktop using 1/4″ x 1″ lag screws.

Attach the keyboard tray to the desktop following the instructions that come with it. Flip the desktop over (Fig 4). And you are done!

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Figure 4. The completed desk

Bonus: Make a set of small drawers

Sue also bought two desktop organizers and asked me to turn them into stand-alone drawers for her desk. Each organizer is 12″W x 9-1/2″H x 14″D and contains three drawers. We will make an industrial frame from metal bar stock to match the desk legs. The frame will hold the bottom organizer off the floor and hold the upper organizer above the bottom one.

To make the front legs of the frame, cut two pieces of 1-3/8″ steel flat bar from Home Depot to 15″ long. To make the back legs, cut two pieces of  1-1/2″ x 1-1/2″ steel angle bar to 15″ long. The angle bar will make the back of the frame. Use PVC tubing to make pads on the bottoms of the legs. Attach them using clear silicone sealant.

Cut eight pieces of flat bar 3″ long. Bend each piece 90° in the middle. Attach these brackets to the legs using 1/4″x1/2″ hex bolts and nuts. Four will be attached 1-1/2″ from the bottom of the legs and four will be attached 1-1/2″ from the top of the legs.

Cut two pieces of 1/8″ Masonite or hardboard to 12-1/2″ x 14″.  These will form the bottoms of the frame. Drill 1/8″ holes in each corner and connect to the brackets using #8 bolts with washers and nuts. The frame is now complete. Slide a desktop organizer into the bottom opening of the frame and set the upper organizer on top of the frame (Figs 5 and 6). Another quick project completed.

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Figure 5 and 6. Front view of desk drawers (left) and rear view (right)

For more ideas on home remodeling projects see the Home Remodeling Guide.

All photos and drawings by George Taniwaki

[Update: Added the name of the company that made the desktop and fixed a couple of typos.]