Gonçalo Calheiros Cruz, M. Sousa, Sara Vilela, F. Teixeira e Costa, F. J. Silva
Lautropia mirabilis is a gram-negative coccoid bacterium isolated from oral and upper respiratory sites with unclear pathogenic potential. We present an exceedingly rare case of peritoneal dialysis-associated peritonitis due to L. mirabilis in a patient with a recent history of periodontal infection, successfully treated with intraperitoneal antibiotics. We propose that clinicians consider this organism as a potential cause of illness.
{"title":"Lautropia mirabilis: An Exceedingly Rare Cause of Peritoneal Dialysis-Associated Peritonitis","authors":"Gonçalo Calheiros Cruz, M. Sousa, Sara Vilela, F. Teixeira e Costa, F. J. Silva","doi":"10.1159/000524494","DOIUrl":"https://doi.org/10.1159/000524494","url":null,"abstract":"Lautropia mirabilis is a gram-negative coccoid bacterium isolated from oral and upper respiratory sites with unclear pathogenic potential. We present an exceedingly rare case of peritoneal dialysis-associated peritonitis due to L. mirabilis in a patient with a recent history of periodontal infection, successfully treated with intraperitoneal antibiotics. We propose that clinicians consider this organism as a potential cause of illness.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"81 - 84"},"PeriodicalIF":0.7,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42867356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Garo, C. Aglaé, H. Perrochia, P. Ahmadpoor, L. Daniel, O. Moranne
Kidney biopsy is the gold standard for diagnosing glomerular kidney disease. Some authors debate the necessity of systematically performing kidney biopsies in ANCA-associated vasculitis (AAV) to confirm the diagnosis and assess the severity of renal damage. Nevertheless, kidney involvement is considered an organ-threatening disease requiring an aggressive immunosuppressive regimen. We present a series of 4 cases with a high clinical suspicion of ANCA-associated crescentic glomerulonephritis based on rising serum creatinine, presence of proteinuria and/or hematuria, and presence of ANCA with specificity against PR-3 or MPO. The main diagnosis, however, was arterionephrosclerosis without renal AAV. Certain comorbidities, such as diabetes and/or high blood pressure, can quickly mimic progressive glomerulonephritis. In addition, some patients with AAV do not have high creatinine, proteinuria, or hematuria levels. ANCA alone is not specific to AAV and has a poor positive predictive value. The main concern is to prevent the unnecessary, inappropriate complications of heavy immunosuppression, i.e., serious infections or risk of future malignancies. Kidney pathological confirmation is important in patients with no compatible extra-renal manifestations of AAV or any other possible renal diagnosis such as may be found in polyvascular disease or diabetic patients.
{"title":"Interest of a Kidney Biopsy to Rule out ANCA-Associated Renal Vasculitis in Glomerulonephritis Patients with a Positive ANCA","authors":"F. Garo, C. Aglaé, H. Perrochia, P. Ahmadpoor, L. Daniel, O. Moranne","doi":"10.1159/000521862","DOIUrl":"https://doi.org/10.1159/000521862","url":null,"abstract":"Kidney biopsy is the gold standard for diagnosing glomerular kidney disease. Some authors debate the necessity of systematically performing kidney biopsies in ANCA-associated vasculitis (AAV) to confirm the diagnosis and assess the severity of renal damage. Nevertheless, kidney involvement is considered an organ-threatening disease requiring an aggressive immunosuppressive regimen. We present a series of 4 cases with a high clinical suspicion of ANCA-associated crescentic glomerulonephritis based on rising serum creatinine, presence of proteinuria and/or hematuria, and presence of ANCA with specificity against PR-3 or MPO. The main diagnosis, however, was arterionephrosclerosis without renal AAV. Certain comorbidities, such as diabetes and/or high blood pressure, can quickly mimic progressive glomerulonephritis. In addition, some patients with AAV do not have high creatinine, proteinuria, or hematuria levels. ANCA alone is not specific to AAV and has a poor positive predictive value. The main concern is to prevent the unnecessary, inappropriate complications of heavy immunosuppression, i.e., serious infections or risk of future malignancies. Kidney pathological confirmation is important in patients with no compatible extra-renal manifestations of AAV or any other possible renal diagnosis such as may be found in polyvascular disease or diabetic patients.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"73 - 80"},"PeriodicalIF":0.7,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45496049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wolfgang Neukirchen, A. Oesterling, D. Wennmann, B. Heitplatz, Peter Ritter, H. Merz, Veit Busch
Immunotactoid glomerulopathy (ITG) occurs infrequently and is characterized by organized IgG containing deposits. It most usually manifests as a concomitant disease of a broad spectrum of oncologic entities. We here present an exceptional case of ITG without glomerular light chain restriction secondary to a IgM kappa type monoclonal gammopathy of undetermined significance. Due to nephrotic syndrome and deterioration of kidney function a rituximab monotherapy was initiated without targeting the plasmacellular augmentation, which was confirmed as the underlying process. The treatment led to a long-term improvement of proteinuria and stabilization of glomerular filtration rate. Its therapeutic effect has to be attributed to immunomodulatory capacities and targeting of podocytes rather than to be interpreted as directed against a bone marrow or glomerular clone. We conclude that rituximab therapy may be a valuable part of the therapeutic options in ITG irrespective of the underlying oncologic entity.
{"title":"Polyclonal Immunotactoid Glomerulopathy Associated with Monoclonal Gammopathy of IgM Type and Underlying Plasmacellular Disease: Successful Treatment with Rituximab Alone","authors":"Wolfgang Neukirchen, A. Oesterling, D. Wennmann, B. Heitplatz, Peter Ritter, H. Merz, Veit Busch","doi":"10.1159/000524131","DOIUrl":"https://doi.org/10.1159/000524131","url":null,"abstract":"Immunotactoid glomerulopathy (ITG) occurs infrequently and is characterized by organized IgG containing deposits. It most usually manifests as a concomitant disease of a broad spectrum of oncologic entities. We here present an exceptional case of ITG without glomerular light chain restriction secondary to a IgM kappa type monoclonal gammopathy of undetermined significance. Due to nephrotic syndrome and deterioration of kidney function a rituximab monotherapy was initiated without targeting the plasmacellular augmentation, which was confirmed as the underlying process. The treatment led to a long-term improvement of proteinuria and stabilization of glomerular filtration rate. Its therapeutic effect has to be attributed to immunomodulatory capacities and targeting of podocytes rather than to be interpreted as directed against a bone marrow or glomerular clone. We conclude that rituximab therapy may be a valuable part of the therapeutic options in ITG irrespective of the underlying oncologic entity.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"63 - 72"},"PeriodicalIF":0.7,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46967288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vision loss from nonarteritic anterior ischemic optic neuropathy (NAION) is a rare complication of hemodialysis. Here, we present a case in a young woman and discuss the pathophysiology and implications for the nephrologist. A 24-year-old woman with end-stage renal disease developed unilateral, painless vision loss following treatment with hemodialysis. Fundoscopy revealed severe left inferior chalky-white opticdisc edema, a presentation consistent with NAION. Her intradialytic blood pressure was reviewed and found to be significantly lower than her baseline, and a multidisciplinary meeting took place between her ophthalmologist and nephrologist to modify her dialysis sessions to minimize the chance of progression or involvement of her fellow eye. At the 2-month follow-up, the opticdisc edema resolved, and her visual function remained stable. Overall, NAION is a rare complication of hemodialysis and may be a result of intradialytic hypotension, platelet and endothelial dysfunction, anemia, and accumulations of toxins such as urea. As there are no established treatments for NAION, management should focus on optimizing modifiable risk factors to prevent further vision loss in the other eye. These factors include increasing the number of dialysis sessions and duration of sessions, reducing the temperature of the dialysate, discouraging eating, and increasing the dialysate’s calcium concentration. Prompt recognition of NAION and multidisciplinary teamwork can minimize the risk of NAION progression and involvement of the contralateral eye.
{"title":"Hemodialysis-Related Vision Loss from Anterior Ischemic Optic Neuropathy","authors":"Arshia Eshtiaghi, J. Micieli","doi":"10.1159/000523985","DOIUrl":"https://doi.org/10.1159/000523985","url":null,"abstract":"Vision loss from nonarteritic anterior ischemic optic neuropathy (NAION) is a rare complication of hemodialysis. Here, we present a case in a young woman and discuss the pathophysiology and implications for the nephrologist. A 24-year-old woman with end-stage renal disease developed unilateral, painless vision loss following treatment with hemodialysis. Fundoscopy revealed severe left inferior chalky-white opticdisc edema, a presentation consistent with NAION. Her intradialytic blood pressure was reviewed and found to be significantly lower than her baseline, and a multidisciplinary meeting took place between her ophthalmologist and nephrologist to modify her dialysis sessions to minimize the chance of progression or involvement of her fellow eye. At the 2-month follow-up, the opticdisc edema resolved, and her visual function remained stable. Overall, NAION is a rare complication of hemodialysis and may be a result of intradialytic hypotension, platelet and endothelial dysfunction, anemia, and accumulations of toxins such as urea. As there are no established treatments for NAION, management should focus on optimizing modifiable risk factors to prevent further vision loss in the other eye. These factors include increasing the number of dialysis sessions and duration of sessions, reducing the temperature of the dialysate, discouraging eating, and increasing the dialysate’s calcium concentration. Prompt recognition of NAION and multidisciplinary teamwork can minimize the risk of NAION progression and involvement of the contralateral eye.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"57 - 62"},"PeriodicalIF":0.7,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48398318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Niranjan Raja, Arul Rajagopalan, J. Arunachalam, A. Prasath, R. Durai, M. Rajendran
Uremic optic neuropathy (UON) is one of the rare causes of vision loss in chronic kidney disease patients. It is infrequently seen nowadays as most of the patients are dialyzed early owing to better availability of medical services. It is a clinical diagnosis, correlating loss of vision with optic disc edema in a patient with kidney failure which improves noticeably with hemodialysis and steroids. We describe a patient with UON with excellent improvement on timely institution of hemodialysis and steroid therapy.
{"title":"Uremic Optic Neuropathy: A Potentially Reversible Complication of Chronic Kidney Disease","authors":"Niranjan Raja, Arul Rajagopalan, J. Arunachalam, A. Prasath, R. Durai, M. Rajendran","doi":"10.1159/000519587","DOIUrl":"https://doi.org/10.1159/000519587","url":null,"abstract":"Uremic optic neuropathy (UON) is one of the rare causes of vision loss in chronic kidney disease patients. It is infrequently seen nowadays as most of the patients are dialyzed early owing to better availability of medical services. It is a clinical diagnosis, correlating loss of vision with optic disc edema in a patient with kidney failure which improves noticeably with hemodialysis and steroids. We describe a patient with UON with excellent improvement on timely institution of hemodialysis and steroid therapy.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"38 - 43"},"PeriodicalIF":0.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46564270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eva Pella, P. Sarafidis, M. Alexandrou, M. Stangou, C. Nikolaidou, D. Kosmidis, A. Papagianni
This is the first report in an adolescent of minimal change disease (MCD) after the first injection of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) with complete remission following steroid treatment. An 18-year-old white male with no prior medical history complained of gastrointestinal symptoms 11 days after his vaccination. Ascites and lower extremity edema were observed a few days later. He was admitted to a hospital as laboratory testing revealed proteinuria of 10.5 g/24 h, normal creatinine levels, and serum albumin of 1.8 g/dL, confirming the presence of nephrotic syndrome. Immunology and serology tests were unremarkable. A diagnostic kidney biopsy showed no significant glomerular or tubular abnormalities in light microscopy with negative immunofluorescence. Treatment with methylprednisolone 48 mg daily was initiated. A week after discharge, proteinuria declined to 1.2 g/24 h, and edema had disappeared, and 6 weeks later, complete remission was evident. As COVID-19 vaccination has been associated with the development of de novo and relapsing MCD, and this case provides additional support for this possible correlation.
{"title":"De novo Minimal Change Disease in an Adolescent after Pfizer-BioNTech COVID-19 Vaccination: A Case Report","authors":"Eva Pella, P. Sarafidis, M. Alexandrou, M. Stangou, C. Nikolaidou, D. Kosmidis, A. Papagianni","doi":"10.1159/000521981","DOIUrl":"https://doi.org/10.1159/000521981","url":null,"abstract":"This is the first report in an adolescent of minimal change disease (MCD) after the first injection of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) with complete remission following steroid treatment. An 18-year-old white male with no prior medical history complained of gastrointestinal symptoms 11 days after his vaccination. Ascites and lower extremity edema were observed a few days later. He was admitted to a hospital as laboratory testing revealed proteinuria of 10.5 g/24 h, normal creatinine levels, and serum albumin of 1.8 g/dL, confirming the presence of nephrotic syndrome. Immunology and serology tests were unremarkable. A diagnostic kidney biopsy showed no significant glomerular or tubular abnormalities in light microscopy with negative immunofluorescence. Treatment with methylprednisolone 48 mg daily was initiated. A week after discharge, proteinuria declined to 1.2 g/24 h, and edema had disappeared, and 6 weeks later, complete remission was evident. As COVID-19 vaccination has been associated with the development of de novo and relapsing MCD, and this case provides additional support for this possible correlation.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"44 - 49"},"PeriodicalIF":0.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45887309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yao-xian Liang, B. Dong, Lei Jiang, Xin Li, C. Shao, Yunan Yan, L. Zuo
Multiple myeloma is a malignant neoplasm leading to a variety of renal diseases. Although most patients have only one pattern of renal pathology, two or more patterns can exist in some patients. Here, we report a 61-year-old man with multiple myeloma developed proteinuria, hematuria, hypertension, and renal insufficiency. A combined presentation of light- and heavy-chain deposition disease and immunotactoid glomerulopathy was proved by kidney biopsy. Treatment of multiple myeloma resulted in a complete resolution of the renal manifestations. This case illustrates the complexity of paraprotein associated renal lesions and emphasizes that further studies examining the physiologic properties and pathologic effects of monoclonal immunoglobulin are needed.
{"title":"Coexistence of Light- and Heavy-Chain Deposition Disease and Immunotactoid Glomerulopathy in a Patient with Multiple Myeloma: A Case Report","authors":"Yao-xian Liang, B. Dong, Lei Jiang, Xin Li, C. Shao, Yunan Yan, L. Zuo","doi":"10.1159/000522513","DOIUrl":"https://doi.org/10.1159/000522513","url":null,"abstract":"Multiple myeloma is a malignant neoplasm leading to a variety of renal diseases. Although most patients have only one pattern of renal pathology, two or more patterns can exist in some patients. Here, we report a 61-year-old man with multiple myeloma developed proteinuria, hematuria, hypertension, and renal insufficiency. A combined presentation of light- and heavy-chain deposition disease and immunotactoid glomerulopathy was proved by kidney biopsy. Treatment of multiple myeloma resulted in a complete resolution of the renal manifestations. This case illustrates the complexity of paraprotein associated renal lesions and emphasizes that further studies examining the physiologic properties and pathologic effects of monoclonal immunoglobulin are needed.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"50 - 56"},"PeriodicalIF":0.7,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46317387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Elghawy, John S. Wang, Alexander C. Hafey, A. Renaghan, R. Whitehair, T. Kindwall‐Keller
Chronic graft-versus-host disease (cGVHD) is a leading cause of non-relapse mortality in allogeneic hematopoietic cell transplant (HCT) recipients. While the current standard of care is proactive in detecting cGVHD in the lungs, liver, and skin, cGVHD involving kidneys is an underrecognized and likely underdiagnosed cause of post-HCT renal dysfunction. Nephrotic syndrome (NS) is a very rare complication of HCT that is postulated to be a glomerular manifestation of cGVHD. Herein, we report 2 cases of post-HCT minimal change disease likely secondary to cGVHD. In both cases, the onset of NS coincided with tapering of calcineurin inhibitors, and 1 patient had previously been diagnosed with cGVHD of the lungs. One patient was treated with corticosteroids alone and the other with a corticosteroids and tacrolimus. Complete, sustained remission was achieved in both cases. Our cases illustrate the implications of the association between cGVHD and post-HCT NS for patient care, including the importance of obtaining a renal biopsy to establish an accurate histopathological diagnosis and guide-appropriate treatment.
{"title":"Minimal Change Disease Secondary to Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplant for Myelodysplastic Syndrome","authors":"O. Elghawy, John S. Wang, Alexander C. Hafey, A. Renaghan, R. Whitehair, T. Kindwall‐Keller","doi":"10.1159/000522333","DOIUrl":"https://doi.org/10.1159/000522333","url":null,"abstract":"Chronic graft-versus-host disease (cGVHD) is a leading cause of non-relapse mortality in allogeneic hematopoietic cell transplant (HCT) recipients. While the current standard of care is proactive in detecting cGVHD in the lungs, liver, and skin, cGVHD involving kidneys is an underrecognized and likely underdiagnosed cause of post-HCT renal dysfunction. Nephrotic syndrome (NS) is a very rare complication of HCT that is postulated to be a glomerular manifestation of cGVHD. Herein, we report 2 cases of post-HCT minimal change disease likely secondary to cGVHD. In both cases, the onset of NS coincided with tapering of calcineurin inhibitors, and 1 patient had previously been diagnosed with cGVHD of the lungs. One patient was treated with corticosteroids alone and the other with a corticosteroids and tacrolimus. Complete, sustained remission was achieved in both cases. Our cases illustrate the implications of the association between cGVHD and post-HCT NS for patient care, including the importance of obtaining a renal biopsy to establish an accurate histopathological diagnosis and guide-appropriate treatment.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"31 - 37"},"PeriodicalIF":0.7,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41446268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hana Flogelová, E. Karaskova, K. Bouchalová, M. Rohanova, V. Latalova, T. Tichý, V. Tesar
Patients on long-term home parenteral nutrition (HPN) occasionally develop glomerulonephritis due to chronic central venous catheter (CVC)-related infection. Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy.
{"title":"Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis as a Complication of Home Parenteral Nutrition","authors":"Hana Flogelová, E. Karaskova, K. Bouchalová, M. Rohanova, V. Latalova, T. Tichý, V. Tesar","doi":"10.1159/000522150","DOIUrl":"https://doi.org/10.1159/000522150","url":null,"abstract":"Patients on long-term home parenteral nutrition (HPN) occasionally develop glomerulonephritis due to chronic central venous catheter (CVC)-related infection. Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"22 - 30"},"PeriodicalIF":0.7,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of hydronephrosis and can be caused by a variety of conditions. Diagnosis of urinary obstruction without significant dilatation of the pelvic-ureteral system requires a higher degree of suspicion, and hence, its identification can become late. In patients without prior cancer screening, the etiology of obstructive uropathy must be broadened to include primary or metastatic malignancy. Clinicians should look beyond the AKI to properly evaluate the etiology of the patient’s presentation and symptoms. In this report, we present the case of a middle-aged female with no known past medical history who presented with AKI secondary to malignant retroperitoneal fibrosis as the first manifestation of metastatic breast cancer. Her AKI was associated with acute onset anuria and was found to have nondilated postrenal AKI with no significant abnormalities on renal imaging. Early onset anuria in the setting of AKI, which persists despite fluid resuscitation, can suggest complete urinary tract obstruction even with reassuring results of initial renal images, and in the patient with no history of cancer screening, malignancy should be suspected as a primary cause of obstructive uropathy.
{"title":"Thinking Beyond Acute Kidney Injury","authors":"Emran El-Alali, Cesar Moreno, Emad Al Jaber","doi":"10.1159/000522312","DOIUrl":"https://doi.org/10.1159/000522312","url":null,"abstract":"Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of hydronephrosis and can be caused by a variety of conditions. Diagnosis of urinary obstruction without significant dilatation of the pelvic-ureteral system requires a higher degree of suspicion, and hence, its identification can become late. In patients without prior cancer screening, the etiology of obstructive uropathy must be broadened to include primary or metastatic malignancy. Clinicians should look beyond the AKI to properly evaluate the etiology of the patient’s presentation and symptoms. In this report, we present the case of a middle-aged female with no known past medical history who presented with AKI secondary to malignant retroperitoneal fibrosis as the first manifestation of metastatic breast cancer. Her AKI was associated with acute onset anuria and was found to have nondilated postrenal AKI with no significant abnormalities on renal imaging. Early onset anuria in the setting of AKI, which persists despite fluid resuscitation, can suggest complete urinary tract obstruction even with reassuring results of initial renal images, and in the patient with no history of cancer screening, malignancy should be suspected as a primary cause of obstructive uropathy.","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"12 1","pages":"16 - 21"},"PeriodicalIF":0.7,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46386685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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