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Case Reports in Nephrology and Dialysis

Clara Lee Ying Ngoh, Bernard Boon Kee Wee, Weng Kin Wong
Injuries to extrarenal arteries caused by percutaneous biopsy needles are very rare but highly lethal due to delay in recognition. Here we report the case of an inadvertent lumbar artery puncture after native renal biopsy and provide a literature review and a proposed workflow for management of massive bleed after renal biopsy. This case highlights evidence-based management considerations regarding massive bleed after renal biopsy, including the first-line imaging modality and the need to consider extrarenal site bleed...
September 2018: Case Reports in Nephrology and Dialysis
Christine Firth, Lucinda A Harris, Maxwell L Smith, Leslie F Thomas
Cronkhite-Canada syndrome (CCS) is a very rare disorder with less than 500 reported cases. It is characterized by extensive gastrointestinal polyposis and ectodermal anomalies including alopecia, cutaneous hyperpigmentation, and onychodystrophy. Only 3 cases of associated kidney disease (membranous nephropathy [MN]) have been reported. A 71-year-old male with CCS was referred for further evaluation of proteinuria. The patient initially presented with abdominal discomfort, weight loss, dysgeusia, skin hyperpigmentation, alopecia, and dystrophic nails...
September 2018: Case Reports in Nephrology and Dialysis
Makoto Harada, Yusuke Miyashita, Tohru Ichikawa, Mamoru Kobayashi
Coral reef aorta is rare type of atherosclerotic diseases with severe calcification in the visceral part of the aorta. We present a case of coral reef aorta with severe abdominal aortic stenosis in a 67-year-old man. The patient presented with hypertension, claudication, and rapid progression of renal dysfunction over several months. Angiography revealed a severely stenotic suprarenal abdominal aorta resulting in renal ischemia and dysfunction. In addition, his right kidney was completely atrophied. After open surgical repair of the stenotic aorta including renal artery reconstruction, renal function did not improve...
September 2018: Case Reports in Nephrology and Dialysis
Yoko Fujita, Tomo Suzuki, Wei Han, Shiika Watanabe, Koichi Yahagi, Mayumi Nakata, Takeshi Okamoto, Daisuke Ichikawa, Junki Koike, Yugo Shibagaki
Immunoglobulin (Ig) A glomerulonephritis (GN) is a heterogeneous disease affected by various factors. Genetic and other factors "hit" DNA, causing IgA malformation and ultimately glomerular injury. We describe a rare case of crescentic IgA GN with sternoclavicular (SC) arthritis in a 75-year-old woman. Despite active IgA GN with cellular crescents, the patient achieved remission of IgA GN without glucocorticoid therapy after remission of SC arthritis was achieved. Considering the patient's clinical course, this case suggested a relationship between IgA GN and SC arthritis...
September 2018: Case Reports in Nephrology and Dialysis
Salman Anwar, Karen Holfeld, Bhanu Prasad
Background: Pyoderma gangrenosum (PG) is a rare, chronic inflammatory condition exhibiting mucopurulent or hemorrhagic exudates. The majority of cases are associated with inflammatory bowel disease, rheumatological diseases, and hematological malignancies. In the absence of typical serological markers and specific histopathological changes, the diagnosis is often clinical. Being rare, it is frequently misdiagnosed, which leads to a delay in instituting appropriate therapy. Case Presentation: We present a 53-year-old male of Aboriginal descent with end-stage renal disease due to diabetes who underwent insertion of a peritoneal dialysis (PD) catheter...
September 2018: Case Reports in Nephrology and Dialysis
Ryosuke Usui, Yohei Tsuchiya, Kosaku Nitta, Minako Koike
The frequency of using rituximab to treat refractory nephrotic syndrome has recently been increasing, and the conventional dose of rituximab used to treat it, 375 mg/m2 body surface area once weekly for 4 weeks, has been modelled on the chemotherapy regimen for B-cell non-Hodgkin's lymphoma. The dose and intervals of rituximab in refractory nephrotic syndrome remain controversial. Clear lymphoma cell hyperplasia is seen in lymphoma patients, but not in nephrotic syndrome patients. Since we thought that it might be possible to reduce the dose of rituximab if only used for the purpose of depleting CD20-positive B cells in nephrotic patients' peripheral blood, we tried semiannually with a single fixed rituximab dose of 100 mg/body, and a complete remission was attained in 3 cases without treatment with prednisolone or cyclosporine...
September 2018: Case Reports in Nephrology and Dialysis
Asma Hasan, Sharon Maynard, Dominick Santoriello, Henry Schairer
Background: Primary hyperoxaluria type 1 (PH1) is a rare autosomal recessive disease caused by a mutation in the AGXT gene, resulting in deficiency of the alanineglyoxylate:aminotransferase enzyme. It is characterized by accumulation of oxalate in the kidneys and other organs. Case Presentation: A Syrian woman with a history of nephrolithiasis and heterozygosity for factor V Leiden and prothrombin gene mutations presented with postpartum renal failure. She required initiation of renal replacement therapy at 14 weeks postpartum...
September 2018: Case Reports in Nephrology and Dialysis
Karolína Krátká, Martin Havrda, Eva Honsová, Ivan Rychlík
Anticoagulation-related nephropathy (ARN) is a significant and underdiagnosed complication in patients who receive anticoagulation therapy. It is characterized by acute kidney injury in the setting of excessive anticoagulation defined as an international normalized ratio > 3.0 in patients treated with warfarin. A definitive diagnosis is made by renal biopsy showing acute tubular necrosis with obstruction of the tubuli by red blood cell casts. However, the evidence shows that ARN can occur during treatment with novel oral anticoagulants as well...
September 2018: Case Reports in Nephrology and Dialysis
Jose Torrealba, Nathan T Sweed, Daniel Burguete, Allen R Hendricks
Bile cast nephropathy (BCN) is seen in patients who have acute kidney injury and severe hyperbilirubinemia due to a wide range of hepatobiliary system diseases. Findings seen by renal biopsy include acute tubular injury with necrotic and sloughed epithelial cells, yellow-green pigment within tubular epithelial cells, and pigmented granular casts. Hall's special stain for bile turns these casts green. In recent years, BCN has been described in a small number of case reports and clinical studies primarily in the setting of severe liver dysfunction...
September 2018: Case Reports in Nephrology and Dialysis
Keita Nakanishi, Hiroshi Kaito, Miki Ogi, Denshi Takai, Junya Fujimura, Tomoko Horinouchi, Tomohiko Yamamura, Shogo Minamikawa, Takeshi Ninchoji, Kandai Nozu, Ken-Ichi Imadome, Kazumoto Iijima
Viral infections in patients with post-kidney transplantation are often difficult to diagnose as well as treat. We herein report three cases with severe viral infections after kidney transplantation. All their causative pathogens could be detected promptly by polymerase chain reaction and flow cytometry during the early stages of infection. These examinations would also be of great use to monitor therapeutic responses and disease activity. It is indeed true that no specific treatment is available for most of the viral infections, but we should be aware that some infections, such as Epstein-Barr virus infection, can be treatable with prompt and specific treatment, such as rituximab...
September 2018: Case Reports in Nephrology and Dialysis
Lucky Aziza Bawazier
Lupus cystitis is a rare complication of systemic lupus erythematosus (SLE). It is characterized by an increase in bladder wall thickness and may be associated with hydroureteronephrosis. Reports, mostly from East Asian countries, indicate that lupus cystitis usually presents with gastrointestinal tract symptoms such as diarrhea, nausea, or abdominal pain. Lower urinarytract symptoms such as dysuria, nocturia, polyuria, and suprapubic pain are also common presenting symptoms. We report a 22-year-old female patient who presented at Cipto Mangunkusumo Teaching Hospital in Indonesia, with profuse and prolonged vaginal bleeding without any other accompanying symptoms...
September 2018: Case Reports in Nephrology and Dialysis
Calvin Tsui, Pouneh Dokouhaki, Bhanu Prasad
We present a 77-year-old Caucasian woman who presented with nephrotic-range proteinuria, microhematuria, renal impairment, and extremely elevated blood pressure. She had a long history of well-controlled type 2 diabetes. Renal biopsy revealed fibrillary deposits in the mesangium and glomerular basement membrane consistent with fibrillary glomerulopathy (FGN), with crescentic changes and thrombotic microangiopathy (TMA). We could not identify any radiological, clinical, or laboratory evidence of autoimmune disorders, lymphoproliferative disorders, and malignancy...
May 2018: Case Reports in Nephrology and Dialysis
Hideaki Yamabe, Mitsuaki Kaizuka, Satoru Tsunoda, Michiko Shimada
Minimal change nephrotic syndrome (MCNS) is the most common cause of nephrotic syndrome in children and can also present in adults. Corticosteroids generally induce remission of MCNS, and relapses are common after reduction or discontinuation of corticosteroids. We experienced a rare case of steroid-sensitive MCNS where the patient relapsed after 52 years of remission. The patient was a 61-year-old Japanese male who visited our clinic for an edema of the lower extremities which had already persisted for a few days...
May 2018: Case Reports in Nephrology and Dialysis
Ramy M Hanna, Umut Selamet, Patrick Bui, Shih-Fan Sun, Olivia Shenouda, Niloofar Nobakht, Marina Barsoum, Farid Arman, Anjay Rastogi
Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death protein 1 (PD-1) antigen and induces an immune response against tumor tissues. It has been successful in inducing remission in patients with severe metastatic disease, often refractory to other chemotherapeutic agents. The risk of injury of other organ systems has been noted with reported cases of glomerular disease and endocrine disease. In addition, hypophysitis as well as dermatological and gastroenterological side effects have been reported...
May 2018: Case Reports in Nephrology and Dialysis
Ramy M Hanna, Naomi So, Marian Kaldas, Jean Hou, Farid Arman, Michelle Sangalang, Bishoy Yanny, Umut Selamet, Sammy Saab, Niloofar Nobakht, Anjay Rastogi
Hepatitis C (HCV) infection has a prevalence of 3 million infected individuals in the United States, according to recent Center for Disease Control reports, and can have various renal manifestations. Cryoglobulins, antibodies that precipitate at colder temperatures in vitro, are a relatively common cause of renal disease in HCV infection. The cryoglobulin proteins can form occlusive aggregates in small glomerular capillary lumina or deposit in other areas of the glomerulus, resulting in hypocomplementemia, proteinuria, hematuria, and renal injury...
May 2018: Case Reports in Nephrology and Dialysis
Amirahwaty Abdullah, Lydia Winnicka, Charumathi Raghu, Violeta Zeykan, Jagmeet Singh
Strongyloidiasis is a well-known parasitic infection endemic in tropical and subtropical areas of the world. While most infected individuals are asymptomatic, strongyloidiasis-related glomerulopathy has not been well documented. We present a case of disseminated strongyloidiasis in a patient with minimal change nephrotic syndrome treated with high-dose corticosteroids. The remission of nephrotic syndrome after treatment of strongyloidiasis suggests a possible causal relationship between Strongyloides and nephrotic syndrome...
May 2018: Case Reports in Nephrology and Dialysis
Seiji Hashimoto, Rie Yamamoto, Tomochika Maoka, Yuichiro Fukasawa, Takao Koike, Takashi Shigematsu
Background: Oxalate nephropathy is a rare disease. Especially chronic oxalate nephropathy still has many unknown aspects as compared to acute oxalate nephropathy with relatively well-known causality. Case Presentation: The patient was a 70-year-old woman who had a history of small bowel resection 25 years before, cholecystectomy 10 years before, and renal stones (calcium oxalate stones) 7 years before. She had been suffering from chronic diarrhea and had been treated by a local physician...
May 2018: Case Reports in Nephrology and Dialysis
Vojtěch Matoušek, Ivan Herold, Lenka Holanová, Martin Balík
A 23-year-old woman was referred to the tertiary centre with acute kidney injury and severe metabolic alkalosis following an accidental ethylene glycol poisoning. The patient had been treated with continuous haemodiafiltration and regional citrate anticoagulation, and a tracheostomy was performed due to pneumonia. Besides severe metabolic alkalosis and hypernatremia, the laboratory tests revealed total protein of 108 g/L on admission to the tertiary centre. The haemodiafiltration with regional citrate anticoagulation continued with parallel correction of the alkalosis and normalisation of the total plasma protein...
May 2018: Case Reports in Nephrology and Dialysis
Vedran Premužić, Marija Santini, Mario Laganović, Marijana Ćorić, Bojan Jelaković
Background: Varicella zoster virus (VZV) is distributed worldwide and is highly contagious. In adults and immunosuppressed patients of any age, the clinical course is much more severe. The most severe complications are pneumonia (the main cause of lethal outcomes in this infection), encephalitis, and very rarely Reye syndrome and hepatitis. Case Presentation: We present a 59-year-old man who came to the emergency department due to varicella and diarrhea. During initial evaluation acute kidney failure (AKF) was diagnosed, and the patient was admitted to the intensive care unit...
May 2018: Case Reports in Nephrology and Dialysis
Wasim S El Nekidy, Derrick Soong, Albert Kadri, Osama Tabbara, Amina Ibrahim, Islam M Ghazi
Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species...
May 2018: Case Reports in Nephrology and Dialysis
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