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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
Xixi Zhang, Ryohei Kuwatsuru, Hiroshi Toei, Daisuke Yashiro, Shingo Okada, Hitomi Kato
Two patients with tuberous sclerosis complex each had multiple bilateral renal angiomyolipomas. After undergoing embolization for a ruptured angiomyolipoma, patient 1 experienced long-lasting abdominal fullness; contrast-enhanced computed tomography (CECT) revealed a large chronic hematoma without contrast extravasation. Patient 2 underwent embolization for the largest right renal angiomyolipoma which contained a chronic hematoma. 2 weeks later, the symptom of abdominal fullness presented, and CECT revealed that the preexisting hematoma had enlarged without contrast extravasation...
May 2018: Case Reports in Nephrology and Dialysis
Yasuhiko Tomino, Atsuko Hisada-Urita, Takuto Seki, Tomonari Watanabe, Reo Kanda, Toshimasa Takahashi
We report herein an adult case of chronic kidney disease (CKD) associated with diabetes. The patient had been treated with insulin injection for diabetes 10 years ago. At the time of his first visit to our division for further examinations, we diagnosed him as CKD: cause (C) diabetes; glomerular filtration rate (GFR) (G) G5 (estimated [e] GFR, 10.2 mL/min/1.73 m2 ; serum creatinine of 4.90 mg/dL); and albuminuria (A) A3 (2.62 g/gCr) by the Japanese Society of Nephrology (JSN) CGA classification. Because he had complained of severe constipation and kidney function, i...
May 2018: Case Reports in Nephrology and Dialysis
Murray L Levin, Shubhada Ahya
The case of a female patient with primary membranous nephropathy is presented. She was treated with corticosteroids and chlorambucil after conservative therapy had failed and went into remission for 5 years. Her nephrotic syndrome recurred but did not respond to the same regimen. She had another complete remission after treatment with corticosteroids and cyclosporine, but the nephrosis recurred after 7 years. Again, she failed to respond with retreatment of steroids plus cyclosporine. She was treated with alternate-day steroid plus mycophenolate and, once again, had a complete remission...
May 2018: Case Reports in Nephrology and Dialysis
Andrea Fisler, Tobias Breidthardt, Nadine Schmidlin, Helmut Hopfer, Michael Dickenmann, Katrin König, Patricia Hirt-Minkowski
Renal dysfunction in the setting of cholestatic liver disease is multifactorial but most often due to decreased kidney perfusion from intravascular volume depletion, acute tubular injury/necrosis, and hepatorenal syndrome. Drug-induced hepatotoxicity may be associated with a cholestatic injury pattern. We report a case of a 56-year-old man with a diagnosis of bile cast nephropathy, as a complication of drug-induced severe hyperbilirubinemia due to the abuse of intramuscular anabolic steroids bought on the internet to increase muscular mass for bodybuilding training...
May 2018: Case Reports in Nephrology and Dialysis
Benjamin Gollasch, Oskar Wischnewski, Birgit Rudolph, Yoland-Marie Anistan, Friedrich C Luft, Maik Gollasch
We present a 42-year-old man with a BMI of 32, who was referred because of proteinuria and decreased renal function. We were impressed by his markedly muscular physique. A renal biopsy was performed, which showed focal segmental glomerular sclerosis (FSGS). Is this patient merely an obese person with FSGS or is something else going on here? We performed extensive clinical and laboratory examinations, genetic testing, and anthropometric data monitoring over time. We transferred our methodology for routine FSGS mutation screening (Sanger sequencing) to the Ion Torrent PGM platform with a new custom-targeted NGS gene panel (Ion Ampliseq FSGS panel) and tested the performance of the system in two cohorts of patients with FSGS...
May 2018: Case Reports in Nephrology and Dialysis
Naoya Toriu, Junichi Hoshino, Saeko Kobori, Sun Watanabe, Masahiko Oguro, Yoichi Oshima, Rikako Hiramatsu, Hiroki Mizuno, Daisuke Ikuma, Akinari Sekine, Noriko Hayami, Keiichi Sumida, Masayuki Yamanouchi, Eiko Hasegawa, Naoki Sawa, Kenmei Takaichi, Motoko Yanagita, Takuya Fujimaru, Eisei Sohara, Shinichi Uchida, Yoshifumi Ubara
We encountered 2 patients with symptomatic huge simple renal cysts. In case 1, 4,000 mL of cyst fluid was drained via a catheter, but intracystic bleeding occurred immediately afterwards. Transcatheter arterial embolization (TAE) was performed, after which the bleeding stopped, and cyst drainage was repeated successfully. After 2 years, the total cyst volume was reduced from 11,775 mL to 75.4 mL. In case 2, TAE was performed prophylactically before drainage. Subsequently, 9,400 mL of fluid was removed from multiple cysts...
January 2018: Case Reports in Nephrology and Dialysis
Shivraj Riar, Mohammed Abdulhadi, Christine Day, Bhanu Prasad
Percutaneous insertion of a peritoneal dialysis (PD) catheter has inherent risks of complications, more so if done "blind" (without fluoroscopy and ultrasound guidance). Despite the perceived disadvantages, there are very few reported cases of mechanical complications after PD catheter insertion. We present an 81-year-old man who underwent percutaneous insertion of dual-cuffed coiled Tenckhoff PD catheter under local anesthesia by a trained nephrologist. The procedure was uneventful, and the patient was discharged 45 min later in a stable state...
January 2018: Case Reports in Nephrology and Dialysis
Jose Torrealba, Jyothsna Gattineni, Allen R Hendricks
Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) is a recently described, uncommon renal disorder which is considered a monoclonal gammopathy of renal significance. Although some patients will have a detectable monoclonal spike, overt hematologic malignancy is found in only a minority. Most patients with PGNMID are over the age of 50 years, and to our knowledge no cases have been reported in children or adolescents. Renal biopsy shows variable histologic patterns by light microscopy, with membranoproliferative and membranous patterns being most common...
January 2018: Case Reports in Nephrology and Dialysis
Kyohei Kunizawa, Junichi Hoshino, Hiroki Mizuno, Tatsuya Suwabe, Keiichi Sumida, Masahiro Kawada, Masayuki Yamanouchi, Akinari Sekine, Noriko Hayami, Rikako Hiramatsu, Eiko Hasegawa, Naoki Sawa, Kenmei Takaichi, Shigeru Shibata, Yoshifumi Ubara
A 59-year-old Japanese woman was admitted for evaluation of muscle weakness. Autosomal dominant polycystic kidney disease had been diagnosed at the age of 47 years, followed by primary aldosteronism at 53 years. At the age of 58, tolvaptan was started (60 mg/day) to treat her renal disease. After 8 months of tolvaptan therapy, hypokalemia-related muscle weakness became prominent, and hypertension became refractory. Finally, treatment with low-dose tolvaptan (30 mg/day) and high-dose spironolactone (100 mg/day) normalized serum potassium and the blood pressure...
January 2018: Case Reports in Nephrology and Dialysis
Tomo Suzuki, Ryutaro Matsumura, Hiroshi Kitamura, Yugo Shibagaki
Class IV lupus nephritis (LN) often has a poorer prognosis than other classes. However, class IV LN has various phenotypes, including not only segmental and global types but also others. We present the case of a 29-year-old woman with class IV-G LN who had an early response to glucocorticoid monotherapy. In addition, multiple lung nodules such as miliary tuberculosis (TB) were detected on computed tomography. All cultures of sputum, gastric fluid, and bone marrow were negative. A kidney biopsy revealed diffuse endocapillary proliferative glomerulonephritis with marked subendothelial deposition...
January 2018: Case Reports in Nephrology and Dialysis
Megumu Fukunaga, Kiyotaka Nagahama, Michiko Aoki, Akira Shimizu, Shigeo Hara, Akira Matsunaga, Eri Muso, Takao Saito
A 20-year-old female student underwent renal biopsy because of chance proteinuria and hematuria. Histological study revealed a membranous nephropathy-like appearance by light microscopy. But immunoglobulins and complements were negative in the glomerulus by immunofluorescence study. On the other hand, plasma apolipoprotein E (ApoE) concentration was elevated to more than 2 times the normal range, and the phenotype, genotype, and DNA sequence studies of her ApoE showed homozygous ApoE2/2 and a heterozygous novel missense mutation called ApoE Toyonaka (Ser197Cys)...
January 2018: Case Reports in Nephrology and Dialysis
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