journal
https://read.qxmd.com/read/38516340/improvement-in-proteinuria-with-sodium-glucose-cotransporter-2-inhibitors-and-esaxerenone-treatment-in-patients-with-chronic-allograft-kidney-disease-a-case-report
#1
Shoichiro Daimon
Proteinuria is a predictor of end-stage renal disease. The effectiveness of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker for the reduction in urinary protein excretion and renoprotection in proteinuric chronic kidney disease patients is well known, and coadministration of and sodium-glucose cotransporter inhibitor and the mineralocorticoid receptor blocker eplerenone has recently demonstrated an additive albuminuria-lowering effect in chronic kidney disease patients. Proteinuria is also an independent predictor of end-stage renal disease in kidney transplant recipients...
2024: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38444903/massive-acetaminophen-ingestion-managed-successfully-with-n-acetylcysteine-fomepizole-and-renal-replacement-therapy
#2
Elizabeth E Williams, Duc Quach, Arthur Daigh
Acetaminophen ingestion is routinely managed with the antidote, N-acetylcysteine (NAC). Massive acetaminophen poisoning has been treated successfully with adjunctive therapies such as fomepizole and hemodialysis. Fomepizole functions by inhibiting cytochrome p560, which prevents tylenol from forming its toxic metabolite, NAPQI. Prior cases have demonstrated favorable outcomes and a significant drop in acetaminophen levels after a single session of intermittent hemodialysis and continuous veno-venous hemofiltration (CVVH)...
2024: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38352852/monoclonal-gammopathy-of-renal-significance-an-atypical-presentation-of-waldenstr%C3%A3-m-s-disease
#3
Pablo Rodríguez-Doyágüez, Motornaya-Morozova, Patricia Martínez-Miguel, Carolina Castillo-Torres, Óscar Toldos-González, Juan José Gil-Fernández
Waldenström's disease is a rare lymphoproliferative syndrome in the bone marrow and sometimes in lymphoid organs which secretes high amounts of monoclonal immunoglobulin M into serum. It can remain indolent for years and rarely affects the kidney, with intraglomerular rather than intratubular damage being predominant, in contrast to multiple myeloma. Different studies identified AL amyloidosis as the most frequent renal lesion, followed by cryoglobulinemic glomerulonephritis. Signs and symptoms may be unspecific, as well as renal manifestations, so collaboration between nephrologists, hematologists, and pathologists is crucial to establish the role of paraprotein in the development of renal damage...
2024: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38239388/a-case-report-of-atypical-anti-glomerular-basement-membrane-nephritis-associated-with-mycobacterium-avium
#4
Julie Bech Jensen, Eva Gravesen, Sidse Graff Jensen, Iain Bressendorff
We present the case of a woman with atypical anti-glomerular basement membrane (anti-GBM) nephritis associated with concurrent pulmonary infection with Mycobacterium avium . A kidney biopsy showed crescentic glomerulonephritis with 50% active crescents and linear IgG staining, but no circulating anti-GBM antibodies were detected, and the patient did not have pulmonary hemorrhage. Despite treatment with a triple-regimen of antibiotics, corticosteroids, and plasmapheresis, the patient did not regain kidney function...
2024: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38222325/bartonella-henselae-infection-mediated-shunt-nephritis
#5
Jennifer Nhan, Shriprasad Deshpande, Craig Futterman, Dong Hyang Kwon, Aadil Kakajiwala
Serum anti-neutrophil cytoplasmic antibody (ANCA) positivity with membranoproliferative pattern on renal biopsy can be due to ANCA-associated vasculitis as well as chronic indolent infections. We present the case of an adolescent boy with congenital heart disease and history of cardiac surgery who presented with severe acute kidney injury requiring hemodialysis. Renal biopsy showed membranoproliferative glomerulonephritis with full-house immunofluorescence pattern. Low serum complements, PR3 ANCA positivity and elevated Bartonella immunoglobulin titers suggested a diagnosis of infective endocarditis-associated glomerulonephritis...
2024: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38222324/multiple-electrolyte-disorders-triggered-by-proton-pump-inhibitor-induced-hypomagnesemia-case-reports-with-a%C3%A2-mini-review-of-the-literature
#6
Camila Costa Souza, Larissa G Rigueto, Henrique Costa Santiago, Antonio Carlos Seguro, Adriana Castello Girardi, Weverton Machado Luchi
Drug-induced hypomagnesemia is an adverse effect with the potential for serious and fatal outcomes. Although rare, chronic use of proton pump inhibitors (PPIs) can cause hypomagnesemia due to impaired intestinal absorption, mainly attributed to reduced transcellular transport of magnesium via transient receptor potential melastatin 6 (TRPM6) and 7 (TRPM7) channels. However, a reduction of magnesium paracellular absorption due to the downregulation of intestinal claudins has also been reported. PPI-induced hypomagnesemia can trigger other concomitant electrolyte derangements, including hypokalemia, hypocalcemia, hypophosphatemia, and hyponatremia...
2024: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38170038/concomitant-presentation-of-thrombotic-thrombocytopenic-purpura-immune-thrombocytopenia-and-autoimmune-hemolytic-anemia-in-a-patient-with-newly-diagnosed-systemic-lupus-erythematosus
#7
Lina Bruns, Linus Völker, Robert Klamroth, Martin K Kuhlmann, Wolfram J Jabs
Thrombocytopenia is always of concern when encountered in emergency settings. We report a case of a 29-year-old women in whom a unique constellation of hematological disorders occurred. The patient had been diagnosed with idiopathic immune thrombocytopenia (ITP) in 2007, with a history of several thrombocytopenic flares. She now presented with homonymous hemianopia accompanied by thrombocytopenia and microangiopathic hemolytic anemia (MAHA) and was soon after diagnosed with a posterior stroke. Symptoms were more reminiscent of acquired thrombotic thrombocytopenic purpura (aTTP) rather than ITP...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/38169875/calciphylaxis-beware-the-ophthalmic-mimic-a-case-series
#8
Chelsea Guymer, Sadia Jahan, Bobak Bahrami, David Sia, Bee Qung Tan, Stephen McDonald, Sumu Simon
PURPOSE: We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of this rare yet highly disabling condition. OBSERVATIONS: We report two cases of ophthalmic calciphylaxis presenting as (1) anterior ischemic optic neuropathy (AION) and cilioretinal artery occlusion in a 76-year-old woman with pre-dialysis kidney failure, and (2) AION with contralateral central retinal artery occlusion (CRAO) in a 44-year-old man on hemodialysis...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37705940/refractory-seizures-in-a-dialysis-patient-and-a-vitamin-consigned-to-oblivion
#9
Satish Haridasan, Rakesh Madhyastha, Muriel Ghosn, Fadi Hijazi, Baraa Abduljawad, Mohamed Ibrahim, Rajaish Madhwani
Intradialytic breakthrough seizures refractory to multiple classes of antiepileptic medications are not common and can be due to many different reasons. Pyridoxine deficiency is an under-recognized cause of such seizures and frequently missed in clinical practice. Many factors specifically related to dialysis can lead to pyridoxine deficiency and in turn can contribute to refractory seizures. Herein, we report one of the very few cases of intradialytic breakthrough refractory seizures secondary to pyridoxine deficiency recognized in the literature...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37575312/fatal-toxic-epidermal-necrolysis-associated-with-sinomenine-in-a-patient-with-primary-membranous-nephropathy
#10
Xue-Xia Li, Jun-Tao Zhang, Xiao-Ying Ding
Sinomenine (SIN), the alkaloid monomer extracted from Sinomenium acutum , is a kind of non-steroidal anti-inflammatory drug widely used in China to treat rheumatoid arthritis (RA) and various glomerular diseases. It has various pharmacological effects such as anti-inflammatory, analgesic, and anti-tumor. As a strong histamine-releasing agent, SIN has drawn increasing attention in regards to its side effects such as allergic, gastrointestinal, and circulatory systemic reactions. In this report, we first described a patient with primary membranous nephropathy (PMN) who was treated with oral intake of SIN and developed medicine-induced toxic epidermal necrolysis (TEN) and subsequently died of septic multi-organ failure...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37533547/rare-case-of-ralstonia-mannitolilytica-peritonitis-in-an-adult-peritoneal-dialysis-patient
#11
Joseph Kim, Litty Thomas, Kavita Bhavan, Ramesh Saxena
Peritonitis is a common complication of peritoneal dialysis (PD) usually caused by skin-dwelling Gram-positive bacteria and Gram-negative bacteria colonizing the gut and urinary tract. Occasionally, uncommon bacteria can cause peritonitis in PD patients. We describe a case of Ralstonia mannitolilytica peritonitis in a 67-year-old woman who has been on PD for more than 10 years with no prior episodes of peritonitis. To our knowledge, this is the first reported case of Ralstonia peritonitis in the United States...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37533546/kidney-dysfunction-due-to-aa-amyloidosis-in-a-morbidly-obese-female
#12
Hassan Izzedine, Abhishek Nimkar, Joyita Bharati, Isabelle Brocheriou, Alexis Mathian, Frederic Charlotte, Kenar D Jhaveri, Sophie Georgin-Lavialle
Kidneys are commonly involved in systemic amyloidosis. Systemic AA amyloidosis is known to be associated with states of chronic inflammation such as autoimmune conditions, chronic infections, and malignancies. Obesity is increasingly recognized to be a risk factor for low-grade, chronic inflammation. We report a 48-year-old female with morbid obesity who presented with unexplained persistent mild kidney dysfunction and low-grade proteinuria. Attempt at evaluating the cause of kidney dysfunction included performing kidney biopsy despite technical challenges...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37485074/eculizumab-discontinuation-in-a-patient-with-atypical-hemolytic-uremic-syndrome-after-chadox1-ncov-19-vaccination
#13
Marisa Roldão, Francisco Ferrer, Karina Lopes
Eculizumab has proven to be effective in patients with atypical hemolytic uremic syndrome (aHUS) in clinical trials and in the real world, but the optimal duration of therapy remains unknown. Standard maintenance treatment is often life-long, but the possibility of discontinuation has not yet been systematically tested. We describe a case of aHUS after ChAdOx1 nCoV-19 vaccination in a patient with homozygous CFHR3/CFHR1 gene deletion who discontinued eculizumab maintenance therapy 24 weeks after achieving disease remission...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37485073/successful-treatment-of-covid-19-associated-collapsing-glomerulopathy-22-months-of-follow-up
#14
Pulkit Gandhi, Caoimhe Sorcha Dowling, Anjali Satoskar, Ankur Shah
The term COVAN (COVID-19-associated nephropathy) has been used to describe collapsing focal segmental glomerulosclerosis (FSGS) in individuals who have been infected with the SARS-CoV-2. This helps differentiate it from the majority of cases of acute kidney injury in COVID-19 patients, which are typically caused by acute tubular injury. The exact pathophysiology is unclear but is proposed to involve pro-inflammatory cytokines such as type 1 interferons, which are thought to increase expression of the APOL1 gene in glomerular epithelial cells...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37408535/severe-refeeding-syndrome-after-starvation-ketoacidosis-requiring-stopping-feeds
#15
Bana Hadid, Farid Arman, Shayan Shirazian
INTRODUCTION: Starvation ketoacidosis (SKA) is a rare cause of ketoacidosis in the general population but can be seen with malignancy. Patients often respond well to treatment, but some rarely develop refeeding syndrome (RFS) as their electrolytes drop to dangerous levels causing organ failure. Typically, RFS can be managed with low-calorie feeds, but sometimes patients require a halt in feeds until their electrolyte imbalances are managed. CASE REPORT: We discuss a woman with synovial sarcoma on chemotherapy who was diagnosed with SKA and then developed severe RFS after treatment with intravenous dextrose...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37363300/immunoelectron-microscopy-findings-in-a-patient-with-c3-glomerulonephritis
#16
Masato Sawamura, Naoki Sawa, Hiroki Mizuno, Yuki Oba, Daisuke Ikuma, Akinari Sekine, Masayuki Yamanouchi, Eiko Hasegawa, Tatsuya Suwabe, Masanori Suzuki, Kei Kono, Keiichi Kinowaki, Kenichi Ohashi, Takashi Ehara, Yoichiro Ikeda, Toshihiro Sawai, Yoshifumi Ubara
We performed a kidney biopsy in a 36-year-old man to evaluate microscopic hematuria and proteinuria. Light microscopy showed increased mesangial matrix and partial swelling of the glomerular basement membrane (GBM), and immunofluorescence showed positive staining only for C3. Immunoelectron microscopy showed that gold particle-labeled C3 was localized in the electron-dense and moderately electron-dense deposits shown by electron microscopy in the mesangium, the thickened GBM near the paramesangium, and the thickened distal portion of the GBM but was not localized in the non-thickened GBM...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37363299/immunoglobulin-a-nephropathy-associated-with-acute-hepatitis-e-infection-first-case-report
#17
Sidra Shafiq Cheema, Manal Fatima Cheema, Samreen Gilani, Shafiqur Rehman Cheema
In this case report, we describe a young male patient who presented with gross hematuria and nephrotic syndrome a few weeks after serologically positive acute hepatitis E virus (HEV) infection. Histopathological examination of renal core biopsy revealed that the majority of the viable glomeruli had a predominantly mesangiopathic process characterized by mild to moderate diffuse increase in mesangial matrix and cellularity with segmental variation. Immunofluorescence microscopy depicted a strong (3+) granular mesangial and capillary loop staining for IgA, consistent with IgA nephropathy (IgAN)...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37363298/vancomycin-and-piperacillin-induced-acute-interstitial-nephritis-in-a-patient-with-lupus-a-case-report-showcasing-rapid-decline-in-renal-function
#18
Oluwadamilola Adisa, Anil Ananthaneni, Bryce Rushing, Nathan Rinehouse, Phani Morisetti
Drug-induced acute interstitial nephritis (AIN) presents as acute kidney injury (AKI) with the use of certain offending drugs. Antibiotics, such as β-lactams, trimethoprim-sulfamethoxazole, fluoroquinolones, and rifampin, account for up to 50% of drug-induced AIN cases. The onset of drug-induced AIN following drug exposure usually ranges from few days to several weeks or months. We present a patient with lupus who had rapid decline in renal function with a single dose of vancomycin and piperacillin-tazobactam (VPT) administration, termed as the "workhorse" regimen at many institutions...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37181588/primary-sj%C3%A3-gren-s-syndrome-with-renal-tubular-acidosis-and-central-pontine-myelinolysis-an-unusual-triad
#19
Zibya Barday, Malcolm Masikati, Nicola Wearne, Brian Rayner, Bianca Davidson, Kathleen Jane Bateman, Erika Jones
Primary Sjögren's syndrome (pSS) is a complex, multisystem autoimmune disorder. It is characterized by lymphocytic infiltration of the exocrine glands. In the setting of pSS, the presence of systemic disease is an important prognostic determinant, but involvement of the kidney is uncommon. The triad of pSS, distal renal tubular acidosis (dRTA), and central pontine myelinolysis (CPM) is rare and potentially fatal. A 42-year-old woman presented with dRTA, profound hypokalemia, and CPM characterized by progressive global quadriparesis, ophthalmoplegia, and encephalopathy...
2023: Clinical Nephrology. Case Studies
https://read.qxmd.com/read/37143613/a-case-of-malignant-hypertension-as-a%C3%A2-presentation-of-atypical-hemolytic-uremic-syndrome
#20
JOURNAL ARTICLE
Chiaki Omiya, Kenichi Koga, Keisuke Nishioka, Akira Sugawara, Yuka Sugawara, Yoko Yoshida, Yoichiro Ikeda, Kensei Yahata
INTRODUCTION: Malignant hypertension (mHTN) damages multiple target organs, including the kidneys. mHTN has been regarded as one of the causes of secondary thrombotic microangiopathy (TMA); however, a high prevalence of complement gene abnormalities was recently reported in cohorts of mHTN. CASE REPORT: We herein describe a 47-year-old male who presented with severe hypertension, renal failure (serum creatinine (sCr): 11.6 mg/dL), heart failure, retinal hemorrhage, hemolytic anemia, and thrombocytopenia...
2023: Clinical Nephrology. Case Studies
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