PLA2R-Negative Membranous Nephropathy Presenting as a Prodrome of IgG4-Related Autoimmune Pancreatitis
Membranous nephropathy (MN) with tubulointerstitial nephritis (TIN) is an established manifestation of immunoglobulin G4 (IgG4)-related disease (IgG4-RD). A pathological feature aiming to distinguish between primary and secondary MN is the presence or absence of glomerular staining for phospholipase A2 receptor (PLA2R), respectively. Isolated MN without TIN has been rarely reported in the context of IgG4-RD. This case report describes a patient with a history of MN successfully treated with steroids and cyclophosphamide, who, 3 years later, presented with unexplained exacerbation of diabetes mellitus due to IgG4-related au...
Source: Case Reports in Nephrology and Dialysis - June 26, 2019 Category: Urology & Nephrology Source Type: research

Remission of Membranous Nephropathy after Treatment of Localised Prostate Cancer
Membranous nephropathy is a cause of the nephrotic syndrome in adults; it can be a primary or secondary process. Secondary causes include solid organ and lymphoid malignancies. Prostate cancer has been reported as the second most common causative malignancy. Remission of membranous nephropathy following treatment of metastatic prostate cancer is well established. In this case, we describe a patient with localised prostate cancer who developed severe nephrotic syndrome (urine protein creatinine ratio 1,616 mg/mmol and serum albumin 17 g/L) secondary to membranous nephropathy. The prostate cancer was deemed of low risk and s...
Source: Case Reports in Nephrology and Dialysis - June 6, 2019 Category: Urology & Nephrology Source Type: research

Severe Complications from an Unexpectedly High Serum Mycophenolic Acid Concentration in a Patient with Renal Failure Secondary to Lupus Nephritis: A Case Report
We report a case of a patient with lupus nephritis in whom severe complications were possibly caused by MMF. The patient was a 17-year-old girl who received a diagnosis of lupus nephritis at the age of 14 years and had been taking steroid and immunosuppressive agents since then. One week after starting MMF 1 g/day instead of mizoribine owing to symptom relapse and serologic data deterioration, she presented with seizure, accompanied by leukopenia, thrombocytopenia, and renal failure. We discontinued MMF because she had extremely high serum mycophenolate acid concentration (88 µg/mL). A few weeks later, she recovered ...
Source: Case Reports in Nephrology and Dialysis - June 4, 2019 Category: Urology & Nephrology Source Type: research

Postinfectious Glomerulonephritis with Crescents in an Elderly Diabetic Patient after Acute Gastroenteritis: Case Report
Postinfectious glomerulonephritis (PIGN) is primarily a disease of childhood. It occurs after upper respiratory tract infection or skin infections. Streptococcus is the most common causative agent, but in the elderly, staphylococcus is the main culprit. In adults, PIGN is more common in immunocompromised patients, particularly diabetics and alcoholics. Here, we report the case of an elderly diabetic male who presented with severe acute kidney injury with active urinary sediment after acute gastroenteritis. Additional analyses revealed a very low serum C3 level and a normal serum C4 level. Renal biopsy showed diffuse prolif...
Source: Case Reports in Nephrology and Dialysis - May 24, 2019 Category: Urology & Nephrology Source Type: research

IgG4-Related Kidney Disease: A Curious Case of Interstitial Nephritis with Hypocomplementemia
IgG4-related kidney disease has been relatively newly recognized over the last two decades as a combination of an autoimmune and allergic disorder, with elevated serum IgG4 level and hypocomplementemia among its characteristic features. Here we report the case of a man with interstitial nephritis presenting with acute kidney injury and hypocomplementemia but normal serum IgG4 level and provide a literature review of IgG4-related kidney disease. This case highlights the importance of IgG4-related kidney disease as an important differential diagnosis in any patient presenting with a clinical syndrome mimicking acute intersti...
Source: Case Reports in Nephrology and Dialysis - May 16, 2019 Category: Urology & Nephrology Source Type: research

Single Pass Albumin Dialysis and Plasma Exchange for Copper Toxicity in Acute Wilson Disease
Conclusion: We conclude that SPAD, with or without PLEX, is effective in reducing serum copper levels as a bridge to liver transplantation in WD. PLEX may be more efficient at removing copper but is associated with a rebound increase in copper levels between sessions.Case Rep Nephrol Dial 2019;9:55 –63 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - May 16, 2019 Category: Urology & Nephrology Source Type: research

Significance of Crescentic Glomeruli in Acute Kidney Injury with Rheumatoid Arthritis
Crescentic glomerulonephritis (GN) without immune reactants or deposits (referred to as pauci-immune) is typically characterized by the presence of anti-neutrophilic cytoplasmic antibodies (ANCA). While ANCA-negative patients might be expected to have a more benign course, they often have poor renal outcomes, especially without treatment with steroids and immune-modulating therapy. Pauci-immune crescentic GN can also co-exist with other autoimmune conditions, including rheumatoid arthritis (RA). Here, we describe an ANCA-negative patient with RA who developed dialysis-requiring acute kidney injury (AKI) with findings consi...
Source: Case Reports in Nephrology and Dialysis - May 5, 2019 Category: Urology & Nephrology Source Type: research

Severe, Symptomatic Hypocalcemia due to Denosumab Administration: Treatment and Clinical Course
We present 2 patients who developed severe, symptomatic hypocalcemia after administration of denosumab. These patients provide an opportunity to describe the clinical course and treatment, including the need to consider a continuous calcium infusion, of severe, symptomatic hypocalcemia caused by denosumab.Case Rep Nephrol Dial 2019;9:33 –41 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - April 25, 2019 Category: Urology & Nephrology Source Type: research

Rapidly Progressive Glomerulonephritis with Delayed Appearance of Anti-Glomerular Basement Membrane Antibody Successfully Treated with Multiple Courses of Steroid Pulse Therapy
Patients with anti-glomerular basement membrane (GBM) antibody glomerulonephritis typically exhibit rapidly progressive glomerulonephritis (RPGN). The renal outcome as well as the prognosis of this disease is worse than other forms of RPGN such as those from microscopic polyangiitis. Therefore, early therapeutic intervention is essential to improve its prognosis. One month before referral to our hospital, a 54-year-old female attended another hospital because of macrohematuria. At that time, she had proteinuria and macrohematuria with normal renal function, was negative for anti-GBM antibodies, and was diagnosed with chron...
Source: Case Reports in Nephrology and Dialysis - April 16, 2019 Category: Urology & Nephrology Source Type: research

MPGN Type 3 Associated with Pemphigus Herpetiformis Mimicking PGNMID and Dermatitis Herpetiformis
A 45-year-old man suffering from dermal blistering disease with proteinuria and hematuria underwent renal biopsy. The renal biopsy specimen suggested proliferative glomerulonephritis with monoclonal IgG deposits under routine light, immunofluorescence and electron microscopy. The staining for IgG subclasses (IgG1 and IgG2) and κ/λ light chain indicated secondary immune complex type MPGN type 3. The patient had been diagnosed as having dermatitis herpetiformis (DH), a phenotype of gluten hypersensitivity prior to the appearance of the renal abnormality. Although common autoantibodies might be related to the pat...
Source: Case Reports in Nephrology and Dialysis - March 21, 2019 Category: Urology & Nephrology Source Type: research

Monotypic IgG1-kappa Atypical Anti-Glomerular Basement Membrane Nephritis: A Case Report
Anti-glomerular basement membrane (anti-GBM) glomerulonephritis is a rare disease caused by autoantibodies against the glomerular basement membrane. Atypical anti-GBM nephritis is clinically less aggressive and characterized by the absence of circulating autoantibodies to the basement membrane. A previously healthy 53-year-old white woman presented with a rising creatinine over a short observation period. Renal biopsy, urinary sediment, and laboratory testing confirmed the diagnosis of atypical anti-GBM disease. She received plasmapheresis, steroids, and cyclophosphamide. She developed hemorrhagic cystitis early in the tre...
Source: Case Reports in Nephrology and Dialysis - March 7, 2019 Category: Urology & Nephrology Source Type: research

Progressive Renal Dysfunction due to IgG4-Related Kidney Disease Refractory to Steroid Therapy: A Case Report
Recently, as the number of case reports of IgG4-related kidney disease (IgG4-RKD) has increased, the histopathological features and clinical approach have been clarified. IgG4-RKD generally has a benign prognosis due to the efficacy of steroid therapy and rarely requires dialysis. Herein, we report a case of IgG4-RKD that presented with a subacute onset, advanced to end-stage kidney disease, and finally required maintenance hemodialysis despite steroid therapy. A 75-year-old man was admitted to our hospital for further evaluation of subacute renal failure. Diffuse enlargement of the kidney on computed tomography and increa...
Source: Case Reports in Nephrology and Dialysis - February 8, 2019 Category: Urology & Nephrology Source Type: research

Lumbar Artery Bleed as a Complication of Percutaneous Renal Biopsy and a Proposed Workflow for Massive Bleeding
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. While angiographic embolization is an effective method of control of haemorrhage, surgical exploration i...
Source: Case Reports in Nephrology and Dialysis - December 13, 2018 Category: Urology & Nephrology Source Type: research

A Case of Rapid Progressive Kidney Dysfunction with Severely Calcified Stenotic 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. There was stenotic anastomosis to the renal artery. After endovascular therapy to the stenotic anastomosis, renal function d...
Source: Case Reports in Nephrology and Dialysis - November 28, 2018 Category: Urology & Nephrology Source Type: research

A Case Report of Cronkhite-Canada Syndrome Complicated by Membranous Nephropathy
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. Endoscopic evaluation showed widespread gastrointestinal nodular inflamma...
Source: Case Reports in Nephrology and Dialysis - November 28, 2018 Category: Urology & Nephrology Source Type: research

A Case of Self-Limiting Crescentic Immunoglobulin A Glomerulonephritis Associated with Sternoclavicular Arthritis
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 a fter remission of SC arthritis was achieved. Considering the patient’s clinical course, this case suggested a relationship between IgA GN and SC arthritis.Case Rep Nephrol Dial 2018;8:246 –252 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - November 21, 2018 Category: Urology & Nephrology Source Type: research

Peritoneal Dialysis Exit Site Pyoderma Gangrenosum: A Case Report
Conclusions: Lesions at the PD catheter exit site are usually treated for infections. However, for ulcers that are painful, rapidly expanding, nonhealing, and unresponsive to antibiotics, PG should be considered as a differential diagnosis. This is the first reported case of PG occurring at the exit site of a PD catheter.Case Rep Nephrol Dial 2018;8:239 –245 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - November 14, 2018 Category: Urology & Nephrology Source Type: research

Erratum
Case Rep Nephrol Dial 2018;8:238 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - November 7, 2018 Category: Urology & Nephrology Source Type: research

Efficacy of Semiannual Single Fixed Low-Dose Rituximab Therapy in Steroid-Dependent Minimal Change Nephrotic Syndrome: A Case Series
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 cell...
Source: Case Reports in Nephrology and Dialysis - October 24, 2018 Category: Urology & Nephrology Source Type: research

Three Severe Cases of Viral Infections with Post-Kidney Transplantation Successfully Confirmed by Polymerase Chain Reaction and Flow Cytometry
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 trea...
Source: Case Reports in Nephrology and Dialysis - October 5, 2018 Category: Urology & Nephrology Source Type: research

Bile Cast Nephropathy: A Pathologic Finding with Manifold Causes Displayed in an Adult with Alcoholic Steatohepatitis and in a Child with Wilson ’s Disease
We present 2 diverse cases of BCN. The first involves an adult with hepatorenal syndrome secondary to alcoholic steatohepatitis and early cirrhosis. Second, we describe the first reported case of BCN in a child with fulminant hepatic failure due to Wilson’s disease. Our cases expand the spectrum of causative diseases, and they provide further evidence that BCN is a distinct pathologic entity w hich may be found in both adult and pediatric patients with a variety of severe liver diseases.Case Rep Nephrol Dial 2018;8:207 –215 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - October 5, 2018 Category: Urology & Nephrology Source Type: research

Bioptically Proven “Anticoagulation-Related Nephropathy“ Induced by Dual Antiplatelet Therapy
We present a case of an 82-year-old man who developed biopsy-proven ARN after the administration of dual antiplatelet therapy with no previous anticoagulation treatment and normal coagulation tests.Case Rep Nephrol Dial 2018;8:216 –222 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - October 5, 2018 Category: Urology & Nephrology Source Type: research

Primary Hyperoxaluria Type 1 with Thrombophilia in Pregnancy: A Case Report
Conclusions: The diagnosis of PH should be considered in patients with severe, recurrent calcium oxalate nephrolithiasis. Early treatment with pyridoxine reduces urinary oxalate excretion and can delay progression to end-stage renal disease (ESRD). After ESRD, intensive dialysis is needed to prevent systemic oxalate accumulation and deposition. Combined liver and kidney transplantation is curative. In our patient, we anticipate that liver transplantation will cure both the hyperoxaluria and the hypercoagulable state.Case Rep Nephrol Dial 2018;8:223 –229 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - October 5, 2018 Category: Urology & Nephrology Source Type: research

Asymptomatic Lupus Cystitis with Bilateral Hydronephrosis
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. She had a history of polyarthralgias, fever, bleeding gums, anemia, and thrombocytopenia 3 months earlier. Abdominal ultrasound examination revealed bilateral hydronephrosis and a thickened bladder wall; the other organs were normal. Laboratory examination confirmed the diagnosis of SLE complicated by lupus nephritis and lupus cystitis. The patient responded well to the treatment with methylprednisolone. The vaginal bleeding stopped w...
Source: Case Reports in Nephrology and Dialysis - September 18, 2018 Category: Urology & Nephrology Source Type: research

Minimal Change Nephrotic Syndrome Relapse after 52 Years of Remission: A Case Report
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. Laboratory testing showed massive urinary protein and low serum total protein and albumin levels. Therefore, ...
Source: Case Reports in Nephrology and Dialysis - September 2, 2018 Category: Urology & Nephrology Source Type: research

Fibrillary Glomerulonephritis with Crescentic and Necrotizing Glomerulonephritis and Concurrent Thrombotic Microangiopathy
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. It was decided not to offer her any immunosuppressive therapy...
Source: Case Reports in Nephrology and Dialysis - September 2, 2018 Category: Urology & Nephrology Source Type: research

A Case of Chronic Calcium Oxalate Nephropathy due to Short Bowel Syndrome and Cholecystectomy
Conclusion: Case reports of chronic oxalate neuropathy are rare in the literature, and its underlying mechanism has not been understood. Our patient had a history of small bowel resection and cholecystectomy. We considered that her short bowel syndrome had influenced the development of calcium oxalate nephropathy.Case Rep Nephrol Dial 2018;8:147 –154 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - August 10, 2018 Category: Urology & Nephrology Source Type: research

Disseminated Strongyloidiasis in Association with Nephrotic Syndrome
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.Case Rep Nephrol Dial 2018;8:155 –160 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - August 10, 2018 Category: Urology & Nephrology Source Type: research

Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis
We present a case of HCV-associated glomerular disease with the surprising biopsy finding of necrotizing and crescentic p-ANCA GN, with a background, low-grade mesangial immune complex GN. Thus, p-ANCA disease should also be considered in HCV-infected patients, in addition to the more typical lesions of MPGN or cryoglobulinemic GN.Case Rep Nephrol Dial 2018;8:161 –170 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - August 10, 2018 Category: Urology & Nephrology Source Type: research

Acute Kidney Injury after Pembrolizumab-Induced Adrenalitis and Adrenal Insufficiency
We report a 70-year-old Caucasian male who underwent treatment with pembrolizumab for adenocarcinoma of the lung. He developed acute adrenal insufficiency and concomitant severe hypotension upon presentation. He did not require renal replacement therapy, rather his severe acute kidney injury resolved with hydration, normalization of blood pressures with vasopressors, and treatment with high-dose corticosteroids. His urinary indices (fractional excretion of urea, FEUrea) and clinical course were highly suspicious for acute tubular necrosis that resolved quickly after treating his underlying adrenalitis. The urinary sediment...
Source: Case Reports in Nephrology and Dialysis - August 10, 2018 Category: Urology & Nephrology Source Type: research

Acute Kidney Failure as a Single Complication of Varicella Virus Infection in an Adult Patient
Conclusion: VZV infection occurs in a range of clinical scenarios, sometimes presenting only with mild symptoms, but in some other setting it can result in severe AKF even in healthy kidneys. Acute VZV infection can lead to isolated, clinically significant kidney failure. The administration of continuous renal replacement therapy and adjusted doses of acyclovir has a favorable effect on the course of the infection, with complete recovery of kidney function.Case Rep Nephrol Dial 2018;8:130 –137 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - August 3, 2018 Category: Urology & Nephrology Source Type: research

A Rare Case of Severe Metabolic Alkalosis with Unusual Hyperproteinemia Treated with Continuous Renal Replacement Therapy and Regional Citrate Anticoagulation
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. The trac...
Source: Case Reports in Nephrology and Dialysis - August 3, 2018 Category: Urology & Nephrology Source Type: research

Erratum
Case Rep Nephrol Dial 2018;8:120 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - July 25, 2018 Category: Urology & Nephrology Source Type: research

Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist
We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.Case Rep Nephrol Dial 2018;8:121 –129 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - July 25, 2018 Category: Urology & Nephrology Source Type: research

Importance of AST-120 (Kremezin ®) Adherence in a Chronic Kidney Disease Patient with Diabetes
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.e., eGFR was not improved by previous medications, we adde...
Source: Case Reports in Nephrology and Dialysis - June 8, 2018 Category: Urology & Nephrology Source Type: research

Postembolization Intratumoral Chronic Bleeding, without the Classic CT Feature of Active Extravasation, in Tuberous Sclerosis Complex-Related Renal Angiomyolipoma: Two Case Reports
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. In both cases, a second embolization of th...
Source: Case Reports in Nephrology and Dialysis - June 8, 2018 Category: Urology & Nephrology Source Type: research

The Unpredictability of Idiopathic Membranous Nephropathy: An Illustrative Case Report
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. She was maintained on low-dose myco...
Source: Case Reports in Nephrology and Dialysis - June 1, 2018 Category: Urology & Nephrology Source Type: research

Bile Cast Nephropathy: The Unknown Dangers of Online Shopping
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. Kidney biopsy showed the histological pattern of diffuse potentially reversible tubular damage with intratubular bile casts obstructing the renal tubules. The patient developed acute kidney injury and needed dialysis treatment for 4 weeks until renal function recovered. The severity of the kidney injury and the requirement of hemodialysis observed in our pati...
Source: Case Reports in Nephrology and Dialysis - May 31, 2018 Category: Urology & Nephrology Source Type: research

The Case: Chronic Kidney Disease Unmasked by Single-Subject Research
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 (I...
Source: Case Reports in Nephrology and Dialysis - May 16, 2018 Category: Urology & Nephrology Source Type: research

Transcatheter Arterial Embolization Therapy for Huge Renal Cysts: Two Case Reports
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. After 1 year, the total cyst volume was reduced from 9,215 mL to 633 mL without bleeding. Based on the...
Source: Case Reports in Nephrology and Dialysis - April 27, 2018 Category: Urology & Nephrology Source Type: research

Accidental Insertion of a Peritoneal Dialysis Catheter in the Urinary Bladder
We present an 81-year-old man who underwent percutaneous insertion of dual-cuffed coiled Tenckhoff PD catheter un der local anesthesia by a trained nephrologist. The procedure was uneventful, and the patient was discharged 45 min later in a stable state. A day later, he noticed a decline in the urine output. A week later at a scheduled clinic visit, upon unclamping the PD catheter, there was a sudden gush of am ber colored fluid. A diagnostic CT scan confirmed the presence of PD catheter entering the abdominal cavity inferior to the umbilicus and the distal end coiled in the urinary bladder. This case illustrates the need ...
Source: Case Reports in Nephrology and Dialysis - April 26, 2018 Category: Urology & Nephrology Source Type: research

Proliferative Glomerulonephritis with Monoclonal Immunoglobulin G Lambda Deposits: Report of the First Pediatric Case
We report a rare pediatric case which occurred in a 17-year-old female. The rarity of this entity in the adult population has not permitted a standard treatment regimen to be established. Our adolescent patient was treated with multiple treatment regimens including prednisone, mycophenolate mofetil, rituximab, bortezomib, and daratumumab. Our case demonstrates that awareness of this disorder by pediatric nephrologists and pathologists is vital to guide accurate disease classification, prognosis, and treatment.Case Rep Nephrol Dial 2018;8:70 –75 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - April 24, 2018 Category: Urology & Nephrology Source Type: research

Tolvaptan for Primary Aldosteronism and Autosomal Dominant Polycystic Kidney Disease: A Case Report
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. Tolvaptan can induce urinary excretion of potassium in patients...
Source: Case Reports in Nephrology and Dialysis - March 28, 2018 Category: Urology & Nephrology Source Type: research

Rapid and Complete Remission of Class IV Lupus Nephritis with Massive Wire Loop Lesions
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. Electron microscopy revealed massive electron-dense deposits in the subendothelial area, mesangium area, and peritubular capillaries. The histological diagnosis was class IV-G (A) LN. We administered high-dose gluco...
Source: Case Reports in Nephrology and Dialysis - March 22, 2018 Category: Urology & Nephrology Source Type: research

Membranous Nephropathy-Like Apolipoprotein E Deposition Disease with Apolipoprotein E Toyonaka (Ser197Cys) and a Homozygous Apolipoprotein E2/2
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). Detailed immunohistochemical studies found that the dense dep...
Source: Case Reports in Nephrology and Dialysis - March 20, 2018 Category: Urology & Nephrology Source Type: research

The Convergence of Vasculopathy and Vasculitis: Computer Mapping Analysis of 2 Renal Biopsies in a Patient with both Systemic Sclerosis and ANCA-Related Vasculitis
Scleroderma vasculopathy and ANCA (antineutrophil cytoplasmic antibodies)-associated glomerulonephritis have rarely been reported to occur simultaneously in one patient. Herein, we report a patient who presented with a classic constellation of clinical and laboratory findings of systemic scleroderma and was subsequently found to be positive for p-ANCA. Two renal biopsies, performed 5 months apart, demonstrated typical changes of the two entities in both acute and “healed” phases, which were analyzed by computer mapping techniques. The two renal biopsies were serially sectioned and stained routinely, and with CD...
Source: Case Reports in Nephrology and Dialysis - March 2, 2018 Category: Urology & Nephrology Source Type: research

C3 Glomerulopathy and Atypical Hemolytic Uremic Syndrome: Two Important Manifestations of Complement System Dysfunction
This article focuses on the clinical differences, pathophysiology, and treatment of aHUS and C3 glomerulopathy.Case Rep Nephrol Dial 2018;8:25 –34 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - February 8, 2018 Category: Urology & Nephrology Source Type: research

Oxcarbazepine Therapy for Complete Central Diabetes Insipidus
We describe a patient with complete central diabetes insipidus and seizures who developed worsening hyponatremia when her dose of oxcarbazepine was increased. The patient maintained a normal serum sodium level and has had appropriately concentrated urine for 5 years on just oxcarbazepine, despite undetectable antidiuretic hormone (ADH) levels. This suggests that oxcarbazepine (or one of its metabolites) may stimulate collecting tubule V2 receptor-G protein complex independent of ADH, resulting in increased renal tubular water reabsorption. Oxcarbazepine may be useful as an alternative therapy for patients with central diab...
Source: Case Reports in Nephrology and Dialysis - January 31, 2018 Category: Urology & Nephrology Source Type: research

Infective Endocarditis Associated with Streptococcal Toxic Shock Syndrome due to Streptococcus dysgalactiae subsp. equisimilis Infection in a Hemodialysis Patient
We report the first case of a hemodialysis patient with infective endocarditis caused byStreptococcus dysgalactiae subsp.equisimilis (SDSE) who presented with streptococcal toxic shock syndrome. In the last decade, there has been an increase in the incidence of SDSE infections. Therefore, it is important to recognize SDSE as a possible causative agent of infective endocarditis in an immunocompromised population, such as hemodialysis patients.Case Rep Nephrol Dial 2017;7:154 –160 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - January 19, 2018 Category: Urology & Nephrology Source Type: research

Exit Site Infection due to < b > < i > Mycobacterium chelonae < /i > < /b > in an Elderly Patient on Peritoneal Dialysis
Nontuberculous mycobacteria (NTM) are rarely isolated from peritoneal dialysis (PD)-associated catheter infections. However, NTM infection is usually difficult to treat and leads to catheter loss. Prompt diagnosis is essential for appropriate treatment. A 70-year-old Japanese man who had been on PD for 2 years and with a medical history of 2 episodes of exit site infections (ESIs) due to methicillin-resistantStaphylococcus aureus was admitted to the hospital due to suspected ESI recurrence. However, Gram staining of the pus revealed no gram-positive cocci. Instead, weakly stained gram-positive rods were observed after 7 da...
Source: Case Reports in Nephrology and Dialysis - January 19, 2018 Category: Urology & Nephrology Source Type: research