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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 CD31 and C...
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 Mycobacterium chelonae 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

Early Conversion from Tacrolimus to Belatacept in a Highly Sensitized Renal Allograft Recipient with Calcineurin Inhibitor-Induced de novo Post-Transplant Hemolytic Uremic Syndrome
Conclusion: Belatacept is a novel costimulation blocker that is devoid of the nephrotoxic properties of CNIs and has been shown to positively impact long-term graft survival and preserve renal allograft function in low-immunologic-risk kidney transplant recipients. Data regarding its use in patients who are broadly sensitized to human leukocyte antigens are scarce, and the increased risk of rejection associated with belatacept has been a deterrent to more widespread use of this immunosuppressive agent. This case serves as an example of a highly sensitized patient that has been successfully converted to a belatacept-based C...
Source: Case Reports in Nephrology and Dialysis - January 19, 2018 Category: Urology & Nephrology Source Type: research

An Unexpected Case of Scurvy in a Peritoneal Dialysis Patient
This case describes an obese adult male peritoneal dialysis patient who presented with a pruritic follicular rash. Nutrient deficiency was not suspected initially in this case because there was no history of protein-calorie malnutrition, but the patient reported a diet devoid of fruits and vegetables and had not been taking his dialysis vitamin as prescribed. Skin biopsy showed follicular hyperkeratosis with fragmented hair shafts and corkscrew hairs consistent with scurvy. After supplementation with ascorbic acid 500 mg twice daily for 2 weeks, the rash resolved completely. Dialysis patients are at increased risk for vita...
Source: Case Reports in Nephrology and Dialysis - December 22, 2017 Category: Urology & Nephrology Source Type: research

A Case Report of Compound Heterozygous CYP24A1 Mutations Leading to Nephrolithiasis Successfully Treated with Ketoconazole
We present a case with these lab findings as well as an elevated 25-hydroxyvitamin D/24,25-dihydroxyvitamin D ratio in whom compound heterozygous CYP24A1 mutations were found. His hypercalciuria resolved and 1,25-vitamin D level improved with ketoconazole treatment. We suggest that it is clinically important to identify patients with this phenotype as testing and treatment options are available which could reduce progression to chronic kidney disease in this population.Case Rep Nephrol Dial 2017;7:167 –171 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - December 19, 2017 Category: Urology & Nephrology Source Type: research

Leukocyte Cell-Derived Chemotaxin 2-Associated Renal Amyloidosis: A Case Report
We present a 64-year-old Hispanic female with a history of hypertension who was referred for chronic kidney disease management. The review of her laboratory tests revealed a serum creatinine of 1.5 –1.8 mg/dL and microalbuminuria (in the presence of a bland urine sediment) in the past year. She denied any history of diabetes, rheumatologic disorders or exposure to intravenous contrast, nonsteroidal anti-inflammatory drugs, herbals, and heavy metals. Serological workup was negative. A renal b iopsy showed diffuse infiltration of glomerulus with pale eosinophilic material strongly positive for Congo red stain and a similar...
Source: Case Reports in Nephrology and Dialysis - December 11, 2017 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 - November 29, 2017 Category: Urology & Nephrology Source Type: research

Difficult Renal Pathological Classification in a Case of Pediatric Nephrotic Syndrome
The underlying histopathology is very important in determining patient management, as the histopathology usually has direct repercussions on the treatment response and clinical course. However, the impact of the method used to assess renal biopsies, i.e., light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM), on the occurrence of a difficult biopsy classification in the native kidneys of pediatric nephrotic patients is unknown. A 12-month-old Japanese boy was diagnosed with nephrotic syndrome (NS); he was administered prednisolone (60 mg/m2/day), and a continuous albumin infusion was started. A renal...
Source: Case Reports in Nephrology and Dialysis - November 29, 2017 Category: Urology & Nephrology Source Type: research

Rare Bacteria Infecting the Heart and Affecting the Kidney of a Young Child
We report our experience of a 12-year-old child who presented with infective endocarditis and blood culture-grownGemella morbillorum– a rarely reported bacteria. The clinical picture was further complicated with severe glomerulonephritis. Renal biopsy was suggestive of crescentic glomerulonephritis. The child was managed with antibiotics, steroids, and plasmapheresis and responded well to the treatment. To our knowledge, this is the first report ofG. morbillorum endocarditis with immune complex deposition and necrotizing glomerulonephritis in a child.Case Rep Nephrol Dial 2017;7:138 –143 (Source: Case Reports in Nephrology and Dialysis)
Source: Case Reports in Nephrology and Dialysis - November 27, 2017 Category: Urology & Nephrology Source Type: research