http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Tue, 21 May 2013 10:54:00 +0000 http://www.hindawi.com/crim/nephrology/2013/268401/ Introduction. Minimal Change Disease (MCD) is the most common cause of nephrotic syndrome in children, while IgA nephropathy is the most common cause of glomerulonephritis worldwide. MCD is responsive to glucocorticoids, while the role of steroids in IgA nephropathy remains unclear. We describe a case of two distinct clinical and pathological findings, raising the question of whether MCD and IgA nephropathy are separate entities or if there is a common pathophysiology. Case Report. A 19-year old man with no medical history presented to the Emergency Department with a 20-day history of anasarca and frothy urine, BUN 68 mg/dL, Cr 2.3 mg/dL, urinalysis 3+ RBCs, 3+ protein, and urine protein : creatinine ratio 6.4. Renal biopsy revealed hypertrophic podocytes on light microscopy, podocyte foot process effacement on electron microscopy, and immunofluorescent mesangial staining for IgA. The patient was started on prednisone and exhibited dramatic improvement. Discussion. MCD typically has an overwhelming improvement with glucocorticoids, while the resolution of IgA nephropathy is rare. Our patient presented with MCD with the uncharacteristic finding of hematuria. Given the improvement with glucocorticoids, we raise the question of whether there is a shared pathophysiologic component of these two distinct clinical diseases that represents a clinical variant. Brandon S. Oberweis, Aditya Mattoo, Ming Wu, and David S. Goldfarb Copyright © 2013 Brandon S. Oberweis et al. All rights reserved. Wed, 08 May 2013 19:27:03 +0000 http://www.hindawi.com/crim/nephrology/2013/124604/ Orlistat is a gastrointestinal lipase inhibitor used for weight reduction in obese individuals. Enteric hyperoxaluria caused by orlistat leads to oxalate absorption. Acute oxalate nephropathy is a rare complication of treatment with orlistat. Herein we report a patient presenting with acute renal failure which improved minimal with intravenous hydration. She was found to have oxalate crystals on renal biopsy. Patient admitted orlistat use over the counter for weight reduction on further questioning. The purpose of this case review is to increase awareness among patients since they are more focused on losing weight. This case also calls for the provider attention to educate patients regarding side effects of orlistat because of easy availability of orlistat over the counter. Dhara Chaudhari, Conchitina Crisostomo, Charles Ganote, and George Youngberg Copyright © 2013 Dhara Chaudhari et al. All rights reserved. Tue, 07 May 2013 08:34:09 +0000 http://www.hindawi.com/crim/nephrology/2013/931523/ Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated C-reactive protein, but creatine kinase is often normal. Diagnosis can be made on clinical presentation and imaging, with magnetic resonance imaging as the gold standard. Histology is often not contributive. Treatment consists of rest, analgesics, rigorous glycemic control and low-dose aspirin. Severe cases of compartment syndrome require fasciotomy. In the current paper, we present two diabetic patients with cystic fibrosis, who are treated with automated peritoneal dialysis and suffered from episodic lower limb infarction. We subsequently review 48 episodes of diabetic muscle infarction previously reported in the literature in patients with end-stage renal disease. G. De Vlieger, B. Bammens, F. Claus, R. Vos, and K. Claes Copyright © 2013 G. De Vlieger et al. All rights reserved. Thu, 02 May 2013 16:06:39 +0000 http://www.hindawi.com/crim/nephrology/2013/158494/ This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150 mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy. U. E. Ekrikpo, E. E. Effa, and E. E. Akpan Copyright © 2013 U. E. Ekrikpo et al. All rights reserved. Wed, 03 Apr 2013 08:50:05 +0000 http://www.hindawi.com/crim/nephrology/2013/839796/ Lithium toxicity is known to affect multiple organ systems, including the central nervous system. Lithium levels have been used in the diagnosis of toxicity and in assessing response to management. There is evidence that nonsteroidal anti-inflammatory medications (NSAIDs) can increase lithium levels and decrease renal lithium clearance. We present a case of lithium toxicity, which demonstrates this effect and also highlights the fact that lithium levels do not correlate with clinical improvement, especially the neurological deficit. Syed Hassan, Fatima Khalid, Zaid Alirhayim, and Syed Amer Copyright © 2013 Syed Hassan et al. All rights reserved. Thu, 28 Mar 2013 13:01:53 +0000 http://www.hindawi.com/crim/nephrology/2013/831903/ Nonhematologic malignancies are rarely reported to be associated with AA amyloidosis. Although the association between renal cell carcinoma and systemic AA amyloidosis has been established, the evidence linking pulmonary cancer to AA amyloidosis is scarce. Here, a case of biopsy-proven renal AA amyloidosis complicated with nephrotic syndrome associated with lung carcinoma is reported. Victor Gueutin, Anne-Lyse Langlois, Nathalie Shehwaro, Ryme Elharraqui, Philippe Rouvier, and Hassane Izzedine Copyright © 2013 Victor Gueutin et al. All rights reserved. Wed, 27 Mar 2013 18:48:54 +0000 http://www.hindawi.com/crim/nephrology/2013/531205/ Multiple myeloma (MM) is an uncommon hematologic malignancy accounting for 1% of all malignancies. Renal involvement is a common complication of MM. Rapid intervention to reverse renal dysfunction may be critical for management, especially in patients with light chain cast nephropathy. Recovery rate ranges from 5% to 15%. We describe an atypical presentation of MM in a young patient who presented with severe renal insufficiency requiring renal replacement therapy and achieved complete renal recovery with chemotherapy. Hasan J. Salameh, Adeel Ahmad, and Tina Kochar Copyright © 2013 Hasan J. Salameh et al. All rights reserved. Sun, 24 Feb 2013 10:14:46 +0000 http://www.hindawi.com/crim/nephrology/2013/213273/ Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach. Pedro Azevedo, Cristina Freitas, Hugo Silva, Pedro Aguiar, Pedro Farrajota, Manuela Almeida, Sofia Pedroso, La Salete Martins, Leonídio Dias, José Ramón Vizcaíno, António Castro Henriques, and António Cabrita Copyright © 2013 Pedro Azevedo et al. All rights reserved. Thu, 21 Feb 2013 10:30:47 +0000 http://www.hindawi.com/crim/nephrology/2013/739820/ Atypical hemolytic-uremic syndrome (aHUS), unlike typical HUS, is not due to bacteria but rather to an idiopathic or genetic cause that promotes dysregulation of the alternative complement pathway. It leads to hemolytic anemia, thrombocytopenia, and renal impairment. Although aHUS secondary to a genetic mutation is relatively rare, when occurring due to a mutation in Factor H (CFH), it usually presents with younger onset and has a more severe course, which in the majority ends with end-stage renal failure. Paradoxically to most available data, our case features acute aHUS due to a CFH mutation with late onset (38-year-old) and rapid progression to end-stage renal disease. Due to current data indicating a high risk of graft failure in such patients, the diagnosis of aHUS secondary to a genetic cause has disqualified our patient from a living (family) donor renal transplantation and left her with no other option but to begin permanent renal replacement therapy. Bartlomiej Posnik, Dorota Sikorska, Krzysztof Hoppe, Krzysztof Schwermer, Krzysztof Pawlaczyk, and Andrzej Oko Copyright © 2013 Bartlomiej Posnik et al. All rights reserved. Thu, 14 Feb 2013 11:17:17 +0000 http://www.hindawi.com/crim/nephrology/2013/195753/ We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR. J. Ramírez, I. C. Bostock, A. Martin-Onraët, S. Calleja, A. Sánchez-Cedillo, L. A. Navarro-Vargas, A. L. Noriega-Salas, O. Martínez-Mijangos, N. O. Uribe-Uribe, M. Vilatoba, B. Gabilondo, L. E. Morales-Buenrostro, and J. Alberú Copyright © 2013 J. Ramírez et al. All rights reserved. Wed, 30 Jan 2013 15:26:17 +0000 http://www.hindawi.com/crim/nephrology/2013/953214/ A 74-year-old man was hospitalized for diabetic nephropathy evaluation and assessment of the effect of treatment on his tubulointerstitial nephritis (TIN). When he was 62 years old, he developed polyarthralgia and had superficial lymph node swelling, mildly increased serum creatinine concentration, hypergammaglobulinemia, hypocomplementemia, high serum IL-2R level, and positive titer of antinuclear antibody. Several tissues were biopsied. Mild chronic sialadenitis and reactive lymphadenitis were identified. Renal specimen showed mild glomerular ischemia, extensive storiform fibrosis, and abundant infiltrating monocytes and plasma cells. He was treated with oral prednisolone and cyclophosphamide. After the treatment, most of his clinical parameters quickly returned to within the reference range. However, he developed diabetes mellitus soon after steroid therapy. At the time of rebiopsy, a high level of serum IgG4 was detected. The second renal biopsy showed diabetic nephropathy without any tubulointerstitial damage. The first biopsied tissues were retrospectively investigated. Large numbers of IgG4-positive plasma cells were detected in the kidneys and lymph nodes. A retrospective diagnosis of IgG4-related TIN with lymph node involvement was made. In conclusion, this paper describes a retrospectively diagnosed case of IgG4-related TIN with lymph node involvement, showing good clinical and pathological prognosis. Qiong Wu, Raima Nakazawa, Hisae Tanaka, Masayuki Endoh, and Masafumi Fukagawa Copyright © 2013 Qiong Wu et al. All rights reserved. Thu, 27 Dec 2012 18:40:53 +0000 http://www.hindawi.com/crim/nephrology/2012/703908/ Urethral mucosa with intestinal metaplasia and dysplasia is a rare occurrence. To date only a single case has been reported in a male with long-standing urethral stricture. We present a 33-year-old female with polypoid intestinal metaplasia and dysplasia of the external urethral meatus in the absence of an inciting factor. Intestinal metaplasia of the urethral mucosa may undergo dysplasia, emphasizing the necessity of a high degree of clinical suspicion and vigilant pathological examination of these lesions. Mary Mathew, Bhavna Nayal, Lakshmi Rao, Raghunath Narayanan Unni, and Joseph Thomas Copyright © 2012 Mary Mathew et al. All rights reserved. Thu, 27 Dec 2012 12:03:59 +0000 http://www.hindawi.com/crim/nephrology/2012/239093/ Botryomycosis is a unique form of bacterial infection, closely mimicking actinomycosis. The usual site of occurrence is the skin and renal botryomycosis is very rare. The most common organism is Staphylococcus aureus which can be identified using Gram stain and confirmed by culture. Early and accurate diagnosis can ensure appropriate antibiotic therapy. We present a young lady diagnosed to have incidental botryomycosis of the kidney, following nephrectomy. Mary Mathew, Bhavna Nayal, Bhawna Nagel, and Joseph Thomas Copyright © 2012 Mary Mathew et al. All rights reserved. Thu, 20 Dec 2012 09:37:15 +0000 http://www.hindawi.com/crim/nephrology/2012/593460/ A histologic diagnosis of amyloidosis requires acquiring tissue containing amyloid fibrils from an affected organ or alternate site. The biopsy site and staining techniques may influence testing accuracy. We present a case in which systemic amyloidosis was suspected; however, biopsies of the bone marrow, an osteosclerotic bone lesion, arterial and venous vessels, and the fat pad were all negative for the diagnostic Congo red stain. An eventual renal biopsy demonstrated AL-amyloidosis, kappa light chain associated with extensive vascular interstitial, and glomerular, involvement. Choice of biopsy site, as well as staining and analysis of the tissue, can influence sensitivity and specificity of amyloid testing. Fat-pad biopsies are less invasive and offer reasonable sensitivity. Bone marrow samples are only diagnostic up to 63% of the time. A renal biopsy offers improved sensitivity and is generally safe in experienced hands, but is a more invasive procedure with increased number of relative contraindications and complications. The choice of the biopsy site should be based on considering the expected yield, accessibility of the site, and the risks associated with the procedure. Kristina Bowen, Nina Shah, and Matthew Lewin Copyright © 2012 Kristina Bowen et al. All rights reserved. Mon, 17 Dec 2012 09:23:54 +0000 http://www.hindawi.com/crim/nephrology/2012/406406/ Sickle cell nephropathy (SCN) is a common complication of sickle cell disease (SCD). It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD). Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients. The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient. The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD. U. H. Okafor, C. Wachukwu, P. Emem-Chioma, and F. S. Wokoma Copyright © 2012 U. H. Okafor et al. All rights reserved. Thu, 13 Dec 2012 10:14:31 +0000 http://www.hindawi.com/crim/nephrology/2012/928083/ Microorganisms of the microsporidia group are obligated intracellular protozoa that belong to the phylum Microspora; currently they are considered to be related or belong to the fungi reign. It is considered an opportunistic infection in humans, and 14 species belonging to 8 different genera have been described. Immunocompromized patients such as those infected with human immunodeficiency virus (HIV), also HIV serum-negative asymptomatic patients, with poor hygienic conditions, and recipients of bone marrow or solid organ transplantation are susceptible to develop deinfection. Sixty transplanted patients with renal microsporidia infection have been reported worldwide. The aim of this paper is to inform about the 2nd case of kidney transplant and microsporidia infection documented in Mexico. Oscar Xavier Hernández-Rodríguez, Octavio Alvarez-Torres, and Norma Ofelia Uribe-Uribe Copyright © 2012 Oscar Xavier Hernández-Rodríguez et al. All rights reserved. Wed, 12 Dec 2012 10:44:35 +0000 http://www.hindawi.com/crim/nephrology/2012/961816/ Chyloperitoneum associated with nephrotic syndrome is rare clinical entity and characterized by milky ascites. The modalities for detection of chyloperitoneum are laboratory investigations and radiological images. Lipoprotein electrophoresis is useful for confirmation of the diagnosis with chyloperitoneum. Treating underlying disease is the most important in the management of these patients. Jui-Hsiang Lin and Wei-Jie Wang Copyright © 2012 Jui-Hsiang Lin and Wei-Jie Wang. All rights reserved. Wed, 12 Dec 2012 09:23:59 +0000 http://www.hindawi.com/crim/nephrology/2012/978170/ Autosomal dominant polycystic kidney disease is a common hereditary disorder characterized by renal and extrarenal, cystic and noncystic manifestations. Connective tissue defects, including cerebral aneurysm, meningeal diverticula, abdominal wall hernias, intestinal diverticula, and cardiac valvular abnormalities, are widely known manifestations. Instead intracardiac aneurysms have never been reported in adults with autosomal dominant polycystic kidney disease. We describe a 65-year-old patient with end-stage renal disease due to autosomal dominant polycystic kidney disease and an atrial septum aneurysm associated with platypnoea-orthodeoxia syndrome. Fausta Catapano, Stefano Pancaldi, Carlo Pace Napoleone, Lucia Barbara De Sanctis, Gaetano Gargiulo, Giuseppe Emiliani, and Antonio Santoro Copyright © 2012 Fausta Catapano et al. All rights reserved. Tue, 04 Dec 2012 08:59:35 +0000 http://www.hindawi.com/crim/nephrology/2012/710230/ A 7-year-old boy presented with a history of acute onset of hematuria, dysuria, and suprapubic pain. Urine routine and microscopy showed 40–45 red cells/high power field. Urine culture was sterile. Radiological investigations showed a focal mucosal lesion with bladder wall thickening. Biopsy of the lesion revealed an edematous mucosa with florid infiltration by eosinophils into the muscularis propria with focal areas of myonecrosis. He was diagnosed as a case of eosinophilic cystitis. The patient received 6 weeks of tapered prednisone therapy. He was asymptomatic on followup. K. S. Venkatesh and Shaila Bhat Copyright © 2012 K. S. Venkatesh and Shaila Bhat. All rights reserved. Wed, 28 Nov 2012 09:10:18 +0000 http://www.hindawi.com/crim/nephrology/2012/860208/ The common variable immunodeficiency disease (CVID) is the most common symptomatic primary antibody deficiency. It is the most frequently observed cause of panhypogammaglobulinemia in adults. Here, we present a case of systemic amyloidosis that developed secondary to the common variable immunodeficiency disease causing recurrent infections in a young female patient. A 24-year-old female patient, who was under treatment at the gynecology and obstetrics clinic for pelvic inflammatory disease, was referred to our clinic when she was observed to have swellings in her legs, hands, and face. She had proteinuria at a rate of 3.5 gr/day, and her serum albumin was 1.5 gr/dl. The levels of immunoglobulins are IgG: 138 mg/dl, IgA: 22,6 mg/dl, and IgM: 16,8 mg/dl. The renal USG revealed that the kidneys were observed to be enlarged. Since the patient had recurrent infections, hypogammaglobulinemia, nephrotic range proteinuria, and enlarged kidneys in the renal USG, she was thought to have type AA amyloidosis and therefore underwent a renal biopsy. The kidney biopsy revealed amyloid (+). So the patient was diagnosed with AA type of amyloidosis secondary to common variable immunodeficiency disease. A treatment regimen (an ACE inhibitor and a statin) with monthly administration of intravenous immunoglobulin was started. Ali Kemal Kadiroğlu, Yaşar Yıldırım, Zülfükar Yılmaz, Hasan Kayabaşı, Yahya Avcı, M. Serdar Yıldırım, and M. Emin Yılmaz Copyright © 2012 Ali Kemal Kadiroğlu et al. All rights reserved. Wed, 21 Nov 2012 14:19:01 +0000 http://www.hindawi.com/crim/nephrology/2012/560854/ Bath salts are substance of abuse that are becoming more common and are difficult to recognize due to negative toxicology screening. Acute kidney injury due to bath salt use has not previously been described. We present the case of a previously healthy male who developed acute kidney injury and dialysis dependence after bath salt ingestion and insufflation. This was self-reported with negative toxicology screening. Clinical course was marked by severe hyperthermia, hyperkalemia, rhabdomyolysis, disseminated intravascular coagulation, oliguria, and sepsis. We discuss signs and symptoms, differential diagnoses, potential mechanisms of injury, management, and review of the literature related to bath salt toxicity. Jonathan McNeely, Samir Parikh, Christopher Valentine, Nabil Haddad, Ganesh Shidham, Brad Rovin, Lee Hebert, and Anil Agarwal Copyright © 2012 Jonathan McNeely et al. All rights reserved. Wed, 14 Nov 2012 11:31:41 +0000 http://www.hindawi.com/crim/nephrology/2012/180691/ Little is known about the utility of treating patients with advanced IgA nephropathy (IgAN). From 2001 to 2005, four patients came to our observation because of serum creatinine higher than 3 mg/dL, proteinuria ranging from 1.8 to 5.1 g/day, and a histological picture of diffuse sclerotic lesions. A corticosteroid course of 12 months was given. Patients were observed for a mean follow up of 84 months. At the end of the steroid course, proteinuria lowered quickly below 1 g/day in two patients, whereas the other two experienced a slower and less persistent decrease of proteinuria. Despite similar lesion severity at renal biopsy, renal function stabilized only in these two ones. In conclusion, these preliminary observations suggest a possible efficacy of corticosteroids in slowing down the progression of renal disease and in postponing the need of dialysis in IgAN patients with stage IV CKD and severe chronic histological lesions. Claudio Pozzi, Francesca Ferrario, Bianca Visciano, and Lucia Del Vecchio Copyright © 2012 Claudio Pozzi et al. All rights reserved. Tue, 06 Nov 2012 08:43:19 +0000 http://www.hindawi.com/crim/nephrology/2012/596923/ Hydatid disease is frequent in endemic regions and sheep farming areas. Most common localization of hydatid cyst occurs in liver followed by lungs. Renal hydatid cyst constitutes about 2–4% of all locations. We report a case of left renal hydatid from a laboratory technician admitted in a tertiary care hospital. There were few cases of renal hydatid disease reported in India among general population but to the best of our knowledge never reported from laboratory worker. The possibility of laboratory-acquired infection cannot be ruled out in this case due to lack of precautionary measures and containment facilities in resource-constrained setting. Venkatesh Seetharam, Vinay Khanna, Padmapriya Jaiprakash, Kranthi Kosaraju, Joseph Thomas, and Chiranjay Mukhopadhayay Copyright © 2012 Venkatesh Seetharam et al. All rights reserved. Sun, 04 Nov 2012 11:59:44 +0000 http://www.hindawi.com/crim/nephrology/2012/731502/ Unanticipated renal failure may be induced by an obstructed urethral catheter that was a component of complex management or difficult insertion. Two patients with new-onset uremia due to obstructed urethral catheters evinced rapid return of renal function when their blocked catheters were replaced. Ankita Patel and Eli A. Friedman Copyright © 2012 Ankita Patel and Eli A. Friedman. All rights reserved. Wed, 17 Oct 2012 14:17:06 +0000 http://www.hindawi.com/crim/nephrology/2012/573650/ AL amyloidosis complicating monoclonal gammopathy of undetermined significance (MGUS) has usually a predominant glomerular deposition of lambda light chain. Heavy proteinuria is one of its cardinal manifestations. A 78-year-old man with a 9-year history of IgG kappa light-chain-MGUS and normal urine protein excretion developed severe renal failure. Serum levels of kappa light chain and serum IgG had been stable while proteinuria was absent throughout the nine-year period. For the first eight years, he had stable stage III chronic kidney disease attributed to bladder outlet obstruction secondary to prostatic malignancy. In the last year, he developed progressive serum creatinine elevation, without any increase in the serum or urine levels of paraproteins or any sign of malignancy. Renal ultrasound and furosemide renogram showed no evidence of urinary obstruction. Renal biopsy revealed AL amyloidosis, with reactivity exclusive for kappa light chains, affecting predominantly the vessels and the interstitium. Glomerular involvement was minimal. Melphalan and prednisone were initiated. However, renal function continues deteriorating. Deposition of AL kappa amyloidosis developing during the course of MGUS predominantly in the wall of the renal vessels and the renal interstitium, while the involvement of the glomeruli is minimal, leads to progressive renal failure and absence of proteinuria. Renal biopsy is required to detect both the presence and the sites of deposition of renal AL kappa light chain amyloidosis. Yijuan Sun, Amarpreet Sandhu, Darlene Gabaldon, Jonathan Danaraj, Karen S. Servilla, and Antonios H. Tzamaloukas Copyright © 2012 Yijuan Sun et al. All rights reserved. Tue, 09 Oct 2012 09:15:09 +0000 http://www.hindawi.com/crim/nephrology/2012/178426/ Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics. Daigoro Hirohama and Hiroshi Miyakawa Copyright © 2012 Daigoro Hirohama and Hiroshi Miyakawa. All rights reserved. Mon, 08 Oct 2012 15:39:49 +0000 http://www.hindawi.com/crim/nephrology/2012/183730/ Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF) or arteriovenous graft (AVG). Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD), atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT) scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure. Jolina Pamela Santos, Zaher Hamadeh, and Naheed Ansari Copyright © 2012 Jolina Pamela Santos et al. All rights reserved. Mon, 17 Sep 2012 11:20:14 +0000 http://www.hindawi.com/crim/nephrology/2012/865193/ We present the case of a patient with systemic sclerosis (SSc) and end stage renal disease (ESRD) who experienced complications of both peritoneal and haemodialysis. We review previously reported outcomes of patients with systemic sclerosis on dialysis and discuss potential shared mechanisms in both the disease pathogenesis and dialysis-related complications, particularly with regards to encapsulating peritoneal sclerosis (EPS). N. Brown, A. Summers, M. C. Venning, and I. N. Bruce Copyright © 2012 N. Brown et al. All rights reserved. Tue, 28 Aug 2012 10:34:19 +0000 http://www.hindawi.com/crim/nephrology/2012/645407/ Introduction. Retroperitoneal fibrosis is a rare cause of acute renal failure (ARF) with only a handful of cases reported in literature. We report a case of a 40-year-old male with an incidental finding of retroperitoneal fibrosis. Case Presentation. Patient is a 40-year-old African American male with no significant past medical history who presented with a four-month history of low back pain and associated nausea with vomiting. Physical examination was significant for elevated blood pressure at 169/107 mmhg and bilateral pedal edema. Significant admission laboratory include blood urea nitrogen (BUN) of 108 mg/dL, serum creatinine (Cr) of 23 mg/dL, bicarbonate of 19 mg/dL, and potassium of 6.2 mmL/L. Renal ultrasound showed bilateral hydronephrosis. Post-void residual urine volume was normal. Abdominopelvic CT scan showed retroperitoneal fibrosis confirmed with fine-needle biopsy. He was treated with a combination of bilateral ureteral stent placement, hemodialysis, and steroid therapy. Four months after hospital discharge, his BUN and Cr levels Improved to 18 mg/dL and 1.25 mg/dL, respectively. Conclusion. Retroperitoneal fibrosis should be considered as a differential diagnosis in patients with acute renal failure and obstructive uropathy. Abdominal CT scan is the examination of choice for diagnosis. Full resolution with treatment depends on the duration of obstruction. Amaka Ezimora, Marquetta L. Faulkner, Oluwafisayo Adebiyi, Abimbola Ogungbemile, Salas-Vega Marianna, and Chike Nzerue Copyright © 2012 Amaka Ezimora et al. All rights reserved. Thu, 09 Aug 2012 10:31:41 +0000 http://www.hindawi.com/crim/nephrology/2012/640365/ Gestational diabetes insipidus is a rare, but well recognized, complication of pregnancy. It is related to excess vasopressinase enzyme activity which is metabolized in the liver. A high index of suspicion of gestational diabetes insipidus is required in a correct clinical setting especially in the presence of other risk factors such as preeclampsia, HELLP syndrome, and twin pregnancies. We are presenting a case of gestational diabetes insipidus in a patient with HELLP syndrome. The newborn in this case also had hypernatremia thereby raising possibilities of vasopressinase crossing the placenta. Renela Gambito, Michael Chan, Mohamed Sheta, Precious Ramirez-Arao, Harmeet Gurm, Allan Tunkel, and Noel Nivera Copyright © 2012 Renela Gambito et al. All rights reserved.