Case Reports in Nephrology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Nephrotic Syndrome Secondary to Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits of Lambda Light Chain Tue, 22 Jul 2014 09:35:14 +0000 http://www.hindawi.com/journals/crin/2014/164694/ We describe a rare case of a 46-year-old woman with history of refractory nephrotic syndrome and hypertension who presented with worsening proteinuria and kidney function. Work-up for both autoimmune and infectious diseases and hematologic malignancies including multiple myeloma were negative. Kidney biopsy demonstrated glomerular sclerotic change with lambda light chain deposits in the subendothelial space, which is consistent with proliferative glomerulonephritis with monoclonal immunoglobulin deposit (PGNMID). The patient was treated with bortezomib and dexamethasone without clinical improvement and eventually became hemodialysis dependent. Seongseok Yun, Beth L. Braunhut, Courtney N. Walker, Waheed Bhati, Amy N. Sussman, and Faiz Anwer Copyright © 2014 Seongseok Yun et al. All rights reserved. Colectomy and Acute Renal Failure: A Case Report with Unusual Presentation Thu, 17 Jul 2014 11:28:58 +0000 http://www.hindawi.com/journals/crin/2014/821970/ Surgery is the only curative modality but occasionally it can have some long term complication such as short bowel syndrome. We presented a case reporting a 63-year-old man who had subtotal colectomy with liver metastasectomy according to the colon adenocarcinoma, following the couple of months of surgery; he had acute kidney injury without any end-organ damage while he had a regular diet and nutrition. Following the regular treatment of renal failure, colorectal cancer recurrence was excluded and then he was discharged from the hospital with a normal serum creatinine level. The patient was admitted to the nephrology clinic again for acute renal failure within 3 weeks of last admission to the hospital. He also denied the insufficient oral water intake and nutrition, but laboratory examination revealed acute renal failure. We suspected for short bowel syndrome (SBS). Following the hydration, loperamide hydrochloride 10 mg/day was started and the patient was followed up with normal serum creatinine and uric acid levels. To the best of our knowledge, this is the first case report, in which a patient with short bowel syndrome presented with prerenal acute renal failure even though he had sufficient oral intake and nutrition and can be treated with hydration and loperamide hydrochloride. Osman Zikrullah Sahin, Cemil Bilir, and Teslime Ayaz Copyright © 2014 Osman Zikrullah Sahin et al. All rights reserved. Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection Thu, 10 Jul 2014 11:46:09 +0000 http://www.hindawi.com/journals/crin/2014/502019/ We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome. Fernando Caravaca, Victor Burguera, Milagros Fernández-Lucas, José Luis Teruel, and Carlos Quereda Copyright © 2014 Fernando Caravaca et al. All rights reserved. Severe Hypocalcemia due to Denosumab in Metastatic Prostate Cancer Thu, 26 Jun 2014 05:34:14 +0000 http://www.hindawi.com/journals/crin/2014/565393/ Denosumab is a monoclonal antibody used for prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors. Hypocalcemia is a rare and dangerous side effect of the drug Denosumab. We present a case of a patient with metastatic prostate cancer who developed severe hypocalcemia after the administration of the drug. The patient’s vitamin D levels were low when checked after administration of the drug, which likely predisposed him to the development of hypocalcemia. He was placed on high doses of oral and intravenous (IV) calcium and vitamin D without any appreciable response in the serum calcium level. His ionized calcium remained below 0.71 mmol/L despite very high doses of oral and IV calcium supplements. During the hospital course, he developed hydronephrosis from the spread of a tumor and did not want to undergo percutaneous nephrostomy tube placement; therefore, it was decided to dialyse him for acute renal failure and to correct his hypocalcemia. Checking calcium and vitamin D levels prior to the administration of Denosumab is vital in preventing hypocalcemia. If hypocalcemia is severe and not responsive to high doses of vitamin D, oral and IV calcium, then hemodialysis with a high calcium bath can correct this electrolyte abnormality. Mohammed Muqeet Adnan, Usman Bhutta, Tanzeel Iqbal, Sufyan AbdulMujeeb, Lukas Haragsim, and Syed Amer Copyright © 2014 Mohammed Muqeet Adnan et al. All rights reserved. Anti-GBM of Pregnancy: Acute Renal Failure Resolved after Spontaneous Abortion, Plasma Exchange, Hemodialysis, and Steroids Tue, 24 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/crin/2014/243746/ Antiglomerular basement membrane disease presenting during pregnancy is very uncommon. We present a case of a pregnant female who presented with acute renal failure needing dialysis from Goodpasture’s disease. She responded very well to just plasma exchange, high dose steroids, and hemodialysis. Cyclophosphamide was never started on this patient. She had a spontaneous abortion in her 8th week of pregnancy and henceforth did very well to regain her renal function. Patient became hemodialysis independent at 2 months and returned to her baseline kidney function at 6 months. We present this remarkable case of recovery from acute renal failure in a patient with anti-GBM disease. We think the flare-up of renal failure was pregnancy related which resolved after spontaneous abortion. Mohammed Muqeet Adnan, Jordan Morton, Syed Hashmi, Sufyan Abdul Mujeeb, William Kern, and Benjamin Jr. Cowley Copyright © 2014 Mohammed Muqeet Adnan et al. All rights reserved. IgG4-Related Tubulointerstitial Nephritis Associated with Membranous Nephropathy in Two Patients: Remission after Administering a Combination of Steroid and Mizoribine Thu, 19 Jun 2014 16:17:40 +0000 http://www.hindawi.com/journals/crin/2014/678538/ We report two cases of Japanese men who presented with proteinuria, eosinophilia, hypocomplementemia, and high serum immunoglobulin G4 (IgG4) concentration and were diagnosed with membranous nephropathy associated with IgG4-related tubulointerstitial nephritis on renal biopsy. The typical renal lesions of IgG4-related disease are tubulointerstitial nephritis, which improves remarkably with steroid therapy, and occasional glomerular changes. In our two cases, renal biopsy revealed IgG4-positive immune complex deposits in glomeruli in a pattern of membranous nephropathy and concurrent tubulointerstitial nephritis with IgG4 plasma cells. In both cases, proteinuria persisted with initial prednisolone treatment and was resolved only after the addition of mizoribine. We report the first two cases in which the combination of prednisolone and mizoribine was effective for treating membranous nephropathy associated with IgG4-related tubulointerstitial nephritis. Kana N. Miyata, Hiromi Kihira, Manabu Haneda, and Yasuhide Nishio Copyright © 2014 Kana N. Miyata et al. All rights reserved. Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone Thu, 19 Jun 2014 06:04:18 +0000 http://www.hindawi.com/journals/crin/2014/940171/ Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count—18,900/μL with no bandemia, hemoglobin 10.8 gm/dL, potassium—6.7 mEq/L, bicarbonate—15 mEq/L, blood urea nitrogen—62 mg/dL, SCr—5.6 mg/dL (baseline: 1.10), and corrected calcium—11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen. Bhanu K. Patibandla, Akshita Narra, Ahmad A. Alwassia, Anthony Bartley, Gurprataap S. Sandhu, James Rooney, and Robert M. Black Copyright © 2014 Bhanu K. Patibandla et al. All rights reserved. Mycobacterium fortuitum and Polymicrobial Peritoneal Dialysis-Related Peritonitis: A Case Report and Review of the Literature Mon, 16 Jun 2014 09:30:18 +0000 http://www.hindawi.com/journals/crin/2014/323757/ Mycobacterium fortuitum is a ubiquitous, rapidly growing nontuberculous mycobacterium (NTM). It is the most commonly reported NTM in peritoneal dialysis (PD) associated peritonitis. We report a case of a 52-year-old man on PD, who developed refractory polymicrobial peritonitis necessitating PD catheter removal and shift to hemodialysis. Thereafter, M. fortuitum was identified in the PD catheter culture and in successive cultures of initial peritoneal effluent and patient was treated with amikacin and ciprofloxacin for six months with a good and sustained clinical response. Months after completion of the course of antibiotics, the patient successfully returned to PD. To our knowledge, this is the first reported case of M. fortuitum peritonitis in the field of polymicrobial PD peritonitis. It demonstrates the diagnostic yield of pursuing further investigations in cases of refractory PD peritonitis. In a systematic review of the literature, only 20 reports of M. fortuitum PD peritonitis were identified. Similar to our case, a delay in microbiological diagnosis was frequently noted and the Tenckhoff catheter was commonly removed. However, the type and duration of antibiotic therapy varied widely making the optimal treatment unclear. Anwar Hamade, Agnieszka Pozdzik, O. Denis, Monika Tooulou, Caroline Keyzer, F. Jacobs, Jose Khabbout, and Joëlle L. Nortier Copyright © 2014 Anwar Hamade et al. All rights reserved. Malignant Pelvic Pheochromocytoma Presenting as NonFunctioning Kidney and Accelerated Hypertension: A Rare Presentation Mon, 16 Jun 2014 09:10:23 +0000 http://www.hindawi.com/journals/crin/2014/985615/ Paragangliomas are neuroendocrine tumors that arise from sympathetic nerve ganglia. They can develop anywhere from the neck to the pelvis, but are most commonly found in the abdomen, particularly at the aortic bifurcation or in the periaortic region. Malignant paragangliomas account for 29–40% of cases. We report a case of 36-year hypertensive female presented with and right flank pain and accelerated hypertension. On evaluation she was diagnosed to have non unctioning kidney due to malignant pelvic paraganglioma with right ureteric encasement. We believe our case is one of the first reported in literature as rare presentation of malignant paraganglioma presenting as nonfunctioning kidney and accelerated hypertension. Santosh Kumar, Kalpesh Mahesh Parmar, Seema Prasad, and Jyotsna Rani Copyright © 2014 Santosh Kumar et al. All rights reserved. Acute Oxalate Nephropathy following Ingestion of Averrhoa bilimbi Juice Wed, 04 Jun 2014 13:06:31 +0000 http://www.hindawi.com/journals/crin/2014/240936/ Plant toxins are known to cause acute kidney injury in tropical countries. We report two cases of acute kidney injury with tubular oxalate deposition following ingestion of Averrhoa bilimbi fruit juice. Both patients had complete renal recovery though one required dialytic support. Sreeja Nair, Jacob George, Sajeev Kumar, and Noble Gracious Copyright © 2014 Sreeja Nair et al. All rights reserved. An Unusual Case of Anti-GBM Antibody Elevation in HIV-Associated Nephropathy Tue, 03 Jun 2014 12:09:38 +0000 http://www.hindawi.com/journals/crin/2014/956475/ Introduction. The most commonly seen glomerular disease in HIV infected patients is HIV-associated nephropathy (HIVAN); however, a multitude of other nephropathies can occur in HIV infection with an almost equal cumulative frequency. We report an unusual case of a patient with clinical and histological evidence of HIVAN in which the diagnosis was initially confounded by the finding of an elevated serum anti-glomerular basement membrane (anti-GBM) antibody. Case Presentation. We present a case of a 27-year-old African American female with a history of schizophrenia, cocaine abuse, and HIV infection who upon admission to our hospital was found to have severe acute kidney injury requiring hemodialysis. Urine studies revealed nephrotic range proteinuria and a serological workup was positive for anti-GBM antibody elevation with a value of 91 units (normal: 0–20 units). A renal biopsy revealed HIVAN with no evidence of crescentic glomerulonephritis or anti-GBM disease. Conclusion. This case highlights the need for careful interpretation of anti-GBM antibody tests in HIV infected patients with kidney disease and, in particular, the need for biopsy confirmation of the diagnosis prior to starting therapy. More research is needed to study the prognostic correlation between the degree of anti-GBM antibody elevation in HIVAN and disease severity. Vinay Minocha, Raafat Makary, and Andreea Poenariu Copyright © 2014 Vinay Minocha et al. All rights reserved. Amiloride as an Alternate Adjuvant Antiproteinuric Agent in Fabry Disease: The Potential Roles of Plasmin and uPAR Thu, 15 May 2014 06:45:28 +0000 http://www.hindawi.com/journals/crin/2014/854521/ Patients with Fabry disease present a higher risk of cardiovascular and kidney morbidity. We present a patient with a past history of biopsy-proven Fabry disease and stage 3 chronic kidney disease. Proteinuria partially dropped from 6.8 g/day to 2.1 g/day despite an aggressive regime which consisted of low-salt diet, agalsidase beta infusions, dual blockade of the renin-angiotensin system, and low-dose maintenance of steroids. As proteinuria is considered a risk marker of cardiovascular disease and of progression of kidney disease, we added amiloride 5 mg/day, a drug with proven effects in podocyte stabilization and proteinuria actions at the distal convoluted tubule. Proteinuria finally decreased to 0.8 g/day. This report highlights the relevance of intervening on proteinuria in a multitarget approach in order to reduce it as much as possible. Due to this pharmacological response, we suggest that although agalsidase beta specific treatment protects the endothelium, the podocyte, and the tubule in Fabry disease and secondary haemodynamic and immunologic pathways are treated with inhibition of the renin-angiotensin system and steroids, amiloride may act as a complementary tool in podocyte stabilization and in proteinuria effects at the distal tubule. H. Trimarchi, M. Forrester, F. Lombi, V. Pomeranz, M. S. Raña, A. Karl, and J. Andrews Copyright © 2014 H. Trimarchi et al. All rights reserved. A Rare Case of Acute Renal Failure Secondary to Rhabdomyolysis Probably Induced by Donepezil Sun, 27 Apr 2014 10:00:11 +0000 http://www.hindawi.com/journals/crin/2014/214359/ Introduction. Acute renal failure (ARF) develops in 33% of the patients with rhabdomyolysis. The main etiologic factors are alcoholism, trauma, exercise overexertion, and drugs. In this report we present a rare case of ARF secondary to probably donepezil-induced rhabdomyolysis. Case Presentation. An 84-year-old male patient was admitted to the emergency department with a complaint of generalized weakness and reduced consciousness for two days. He had a history of Alzheimer’s disease for one year and he had taken donepezil 5 mg daily for two months. The patient’s physical examination revealed apathy, loss of cooperation, and decreased muscle strength. Laboratory studies revealed the following: urea: 128 mg/dL; Creatinine 6.06 mg/dL; creatine kinase: 3613 mg/dL. Donepezil was discontinued and the patient’s renal function tests improved gradually. Conclusion. Rhabdomyolysis-induced acute renal failure may develop secondary to donepezil therapy. Osman Zikrullah Sahin, Teslime Ayaz, Suleyman Yuce, Fatih Sumer, and Serap Baydur Sahin Copyright © 2014 Osman Zikrullah Sahin et al. All rights reserved. Association of Acute Interstitial Nephritis with Carnivora, a Venus Flytrap Extract, in a 30-Year-Old Man with Hodgkin’s Lymphoma Tue, 15 Apr 2014 12:20:19 +0000 http://www.hindawi.com/journals/crin/2014/486173/ Acute interstitial nephritis (AIN) is a common cause of acute kidney injury and has been associated with a variety of medications. This is the case of 30-year-old man with Hodgkin’s lymphoma who on routine labs before chemotherapy was found to have acute nonoliguric renal failure. A kidney biopsy was performed and confirmed the diagnosis of acute interstitial nephritis. The patient had taken several medications including a higher dose of Carnivora, a Venus flytrap extract, composed of numerous amino acids. The medication was discontinued and kidney function improved towards the patient’s baseline indicating that this may be the possible cause of his AIN. Proximal tubular cell uptake of amino acids increasing transcription of nuclear factor-kappaB is a proposed mechanism of AIN from this compound. Susan Ziolkowski and Catherine Moore Copyright © 2014 Susan Ziolkowski and Catherine Moore. All rights reserved. Acute Renal Failure and Jaundice without Methemoglobinemia in a Patient with Phenazopyridine Overdose: Case Report and Review of the Literature Wed, 05 Mar 2014 13:29:15 +0000 http://www.hindawi.com/journals/crin/2014/845372/ Phenazopyridine is a commonly used urinary analgesic available throughout the United States. Ingestion of large quantities can lead to methemoglobinemia, hemolytic anemia, jaundice, and acute renal failure. We report a case of a 78-year-old male with previously normal renal function who developed acute renal failure and jaundice without methemoglobinemia or hyperbilirubinemia after taking nearly 8 g of phenazopyridine over the course of 4 days. Initially presenting with oliguria, the urine output began to increase by day 2 of his admission, and the creatinine peaked 11 days after he began taking phenazopyridine, and he was discharged safely soon after. To our knowledge, this is the first such case of renal failure and jaundice without methemoglobinemia or hemolytic anemia in an adult patient with normal renal function. Ian Holmes, Nathaniel Berman, and Vinicius Domingues Copyright © 2014 Ian Holmes et al. All rights reserved. Blockade of Alternative Complement Pathway in Dense Deposit Disease Thu, 06 Feb 2014 13:32:25 +0000 http://www.hindawi.com/journals/crin/2014/201568/ A patient aged 17 with dense deposit disease associated with complement activation, circulating C3 Nef, and Factor H mutation presented with nephrotic syndrome and hypertension. Steroid therapy, plasma exchange, and rituximab failed to improve proteinuria and hypertension despite a normalization of the circulating sC5b9 complex. Eculizumab, a monoclonal antibody directed against C5, was used to block the terminal product of the complement cascade. The dose was adapted to achieve a CH50 below 10%, but proteinuria and blood pressure were not improved after 3 months of treatment. Aurore Berthe-Aucejo, Mathieu Sacquépée, Marc Fila, Michel Peuchmaur, Emilia Perrier-Cornet, Véronique Frémeaux-Bacchi, and Georges Deschênes Copyright © 2014 Aurore Berthe-Aucejo et al. All rights reserved. Membranoproliferative Glomerulonephritis in Patients with Chronic Venous Catheters: A Case Report and Literature Review Thu, 30 Jan 2014 09:12:58 +0000 http://www.hindawi.com/journals/crin/2014/159370/ Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus. We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome. We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa. The importance of routine monitoring of kidney function and urinalysis among patients with chronic central venous catheterization is highlighted as kidney injury may herald or coincide with overtly infected chronic indwelling central venous catheters. John Sy, Cynthia C. Nast, Phuong-Thu T. Pham, and Phuong-Chi T. Pham Copyright © 2014 John Sy et al. All rights reserved. Severe Symptomatic Hypermagnesemia Associated with Over-the-Counter Laxatives in a Patient with Renal Failure and Sigmoid Volvulus Mon, 06 Jan 2014 12:31:49 +0000 http://www.hindawi.com/journals/crin/2014/560746/ Hypermagnesemia is an uncommon but a potentially serious clinical condition. Over-the-counter magnesium containing products are widely used as antacids or laxatives. Although generally well tolerated in patients with normal renal function, their unsupervised use in the elderly can result in severe symptomatic hypermagnesemia, especially in those patients with concomitant renal failure and bowel disorders. We report a case of severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a 70-year-old male patient with renal failure and sigmoid volvulus, who was successfully treated with hemodialysis. Talal Khairi, Syed Amer, Samuel Spitalewitz, and Lutfi Alasadi Copyright © 2014 Talal Khairi et al. All rights reserved. A Case of Methanol Poisoning in a Child Mon, 06 Jan 2014 09:59:41 +0000 http://www.hindawi.com/journals/crin/2014/652129/ We report the case of a girl admitted to the emergency room with a history of four hours' acute illness, characterized by nausea, vomiting, salivation, headache, blurred vision, and acidotic “Kussmaul” breathing. Arterial blood gases showed severe mixed acidosis, metabolic and respiratory with high anion gap. She had ingested the contents of a scent bottle containing methanol, which she thought was a soft drink bottle. The girl was managed with hemodialysis and strong intravenous hydration. She improved well and made a full recovery. Reyner Loza and Dimas Rodriguez Copyright © 2014 Reyner Loza and Dimas Rodriguez. All rights reserved. Pseudorenal Failure Secondary to Reversed Intraperitoneal Autodialysis Wed, 25 Dec 2013 14:18:17 +0000 http://www.hindawi.com/journals/crin/2013/982391/ A 16-year-old boy was admitted for anuria, ascites, and abdominal pain. The patient had undergone a laparoscopic appendectomy two days prior to admission. Initial laboratory analysis revealed a plasma creatinine level of 5,07 mg/dL and blood urea nitrogen level of 75 mg/dL. Computed tomography imaging revealed diffuse abdominal ascites with normal kidneys without signs of hydronephrosis. Laprascopic revision found a 3 mm bladder tear and yielded an aspirate of 1,8 litre abdominal fluid. The abdominal fluid exhibited a fluid : serum creatinine ratio exceeding 1, indicating uroperitoneum. This case underscores the importance of bladder ruptures causing uroperitoneum presenting with azotemia. Pieter Martens Copyright © 2013 Pieter Martens. All rights reserved. Withdrawal from Dialysis and Palliative Care for Severely Ill Dialysis Patients in terms of Patient-Centered Medicine Wed, 04 Dec 2013 17:45:04 +0000 http://www.hindawi.com/journals/crin/2013/761691/ We treated a dementia patient with end stage chronic kidney disease (CKD). The patient also had severe chronic heart disease and suffered from untreatable respiratory distress during the clinical course of his illness. We therefore initiated peritoneal dialysis therapy (PD) as renal replacement therapy, although we had difficulties continuing stable PD for many reasons, including a burden on caregivers and complications associated with PD therapy itself. Under these circumstances we considered that palliative care prior to intensive care may have been an optional treatment. This was a distressing decision regarding end-of-life care for this patient. We were unable to confirm the patient’s preference for end-of-life care due to his dementia. Following sufficiently informed consent the patient’s family accepted withdrawal from dialysis (WD). We simultaneously initiated nonabandonment and continuation of careful follow-up including palliative care. We concluded that the end-of-life care we provided would contribute to a peaceful and dignified death of the patient. Although intensive care based on assessment of disease is important, there is a limitation to care, and therefore we consider that WD and palliative care are acceptable options for care of our patients in the terminal phase of their lives. Hideaki Ishikawa, Nao Ogihara, Saori Tsukushi, and Junichi Sakamoto Copyright © 2013 Hideaki Ishikawa et al. All rights reserved. Tolvaptan in the Treatment of Acute Hyponatremia Associated with Acute Kidney Injury Wed, 20 Nov 2013 10:38:20 +0000 http://www.hindawi.com/journals/crin/2013/801575/ Hyponatremia defined as a plasma sodium concentration of less than 135 mmol/L is a very common disorder, occurring in hospitalized patients. Hyponatremia often results from an increase in circulating arginine vasopressin (AVP) levels and/or increased renal sensitivity to AVP, combined with an increased intake of free water. Hyponatremia is subdivided into three groups, depending on clinical history and volume status: hypovolemic, euvolemic, and hypervolemic. Acute symptomatic hyponatremia is usually treated with hypertonic (3%) saline. Syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) and hypervolemic hyponatremia caused by heart failure or cirrhosis are treated with vasopressin antagonists (vaptans) since they increase plasma sodium (Na2+) concentration via their aquaretic effects (augmentation of free-water clearance). The role of tolvaptan in the treatment of acute hyponatremia and conversion of oliguric to nonoliguric phase of acute tubular necrosis has not been previously described. Shilpa Gopinath, Kalyana C. Janga, Sheldon Greenberg, and Shree K. Sharma Copyright © 2013 Shilpa Gopinath et al. All rights reserved. Pulmonary-Renal Syndrome with Negative ANCAs and Anti-GBM Antibody Thu, 31 Oct 2013 10:54:25 +0000 http://www.hindawi.com/journals/crin/2013/434531/ We report the case of a 76-year-old woman who was referred to our hospital for a gradually worsening cough and renal dysfunction. Although pneumonia was initially suspected, imaging findings of the lungs revealed diffuse alveolar hemorrhage at a later date. Renal failure developed and hemodiafiltration was performed on the 9th day. Rapidly progressive glomerulonephritis with crescent formation was diagnosed by renal biopsy. This case presentation has important clinical implications because uncategorizable pulmonary-renal syndrome (PRS) without the presence of ANCAs and anti-GBM antibody is extremely rare and has high rates of morbidity and mortality. No treatment has been established. Hiroshi Yamaguchi, Atsuhisa Shirakami, Takashi Haku, Takashige Taoka, Yoshikazu Nakanishi, Toru Inai, and Takanori Hirose Copyright © 2013 Hiroshi Yamaguchi et al. All rights reserved. Seizure, Deafness, and Renal Failure: A Case of Barakat Syndrome Tue, 22 Oct 2013 17:00:56 +0000 http://www.hindawi.com/journals/crin/2013/261907/ Barakat syndrome (also known as HDR syndrome) is an autosomal dominant disorder characterized by hypoparathyroidism, sensorineural deafness, and renal disease caused by mutation of the GATA3 gene located at chromosome 10p15. The exact prevalence of this disorder is not known but is very rare, with only about a dozen cases reported in the literature. Here, we report a case of 58-year-old man from Ardabil who presented with seizure due to hypocalcemia. Further history revealed bilateral deafness. Audiogram confirmed sensorineural hearing loss of both sides. His laboratory data were consistent with hypoparathyroidism and renal failure. He was diagnosed to have Barakat syndrome based on his clinical and laboratory data. In conclusion, we need to be aware of rare inherited conditions in a patient with abnormal physical and laboratory findings even though their initial presentation was seizure and hypocalcemia. Nasrollah Maleki, Bahman Bashardoust, Manouchehr Iranparvar Alamdari, and Zahra Tavosi Copyright © 2013 Nasrollah Maleki et al. All rights reserved. Pyrazinamide-Induced Exfoliative Dermatitis in a Patient on Hemodialysis: A Rare Complication Wed, 18 Sep 2013 18:29:39 +0000 http://www.hindawi.com/journals/crin/2013/387293/ A 60-year-old male patient on maintenance hemodialysis was started on antituberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide for pulmonary tuberculosis. After 4 weeks of therapy, he developed pruritic lesions in the extremities followed by exfoliation. The lesions progressively spread over the entire body. Lesions resolved after withdrawal of antituberculosis medications and administration of oral corticosteroids and antihistamines. After 2 weeks antituberculosis drugs were rechallenged one at a time. Administration of oral pyrazinamide resulted in reappearance of symptoms (pruritis and erythema) within 48 hours. Pyrazinamide was substituted with ofloxacin while other three drugs were restarted without any side effects. The case illustrates a rare but potentially dangerous complication of pyrazinamide therapy. Krishnaswamy Jaisuresh Copyright © 2013 Krishnaswamy Jaisuresh. All rights reserved. Bilateral Renal Mass-Renal Disorder: Tuberculosis Sun, 15 Sep 2013 17:47:41 +0000 http://www.hindawi.com/journals/crin/2013/724693/ A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR) has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable. Ozlem Tiryaki, Celalettin Usalan, and Samet Alkan Copyright © 2013 Ozlem Tiryaki et al. All rights reserved. Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis Thu, 12 Sep 2013 10:32:16 +0000 http://www.hindawi.com/journals/crin/2013/640976/ Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG) may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence. Jun Muratsu, Atsuyuki Morishima, Hiroyasu Ueda, Hisatoyo Hiraoka, and Katsuhiko Sakaguchi Copyright © 2013 Jun Muratsu et al. All rights reserved. A Rare Case of Aeromonas Hydrophila Catheter Related Sepsis in a Patient with Chronic Kidney Disease Receiving Steroids and Dialysis: A Case Report and Review of Aeromonas Infections in Chronic Kidney Disease Patients Sat, 24 Aug 2013 08:26:46 +0000 http://www.hindawi.com/journals/crin/2013/735194/ Aeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is rare. We present our case here and take the opportunity to give a brief review of AH infections in CKD patients. Muhammad Abdul Mabood Khalil, Abdur Rehman, Waqar Uddin Kashif, Manickam Rangasami, and Jackson Tan Copyright © 2013 Muhammad Abdul Mabood Khalil et al. All rights reserved. Prolonged Recovery Time from Zoledronic Acid Induced Acute Tubular Necrosis: A Case Report and Review of the Literature Mon, 29 Jul 2013 14:02:58 +0000 http://www.hindawi.com/journals/crin/2013/651246/ Acute tubular necrosis (ATN) due to bisphosphonates has been reported with Zoledronic acid but the time to recovery (if any) has been usually less than 4 months. Possible recovery time from ATN of any cause is usually less than 6 months. In this paper, we present the case of a 59-year-old Caucasian female with metastatic breast cancer who had received 16 monthly injections of Zoledronic acid for treatment of tumor induced hypercalcemia and developed several episodes of mild acute kidney injury which resolved by withholding treatment. Unfortunately, after the sixteenth injection, the patient experienced severe acute kidney injury, with a peak serum creatinine of 8.0 mg/dL. Although urinalysis showed muddy brown casts, because of atypical recovery time and presence of eosinophiluria and subnephrotic range proteinuria, a kidney biopsy was performed. Diagnosis of typical acute tubular necrosis was confirmed without any other concomitant findings. The course was remarkable for an unusually slow recovery of renal function over 15 months without need for renal replacement therapy until the patient expired from her metastatic cancer two years later. We reviewed all the published cases of acute kidney injury due to Zoledronic acid and suggest recommendations for clinicians and researchers. Frederic Rahbari-Oskoui, Odicie Fielder, Nima Ghasemzadeh, and Randolph Hennigar Copyright © 2013 Frederic Rahbari-Oskoui et al. All rights reserved. Adalimumab (TNFα Inhibitor) Therapy Exacerbates IgA Glomerulonephritis Acute Renal Injury and Induces Lupus Autoantibodies in a Psoriasis Patient Wed, 24 Jul 2013 09:24:30 +0000 http://www.hindawi.com/journals/crin/2013/812781/ Adalimumab (Humira) is a tumour necrosis factor α (TNFα) inhibitor that is approved for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn's disease, ankylosing spondylitis, and juvenile idiopathic arthritis (Sullivan and Preda (2009), Klinkhoff (2004), and Medicare Australia). Use of TNFα inhibitors is associated with the induction of autoimmunity (systemic lupus erythematosus, vasculitis, and sarcoidosis or sarcoid-like granulomas) (Ramos-Casals et al. (2010)). We report a patient with extensive psoriasis presenting with renal failure and seropositive lupus markers without classical lupus nephritis after 18 months treatment with adalimumab. He has renal biopsy proven IgA nephritis instead. Renal biopsy is the key diagnostic tool in patients presenting with adalimumab induced nephritis and renal failure. He made a remarkable recovery after adalimumab cessation and steroid treatment. To our knowledge, this is a unique case of a psoriasis patient presenting with seropositive lupus markers without classical lupus nephritis renal failure and had renal biopsy proven IgA glomerulonephritis after receiving adalimumab. S. S. Wei and R. Sinniah Copyright © 2013 S. S. Wei and R. Sinniah. All rights reserved.