Case Reports in Nephrology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. A Novel Technique for Laparoscopic Salvage of CAPD Catheter Malfunction and Migration: The Santosh-PGI Hanging Loop Technique Mon, 30 Mar 2015 09:47:25 +0000 CAPD catheter malfunction is a common problem. Obstruction due to wrapping by appendices epiploicae of sigmoid colon has been rarely reported in literature. We report a case of CAPD catheter malfunction caused by catheter tip migration and obstruction by appendices epiploicae that was successfully managed by laparoscopic hanging loop technique. This case report highlights the ease with which epiplopexy can be performed and catheter tip migration can be prevented by this innovative laparoscopic procedure. Santosh Kumar, Shivanshu Singh, Aditya Prakash Sharma, and Manish Rathi Copyright © 2015 Santosh Kumar et al. All rights reserved. Severe Rhabdomyolysis Associated with Simvastatin and Role of Ciprofloxacin and Amlodipine Coadministration Thu, 26 Mar 2015 12:45:43 +0000 Simvastatin is among the most commonly used prescription medications for cholesterol reduction and the most common statin-related adverse drug reaction is skeletal muscle toxicity. Multiple factors have been shown to influence simvastatin-induced myopathy. In addition to age, gender, ethnicity, genetic predisposition, and dose, drug-drug interactions play a major role. This is particularly true for drugs that are extensively metabolized by cytochrome P450 (CYP)3A4. We describe a particularly severe case of rhabdomyolysis after the introduction of ciprofloxacin, a weak CYP3A4 inhibitor, in a patient who previously tolerated the simvastatin-amlodipine combination. Nicolas De Schryver, Xavier Wittebole, Peter Van den Bergh, Vincent Haufroid, Eric Goffin, and Philippe Hantson Copyright © 2015 Nicolas De Schryver et al. All rights reserved. Palliative Care for a Mentally Incompetent End Stage Renal Failure Patient: Why Is It Important? Mon, 09 Mar 2015 12:37:49 +0000 People with intellectual disabilities are among the most disadvantaged groups in society. Here we report a mentally incompetent end stage renal failure (ESRF) patient with frequent emergency visits who made a significant improvement in symptoms control and reduction in casualty visits after introduction of renal palliative care service. Multidisciplinary approach would be useful in this case. Kwok-Ying Chan, Terence Yip, Mau-Kwong Sham, Benjamin Hon-Wai Cheng, Cho-Wing Li, Yim-Chi Wong, and Vikki Wai-Kee Lau Copyright © 2015 Kwok-Ying Chan et al. All rights reserved. The Hidden Cost of Untreated Paragangliomas of the Head and Neck: Systemic Reactive (AA) Amyloidosis Mon, 09 Mar 2015 09:35:54 +0000 We report a case of a 51-year-old man who was diagnosed with systemic reactive (AA) amyloidosis in association with untreated glomus jugulare and glomus caroticum tumors. He refused radiotherapy and renal replacement therapy. Paragangliomas, although rare, should be considered one of the tumors that can result in AA amyloidosis. Erkan Dervisoglu, Murat Ozturk, Mehmet Tuncay, Gulhatun Kilic Dervisoglu, Yesim Gurbuz, and Serhan Derin Copyright © 2015 Erkan Dervisoglu et al. All rights reserved. The Impact of Intensified Hemodialysis on Pruritus in an End Stage Renal Disease Patient with Biliary Ductopenia Wed, 04 Mar 2015 13:37:29 +0000 We report a unique observation characterized by the coexistence of idiopathic adulthood ductopenia (IAD), a rare cholestatic disease, and end stage renal failure treated by conventional hemodialysis in a patient awaiting double renal and liver transplantation. As pruritus gradually worsened, we hypothesized that intensified dialysis could alleviate the symptoms. Conventional hemodialysis following 3 hours/3 times a week regimen was initiated in December 2013. Due to increasing pruritus not responding to standard medical therapy, intensified hemodialysis following 2.5 hours/5 times a week regimen was started in May 2014. During two weeks, a temporary decrease in bilirubin levels was observed. No major changes on other liver function tests and inflammatory markers occurred. Nevertheless, a persistent improvement on pruritus and general wellbeing was obtained during the four weeks’ study period. The pathogenesis of itch encompasses multiple factors, and, in our case, both uremic and cholestatic pruritus are involved, although the latter is likely to account for a greater proportion. By improving itch intensity, through better clearance of uremic and cholestatic toxins which we detail further, intensive dialysis appears to be an acceptable short-term method for patients with hepatic cholestasis and moderate pruritus not responding to conventional therapy. Additional studies are needed to assess and differentiate precisely factors contributing to pruritus of both origins. Sandra Chomicki and Omar Dahmani Copyright © 2015 Sandra Chomicki and Omar Dahmani. All rights reserved. Retracted: Anti-GBM of Pregnancy: Acute Renal Failure Resolved after Spontaneous Abortion, Plasma Exchange, Hemodialysis, and Steroids Thu, 26 Feb 2015 08:13:50 +0000 Case Reports in Nephrology Copyright © 2015 Case Reports in Nephrology. All rights reserved. A Case of Nephrotic Syndrome, Showing Evidence of Response to Saquinavir Sat, 31 Jan 2015 16:09:43 +0000 The treatment of primary nephrotic syndrome such as minimal change nephropathy, membranous nephropathy, and focal segmental glomerulosclerosis nephropathy remains challenging. Whilst most cases of idiopathic nephrotic syndrome respond to steroid therapy and experience a limited number of relapses prior to complete remission, some cases suffer from frequent relapses and become steroid dependent or are primarily steroid resistant. Treatment options are limited to immunosuppressive drugs with significant side effect profiles. New modalities targeting novel pathways in the pathogenesis of nephrotic syndrome are actively sought. Here we report the case of a patient with steroid dependent focal segmental glomerulosclerosis (FSGS) nephrotic syndrome with a favourable response to a novel proteasome inhibitor saquinavir. Giles Walters, Faisal A. Choudhury, and Budhima Nanayakkara Copyright © 2015 Giles Walters et al. All rights reserved. Concomitant Persistent Left Superior Vena Cava and Horseshoe Kidney Tue, 13 Jan 2015 09:19:16 +0000 Persistent left superior vena cava (PLSVC) and horseshoe kidney (HSK) are common congenital abnormalities; however presence of both in the same person is extremely rare. A patient with hepatitis C cirrhosis awaiting transplant presented with worsening liver dysfunction, diagnosed with acute renal failure secondary to hepatorenal syndrome, and required X-ray fluoroscopy guided tunneled venous catheter placement for hemodialysis. Review of imaging studies demonstrated coexistence of PLSVC and HSK. PLSVC in adulthood is usually incidental with the most common drainage pattern being without physiologic dysfunction. Isolated horseshoe kidney is still the most common of renal fusion anomalies; however etiology of coexistent PLSVC remains unknown. Faraz Jaffer and Vijay Chandiramani Copyright © 2015 Faraz Jaffer and Vijay Chandiramani. All rights reserved. Chronic Renal Failure Presenting for the First Time as Pulmonary Mucormycosis with a Fatal Outcome Tue, 13 Jan 2015 06:28:48 +0000 Pulmonary mucormycosis is an uncommon, but important, opportunistic fungal pneumonia which is often diagnosed late. Renal failure as the predominant presenting feature is not common in mucormycosis. Moreover, sudden, massive hemoptysis is not a usual complication. In this report we describe fatal pulmonary mucormycosis in a young patient with a previously undiagnosed chronic renal failure. B. Jayakrishnan, Jamal Al Aghbari, Dawar Rizavi, Sinnakirouchenan Srinivasan, Ritu Lakhtakia, and Dawood Al Riyami Copyright © 2015 B. Jayakrishnan et al. All rights reserved. Spontaneous Forniceal Rupture in Pregnancy Sun, 11 Jan 2015 09:01:21 +0000 Forniceal rupture is a rare event in pregnancy. We report a case of a 26-year-old primigravid woman who experienced a forniceal rupture at 23 weeks of gestation with no inciting cause except for pregnancy. Pregnancy is associated with ureteral compression due to increase in pelvic vasculature with the right ureter more dilated due to anatomic reasons. Hormones such as prostaglandins and progesterone render the ureter more distensible to allow for pressure build-up and an obstructive picture at the collecting system. We will discuss physiologic changes in pregnancies that predispose to this uncommon phenomenon and the most up-to-date management strategies. Roshni Upputalla, Robert M. Moore, and Belinda Jim Copyright © 2015 Roshni Upputalla et al. All rights reserved. An Unusual Initial Presentation of Lupus Nephritis as a Renal Mass Thu, 08 Jan 2015 12:06:13 +0000 Lupus nephritis is a frequent manifestation of systemic lupus erythematous. Lupus nephritis usually presents with abnormal urinalysis, proteinuria, and/or renal insufficiency. We report a case of a 48-year-old woman who underwent partial nephrectomy for a fortuitously discovered solid enhancing left kidney mass. No neoplastic cells were found in the biopsy specimen; however, the pathology findings were compatible with immune complex glomerulonephritis with a predominantly membranous distribution, a pattern suggestive of lupus nephritis. The mass effect was apparently due to a dense interstitial lymphocytic infiltrate resulting in a pseudotumor. Further investigation revealed microscopic hematuria with a normal kidney function and no significant proteinuria. Antinuclear antibodies were negative, although anti-DNA and anti-SSA/Rho antibodies were positive. A diagnosis of probable silent lupus nephritis was made and the patient was followed up without immunosuppressive treatment. After two years of follow-up, she did not progress to overt disease. To our knowledge, this represents the first case of lupus nephritis with an initial presentation as a renal mass. Remi Goupil, Annie-Claire Nadeau-Fredette, Virginie Royal, Alexandre Dugas, and Jean-Philippe Lafrance Copyright © 2015 Remi Goupil et al. All rights reserved. A Case of Concurrent MPO-/PR3-Negative ANCA-Associated Glomerulonephritis and Membranous Glomerulopathy Thu, 08 Jan 2015 09:57:40 +0000 We report a case in which antineutrophil cytoplasmic antibody- (ANCA-) associated glomerulonephritis and membranous glomerulopathy (MGN) were detected concurrently. The patient showed rapidly progressive renal deterioration. A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes. Indirect immunofluorescence examination of the patient’s neutrophils showed a perinuclear pattern. Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome. The relationship between these two etiologically distinct entities, MPO-/PR3-negative ANCA-associated glomerulonephritis and MGN, remains unclear. Yasuyuki Nakada, Nobuo Tsuboi, Yasuto Takahashi, Hiraku Yoshida, Yoriko Hara, Hideo Okonogi, Tetsuya Kawamura, Yoshihiro Arimura, and Takashi Yokoo Copyright © 2015 Yasuyuki Nakada et al. All rights reserved. Acute Tubular Necrosis after Ingestion of a Fertilizer Containing Sodium Silicate Wed, 10 Dec 2014 00:10:35 +0000 Silica nephropathy occurs after chronic heavy exposure to silica, resulting in the development of chronic kidney disease and progression to end-stage renal disease. However, acute kidney injury due to silica exposure is rare and its renal pathology remains unclear. Here, we report a case of acute sodium silica poisoning presenting as acute kidney injury. A 42-year-old man ingested a fertilizer containing sodium silicate. His serum creatinine increased by 5.06 mg/dL from 1.1 mg/dL 2 days after silicate ingestion. Owing to the decline in kidney function despite fluid therapy, a kidney biopsy was performed. The kidney showed acute tubular necrosis without infiltration of inflammatory cells. On day 5 of admission, hemodialysis was initiated to treat the hyperkalemia and oliguria, and treatment with methylprednisolone was initiated for the acute lung injury. The patient was administered 1 mg/kg of methylprednisolone intravenously daily for 2 weeks, followed by a 2-week taper. Hemodialysis was discontinued on day 10 and the patient’s renal function recovered completely. However, he died on day 40 of hospitalization owing to complicated lung fibrosis and persistent pneumothorax/pneumomediastinum. Hyeon Woo Lee, Yong Jun Choi, Se Won Oh, Hye Kyeong Park, Kum Hyun Han, Han Seong Kim, and Sang Youb Han Copyright © 2014 Hyeon Woo Lee et al. All rights reserved. Ceftriaxone-Induced Acute Encephalopathy in a Peritoneal Dialysis Patient Sun, 07 Dec 2014 00:10:23 +0000 Encephalopathy is a rare side effect of third and fourth generation cephalosporins. Renal failure and preexisting neurological disease are notable risk factors. Recognition is important as discontinuing the offending agent usually resolves symptoms. We present a case of acute encephalopathy in a patient with end stage renal disease (ESRD) treated with peritoneal dialysis (PD) who received intravenous ceftriaxone for peritonitis. This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis. Sami Safadi, Michael Mao, and John J. Dillon Copyright © 2014 Sami Safadi et al. All rights reserved. Successful Treatment of Infectious Endocarditis Associated Glomerulonephritis Mimicking C3 Glomerulonephritis in a Case with No Previous Cardiac Disease Sun, 23 Nov 2014 08:23:40 +0000 We report a 42-year-old man with subacute infectious endocarditis (IE) with septic pulmonary embolism, presenting rapidly progressive glomerulonephritis and positive proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA). He had no previous history of heart disease. Renal histology revealed diffuse endocapillary proliferative glomerulonephritis with complement 3- (C3-) dominant staining and subendothelial electron dense deposit, mimicking C3 glomerulonephritis. Successful treatment of IE with valve plastic surgery gradually ameliorated hypocomplementemia and renal failure; thus C3 glomerulonephritis-like lesion in this case was classified as postinfectious glomerulonephritis. IE associated glomerulonephritis is relatively rare, especially in cases with no previous history of valvular disease of the heart like our case. This case also reemphasizes the broad differential diagnosis of renal involvement in IE. Yosuke Kawamorita, Yoshihide Fujigaki, Atsuko Imase, Shigeyuki Arai, Yoshifuru Tamura, Masayuki Tanemoto, Hiroshi Uozaki, Yutaka Yamaguchi, and Shunya Uchida Copyright © 2014 Yosuke Kawamorita et al. All rights reserved. ANCA Associated Vasculitis and Renal Failure Related to Propylthiouracil and Hyperthyroidism Induced Cholestasis in the Same Case Thu, 20 Nov 2014 09:41:05 +0000 Introduction. Liver involvement due to hyperthyroidism and also ANCA positive vasculitis related renal failure cases were reported separately several times before. However, to our knowledge, these two complications together in the same case had never been observed before. Case Presentation. The case of an ANCA positive 71-year-old Caucasian male with renal failure and lung involvement, subclinical hyperthyroidism, and intrahepatic cholestatic jaundice was presented in this paper. After exclusion of all of the other possibilities, cholestatic hepatitis was explained by subclinical hyperthyroidism; renal failure and lung involvement were interpreted as ANCA related vasculitis which might be a side effect of propylthiouracil use. Conclusion. The coexistence of these rare conditions in the same patient deserves emphasis and it is worth reporting. This case demonstrates that following the clinical course of the patient is essential after prescribing any medications to see whether any complication occurs or not. If the complications of this case were noticed earlier, it would be possible to treat and to prevent the permanent damages. Mehmet Tuncay, Emine Kivrakoglu, Itir Yegenaga, and Erkan Dervisoglu Copyright © 2014 Mehmet Tuncay et al. All rights reserved. Successfully Treated Calcific Uremic Arteriolopathy: Two Cases of a High Anion Gap Metabolic Acidosis with Intravenous Sodium Thiosulfate Wed, 19 Nov 2014 09:08:47 +0000 Calcific uremic arteriolopathy (CUA) is a rare and potentially fatal disorder of calcification involving subcutaneous small vessels and fat in patients with renal insufficiency. We describe the successful use of intravenous sodium thiosulfate (STS) for the treatment of CUA in two patients. The first case was complicated by the development of a severe anion gap metabolic acidosis, which was accompanied by a seizure. Both patients had complete wound healing within five months. Although STS should be considered in the treatment of CUA, little is known about pharmacokinetics and additional studies are required to determine dosing strategies to minimize severe potential side effects. Joshua L. Rein, Kana N. Miyata, Kobena A. Dadzie, Steven J. Gruber, Roxana Sulica, and James F. Winchester Copyright © 2014 Joshua L. Rein et al. All rights reserved. Postoperative Atypical Hemolytic Uremic Syndrome Associated with Complement C3 Mutation Sun, 09 Nov 2014 00:00:00 +0000 Atypical hemolytic uremic syndrome (aHUS) can be distinguished from typical or Shiga-like toxin-induced HUS. The clinical outcome is unfavorable; up to 50% of affected patients progress to end-stage renal failure and 25% die during the acute phase. Multiple conditions have been associated with aHUS, including infections, drugs, autoimmune conditions, transplantation, pregnancy, and metabolic conditions. aHUS in the nontransplant postsurgical period, however, is rare. An 8-month-old boy underwent surgical repair of tetralogy of Fallot. Neurological disturbances, acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia developed 25 days later, and aHUS was diagnosed. Further evaluation revealed that his complement factor H (CFH) level was normal and that anti-FH antibodies were not detected in his plasma. Sequencing of his CFH, complement factor I, membrane cofactor protein, complement factor B, and thrombomodulin genes was normal. His ADAMTS-13 (a disintegrin-like and metalloprotease with thrombospondin-1 repeats 13) activity was also normal. However, he had a potentially causative mutation (R425C) in complement component C3. Restriction fragment length polymorphism analysis revealed that his father and aunt also had this mutation; however, they had no symptoms of aHUS. We herein report a case of aHUS that developed after cardiovascular surgery and was caused by a complement C3 mutation. Eiji Matsukuma, Atsushi Imamura, Yusuke Iwata, Takamasa Takeuchi, Yoko Yoshida, Yoshihiro Fujimura, Xinping Fan, Toshiyuki Miyata, and Takashi Kuwahara Copyright © 2014 Eiji Matsukuma et al. All rights reserved. Microscopic Polyangiitis following Silicone Exposure from Breast Implantation Thu, 16 Oct 2014 14:11:29 +0000 We describe a case of a patient who developed microscopic polyangiitis (MPA) in the setting of exposure to silicone after breast implantation. A 57-year-old Hispanic woman was admitted to our hospital with complaints of fever, cough, and hemoptysis. She had undergone silicone breast implantation two years prior to presentation. She was diagnosed as having microscopic polyangiitis (MPA) based on acute progressive renal failure, hematuria, pulmonary hemorrhage, and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA). A renal biopsy performed showed focal segmental necrotizing and crescentic glomerulonephritis. The patient received high dose steroids, cyclophosphamide, and plasmapheresis with remarkable clinical response. This case report raises the possibility of the development of MPA after silicone exposure from breast implantation. Judy Tan, Fuad Spath, Rakesh Malhotra, Zaher Hamadeh, and Anjali Acharya Copyright © 2014 Judy Tan et al. All rights reserved. Hepatitis E Infection in a Renal Transplant Recipient Thu, 11 Sep 2014 06:45:54 +0000 An asymptomatic 35-year-old renal transplant recipient was noted to have deranged liver function tests. Liver biopsy revealed a portal inflammatory process with mild lobular activity and portal fibrous expansion, consistent with a virally mediated process. An extensive viral screen confirmed infection with Hepatitis E virus genotype 3 (HEV-3). There is increased awareness about locally acquired Hepatitis E virus (HEV) infection in the transplant population in the UK. The important implications of this infection are becoming more apparent as progression to liver cirrhosis can occur. However, the incidence, natural history, and treatment of HEV infection in the transplant population are not well established. This report illustrates a case of delayed spontaneous clearance of the HEV infection. Diana Vassallo, Mir Mubariz Husain, Shaun Greer, Stephen McGrath, Samreen Ijaz, and Durga Kanigicherla Copyright © 2014 Diana Vassallo et al. All rights reserved. Hydralazine Induces Myeloperoxidase and Proteinase 3 Anti-Neutrophil Cytoplasmic Antibody Vasculitis and Leads to Pulmonary Renal Syndrome Tue, 26 Aug 2014 00:00:00 +0000 We report a case of hydralazine-induced ANCA-associated glomerulonephritis with pulmonary hemorrhage. A 62-year-old Hispanic man with hypertension, who was being treated with hydralazine 100 mg three times a day for four and half years, presented to the hospital with severe anemia. He had acute kidney injury and urinalysis showed proteinuria, dysmorphic RBCs, and rare RBC cast. CT scan of the chest revealed bilateral pulmonary ground-glass infiltrates. Transbronchial biopsy was consistent with pulmonary hemorrhage. Serologic tests showed high titer PR3 ANCA and, to a lesser extent, MPO ANCA. Kidney biopsy revealed focal segmental necrotizing glomerulonephritis with crescents, without evidence of immune complex deposits. Hydralazine was discontinued and the patient was treated with corticosteroids and intravenous cyclophosphamide. At one-year follow-up, he had no symptoms and anemia had resolved. Kidney function improved dramatically. Serology showed undetectable PR3 ANCA and minimally elevated MPO ANCA. To our knowledge, hydralazine-associated PR3 ANCA has not been previously reported. The possibility of ANCA systemic vasculitis should be included in the differential diagnosis of any patient with hydralazine use and pulmonary renal syndrome. This is a potentially life threatening condition requiring prompt cessation of the drug and treatment with glucocorticoids and immunosuppression. Gaurav Agarwal, Ghayyath Sultan, Sherry L. Werner, and Claudia Hura Copyright © 2014 Gaurav Agarwal et al. All rights reserved. A Case of Chronic Ethylene Glycol Intoxication Presenting without Classic Metabolic Derangements Thu, 21 Aug 2014 08:37:11 +0000 Acute ethylene glycol ingestion classically presents with high anion gap acidosis, elevated osmolar gap, altered mental status, and acute renal failure. However, chronic ingestion of ethylene glycol is a challenging diagnosis that can present as acute kidney injury with subtle physical findings and without the classic metabolic derangements. We present a case of chronic ethylene glycol ingestion in a patient who presented with acute kidney injury and repeated denials of an exposure history. Kidney biopsy was critical to the elucidation of the cause of his worsening renal function. Stephanie M. Toth-Manikowski, Hanni Menn-Josephy, and Jasvinder Bhatia Copyright © 2014 Stephanie M. Toth-Manikowski et al. All rights reserved. Successful Antiviral Triple Therapy in a Longstanding Refractory Hepatitis C Virus Infection with an Acute Kidney Injury Thu, 14 Aug 2014 00:00:00 +0000 Introduction. The HCV infection is a common disease with many chronically infected patients worldwide. So far, the standard therapy of a chronic HCV infection consisted of interferon as single therapy or in combination with ribavirin. After approval of the two protease inhibitors, boceprevir and telaprevir, the standard therapy for patients with genotype 1 changed. In patients with acute kidney injury (AKI) these therapies are not approved and have so far not been evaluated in studies. Case Report. In April 2012, a 58-year-old female was admitted due to a cryoglobulin-positive chronic HCV infection which had been treated with interferon and ribavirin. Currently, the patient was admitted because of severe complications with an acute kidney injury. We treated our patient successfully with a boceprevir based triple therapy. Conclusion. Limited data suggests that a therapy with ribavirin in patients with AKI seems to be safe under close monitoring. Our patient was treated successfully with a protease inhibitor based triple therapy. Nevertheless, it is necessary to plan an interventional study to evaluate the exact risk-benefit profile of triple therapy regimens in patients with AKI and hepatitis C. David Callau Monje, Niko Braun, Joerg Latus, Kerstin Amann, Mark Dominik Alscher, and Martin Kimmel Copyright © 2014 David Callau Monje et al. All rights reserved. Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis Tue, 12 Aug 2014 12:56:34 +0000 Systemic reactive AA amyloidosis is a life-threatening complication of chronic inflammatory diseases. Anti-interleukin-6 receptor, tocilizumab (TCZ), has been shown to improve clinical symptoms of patients with AA amyloidosis, accompanied with regression of the amyloid deposition. We report a case of AA amyloidosis evaluated by histology of multiple organs before and after TCZ treatment. A woman in her 60s with rheumatoid arthritis was referred to our hospital because of cardiac and renal dysfunction. A gastric and renal biopsy revealed the deposition of AA amyloid, and echocardiography revealed concentric left ventricular hypertrophy. Her estimated glomerular filtration rate was decreased to 8.6 mL/min/1.73 m2, and B-type natriuretic peptide, C-reactive protein, and serum amyloid A protein were significantly elevated. TCZ treatments markedly decreased her serum amyloid A protein and C-reactive protein levels, but hemodialysis was required 1 year later. Endoscopic gastric rebiopsy 3 years after initiation of TCZ treatments revealed the regression of amyloid deposition and echocardiography revealed improvement of her left ventricular hypertrophy. However, a renal rebiopsy revealed that the amyloid deposition had not regressed. In conclusion, these observations suggest that the therapeutic effects of TCZ can vary among organs in patients with AA amyloidosis. Masaru Matsui, Satoshi Okayama, Hideo Tsushima, Kenichi Samejima, Tomoko Kanki, Ayako Hasegawa, Katsuhiko Morimoto, Yasuhiro Akai, Masato Takano, Shiro Uemura, Chiho Ohbayashi, and Yoshihiko Saito Copyright © 2014 Masaru Matsui et al. All rights reserved. Infection Related Glomerulonephritis Associated with Staphylococcus epidermidis in the Absence of Prosthetic Material Mon, 04 Aug 2014 00:00:00 +0000 We report a case of a 72-year-old diabetic male who developed infection-related glomerulonephritis (IRGN) in the setting of severe Staphylococcus epidermidis infection. He required renal replacement therapy for 6 weeks, but had full recovery of his kidney function with aggressive treatment of the infection. While this pathogen has been previously implicated as the cause of shunt nephritis, it is exceptionally rare to be associated with IRGN in the absence of a shunt or other prosthetic material. Samer Mohandes, Eshetu Obole, Anjali Satoskar, and Hari Polenakovik Copyright © 2014 Samer Mohandes et al. 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 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 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 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 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 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.