Case Reports in Nephrology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis Sun, 02 Aug 2015 13:35:49 +0000 Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location. Nikos Sabanis, Eleni Paschou, Eleni Gavriilaki, Maria Mourounoglou, and Sotirios Vasileiou Copyright © 2015 Nikos Sabanis et al. All rights reserved. Crossed Renal Ectopia without Fusion: An Uncommon Cause of Abdominal Mass Tue, 28 Jul 2015 09:39:32 +0000 Crossed renal ectopia is a rare congenital anomaly usually associated with fused kidneys (90%). Most cases are asymptomatic and remain undiagnosed. We report an unusual case of nonfused crossed renal ectopia. The 11-year-old adolescent female patient was admitted with abdominal pain, anorexia, weight loss, and periumbilical mass. Although the initial clinical suspicion was a tumoral lesion, abdominal ultrasound and magnetic resonance examination revealed crossed renal ectopia without fusion. The renal ectopy was incidentally diagnosed, as described in 20 to 30% of cases. In this case, the associated nonspecific symptoms were a coincidence. Ana Ratola, Maria Miguel Almiro, Rita Lacerda Vidal, Nuno Neves, Adelaide Bicho, and Sofia Figueiredo Copyright © 2015 Ana Ratola et al. All rights reserved. Levamisole/Cocaine Induced Systemic Vasculitis and Immune Complex Glomerulonephritis Tue, 28 Jul 2015 08:52:25 +0000 Levamisole is an antihelminthic and immunomodulator medication that was banned by the USFDA in 1998. It has been increasingly used to adulterate cocaine due to its psychotropic effects and morphological properties. Adverse reactions including cutaneous vasculitis, thrombocytopenia, and agranulocytosis have been well described. Despite systemic vasculitis in this setting, renal involvement is uncommon. We report here a case of ANCA positive systemic vasculitis with biopsy proven immune complex mediated glomerulonephritis likely secondary to levamisole/cocaine. A 40-year-old Caucasian male with no past medical history presented with 3-week history of fatigue, skin rash, joint pains, painful oral lesions, oliguria, hematuria, worsening dyspnea on exertion, and progressive lower extremity edema. He had a history of regular tobacco and cocaine use. Lab testing revealed severe anemia, marked azotemia, deranged electrolytes, and 4.7 gm proteinuria. Rheumatologic testing revealed hypocomplementemia, borderline ANA, myeloperoxidase antibody, and positive atypical p-ANCA. Infectious and other autoimmune workup was negative. Kidney biopsy was consistent with immune mediated glomerulonephritis and showed mesangial proliferation and immune complex deposition consisting of IgG, IgM, and complement. High dose corticosteroids and discontinuing cocaine use resulted in marked improvement in rash, mucocutaneous lesions, and arthritis. There was no renal recovery and he remained hemodialysis dependent. Lohit Garg, Sagar Gupta, Abhishek Swami, and Ping Zhang Copyright © 2015 Lohit Garg et al. All rights reserved. Pulmonary Limited MPO-ANCA Microscopic Polyangiitis and Idiopathic Lung Fibrosis in a Patient with a Diagnosis of IgA Nephropathy Wed, 22 Jul 2015 12:24:33 +0000 We present a case of a male patient with chronic renal insufficiency, due to crescentic glomerulonephritis with IgA deposits, who successively developed (idiopathic) thrombocytopenic purpura (ITP) and MPO-ANCA microscopic polyangiitis (MPA) with pulmonary fibrosis. The patient presented with cough, weight loss, and dyspnea on exertion. CT imaging and pulmonary function tests were compatible with interstitial pneumonitis with pulmonary fibrosis. Laboratory results showed high MPO-ANCA titers; the urinary sediment was bland. The patient was treated successfully with cyclophosphamide and methyl-prednisolone. This unique case illustrates the diagnostic and therapeutic challenges of an unusual presentation of microscopic polyangiitis presenting first as isolated kidney disease with recurrence in the form of pneumonitis without renal involvement, in association with renal IgA deposits and ITP as coexisting autoimmune conditions. Alwin Tilanus, Patricia Van der Niepen, Caroline Geers, and Karl Martin Wissing Copyright © 2015 Alwin Tilanus et al. All rights reserved. Homozygosity for the E526V Mutation in Fibrinogen A Alpha-Chain Amyloidosis: The First Report Tue, 23 Jun 2015 09:44:34 +0000 Systemic hereditary amyloidoses are autosomal dominant diseases associated with mutations in genes encoding ten different proteins. The clinical phenotype has implications on therapeutic approach, but it is commonly variable and largely dependent on the type of mutation. Except for rare cases involving gelsolin or transthyretin, patients are heterozygous for the amyloidogenic variants. Here we describe the first patient identified worldwide as homozygous for a nephropathic amyloidosis, involving the fibrinogen variant associated with the fibrinogen alpha-chain E526V (p.Glu545Val) mutation. In 1989, a 44-year-old woman presented with hypertension, hepatosplenomegaly, nephrotic syndrome, and renal failure. She started hemodialysis in 1990 and 6 years later underwent isolated kidney transplantation from a deceased donor. Graft function and clinical status were unremarkable for 16 years, despite progressively increased left ventricular mass on echocardiography. In 2012, 4 months before death, she deteriorated rapidly with severe heart failure, precipitated by Clostridium difficile colitis and urosepsis. Affected family members developed nephropathy, on average, nearly three decades later, which may be explained by the gene dosage effects on the phenotype of E526V (p.Glu545Val) fibrinogen A alpha-chain amyloidosis. Isabel Tavares, Luísa Lobato, Carlos Matos, Josefina Santos, Paul Moreira, Maria João Saraiva, and António Castro Henriques Copyright © 2015 Isabel Tavares et al. All rights reserved. Solitary Crossed Renal Ectopia: Concurrence of Posterior Urethral Valve and Hypospadias Thu, 18 Jun 2015 11:49:28 +0000 Solitary crossed renal ectopia (SCRE) represents an exceedingly rare congenital disorder. Although skeletal and genitourinary abnormalities most commonly accompany this condition, vesicoureteral reflux (VUR) has been described in only a few cases. Here, we present two unique cases of SCRE complicated by high-grade VUR concomitant with posterior urethral valve in one case and hypospadias in the other one. We also provide a brief review of the literature on this subject. Amin Bagheri, Reza Khorramirouz, Sorena Keihani, Mehdi Fareghi, and Abdol-Mohammad Kajbafzadeh Copyright © 2015 Amin Bagheri et al. All rights reserved. Nonsecretory Multiple Myeloma and AL Amyloidosis Presenting with Nephrotic Range Proteinuria Thu, 21 May 2015 16:03:24 +0000 Nonsecretory multiple myeloma (NSMM) is the absence of a detectable monoclonal protein in serum and urine of a multiple myeloma (MM) patient and immunoglobulin light chain (AL) amyloidosis is a significantly rare complication. A case of NSMM with AL amyloidosis and nephrotic range proteinuria is presented. Sharing clinical, therapeutic, and prognostic characteristics with MM, real challenge may be during initial diagnosis of NSMM and assessment of treatment response. In elderly patients with unexplained renal dysfunction, MM should be in the differential diagnosis and the absence of a monoclonal protein should not rule out MM but should remind us of the possibility of NSMM. Ozlem Beyler Kilic, Ali Kemal Oguz, Ihsan Ergun, Dilek Ertoy Baydar, and Meltem Ayli Copyright © 2015 Ozlem Beyler Kilic et al. All rights reserved. Copious Podocyturia without Proteinuria and with Normal Renal Function in a Young Adult with Fabry Disease Tue, 12 May 2015 06:23:12 +0000 The time for starting a patient with Fabry disease on enzyme replacement therapy is still a matter of debate, particularly when no overt classical clinical signs or symptoms are present. With respect to Fabry nephropathy, a dual problem coexists: the reluctance of many nephrologists to start enzyme replacement infusion until signs of renal disease appear as the appearance of proteinuria or an elevation in serum creatinine and the lack of validated biomarkers of early renal damage. In this regard, proteinuria is nowadays considered as an early and appropriate marker of kidney disease and of cardiovascular morbidity and mortality. However, in this report we demonstrate that podocyturia antedates the classical appearance of proteinuria and could be considered as an even earlier biomarker of kidney damage. Podocyturia may be a novel indication for the initiation of therapy in Fabry disease. H. Trimarchi, R. Canzonieri, A. Muryan, A. Schiel, A. Araoz, M. Forrester, A. Karl, F. Lombi, J. Andrews, V. Pomeranz, T. Rengel, and E. Zotta Copyright © 2015 H. Trimarchi et al. All rights reserved. The Rarest of the Rare: Crossed Fused Renal Ectopia of the Superior Ectopia Type Wed, 29 Apr 2015 13:54:39 +0000 Crossed fused renal ectopia is a rare congenital anomaly of the urinary system where one kidney crosses over to opposite side and the parenchyma of the two kidneys fuse. Herein, we present an atypical CFRE case whose renal anatomy does not exactly match any of the already defined CFRE types. Both of the kidneys are ectopic with the crossed ectopic right kidney lying superiorly and fused to the upper pole of the left kidney. Renal arteries were originating from the common iliac arteries. A focal 90% stenosis was observed on the right main renal artery. The patient is borderline hypertensive. Leyla Akdogan, Ali Kemal Oguz, Tarkan Ergun, and Ihsan Ergun Copyright © 2015 Leyla Akdogan et al. All rights reserved. A Case of Newly Diagnosed Klippel Trenaunay Weber Syndrome Presenting with Nephrotic Syndrome Mon, 27 Apr 2015 08:14:50 +0000 Klippel Trenaunay Weber syndrome (KTWS) is a rare disease characterized by hemihypertrophy, variceal enlargement of the veins, and arteriovenous (AV) malformations. Renal involvement in KTWS is not known except in rare case reports. Herein, we present a case of KTWS with nephrotic syndrome. A 52-year-old male was admitted due to dyspnea and swelling of the body for the last three months. The pathological physical findings were diffuse edema, decreased lung sounds at the right basal site, increased diameter and decreased length of the left leg compared with the right one, diffuse variceal enlargements, and a few hemangiomatous lesions on the left leg. The pathological laboratory findings were hypoalbuminemia, hyperlipidemia, increased creatinine level (1.23 mg/dL), and proteinuria (7.6 g/day). Radiographic pathological findings were cystic lesions in the liver, spleen, and kidneys, splenomegaly, AV malformation on the left posterolateral thigh, and hypertrophy of the soft tissues of the proximal left leg. He was diagnosed to have KTWS with these findings. Renal biopsy was performed to determine the cause of nephrotic syndrome. The pathologic examination was consistent with focal segmental sclerosis (FSGS). He was started on oral methylprednisolone at the dosage of 1 mg/kg and began to be followedup in the nephrology outpatient clinic. Egemen Cebeci, Secil Demir, Meltem Gursu, Abdullah Sumnu, Mehmet Yamak, Barıs Doner, Serhat Karadag, Sami Uzun, Ahmet Behlul, Oktay Ozkan, and Savas Ozturk Copyright © 2015 Egemen Cebeci et al. All rights reserved. Donor-Derived Myeloid Sarcoma in Two Kidney Transplant Recipients from a Single Donor Tue, 21 Apr 2015 13:00:52 +0000 We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescence in situ hybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement. Amudha Palanisamy, Paul Persad, Patrick P. Koty, Laurie L. Douglas, Robert J. Stratta, Jeffrey Rogers, Amber M. Reeves-Daniel, Giuseppe Orlando, Alan C. Farney, Michael W. Beaty, Mark J. Pettenati, Samy S. Iskandar, David D. Grier, Scott A. Kaczmorski, William H. Doares, Michael D. Gautreaux, Barry I. Freedman, and Bayard L. Powell Copyright © 2015 Amudha Palanisamy et al. All rights reserved. Two Brothers with Bardet-Biedl Syndrome Presenting with Chronic Renal Failure Wed, 15 Apr 2015 12:57:12 +0000 Bardet-Biedl Syndrome (BBS) is a rarely seen autosomal recessive transfer disease characterised by retinal dystrophy, obesity, extremity deformities, mental retardation, and renal and genital system anomalies. BBS shows heterogenic transfer. To date, 18 genes (BBS1–18) and 7 BBS proteins have been defined as related to BBS. All of the defined BBS genes have been shown to be related to the biogenesis or function of cilia. Renal failure accompanying the syndrome, especially in the advanced stages, is the most common cause of mortality. Therefore, as one of the major diagnostic criteria, renal damage is of great importance in early diagnosis. This paper presents the cases of two brothers with BBS who presented with chronic renal failure. Cem Sahin, Bulent Huddam, Gulhan Akbaba, Hasan Tunca, Emine Koca, and Mustafa Levent Copyright © 2015 Cem Sahin et al. All rights reserved. Neonatal Urinary Ascites: A Report of Three Cases Tue, 14 Apr 2015 14:33:12 +0000 Urinary ascites in neonates is not a common condition. Three cases of urinary ascites are presented and each of them has a different aetiology. Neonates with urinary ascites usually present as clinical emergency, requiring resuscitation, ventilator support, and subsequent drainage of urine. The ultimate management depends on the site of extravasation and the underlying cause. Adaobi Solarin, Priya Gajjar, and Peter Nourse Copyright © 2015 Adaobi Solarin et al. 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.