Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated C-reactive protein, but creatine kinase is often normal. Diagnosis can be made on clinical presentation and imaging, with magnetic resonance imaging as the gold standard. Histology is often not contributive. Treatment consists of rest, analgesics, rigorous glycemic control and low-dose aspirin. Severe cases of compartment syndrome require fasciotomy. In the current paper, we present two diabetic patients with cystic fibrosis, who are treated with automated peritoneal dialysis and suffered from episodic lower limb infarction. We subsequently review 48 episodes of diabetic muscle infarction previously reported in the literature in patients with end-stage renal disease.

G. De Vlieger

B. Bammens

F. Claus

R. Vos

K. Claes

Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150&#x2009;mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy.

U. E. Ekrikpo

E. E. Effa

E. E. Akpan

Ectopic Thoracic Kidney and End-Stage Renal Disease in a 38-Year-Old Nigerian

Lithium toxicity is known to affect multiple organ systems, including the central nervous system. Lithium levels have been used in the diagnosis of toxicity and in assessing response to management. There is evidence that nonsteroidal anti-inflammatory medications (NSAIDs) can increase lithium levels and decrease renal lithium clearance. We present a case of lithium toxicity, which demonstrates this effect and also highlights the fact that lithium levels do not correlate with clinical improvement, especially the neurological deficit.

Syed Hassan

Fatima Khalid

Zaid Alirhayim

Syed Amer

Lithium Toxicity in the Setting of Nonsteroidal Anti-Inflammatory Medications

Nonhematologic malignancies are rarely reported to be associated with AA amyloidosis. Although the association between renal cell carcinoma and systemic AA amyloidosis has been established, the evidence linking pulmonary cancer to AA amyloidosis is scarce. Here, a case of biopsy-proven renal AA amyloidosis complicated with nephrotic syndrome associated with lung carcinoma is reported.

Victor Gueutin

Anne-Lyse Langlois

Nathalie Shehwaro

Ryme Elharraqui

Philippe Rouvier

Hassane Izzedine

Nephrotic Syndrome Associated with Lung Cancer: A Rare Case of Malignancy Associated with AA Amyloidosis

Multiple myeloma (MM) is an uncommon hematologic malignancy accounting for 1&#x25; of all malignancies. Renal involvement is a common complication of MM. Rapid intervention to reverse renal dysfunction may be critical for management, especially in patients with light chain cast nephropathy. Recovery rate ranges from 5&#x25; to 15&#x25;. We describe an atypical presentation of MM in a young patient who presented with severe renal insufficiency requiring renal replacement therapy and achieved complete renal recovery with chemotherapy.

Hasan J. Salameh

Adeel Ahmad

Tina Kochar

A Rare Case of Renal Recovery in a Young Patient with Multiple Myeloma

Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.

Pedro Azevedo

Cristina Freitas

Hugo Silva

Pedro Aguiar

Pedro Farrajota

Manuela Almeida

Sofia Pedroso

La Salete Martins

Leon&#xed;dio Dias

Jos&#xe9; Ram&#xf3;n Vizca&#xed;no

Ant&#xf3;nio Castro Henriques

Ant&#xf3;nio Cabrita

A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

Atypical hemolytic-uremic syndrome (aHUS), unlike typical HUS, is not due to bacteria but rather to an idiopathic or genetic cause that promotes dysregulation of the alternative complement pathway. It leads to hemolytic anemia, thrombocytopenia, and renal impairment. Although aHUS secondary to a genetic mutation is relatively rare, when occurring due to a mutation in Factor H (CFH), it usually presents with younger onset and has a more severe course, which in the majority ends with end-stage renal failure. Paradoxically to most available data, our case features acute aHUS due to a CFH mutation with late onset (38-year-old) and rapid progression to end-stage renal disease. Due to current data indicating a high risk of graft failure in such patients, the diagnosis of aHUS secondary to a genetic cause has disqualified our patient from a living (family) donor renal transplantation and left her with no other option but to begin permanent renal replacement therapy.

Bartlomiej Posnik

Dorota Sikorska

Krzysztof Hoppe

Krzysztof Schwermer

Krzysztof Pawlaczyk

Andrzej Oko

Acute Progression of Adult-Onset Atypical Hemolytic-Uremic Syndrome due to CFH Mutation: A Case Report

We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR.

J. Ram&#xed;rez

I. C. Bostock

A. Martin-Onra&#xeb;t

S. Calleja

A. S&#xe1;nchez-Cedillo


							L. A. Navarro-Vargas

A. L. Noriega-Salas

O. Mart&#xed;nez-Mijangos

N. O. Uribe-Uribe


							M. Vilatoba

B. Gabilondo

L. E. Morales-Buenrostro

J. Alber&#xfa;

Fever, Haematuria, and Acute Graft Dysfunction in Renal Transplant Recipients Secondary to Adenovirus Infection: Two Case Reports

A 74-year-old man was hospitalized for diabetic nephropathy evaluation and assessment of the effect of treatment on his tubulointerstitial nephritis (TIN). When he was 62 years old, he developed polyarthralgia and had superficial lymph node swelling, mildly increased serum creatinine concentration, hypergammaglobulinemia, hypocomplementemia, high serum IL-2R level, and positive titer of antinuclear antibody. Several tissues were biopsied. Mild chronic sialadenitis and reactive lymphadenitis were identified. Renal specimen showed mild glomerular ischemia, extensive storiform fibrosis, and abundant infiltrating monocytes and plasma cells. He was treated with oral prednisolone and cyclophosphamide. After the treatment, most of his clinical parameters quickly returned to within the reference range. However, he developed diabetes mellitus soon after steroid therapy. At the time of rebiopsy, a high level of serum IgG4 was detected. The second renal biopsy showed diabetic nephropathy without any tubulointerstitial damage. The first biopsied tissues were retrospectively investigated. Large numbers of IgG4-positive plasma cells were detected in the kidneys and lymph nodes. A retrospective diagnosis of IgG4-related TIN with lymph node involvement was made. In conclusion, this paper describes a retrospectively diagnosed case of IgG4-related TIN with lymph node involvement, showing good clinical and pathological prognosis.

Qiong Wu

Raima Nakazawa

Hisae Tanaka

Masayuki Endoh

Masafumi Fukagawa

A Retrospectively Diagnosed Case of IgG4-Related Tubulointerstitial Nephritis Showing Good Renal Outcome and Pathological Progress

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Case Reports in Nephrology publishes case reports and case series focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders, including cancer. The journal also focuses on advances in transplantation techniques.

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Case Reports in Nephrology - Table of contents 2013

title

Case Reports in Nephrology publishes case reports and case series focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders, including cancer. The journal also focuses on advances in transplantation techniques.

Case Reports in Nephrology