Clinical Nephrology. Case Studies最新文献

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Recovering from a renal vascular catastrophe: Case report. 从肾血管灾难恢复:病例报告。
Clinical Nephrology. Case Studies Pub Date : 2023-01-01 DOI: 10.5414/CNCS110984
Diogo Francisco, Gonçalo Pimenta, Ana Cristina Martins, Ivo Laranjinha, Hermínia Estibeiro, Célia Gil, Margarida Gonçalves, Maria Augusta Gaspar
{"title":"Recovering from a renal vascular catastrophe: Case report.","authors":"Diogo Francisco,&nbsp;Gonçalo Pimenta,&nbsp;Ana Cristina Martins,&nbsp;Ivo Laranjinha,&nbsp;Hermínia Estibeiro,&nbsp;Célia Gil,&nbsp;Margarida Gonçalves,&nbsp;Maria Augusta Gaspar","doi":"10.5414/CNCS110984","DOIUrl":"https://doi.org/10.5414/CNCS110984","url":null,"abstract":"<p><p>Renal artery thrombosis is a rare vascular event that precipitates renal infarction. Although in up to one third of cases the etiology is not identified, renal artery lesions, cardioembolism and acquired thrombophilias are the main causes. A bilateral simultaneous idiopathic renal artery thrombosis is an unlikely coincidence. We present two cases of patients with acute bilateral renal artery thrombosis of unknown etiology. Cardiac embolism, acquired thrombophilia and occult neoplasm workups were negative. Both cases were temporarily hemodialysis-dependent and partially recovered renal function under conservative approach with systemic anticoagulation. Recommendations on optimal treatment for renal artery thrombosis are still lacking. We discuss the available options.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":"11 ","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9990425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9079896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Vancomycin- and piperacillin-induced acute interstitial nephritis in a patient with lupus: A case report showcasing rapid decline in renal function. 万古霉素和哌拉西林诱导的狼疮患者急性间质性肾炎:一例报告显示肾功能迅速下降。
Clinical Nephrology. Case Studies Pub Date : 2023-01-01 DOI: 10.5414/CNCS111180
Oluwadamilola Adisa, Anil Ananthaneni, Bryce Rushing, Nathan Rinehouse, Phani Morisetti
{"title":"Vancomycin- and piperacillin-induced acute interstitial nephritis in a patient with lupus: A case report showcasing rapid decline in renal function.","authors":"Oluwadamilola Adisa,&nbsp;Anil Ananthaneni,&nbsp;Bryce Rushing,&nbsp;Nathan Rinehouse,&nbsp;Phani Morisetti","doi":"10.5414/CNCS111180","DOIUrl":"https://doi.org/10.5414/CNCS111180","url":null,"abstract":"<p><p>Drug-induced acute interstitial nephritis (AIN) presents as acute kidney injury (AKI) with the use of certain offending drugs. Antibiotics, such as β-lactams, trimethoprim-sulfamethoxazole, fluoroquinolones, and rifampin, account for up to 50% of drug-induced AIN cases. The onset of drug-induced AIN following drug exposure usually ranges from few days to several weeks or months. We present a patient with lupus who had rapid decline in renal function with a single dose of vancomycin and piperacillin-tazobactam (VPT) administration, termed as the \"workhorse\" regimen at many institutions. In addition, she did not exhibit many clinical and laboratory signs of AIN, making diagnosis challenging. Prompt kidney biopsy and early steroid therapy had a critical role in recovery of the patient's renal function. The median duration for renal impairment in vancomycin-induced AIN is 26 days. Onset of AKI is usually rapid from VPT, within 3 - 5 days of drug exposure. However, the severity of AKI is often low, in contrast to this patient whose AKI reached a stage 3 (AKIN/KDIGO) within 2 days from drug exposure. This study highlights the nephrotoxic potential of piperacillin, especially when used along with vancomycin, concurrent with recent evidence. Within rising antibiotic usage rates, is important to consider AIN in the differential diagnosis of rapidly declining AKI, especially with the combined use of VPT.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":"11 ","pages":"99-103"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9716990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Eculizumab discontinuation in a patient with atypical hemolytic uremic syndrome after ChAdOx1 nCoV-19 vaccination. 1例非典型溶血性尿毒症患者在接种ChAdOx1 nCoV-19疫苗后停用依珠单抗
Clinical Nephrology. Case Studies Pub Date : 2023-01-01 DOI: 10.5414/CNCS111070
Marisa Roldão, Francisco Ferrer, Karina Lopes
{"title":"Eculizumab discontinuation in a patient with atypical hemolytic uremic syndrome after ChAdOx1 nCoV-19 vaccination.","authors":"Marisa Roldão,&nbsp;Francisco Ferrer,&nbsp;Karina Lopes","doi":"10.5414/CNCS111070","DOIUrl":"https://doi.org/10.5414/CNCS111070","url":null,"abstract":"<p><p>Eculizumab has proven to be effective in patients with atypical hemolytic uremic syndrome (aHUS) in clinical trials and in the real world, but the optimal duration of therapy remains unknown. Standard maintenance treatment is often life-long, but the possibility of discontinuation has not yet been systematically tested. We describe a case of aHUS after ChAdOx1 nCoV-19 vaccination in a patient with homozygous <i>CFHR3/CFHR1</i> gene deletion who discontinued eculizumab maintenance therapy 24 weeks after achieving disease remission. We report the safety of discontinuing eculizumab treatment with the aim of minimizing the risk of adverse reactions, reducing the risk of meningitis, improving quality of life, and reducing the considerable treatment costs.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":"11 ","pages":"114-116"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9855579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Immunoglobulin A nephropathy associated with acute hepatitis E infection: First case report. 免疫球蛋白A肾病与急性戊型肝炎感染:第一例报告。
Clinical Nephrology. Case Studies Pub Date : 2023-01-01 DOI: 10.5414/CNCS111100
Sidra Shafiq Cheema, Manal Fatima Cheema, Samreen Gilani, Shafiqur Rehman Cheema
{"title":"Immunoglobulin A nephropathy associated with acute hepatitis E infection: First case report.","authors":"Sidra Shafiq Cheema,&nbsp;Manal Fatima Cheema,&nbsp;Samreen Gilani,&nbsp;Shafiqur Rehman Cheema","doi":"10.5414/CNCS111100","DOIUrl":"https://doi.org/10.5414/CNCS111100","url":null,"abstract":"<p><p>In this case report, we describe a young male patient who presented with gross hematuria and nephrotic syndrome a few weeks after serologically positive acute hepatitis E virus (HEV) infection. Histopathological examination of renal core biopsy revealed that the majority of the viable glomeruli had a predominantly mesangiopathic process characterized by mild to moderate diffuse increase in mesangial matrix and cellularity with segmental variation. Immunofluorescence microscopy depicted a strong (3+) granular mesangial and capillary loop staining for IgA, consistent with IgA nephropathy (IgAN). This pattern of mesangial and glomerular capillary loop staining of IgA is suggestive of secondary IgAN. Further research is required to explore the relationship between IgAN and acute HEV infection.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":"11 ","pages":"95-98"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9716991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Refractory seizures in a dialysis patient and a vitamin consigned to oblivion. 透析患者的顽固性癫痫发作和被遗忘的维生素。
Clinical Nephrology. Case Studies Pub Date : 2023-01-01 DOI: 10.5414/CNCS111140
Satish Haridasan, Rakesh Madhyastha, Muriel Ghosn, Fadi Hijazi, Baraa Abduljawad, Mohamed Ibrahim, Rajaish Madhwani
{"title":"Refractory seizures in a dialysis patient and a vitamin consigned to oblivion.","authors":"Satish Haridasan,&nbsp;Rakesh Madhyastha,&nbsp;Muriel Ghosn,&nbsp;Fadi Hijazi,&nbsp;Baraa Abduljawad,&nbsp;Mohamed Ibrahim,&nbsp;Rajaish Madhwani","doi":"10.5414/CNCS111140","DOIUrl":"https://doi.org/10.5414/CNCS111140","url":null,"abstract":"<p><p>Intradialytic breakthrough seizures refractory to multiple classes of antiepileptic medications are not common and can be due to many different reasons. Pyridoxine deficiency is an under-recognized cause of such seizures and frequently missed in clinical practice. Many factors specifically related to dialysis can lead to pyridoxine deficiency and in turn can contribute to refractory seizures. Herein, we report one of the very few cases of intradialytic breakthrough refractory seizures secondary to pyridoxine deficiency recognized in the literature.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":"11 ","pages":"132-135"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10609379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bilateral renal mucormycosis following COVID-19 infection: A therapeutic challenge. 感染 COVID-19 后的双侧肾脏粘液瘤病:治疗难题
Clinical Nephrology. Case Studies Pub Date : 2022-11-24 eCollection Date: 2022-01-01 DOI: 10.5414/CNCS110874
Rajasekaran Kishor Kumar, Rajeev A Annigeri, Ram Gopalakrishnan, Sunil S Kaveripattu, Nitesh Jain
{"title":"Bilateral renal mucormycosis following COVID-19 infection: A therapeutic challenge.","authors":"Rajasekaran Kishor Kumar, Rajeev A Annigeri, Ram Gopalakrishnan, Sunil S Kaveripattu, Nitesh Jain","doi":"10.5414/CNCS110874","DOIUrl":"10.5414/CNCS110874","url":null,"abstract":"<p><p>India witnessed an epidemic of mucormycosis during the second wave of the COVID-19 pandemic. Renal mucormycosis has been reported rarely, mostly from India, but only 2 cases have been reported following COVID-19 infection to date. We report a case of mucormycosis predominantly affecting kidneys in a young and previously healthy male following COVID-19 pneumonia, for which he had received corticosteroid, remdesivir, and tocilizumab. He presented with hematuria, progressive oliguria, and severe acute kidney injury (AKI) requiring dialysis. The diagnosis was made on kidney biopsy and contrast-enhanced CT (CECT) showed segmental and subsegmental renal artery pseudoaneurysms with distal occlusion of both kidneys. He underwent bilateral nephrectomy and received high-dose amphotericin (AMB) and posaconazole. He developed cardiac arrhythmia and pulmonary edema attributed to AMB-related cardiotoxicity after a cumulative ABM dose of 2,450 mg. This is the first case report describing the survival of a patient with bilateral renal mucormycosis following COVID-19 infection. Our case report highlights the importance of considering mucormycosis in a patient with post-COVID-19 AKI to make an early diagnosis and aggressive management comprising of surgical debridement and high-dose AMB to improve survival.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":" ","pages":"76-81"},"PeriodicalIF":0.0,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9707366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute kidney injury associated to sulfamethoxazole urine crystal: The importance of clinical suspicion. 磺胺甲恶唑尿晶所致急性肾损伤:临床怀疑的重要性。
Clinical Nephrology. Case Studies Pub Date : 2022-09-23 eCollection Date: 2022-01-01 DOI: 10.5414/CNCS110931
Rodrigo A Sepúlveda, Fiorella Anghileri, Juan Pablo Huidobro E, Rodrigo Julio, Eduardo Ávila, Cristián Figueroa
{"title":"Acute kidney injury associated to sulfamethoxazole urine crystal: The importance of clinical suspicion.","authors":"Rodrigo A Sepúlveda,&nbsp;Fiorella Anghileri,&nbsp;Juan Pablo Huidobro E,&nbsp;Rodrigo Julio,&nbsp;Eduardo Ávila,&nbsp;Cristián Figueroa","doi":"10.5414/CNCS110931","DOIUrl":"https://doi.org/10.5414/CNCS110931","url":null,"abstract":"<p><p>Management of acute kidney injury (AKI) associated with drug-induced crystal nephropathy can be difficult, and timely diagnosis is critical to resolve this condition. We present the case of a 55-year-old woman with history of systemic lupus erythematosus (SLE), who, after treatment with trimethoprim/sulfamethoxazole (TMP/SMX) for suspected <i>Pneumocystis jirovecii</i> pneumonia, developed severe AKI. Automated urinary sediment initially reported hematuria, leukocyturia and \"uric acid crystals\". She did not have allergic symptoms, clinical manifestations of active SLE nor hyperuricemia. AKI persisted despite volume expansion with crystalloids. Due to SMX exposure, it was suspected that \"uric acid crystals\" could be in reality \"SMX crystals\", and were a possible cause of crystal nephropathy. TMP/SMX was withheld and urinary alkalization was performed, with subsequent resolution of AKI. SMX urine crystals were posteriorly confirmed by Fourier transform infrared spectroscopy.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":" ","pages":"71-75"},"PeriodicalIF":0.0,"publicationDate":"2022-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40384568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
A patient with dialysis-dependent acute kidney injury due to hantavirus complicated with SARS-CoV-2 infection. 汉坦病毒合并SARS-CoV-2感染所致透析依赖性急性肾损伤1例
Clinical Nephrology. Case Studies Pub Date : 2022-08-04 eCollection Date: 2022-01-01 DOI: 10.5414/CNCS110846
Virginia Geladari, Pantelis A Sarafidis, Maria-Eleni Alexandrou, Danai Faitatzidou, Christina Nikolaidou, Maria Stangou, Aikaterini Papagianni
{"title":"A patient with dialysis-dependent acute kidney injury due to hantavirus complicated with SARS-CoV-2 infection.","authors":"Virginia Geladari,&nbsp;Pantelis A Sarafidis,&nbsp;Maria-Eleni Alexandrou,&nbsp;Danai Faitatzidou,&nbsp;Christina Nikolaidou,&nbsp;Maria Stangou,&nbsp;Aikaterini Papagianni","doi":"10.5414/CNCS110846","DOIUrl":"https://doi.org/10.5414/CNCS110846","url":null,"abstract":"<p><p>In this case, we report a 64-year-old man presenting with anorexia, nausea and vomiting, mild abdominal pain, and oligoanuria for a few hours. His previous medical history included diabetes, hypertension, and chronic kidney disease (CKD) stage 3. Upon arrival, laboratory results revealed stage III acute kidney injury (AKI) with hyperkalemia requiring dialysis treatment. During hospitalization, both pre-renal and post-renal causes of AKI were excluded, and a careful diagnostic evaluation, including kidney biopsy and serology testing, revealed acute interstitial nephritis and positive IgM for hantavirus. The patient was started on steroid treatment, which led to complete recovery of kidney function over 3 months. Moreover, during his hospitalization, the patient was also diagnosed with SARS-CoV-2 infection, possibly due to intra-hospital transmission and was hospitalized at the COVID-19 Department for 14 days, eventually with no further complications. Hantavirus nephropathy should be at the differential diagnosis of AKI, even in the absence of typical symptoms. Steroid treatment may be helpful in reversal of kidney injury.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":" ","pages":"64-70"},"PeriodicalIF":0.0,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40601499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Minimal change disease and COVID-19 vaccination: Four cases and review of literature. 微小变化病与COVID-19疫苗接种:4例及文献综述。
Clinical Nephrology. Case Studies Pub Date : 2022-07-21 eCollection Date: 2022-01-01 DOI: 10.5414/CNCS110924
Preeti Chandra, Marisa Roldao, Cinthia Drachenberg, Paulo Santos, Naoki Washida, Alexander Clark, Bipin Bista, Ryunosuke Mitsuna, Angelito Yango
{"title":"Minimal change disease and COVID-19 vaccination: Four cases and review of literature.","authors":"Preeti Chandra,&nbsp;Marisa Roldao,&nbsp;Cinthia Drachenberg,&nbsp;Paulo Santos,&nbsp;Naoki Washida,&nbsp;Alexander Clark,&nbsp;Bipin Bista,&nbsp;Ryunosuke Mitsuna,&nbsp;Angelito Yango","doi":"10.5414/CNCS110924","DOIUrl":"https://doi.org/10.5414/CNCS110924","url":null,"abstract":"<p><p>There have been multiple reports of the development of de novo or relapse of glomerular diseases after SARS-CoV-2 vaccination. While most of them have occurred with the mRNA vaccines (Pfizer/BioNTech and Moderna/NIAID), there also have been reports associated with the vector vaccines (AstraZeneca/ChAdOx1-S) vaccine and the inactivated vaccines. Minimal change disease (MCD) is one of the more common glomerular diseases noted to have been associated with the COVID-19 vaccination. We report here 4 more cases of MCD occurring in association with the COVID-19 vaccine, 3 were de novo cases, and 1 case had a relapse of MCD. We also review all the 41 cases described thus far in the literature and review potential common pathways activated by the vaccination that play a role in the pathogenesis of MCD.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":" ","pages":"54-63"},"PeriodicalIF":0.0,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9316439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40668185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Concurrent presentation of IgG4-related tubulointerstitial nephritis and ANCA MPO crescentic glomerulonephritis. 同时出现igg4相关的小管间质性肾炎和ANCA MPO月牙状肾小球肾炎。
Clinical Nephrology. Case Studies Pub Date : 2022-07-04 eCollection Date: 2022-01-01 DOI: 10.5414/CNCS110852
Henry H L Wu, Claire C Y Wang, Alexander Woywodt, Arvind Ponnusamy
{"title":"Concurrent presentation of IgG4-related tubulointerstitial nephritis and ANCA MPO crescentic glomerulonephritis.","authors":"Henry H L Wu,&nbsp;Claire C Y Wang,&nbsp;Alexander Woywodt,&nbsp;Arvind Ponnusamy","doi":"10.5414/CNCS110852","DOIUrl":"https://doi.org/10.5414/CNCS110852","url":null,"abstract":"<p><p>Concurrent IgG4-related tubulointerstitial nephritis and anti-neutrophil cytoplasmic antibodies (ANCA) myeloperoxidase (MPO) crescentic glomerulonephritis is an uncommon scenario, and the link between the two conditions, if any, is incompletely understood. We report the case of a 58-year-old woman who presented with a 2-month history of malaise and joint pain and was found to have acute kidney injury and hemato-proteinuria. Initial immunological tests revealed positive anti-neutrophil cytoplasmic antibodies with a peri-nuclear pattern (pANCA). An enzyme-linked immunoassay (ELISA) for anti-MPO antibodies was also positive, leading to a tentative diagnosis of ANCA-associated small vessel vasculitis with renal involvement. Steroid treatment was commenced, and an urgent kidney biopsy was performed. This showed crescentic glomerulonephritis, but also demonstrated concurrent tubulointerstitial nephritis with a dominance of IgG4-producing plasma cells. Serum IgG4 levels were also elevated. The patient was initially treated with intravenous cyclophosphamide and steroids and then switched to rituximab. When last seen, she was well after 1 dose of rituximab, with kidney function, inflammatory parameters, and serum IgG4 levels returning to normal levels. The concurrent presentation of ANCA-associated vasculitis and IgG4 renal disease is rare with only few cases reported in the literature. More work is needed to understand pathophysiology, outcomes, and management options for this complex scenario.</p>","PeriodicalId":10398,"journal":{"name":"Clinical Nephrology. Case Studies","volume":" ","pages":"47-53"},"PeriodicalIF":0.0,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40592849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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