Clinical nephrology. Case studies最新文献

{"title":"Acute kidney injury and nephrotic syndrome caused by a \"magic pill\".","authors":"Yangming Cao, Thao Phan, Patil Armenian, Jonathan E Zuckerman","doi":"10.5414/CNCS111804","DOIUrl":"10.5414/CNCS111804","url":null,"abstract":"<p><strong>Introduction: </strong>The sudden onset of nephrotic syndrome (NS) and acute interstitial nephritis (AIN) seems to be an uncommon but distinct nonsteroidal anti-inflammatory drug (NSAID)-related renal syndrome.</p><p><strong>Case presentation: </strong>We present such a case in a patient who took a \"magic pill\" for gout. Renal biopsy revealed minimal change disease (MCD), acute interstitial nephritis (AIN), severe acute tubular injury (ATI), and IgA nephropathy (IgAN). He was treated with an aborted course of high-dose prednisone, with complete resolution of his renal diseases. The pathologic finding of the combination of MCD and AIN raised the possibility of a drug effect. One of the pills was analyzed and found to be primarily composed of diclofenac. Initially, we considered IgAN a bystander, considering primary IgAN is the most common glomerulonephritis worldwide, especially in Asians and Hispanics. However, the complete resolution of urinary findings after discontinuation of the pill followed by a few days' treatment with prednisone, together with no recurrence of the kidney disease over 6 years, made us speculate that IgAN may have also been triggered by diclofenac.</p><p><strong>Conclusion: </strong>We presented a case of AIN, MCD, and IgAN associated with diclofenac masquerading as a \"herbal\" medicine. The cause was suggested by pathology and confirmed with high-resolution liquid chromatography mass spectrometry testing of the pills. A history of NSAID use should be diligently sought in any patient who presents with NS and AIN. In addition, this is the first report of IgAN possibly induced by NSAID without recurrence after 6 years' follow-up.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115933","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}

{"title":"Secukinumab effectively manages ankylosing spondylitis in a hemodialysis patient without side effects.","authors":"Zewen Zhao, Yuhe Yin, Xiaoying Dong, Qingqing Gao, Haowen Lin, Siqi Peng, Yiming Tao, Sichun Wen, Bohou Li, Qiong Wu, Renwei Huang, Sijia Li, Ting Lin, Hao Dai, Zhuo Li, Lixia Xu, Jianchao Ma, Feng Wen, Zhonglin Feng, Shuangxin Liu, Yanhai Cui","doi":"10.5414/CNCS111717","DOIUrl":"10.5414/CNCS111717","url":null,"abstract":"<p><strong>Introduction: </strong>Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disease that primarily affects the spine and sacroiliac joints. In recent years, biologic agents have gained increasing popularity in the treatment of AS due to their high targeting specificity and favorable side effect profiles. Among these, secukinumab has emerged as an effective treatment option. However, the safety and efficacy of secukinumab in patients undergoing hemodialysis has not yet been thoroughly verified.</p><p><strong>Case report: </strong>Here, we report the successful treatment of AS with secukinumab in a 36-year-old male patient undergoing hemodialysis. The patient presented with recurrent lumbosacral pain and tested positive for HLA-B27. After treatment, significant improvements were observed in both the imaging characteristics of the synovial joints and the patient's symptoms.</p><p><strong>Conclusion: </strong>This case suggests that secukinumab may have a positive effect on AS in patients on hemodialysis, without apparent adverse effects.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"53-58"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115990","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}

{"title":"Karyomegalic interstitial nephritis: A case series and review of the literature on genetic insights and clinical challenges.","authors":"Seyda Gul Ozcan, Durdane Yagmur Ersoy, Ali Osman Polat, Iclal Gurses, Aysel Kalaycı Yigin, Sinan Trabulus, Nurhan Seyahi","doi":"10.5414/CNCS111727","DOIUrl":"10.5414/CNCS111727","url":null,"abstract":"<p><p>Karyomegalic interstitial nephritis (KIN) is a rare hereditary form of chronic interstitial nephritis that was first described over 50 years ago. It is characterized by karyomegalic tubular epithelial cells and progressive chronic kidney disease, often leading to end-stage renal disease by the fifth decade of life. Recent studies have identified FAN1 mutations as a key genetic contributor, with additional associations to environmental factors and toxic exposures, such as ochratoxin A, alkylating agents, and heavy metals, which may act as potential triggers of the disease. We present a detailed analysis of KIN cases, highlighting genetic diversity, clinical manifestations, and management challenges, complemented by a comprehensive review of the literature.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"41-52"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12172184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319138","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}

{"title":"2,8-dihyroxyadenine (DHA) crystalline nephropathy: A case report.","authors":"Jawad Iqbal Rather, Mukaresh Fatima, Muzafar Maqsood Wani, Imran Khan, Muzamil Ahmad Wani, Amir Farooq","doi":"10.5414/CNCS111590","DOIUrl":"10.5414/CNCS111590","url":null,"abstract":"<p><p>Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal disorder with extremely variable presentation. The disease spectrum ranges from completely asymptomatic to 2,8-dihydroxyadenine (DHA) stones to massive deposition of DHA crystals leading to DHA crystalline nephropathy. We report a case of a 45-year-old woman who presented with acute kidney injury and recurrent vomiting. Kidney biopsy revealed precipitation of brown crystals in tubular lumina with acute tubular injury with characteristic birefringence on polarizing light, confirming the unexpected diagnosis of DHA crystalline nephropathy. She was started on a xanthine oxidase inhibitor which resulted in an improvement of kidney function. This case highlights the fact that APRT deficiency can have varied presentations and is an important hereditary cause of crystalline nephropathy.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782219","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}

{"title":"Atypical presentation of H1N1-induced thrombotic microangiopathy with CD46 gene mutation\u2029.","authors":"Aman Pal, Emmanuel Aydin-Ghormoz, Swati Mehta, M J Hajianpour, Emily Gaine, Muhammad Ali Zia, Elie Tannous, Andrea Lightle, Krishnakumar Hongalgi","doi":"10.5414/CNCS111525","DOIUrl":"10.5414/CNCS111525","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombotic microangiopathy (TMA) is a pathological description which clinically presents with thrombocytopenia, microangiopathic hemolytic anemia (MAHA), and organ dysfunction. The etiology of TMA is broadly classified into four categories: primary hereditary, primary acquired, secondary, and infection associated. H1N1 influenza is a rare etiology of complement-mediated TMA (CM-TMA) with there being under 30 cases reported to date, and its odd presentation with hemoptysis making it a challenge to diagnose.</p><p><strong>Case presentation: </strong>We present a case of a Caucasian female in her 20s presenting to the hospital with a viral prodrome in setting of a new acute kidney injury (creatinine 8.2 mg/dL), thrombocytopenia (platelet count 14,000/mm³), and H1N1 influenza positive. She developed hemoptysis the next day, with no respiratory distress. Rheumatology work-up for antineutrophilic cytoplasmic antibodies (ANCA), anti-glomerular basement membrane (anti-GBM), and antiphospholipid syndrome (APS) antibodies was negative. CT chest was also negative for pulmonary hemorrhage. Plasma exchange was started empirically until ADAMTS13 activity returned normal (120%), and she was further commenced on eculizumab after an atypical hemolytic uremic syndrome (aHUS)/TMA/Complement 3 Glomerulopathy (C3G) gene panel was sent. Molecular studies revealed a splice site variant of MCP/CD46 gene, which was reiterated on a renal biopsy. The patient was counselled on the genetic results, including predisposition to future events and the importance of long-term eculizumab treatment.</p><p><strong>Discussion: </strong>CM-TMA is a consequence of alternative pathway dysregulation, commonly associated with genetic mutations which could phenotypically be unmasked by infections, such as influenza virus.</p><p><strong>Conclusion: </strong>Our case highlights the importance of keeping a broad differential beyond classic pulmonary-renal syndromes in patients presenting with hemoptysis and TMA, while understanding the pathophysiology of infections unmasking genetic mutations in CM-TMA.\u2029.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"28-36"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672083","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}

{"title":"A case report of renal oxalosis and secondary hyperoxaluria due to chronic high vitamin C consumption.","authors":"Ioannis Eleftherios Neofytou, Georgios Lioulios, Emmanouil Almaliotis, Dimitra Vasilia Daikidou, Aikaterini Mplatsa, Elias Minasidis","doi":"10.5414/CNCS111462","DOIUrl":"10.5414/CNCS111462","url":null,"abstract":"<p><p>Renal oxalosis occurs from supersaturation of the urine with oxalate in the presence of calcium, resulting in deposition of calcium oxalate crystals within renal tissue and, consequently, progressive renal disease. One of the causes of secondary hyperoxaluria is a high intake of vitamin C, which exceeds the renal excretion capacity, and can induce renal oxalosis. We present a case involving a 67-year-old patient with chronic kidney disease and proteinuria, associated with secondary hyperoxaluria and renal oxalosis, who reported prolonged, excessive intake of vitamin C supplements. The patient presented with a gradual worsening of his renal function and proteinuria during the last 6-month period, after an episode of SARS-CoV-2 infection. The kidney biopsy revealed calcium oxalate crystals within the renal tissue. Thorough investigation and history-taking revealed a substantial increase in vitamin C supplementation during the SARS-CoV-2 infection (up to 3 g daily), indicating secondary hyperoxaluria as the causative factor. Overall during the pandemic, supplement consumption dramatically increased and patients were not adequately informed about the risks of various over-the-counter products. Excessive intake of vitamin C, popularized for its supposed health benefits, can lead, among others, to secondary hyperoxaluria and renal oxalosis. Prompt recognition is pivotal to initiate management and to prevent irreversible kidney damage.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"18-27"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672170","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}

{"title":"Secondary congenital nephrotic syndrome complicated by acute mesenteric ischemia: A case report.","authors":"Gita Benbrahim Ansari, Hanane Aboufaris, Zineb Hammoumi, Mounia Al Zemmouri, Kenza Bouayed","doi":"10.5414/CNCS111438","DOIUrl":"10.5414/CNCS111438","url":null,"abstract":"<p><p>Thromboembolic events are among the most serious, yet rare complications of nephrotic syndrome. While peripheral venous thrombosis and pulmonary embolism are the most common, superior mesenteric artery thrombosis is a rare but life-threatening occurrence. We present a case of severe cytomegalovirus (CMV) infection complicated by congenital nephrotic syndrome, leading to mesenteric ischemia.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"13-17"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607714","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}

{"title":"Non-uremic calciphylaxis: A dermatologic complication in both MASH and alcohol-associated cirrhosis.","authors":"Dylan Rose Balter, Yueming Cao, James Garritano, Goran Micevic, Andrew Sanchez","doi":"10.5414/CNCS111578","DOIUrl":"10.5414/CNCS111578","url":null,"abstract":"<p><p>A woman with metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis presented to our hospital with hepatic encephalopathy, acute kidney injury, and painful skin lesions. A skin biopsy and broad work-up led to a diagnosis of non-uremic calciphylaxis. Despite treatment with IV sodium thiosulfate therapy, the patient ultimately passed away from infectious complications. This case highlights the need to recognize non-uremic calciphylaxis, which is a dermatologic complication associated with both alcohol-associated and MASH cirrhosis. While treatment options are currently limited, recognition of non-uremic calciphylaxis is crucial for enabling honest conversations with patients about prognosis.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"8-12"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416653","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}

{"title":"Minimal change disease in treatment-naïve hepatitis C virus infection: A case report and literature review.","authors":"Juliano Alhaddad, Hazim Allos, Dimo Dimitrov, Claudia M Nader, Helmut G Rennke, Bertrand L Jaber","doi":"10.5414/CNCS111506","DOIUrl":"10.5414/CNCS111506","url":null,"abstract":"<p><p>Minimal change disease (MCD) accounts for 10 - 15% of idiopathic nephrotic syndromes in adults. Chronic hepatitis C virus (HCV) infection is rarely ascribed as a cause of MCD and was previously associated with interferon-based therapy. MCD in treatment-naïve chronic HCV infection is extremely rare, with only 3 cases reported in the literature. We report on a 67-year-old woman presenting with acute nephrotic syndrome and severe acute kidney injury requiring short-term dialysis. She was initially treated empirically with glucocorticoids and underwent a kidney biopsy that revealed MCD with evidence of acute tubular necrosis and mild focal acute interstitial nephritis. An extensive work-up was only significant for the presence of anti-HCV antibody with an elevated HCV viral load of genotype 1b. Her kidney function recovered, and she was discharged on an oral prednisone course with a planned taper. 4.5 months later, her HCV infection was treated with ledipasvir and sofosbuvir, and she achieved sustained virological response. The nephrotic syndrome remained in remission 24 months after initial presentation. This is a unique case where sustained remission of both the nephrotic syndrome and the HCV infection were achieved with glucocorticoids and direct antiviral agents, respectively.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"13 ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019675","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}

{"title":"Significant response to tocilizumab in a case of immune deposits-related membranoproliferative glomerulonephritis and tubulointerstitial nephritis complicated by multicentric Castleman's disease.","authors":"Hisashi Sugimoto, Naoki Sawa, Daisuke Ikuma, Yuki Oba, Hiroki Mizuno, Akinari Sekine, Masayuki Yamanouchi, Eiko Hasegawa, Tatsuya Suwabe, Takehiko Wada, Kei Kono, Keiichi Kinowaki, Kenichi Ohashi, Kazuho Honda, Yukiko Kanetsuna, Kensuke Joh, Yutaka Yamaguchi, Yoshifumi Ubara","doi":"10.5414/CNCS111337","DOIUrl":"https://doi.org/10.5414/CNCS111337","url":null,"abstract":"<p><p>A 47-year-old woman with a 12-year history of anemia and high C-reactive protein (CRP) levels was admitted to our hospital with worsening fatigue and night sweats. She had high levels of immunoglobulin G (IgG; 4182 mg/dL), IgA (630.6 mg/dL), and CRP (7.44 mg/dL); a low hemoglobin level (8.9 g/dL); urinary protein (11.83 g/day); and urinary sediment (20 - 29 red blood cells per high power field). On the basis of the clinical findings and biopsied lymph nodes, we diagnosed multicentric Castleman's disease (MCD). Light microscopy of kidney biopsy samples revealed various nephropathies, including membranoproliferative glomerulonephritis with crescentic formation and focal segmental sclerosis and tubulointerstitial nephritis. Immunofluorescence and electron microscopy revealed IgG-positive deposits in the subepithelial areas, mesangial areas, and tubular basement membrane. The patient's clinical findings including kidney disease improved after treatment with tocilizumab. MCD is considered to be caused by abnormally high levels of interleukin (IL)-6. Tocilizumab, an IL-6 receptor antagonist, was effective in this patient, indicating that the immune complex-related kidney findings were also related to MCD.</p>","PeriodicalId":510898,"journal":{"name":"Clinical nephrology. Case studies","volume":"12 ","pages":"73-82"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961047","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}