{"title":"Normoglycemic diabetic nephropathy: the role of insulin resistance.","authors":"Edward J Filippone, Astha Gupta, John L Farber","doi":"10.1159/000364901","DOIUrl":"https://doi.org/10.1159/000364901","url":null,"abstract":"<p><p>The pathophysiology of diabetic nephropathy (DN) is complex and incompletely understood. Whereas hyperglycemia is clearly important, the role of insulin resistance (IR) is increasingly recognized. We present the case of a normotensive non-smoking obese woman with nephrotic syndrome who was found to have DN by biopsy. All measures of glucose metabolism, including fasting glucose, glycosylated hemoglobin, and oral glucose tolerance testing, were repeatedly normal with little exception. IR was documented, however, based on the presence of the metabolic syndrome and an elevated homeostasis model assessment of IR. We posit that this IR is central to the pathogenesis of our patient's lesion, and this may explain other cases of DN with normoglycemia. The literature supporting this concept is discussed. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"137-43"},"PeriodicalIF":0.0,"publicationDate":"2014-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000364901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32547171","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 of bladder-inverted papilloma after brachytherapy for prostate cancer.","authors":"Taisuke Ezaki, Takeo Kosaka, Shuji Mikami, Naoto Kaburaki, Ryuichi Mizuno, Mototsugu Oya","doi":"10.1159/000365142","DOIUrl":"https://doi.org/10.1159/000365142","url":null,"abstract":"<p><p>An 82-year-old male who presented with the chief complaint of gross hematuria and a history of prostate cancer treated with brachytherapy 6 years previously is described. Cystoscopy revealed multiple bladder tumors on the right posterior wall. A transurethral resection of the bladder tumor was performed and a pathological diagnosis of the inverted papilloma was made. To the best of our knowledge, this case is the first report of bladder-inverted papilloma after brachytherapy for prostate cancer. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"131-6"},"PeriodicalIF":0.0,"publicationDate":"2014-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000365142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32547170","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":"Nondialytic therapy for elderly patients in a critical care setting.","authors":"Hideaki Ishikawa, Junichi Sakamoto","doi":"10.1159/000363733","DOIUrl":"https://doi.org/10.1159/000363733","url":null,"abstract":"<p><p>It is frequently necessary to admit critically ill elderly patients to intensive care units (ICUs) due to their physiological impairments and co-morbidities. Several life-sustaining therapies such as mechanical ventilation are performed as necessary treatment in these ICUs. Sometimes renal replacement therapy (i.e. dialysis) is considered for elderly patients with complicating serious renal insufficiency. However, although the necessity for dialysis is recognized, some elderly patients may not benefit from this care because of their limited life expectancy. Until recently, life-sustaining support for critically ill elderly patients in Japan has been used routinely, regardless of the medical futility. The issue of providing better end-of-life care for elderly patients even in the ICU is now being raised frequently. We therefore wish to highlight the issue of end-of-life care and decision-making in the ICU, focusing on nondialytic therapy (NDT). The aim of this article was to assess whether NDT is an acceptable optional care for critically ill elderly patients with serious kidney diseases, even in the ICU. We hope our experiences may be helpful to physicians with an interest in decision-making and end-of-life care. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"126-30"},"PeriodicalIF":0.0,"publicationDate":"2014-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363733","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32547211","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}
Edwin M Spithoven, Niek F Casteleijn, Paul Berger, Roel Goldschmeding
{"title":"Nephrectomy in autosomal dominant polycystic kidney disease: a patient with exceptionally large, still functioning kidneys.","authors":"Edwin M Spithoven, Niek F Casteleijn, Paul Berger, Roel Goldschmeding","doi":"10.1159/000363378","DOIUrl":"https://doi.org/10.1159/000363378","url":null,"abstract":"<p><p>Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. It is characterized by progressive cyst formation in both kidneys, often leading to end-stage kidney disease. Indications for surgical removal of an ADPKD kidney include intractable pain, hematuria, infection, or exceptional enlargement and small abdominal cavity hampering implantation of a donor kidney. We report the case of an extraordinarily large ADPKD kidney weighing 8.7 kg (19.3 lb) with a maximal length of 48 cm (19 inch), and with cysts filled with both clear and bloody fluid. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"109-12"},"PeriodicalIF":0.0,"publicationDate":"2014-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32507372","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}
Jonathan Amatruda, Kevin Dieckhaus, Poornima Hegde, John Taylor
{"title":"Bladder Cancer versus Hemorrhagic Cystitis: A Case of Mistaken Identity in a 34-Year-Old Male Undergoing Therapy for Granulomatosis with Polyangiitis.","authors":"Jonathan Amatruda, Kevin Dieckhaus, Poornima Hegde, John Taylor","doi":"10.1159/000363692","DOIUrl":"https://doi.org/10.1159/000363692","url":null,"abstract":"<p><p>A 34-year-old male was referred for management of bladder cancer noted on workup for gross hematuria and new-onset irritative voiding symptoms. The patient's history was significant for recently diagnosed granulomatosis with polyangiitis for which he was undergoing treatment with oral cyclophosphamide and corticosteroids. Cystoscopy revealed lesions suspicious for malignancy, but the patient was diagnosed with hemorrhagic cystitis secondary to BK virus infection upon cytology review, and immunostaining confirmed a polyomavirus infection of the urothelium. The patient's symptoms resolved after a modification of his immunosuppressive regimen, and antiviral therapy was ultimately unnecessary. Though symptomatic BK virus infection of the genitourinary tract is common in immunosuppressed transplant patients, its occurrence in a patient undergoing immunomodulation for an autoimmune disease has not been reported yet. This case illustrates the potential for active BK virus infections in atypical patient populations and underscores the importance of rigorous hematuria workup, particularly in patients with multiple risk factors. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"120-5"},"PeriodicalIF":0.0,"publicationDate":"2014-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32507374","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}
Licia Peruzzi, Roberto Bonaudo, Alessandro Amore, Federica Chiale, Maria Elena Donadio, Luca Vergano, Rosanna Coppo
{"title":"Neonatal sepsis with multi-organ failure and treated with a new dialysis device specifically designed for newborns.","authors":"Licia Peruzzi, Roberto Bonaudo, Alessandro Amore, Federica Chiale, Maria Elena Donadio, Luca Vergano, Rosanna Coppo","doi":"10.1159/000363691","DOIUrl":"https://doi.org/10.1159/000363691","url":null,"abstract":"<p><p>Neonatal sepsis due to E. coli is often complicated by multiple organ failure (MOF) and a high mortality risk. We report the case of a term newborn discharged in good condition who suddenly fell into septic shock after 11 days and required immediate resuscitation, volume expansion and a high-dosage amine infusion. Extremely severe metabolic acidosis, disseminated intravascular coagulation (DIC) with diffuse bleeding, and unstable hemodynamic status with oliguria turned into strict anuria, and the patient became anuric. The presence of DIC, with gastric and intestinal bleeding, rendered peritoneal dialysis impossible. Continuous renal replacement therapy (CRRT) was started with the new dialysis machine CARPEDIEM(®) (Cardio-Renal Pediatric Dialysis Emergency Machine), available on a trial-basis in our center, after the surgical placement of jugular double-lumen central venous catheters. A 'ready to use' neonatal kit with a low-priming volume of the extracorporeal circuit allowed a prompt hemofiltration start. The filtration CRRT was continuously performed for 48 h, then intermittently (12 h/day) for 2 more days and interrupted on day 5 for diuresis reprisal. Acute kidney injury and multi-organ failure resolved after 5 days. The child survived without neurological damage, with a normal renal function and a normal development at 9 months follow-up. In conclusion, a prompt CRRT start with this specifically designed neonatal device allowed a progressive stabilization of hemodynamics, a better control of acidosis, a reduction of amine requirement, a gradual control of fluid overload and a rapid improvement of MOF, DIC as well as a resolution of the acute kidney injury. The device also allowed the extension of CRRT in the neonatal age. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"113-9"},"PeriodicalIF":0.0,"publicationDate":"2014-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32507373","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":"Renal infarction in a patient with pulmonary vein thrombosis after left upper lobectomy.","authors":"Shun Manabe, Yasuko Oshima, Marie Nakano, Teruhiro Fujii, Takamitsu Maehara, Kosaku Nitta, Michiyasu Hatano","doi":"10.1159/000363224","DOIUrl":"https://doi.org/10.1159/000363224","url":null,"abstract":"<p><p>A 43-year-old male experienced renal infarction (RI) following left upper lobectomy for lung cancer. The patient complained of acute-onset severe left flank pain on the 14th postoperative day. A contrast-enhanced computed tomography (CT) of the abdomen revealed RI by a large wedge-shaped defect in the left kidney. A chest CT scan located the thrombus in the stump (a blind-ended vessel) of the left superior pulmonary vein. Therefore, thromboembolic RI caused by pulmonary vein thrombosis was suspected. Anticoagulation therapy was initiated with heparin and warfarin to treat RI and to prevent further embolic episodes. Two months later, pulmonary vein thrombosis had resolved without the appearance of additional peripheral infarction. This case emphasizes the need to consider thrombus in the stump of the pulmonary vein as a cause of RI. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"103-8"},"PeriodicalIF":0.0,"publicationDate":"2014-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32472834","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":"Primary Effusion Lymphoma in an Elderly HIV-Negative Patient with Hemodialysis: Importance of Evaluation for Pleural Effusion in Patients Receiving Hemodialysis.","authors":"Yosuke Sasaki, Takuya Isegawa, Akira Shimabukuro, Tomoki Yonaha, Hiroyasu Yonaha","doi":"10.1159/000363223","DOIUrl":"https://doi.org/10.1159/000363223","url":null,"abstract":"<p><p>Pleural effusion is a ubiquitous complication in hemodialysis (HD) patients. Common etiologies of pleural effusion in this patient group are heart failure, volume overload, parapneumonic effusion, tuberculotic pleuritis, and uremic pleuritis. Although thoracentesis is a useful diagnostic method of pleural effusion, empirical reduction of the dry weight is often attempted without thoracentesis because pleural effusion is commonly caused by volume overload and responds to the dry-weight reduction. However, this empiricism has a risk of overlooking or delaying the diagnosis of potentially fatal etiologies that need specific treatments. We report an 86-year-old human immunodeficiency virus (HIV)-negative male on HD with primary effusion lymphoma (PEL), a large-cell non-Hodgkin lymphoma presenting with characteristic lymphomatous effusions in the absence of solid tumor masses, which is in association with human herpes virus 8 (HHV8) infection in immunocompromised individuals. The patient presented with left-sided pleural effusion. This is the first case report of PEL developing in a patient receiving HD. Thoracentesis and cytological analysis of the effusion was key to the diagnosis. We also review the literature regarding pleural effusion in HD patients. Further, we examine Kaposi's sarcoma herpes virus/HHV8-negative effusion-based lymphoma, a newly proposed distinct lymphoma that clinically and cytomorphologically resembles PEL, because it can be cured without chemotherapy. This report may arouse clinicians' attention regarding the importance of evaluation for pleural effusion in HD patients, especially when the effusion or symptoms associated with pleural effusion are refractory to volume control. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"95-102"},"PeriodicalIF":0.0,"publicationDate":"2014-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000363223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32472833","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":"Focal Segmental Glomerulosclerosis Secondary to Juxtaglomerular Cell Tumor during Pregnancy: A Case Report.","authors":"Yasushi Ohashi, Shizuka Kobayashi, Taichi Arai, Tetsuo Nemoto, Chizu Aoki, Masato Nagata, Ken Sakai","doi":"10.1159/000362757","DOIUrl":"https://doi.org/10.1159/000362757","url":null,"abstract":"<p><p>Juxtaglomerular cell tumor is a rare renal neoplasm. Secondary hypertension with juxtaglomerular cell tumor can be seen in females in their 20s and 30s. We present a case of juxtaglomerular cell tumor during pregnancy. A 32-year-old female was hospitalized for refractory hypertension and nephrotic syndrome in the 23rd gestational week. One year before admission, she had been diagnosed with hypertension; plasma renin activity at that time had been 2.3 ng/ml/h. Her blood pressure was uncontrolled during pregnancy, and proteinuria was detected in the 12th gestational week despite the administration of antihypertensive medications. Laboratory data showed proteinuria, hypokalemia, and hypoalbuminemia. In the 25th gestational week, she underwent surgical termination of the pregnancy because of congestive heart failure and acute renal injury. After the termination of the pregnancy and the delivery of a viable fetus, her hypertension and nephrotic syndrome were found to persist with a high plasma renin activity (13 ng/ml/h). Ultrasonography showed a 5.5-cm left renal cystic mass with a partially solid component at the lower renal pole. The left kidney with the renal mass was excised by laparoscopic nephrectomy. Plasma renin activity normalized the next day, with a decrease in blood pressure to 120-130/80-90 mm Hg; however, proteinuria remained at ≥3.5 g/day. On the basis of histopathological findings, the patient was diagnosed with a juxtaglomerular cell tumor and focal segmental glomerulosclerosis. Juxtaglomerular cell tumor is a rare renin-secreting tumor associated with refractory hypertension in young females and is a possible cause of hypertension during pregnancy. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 2","pages":"88-94"},"PeriodicalIF":0.0,"publicationDate":"2014-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000362757","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32421087","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}
Niina Koivuviita, Risto Tertti, Maija Heiro, Ilkka Manner, Kaj Metsärinne
{"title":"Thromboembolism as a cause of renal artery occlusion and acute kidney injury: the recovery of kidney function after two weeks.","authors":"Niina Koivuviita, Risto Tertti, Maija Heiro, Ilkka Manner, Kaj Metsärinne","doi":"10.1159/000362538","DOIUrl":"https://doi.org/10.1159/000362538","url":null,"abstract":"<p><p>Thromboembolic occlusion is a rare cause of acute kidney injury (AKI). It may lead to permanent loss of renal function. Our patient, who had dilated cardiomyopathy and prosthetic aortic valve, presented with AKI due to thromboembolic arterial occlusion of a solitary functioning kidney. After 2 weeks delay, local intra-arterial thrombolytic treatment with recombinant tissue plasminogen activator was performed without sufficient effect. However, a subsequent percutaneous transluminal angioplasty with stenting was successful. Diuresis began immediately, and renal function was fully recovered after 2 weeks. Although there had been no evident arterial circulation in the kidney, we think that minor flow through subtotal occlusion of the main renal artery made the hibernation of kidney tissue possible and contributed to the recovery. Thus, even after prolonged ischemia, revascularization can be useful. </p>","PeriodicalId":89663,"journal":{"name":"Case reports in nephrology and urology","volume":"4 1","pages":"82-7"},"PeriodicalIF":0.0,"publicationDate":"2014-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000362538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32358328","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}