Case Reports in Nephrology最新文献

{"title":"Recurrent Invasive <i>Staphylococcus aureus</i> Infections in a Non-Neutropenic Hemodialysis Patient With Myelodysplastic Syndrome: A Case Report.","authors":"Keisuke Ono, Nobuhiro Ayuzawa, Takahisa Kawakami, Koichi Taniwaki, Shiori Arai, Aoi Kanematsu, Yuki Suhara, Mitsumasa Kishimoto, Yoshinori Komagata","doi":"10.1155/crin/1023646","DOIUrl":"https://doi.org/10.1155/crin/1023646","url":null,"abstract":"<p><strong>Introduction: </strong>Myelodysplastic syndromes (MDS) may be overlooked in patients undergoing hemodialysis (HD) because anemia is commonly attributed to renal anemia and treated with erythropoiesis-stimulating agents. MDS is also associated with an increased risk of bacterial infections due to neutropenia and qualitative immune dysfunction. We report recurrent invasive methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA) infections in a patient undergoing HD with concomitant MDS.</p><p><strong>Case presentation: </strong>The patient was a 76-year-old man undergoing HD for end-stage kidney disease due to nephrosclerosis who was referred to our hospital because of persistent anemia despite high-dose darbepoetin alfa therapy. He had a history of CHOP therapy for diffuse large B-cell lymphoma, and his MDS was considered possibly therapy related. Bone marrow aspiration revealed trilineage dysplasia and 3.4% blasts without chromosomal abnormalities, leading to a diagnosis of MDS with multilineage dysplasia. Approximately 1 year later, he developed persistent fever. Blood cultures yielded MSSA, and imaging studies revealed septic pulmonary embolism and multiple cerebral infarctions. He improved after intravenous cefepime therapy. Twenty-two months later, he developed fever and left shoulder pain. Contrast-enhanced computed tomography revealed an abscess in the left subscapularis muscle, and MSSA was isolated from the drainage fluid after CT-guided drainage. He improved with drainage and antibiotic therapy. In both episodes, the neutrophil count was preserved.</p><p><strong>Conclusion: </strong>This case illustrates recurrent invasive MSSA infections in a non-neutropenic HD patient with possibly therapy-related MDS. HD-related factors should be carefully evaluated as common causes of recurrent <i>S. aureus</i> infection, and MDS may represent an additional, unproven host factor. MDS should be considered in ESA-resistant anemia in HD patients, particularly in those with a history of cytotoxic chemotherapy.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"1023646"},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163598","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":"Missed Diagnosis of Clear Cell Renal Cell Carcinoma on Noncontrast Computed Tomography: The Potential Role of Artificial Intelligence in Reducing Radiological Diagnostic Error.","authors":"Fabio Massimo Abenavoli, Omar Tujjar, Andrea Alfonso","doi":"10.1155/crin/5359978","DOIUrl":"10.1155/crin/5359978","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype of malignant renal neoplasms, with an increasing incidence in Western countries. Early diagnosis is a critical determinant of prognosis, as advanced-stage disease with metastatic dissemination entails a significantly reduced median survival. Characterizing complex cystic renal lesions presents a recognized diagnostic challenge on noncontrast computed tomography (CT), which often leads to underestimation and missed diagnoses. Artificial intelligence (AI) applied to diagnostic imaging is emerging as a supplementary decision-support tool, but its integration must be critically evaluated to understand its potential to reduce diagnostic errors as well as its limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;We report the case of a 73-year-old male physician with a history of myocardial infarction who presented with left flank pain. An initial noncontrast CT of the urinary tract on January 15 revealed a 37-mm left upper-pole renal cyst and a 5-mm suspected calculus. The cyst was characterized as simple, and the report offered only a generic follow-up recommendation. Over the next 4 months, the patient's persistent pain was attributed entirely to presumed ureteric stone disease, leading to a ureteroscopy and ureteral stent placement, without characterizing the known renal cyst with contrast. On June 5 (5 months after the initial CT), a contrast-enhanced CT revealed a 6-cm heterogeneous, exophytic left renal mass. Subsequent staging confirmed pulmonary and cerebral metastases from ccRCC. The patient died in mid-August, 7 months after the initial CT. Retrospective re-evaluation of the baseline CT images, both by a senior radiologist and through an AI platform, confirmed that the lesion already exhibited features suspicious for neoplasia at the time of the first scan, warranting further investigation with contrast-enhanced CT or magnetic resonance imaging in accordance with international guidelines. Simulated retrospective analysis via a web-based AI platform not only flagged the mass as suspicious but also generated several critical errors (e.g., hallucinating contrast enhancement on the unenhanced scan, mislocalizing the mass to the mid-to-lower pole, and claiming it was \"new\" without comparison data).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case demonstrates how a complex cystic renal lesion may be underestimated in the absence of contrast medium and an adequate level of clinical-radiological suspicion. Re-evaluation by AI produced a result consistent with that of the expert radiologist, suggesting that systematic integration of AI tools into the radiological workflow could contribute to reducing diagnostic errors, particularly in settings where interobserver variability represents a clinically significant risk factor. AI can act as an effective supplementary decision-support tool to reduce perceptual errors; clinicians and radiologists ","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"5359978"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079894","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":"Use of Slow Low-Efficiency Dialysis in a Patient With Status Epilepticus Secondary to Herpes Simplex Encephalitis With Severe Acute Kidney Injury.","authors":"Abigayle Therese R Guiritan, Arlene C Crisostomo","doi":"10.1155/crin/5586128","DOIUrl":"10.1155/crin/5586128","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) in the critical care unit is an independent risk factor for poor outcomes such as mortality. In patients with acute neurological injury and severe AKI, the timing and renal replacement therapy (RRT) modifications must be considered. Sustained low-efficiency dialysis (SLED) is a cost-effective alternative to continuous renal replacement therapy (CRRT) in critically ill AKI patients. We present a case of a 43-year-old male diagnosed with status epilepticus secondary to herpes simplex virus Type 1 (HSV-1) central nervous system (CNS) infection who developed severe AKI and underwent SLED.</p><p><strong>Case presentation: </strong>We present a case of a 43-year-old male, hypertensive, with no known chronic kidney disease (CKD) who was referred to nephrology service for management of AKI. He was being managed as a case of status epilepticus secondary to CNS infection. Diagnostic tests revealed elevated creatinine at 3.72 mg/dL from 0.9 mg/dL. Blood urea nitrogen was at 39 mg/dL. Sodium was at 148 mEq/L, and potassium at 3.4 mEq/L. Urinalysis had trace protein, moderate blood, and red blood cells at 12 cells per high power field (hpf). Creatine kinase MM (CK-MM) was at 514 U/L (2.2x ULN). The patient also had marginal urine output at 0.2-0.4 mL/kg/h with the patient weighing 86 kg. Although the patient had Stage 3 AKI, RRT was initiated as a supportive measure. He underwent SLED for 6 hours with net ultrafiltration at 0 mL. Urine output gradually improved from 0.9 to 1.3 mL/kg/h. Repeat creatinine taken 2 days after showed a decreasing trend to 2.68 mg/dL. Seizures were controlled with midazolam drip, valproic acid, and lacosamide. Renal parameters were continuously monitored, and continuation of renal replacement was not deemed necessary. During his stay at the neurocritical care unit, lumbar puncture was performed, and cerebrospinal fluid tested positive for HSV-1. Appropriate antimicrobials and methylprednisolone pulse therapy 1 g intravenously for 5 days were given. Neurologic status improved with a Glasgow coma scale of 11T (E4VTM6). Renal parameters were serially monitored, with repeat creatinine prior to discharge at 0.6 mg/dL.</p><p><strong>Conclusion: </strong>SLED can be used as a treatment modality in a neurocritically ill patient with status epilepticus for solute clearance. Good clinical judgment, early recognition, and ability to individualize care with management of AKI in the critical care unit can help improve clinical outcomes.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"5586128"},"PeriodicalIF":0.0,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073715","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":"Membranous Nephropathy Secondary to Syphilis.","authors":"Ifeoluwa Stowe, Shreya R Saxena, Riya Paluri, Damodar R Kumbala","doi":"10.1155/crin/9592129","DOIUrl":"10.1155/crin/9592129","url":null,"abstract":"<p><p>Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in the adult population. Although the majority of the cases of MN are without any inciting event, about a third are caused or associated with immune diseases, infectious diseases, and drugs and toxins. There have been very few cases of association of syphilis and MN. We describe this rare infectious cause of MN in a 41-year-old patient who presented with nephrotic syndrome. The patient was diagnosed with secondary syphilis. He was treated successfully with complete resolution of his nephrotic picture. A thorough clinical history and physical examination which resulted in a suspicion for sexually transmitted disease led us to the successful diagnosis and treatment of this rare condition.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"9592129"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036350","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":"Type III Collagen Glomerulopathy Presenting With Divergent Histopathological Patterns: Report of Two Adult Cases and Diagnostic Pitfalls.","authors":"Fatemeh Nili, Alireza Abdollahi, Parisa Arabmohammadi, Samaneh Salarvand","doi":"10.1155/crin/6022775","DOIUrl":"10.1155/crin/6022775","url":null,"abstract":"<p><p>Type III collagen glomerulopathy (collagenofibrotic glomerulopathy) is a rare idiopathic renal disorder. It is characterized by abnormal deposition of Type III collagen fibrils within the mesangial and subendothelial compartments of glomeruli. Due to its nonspecific clinical presentation and histopathologic overlap with more common glomerular diseases, it is frequently underdiagnosed unless electron microscopy is performed. We report two adult male patients who presented with progressive renal dysfunction, proteinuria, hematuria, and hypertension. In both cases, initial renal biopsies were misleading. The first patient received a diagnosis of tubulointerstitial nephritis; the second was diagnosed with focal segmental glomerulosclerosis (FSGS). Repeat kidney biopsies revealed mesangial expansion, glomerular basement membrane thickening, and variable degrees of chronic glomerulosclerosis on light microscopy. Immunofluorescence was negative or nonspecific in both cases, with no significant immune complex deposition. Definitive diagnosis was established by electron microscopy, which demonstrated characteristic curvilinear collagen fibrils, approximately 60 nm in diameter, within the mesangial and subendothelial spaces, without evidence of immune complex deposits. The two cases represented different stages of disease. One showed relatively preserved glomerular architecture consistent with earlier-stage involvement, while the other exhibited advanced diffuse glomerulosclerosis and severe tubulointerstitial fibrosis. Together, they illustrate the broad morphologic spectrum of this entity. These cases highlight the diagnostic challenge posed by Type III collagen glomerulopathy and its frequent misclassification as other glomerular diseases, particularly FSGS and membranoproliferative patterns. Our findings underscore the essential role of electron microscopy in reaching a definitive diagnosis. Given how often this condition is missed, it may be underrecognized rather than truly rare. Early and accurate diagnosis is critical to avoid mismanagement in patients with unexplained proteinuric kidney disease.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"6022775"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023898","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 With Mesangial IgA Deposition: A Clinicopathological Case Series From a Tunisian Referral Center.","authors":"Meriam Hajji, Ilhem Ben Othman, Abir Boussetta, Rihab Zouaoui, Nada Sellami, Hayet Kaaroud, Taher Gargueh, Ezzeddine Abderrahim","doi":"10.1155/crin/7021133","DOIUrl":"10.1155/crin/7021133","url":null,"abstract":"<p><strong>Background: </strong>Minimal change disease (MCD) associated with mesangial immunoglobulin A (IgA) deposition, historically referred to as \"IgA Nephrosis,\" is a rare and nosologically controversial entity. Whether it represents MCD with incidental mesangial IgA deposition, a dual glomerulopathy combining MCD and subclinical IgA nephropathy (IgAN), or a distinct clinicopathological phenotype remains uncertain. Only isolated case reports and small series have been published to date.</p><p><strong>Methods: </strong>We retrospectively identified six consecutive patients (three children/adolescents and three adults; four males and two females) evaluated at the Kidney Pathology Laboratory of the Department of Nephrology, Charles Nicolle Hospital, Tunis, between 1995 and 2025. All patients presented with nephrotic syndrome, minimal or absent glomerular abnormalities on light microscopy, and dominant mesangial IgA deposits on direct immunofluorescence.</p><p><strong>Results: </strong>Microscopic hematuria was present in three patients, while one patient reported a remote episode of macroscopic hematuria during childhood. Light microscopy revealed essentially normal glomeruli in three cases and only mild mesangial hypercellularity and/or matrix expansion in the remaining cases, without endocapillary proliferation, crescents, necrotizing lesions, or significant chronic damage. Immunofluorescence consistently demonstrated dominant or exclusive mesangial IgA deposits, variably associated with IgM, IgG, C3, C1q, fibrinogen, or light-chain co-deposition. Electron microscopy was unavailable. Most patients exhibited steroid-sensitive disease, although relapsing courses were frequent.</p><p><strong>Conclusions: </strong>MCD with mesangial IgA deposition represents an uncommon clinicopathological entity situated at the interface between MCD and IgAN. The marked discrepancy between severe nephrotic syndrome and minimal histological lesions despite mesangial IgA deposition strongly suggests a predominant podocytopathy rather than classical proliferative IgAN. Recognition of this phenotype is important to avoid diagnostic misclassification and inappropriate therapeutic strategies. Further studies integrating ultrastructural and molecular analyses are required to clarify its pathogenesis and nosological position.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"7021133"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023943","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":"Tuberculosis-Associated Renal Amyloidosis Presenting as Nephrotic Syndrome: A Case Report From Ethiopia.","authors":"Alemayehu Abebe Guji, Daniel Rebuma Bekele, Getnet Amberber Degefu, Birhanu Gudeta Geleta, Derebe Shashigo Leilago, Kedir Negesso Tukeni","doi":"10.1155/crin/3992146","DOIUrl":"10.1155/crin/3992146","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) is highly prevalent in Ethiopia, and extrapulmonary manifestations pose significant diagnostic challenges. Among its rare complications, renal amyloidosis (AA type) can present with nephrotic syndrome and progressive renal dysfunction. In resource-limited settings, the absence of routine TB screening and restricted timely access to renal biopsy often lead to empirical immunosuppression, which may worsen outcomes by reactivating latent infections.</p><p><strong>Case presentation: </strong>We report a case of a 43-year-old Ethiopian male with a 5-month history of generalized edema, fatigue, flank pain, and nephrotic-range proteinuria (19.7 g/24 h). Initial evaluation suggested high-risk membranous nephropathy, and empirical immunosuppression with prednisone and cyclophosphamide was initiated before biopsy confirmation due to a delay in the renal biopsy results. The patient subsequently developed axillary lymphadenopathy and \"B\" symptoms. Renal biopsy results obtained after initiation of chemotherapy revealed Congo red-positive deposits with green birefringence under polarized light, consistent with AA amyloidosis. At the same time, lymph node histology demonstrated necrotizing granulomatous inflammation, confirming extrapulmonary TB. Anti-TB therapy (RHZE regimen) led to initial clinical improvement and stabilization of the renal function. However, 3 weeks later, the patient developed severe pulmonary sepsis and died of septic shock despite intensive care.</p><p><strong>Conclusion: </strong>This case underscores the importance of excluding infectious etiologies, particularly TB, before initiating immunosuppressive therapy in patients with nephrotic syndrome in endemic regions. Empirical immunosuppression without histopathological confirmation risks reactivating latent TB and delaying appropriate treatment. Routine TB screening with IGRA or TST, combined with timely renal biopsy, should be prioritized in resource-limited settings to prevent misdiagnosis and improve patient outcomes.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"3992146"},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007871","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":"Severe Hypokalemia Associated With Piperacillin-Tazobactam Use.","authors":"Angelina Kravcik, Jason Zelt, Stephen Kravcik","doi":"10.1155/crin/1957735","DOIUrl":"10.1155/crin/1957735","url":null,"abstract":"<p><p>Piperacillin-tazobactam is a generally well-tolerated broad-spectrum antibacterial. Mild hypokalemia may occur with piperacillin-tazobactam therapy as a result of increased renal potassium losses. Severe hypokalemia is rare. We report here a case of very severe hypokalemia during piperacillin-tazobactam therapy, refractory to aggressive potassium replacement.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"1957735"},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896558","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 Hyperoxaluria Type 1 Diagnosed After Kidney Transplantation in the Absence of Classical Features.","authors":"Rawh Sultan, Zein A Alsayed-Ahmad, Ahmad Ryyan Shheibar, Rawda Shawwa, Karam Albitar, Sami Albitar","doi":"10.1155/crin/4378614","DOIUrl":"10.1155/crin/4378614","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperoxaluria Type 1 is a rare inherited metabolic disorder caused by pathogenic variants in the AGXT gene. Because the disorder leads to excessive internal oxalate formation, progressive end-stage kidney disease (ESKD) may occur. While most affected individuals present during childhood, a subset is diagnosed only later in adult life, frequently after substantial renal deterioration. Delayed diagnosis increases the risk of recurrent oxalate nephropathy and graft dysfunction following kidney transplantation.</p><p><strong>Case presentation: </strong>We report a 30-year-old woman with ESKD of unknown aetiology who underwent living-donor kidney transplantation. One year later, during a subsequent pregnancy, she developed progressive graft dysfunction. Kidney biopsy demonstrated extensive calcium oxalate crystal deposition, raising suspicion for an underlying metabolic disorder. Genetic testing subsequently confirmed a pathogenic AGXT mutation, establishing the diagnosis of adult-onset PH1. Urinary oxalate concentrations were within normal limits before and after transplantation, emphasizing the diagnostic challenge.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering PH1 in adults with unexplained chronic or ESKD, even in the absence of classical features or elevated urinary oxalate excretion. Early genetic testing and careful assessment of family history are essential for timely diagnosis, enabling appropriate transplant planning, disease-specific therapy, and genetic counselling.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"4378614"},"PeriodicalIF":0.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863756","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":"Lupus Nephritis Exhibiting a Membranoproliferative Pattern in Primary Myelofibrosis: A Diagnostic Challenge of Occult SLE.","authors":"Alaa Alem, Raghad Altayyar, Fadyah Alradaddi, Rayan Alahmadi","doi":"10.1155/crin/2339466","DOIUrl":"10.1155/crin/2339466","url":null,"abstract":"<p><p>Lupus nephritis (LN) with a membranoproliferative pattern is an uncommon but recognized renal manifestation of systemic lupus erythematosus (SLE). While autoimmune myelofibrosis (AMF) has been described in association with SLE, the coexistence of primary myelofibrosis (PMF) with this pattern of LN has not been previously documented. We report a 50-year-old man with JAK2-positive PMF, undifferentiated connective tissue disease (UCTD), and Stage 3b chronic kidney disease who developed nephrotic syndrome and worsening kidney function. Initial serologic evaluation revealed positive antinuclear antibody (ANA), low serum complement C3, and negative antidouble-stranded DNA (anti-dsDNA) antibodies. Kidney biopsy demonstrated a membranoproliferative pattern of injury with mesangial and subendothelial immune complex deposits staining for IgM and C1q. Subsequent testing revealed high-titer anticardiolipin IgM antibodies. The patient met the 2019 EULAR/ACR classification criteria for SLE. Induction therapy with high-dose prednisone and mycophenolate mofetil resulted in a partial remission, with stabilization of renal function on follow-up. To our knowledge, this is the first reported case of LN with a membranoproliferative pattern of injury in a patient with PMF. The case underscores the diagnostic value of kidney biopsy in uncovering occult systemic autoimmune disease in patients with myeloproliferative neoplasms (MPNs), particularly when the clinical and demographic profile is atypical for SLE.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"2339466"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812056","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}