CEN Case Reports最新文献_第4页

Multifactorial acute kidney injury with findings suggestive of arcuate venous thrombosis: a case report. 多因素急性肾损伤伴弓形静脉血栓形成1例报告。

IF 1

CEN Case Reports Pub Date : 2026-07-20 DOI: 10.1007/s13730-026-01165-8

Peng Junqiong, Liu Shaojun, Zhou Lifang, Li Chunqing, Yu Yafen

{"title":"Multifactorial acute kidney injury with findings suggestive of arcuate venous thrombosis: a case report.","authors":"Peng Junqiong, Liu Shaojun, Zhou Lifang, Li Chunqing, Yu Yafen","doi":"10.1007/s13730-026-01165-8","DOIUrl":"10.1007/s13730-026-01165-8","url":null,"abstract":"Renal arcuate vein thrombosis (RAVT) is a rare and often underrecognized cause of acute kidney injury (AKI) that typically requires renal biopsy for diagnosis. We report a 29-year-old man who developed AKI following heavy alcohol intake, an upper respiratory tract infection, and exposure to multiple medications including repeated nonsteroidal anti-inflammatory drugs and traditional Chinese patent medicines. Laboratory tests showed mild proteinuria without hematuria and negative autoimmune serology, with normal renal imaging. Renal biopsy revealed acute tubular injury and thrombus-like material within arcuate veins, accompanied by mild medullary hemorrhage and focal vascular necrosis, findings suggestive of arcuate venous thrombosis. Renal function recovered completely after supportive therapy within eight days.This case highlights that an arcuate venous lesion suggestive of thrombosis may be an underrecognized finding in patients with multifactorial, biopsy-proven AKI, even when the clinical presentation and imaging findings are nonspecific. Awareness of this possibility may broaden the differential diagnosis in selected patients with unexplained or disproportionate AKI and multiple renal risk factors, and kidney biopsy may help identify otherwise unrecognized vascular involvement.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520079","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

A case of overcoming De Novo thrombotic microangiopathy associated with hyperacute rejection in a living donor ABO-incompatible kidney transplantation despite severe intraoperative graft injury. 尽管术中严重的移植损伤，活体供体abo血型不相容肾移植克服伴有超急性排斥反应的新生血栓性微血管病的病例。

IF 1

CEN Case Reports Pub Date : 2026-07-20 DOI: 10.1007/s13730-026-01161-y

Hiroshi Ide, Yusuke Tomita, Masahiro Koizumi, Go Ogura, Michio Nakamura

{"title":"A case of overcoming De Novo thrombotic microangiopathy associated with hyperacute rejection in a living donor ABO-incompatible kidney transplantation despite severe intraoperative graft injury.","authors":"Hiroshi Ide, Yusuke Tomita, Masahiro Koizumi, Go Ogura, Michio Nakamura","doi":"10.1007/s13730-026-01161-y","DOIUrl":"10.1007/s13730-026-01161-y","url":null,"abstract":"A 19-year-old male with end-stage renal disease caused by vesicoureteral reflux, hypertension, and type 2 diabetes mellitus underwent preemptive kidney transplantation using his mother's left kidney. This was an ABO-incompatible kidney transplant between a recipient with blood type O and a donor with blood type B. Therefore, plasma exchange and rituximab administration were performed preoperatively as desensitization therapy. Immediately after vascular anastomosis, blood flow in the transplanted renal cortex was assessed using ultrasonography, which was deemed adequate. Nonetheless, the urine output did not increase. Ultrasound re-evaluation revealed an elevated vascular resistance index in the transplanted renal cortex, raising hyperacute rejection suspicion. Rejection therapy was initiated before vesicoureteral anastomosis. Because concomitant de novo thrombotic microangiopathy (dnTMA) was also suspected, anticoagulant therapy was initiated. By the end of the surgery, the velocity of the renal cortical blood flow had decreased, prompting immediate plasma exchange. Hemodialysis was performed on postoperative day (POD) 0 but was not required thereafter. Serum creatinine levels remained at around 5-6 mg/dL for some time; nevertheless, they began to decrease on POD15, finally improving to 1.36 mg/dL on POD 65. A renal biopsy performed 1 h after reperfusion revealed fibrin thrombi and inflammatory cell infiltrates in the glomerular capillaries (g1), resulting in the diagnosis of dnTMA due to hyperacute rejection. The cause of hyperacute rejection was possibly HLA-DP donor-specific antibody. This report describes a case in which the prompt treatment for dnTMA due to hyperacute rejection preserved graft function.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520076","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

A case of lymphomatoid granulomatosis with renal involvement. 淋巴瘤样肉芽肿累及肾脏1例。

IF 1

CEN Case Reports Pub Date : 2026-07-20 DOI: 10.1007/s13730-026-01163-w

Riku Miyahara, Wataru Sone, Takuya Suda, Shohei Makiishi, Taito Miyake

{"title":"A case of lymphomatoid granulomatosis with renal involvement.","authors":"Riku Miyahara, Wataru Sone, Takuya Suda, Shohei Makiishi, Taito Miyake","doi":"10.1007/s13730-026-01163-w","DOIUrl":"10.1007/s13730-026-01163-w","url":null,"abstract":"Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus-associated B-cell lymphoproliferative disorder. While LYG mainly causes pulmonary lesions, it is also known to cause extrapulmonary lesions involving the kidney; however, there are limited reports describing the pathology of extrapulmonary lesions in detail. We report the case of an 82-year-old woman who presented with fever and multiple pulmonary nodules, along with elevated urinary β2-microglobulin and proteinuria. A renal biopsy revealed granuloma-like interstitial infiltrates consisting predominantly of CD3+ and CD4+ T lymphocytes with scattered CD20+ B cells and histiocytes. Similar findings on CT-guided lung biopsy raised the possibility of Grade 1 LYG, although a definitive diagnosis could not be established. Following transient clinical improvement with corticosteroids, pulmonary lesions recurred. Subsequent video-assisted thoracoscopic surgery confirmed the presence of Epstein-Barr virus-encoded small (EBER)-RNA positive cells, establishing a final diagnosis of LYG. Detailed descriptions of the renal pathology of LYG are scarce. This case adds to the limited number of reported cases and highlights the value of renal biopsy in excluding alternative diagnoses, particularly when a definitive diagnosis cannot be made using transbronchial or CT-guided lung biopsy.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520090","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

Histopathological improvement in kidney AL amyloid deposits following daratumumab-based chemotherapy and autologous peripheral blood stem cell transplantation: a case report. 达拉图单抗化疗和自体外周血干细胞移植后肾AL淀粉样蛋白沉积的组织病理学改善：一例报告。

IF 1

CEN Case Reports Pub Date : 2026-07-20 DOI: 10.1007/s13730-026-01164-9

Shuma Hirashio, Sayuri Ohnari, Moe Kadono, Takeshi Shimomura, Yoshiro Tachiyama, Takao Masaki

{"title":"Histopathological improvement in kidney AL amyloid deposits following daratumumab-based chemotherapy and autologous peripheral blood stem cell transplantation: a case report.","authors":"Shuma Hirashio, Sayuri Ohnari, Moe Kadono, Takeshi Shimomura, Yoshiro Tachiyama, Takao Masaki","doi":"10.1007/s13730-026-01164-9","DOIUrl":"10.1007/s13730-026-01164-9","url":null,"abstract":"AL amyloidosis is characterized by extracellular deposition of immunoglobulin light-chain fibrils, frequently leading to kidney involvement and progressive organ dysfunction. We report a case of kidney AL amyloidosis secondary to multiple myeloma in which daratumumab-based chemotherapy combined with autologous peripheral blood stem cell transplantation resulted in marked improvement, as confirmed by sequential kidney biopsy. The initial biopsy revealed vascular-dominant amyloid deposition, whereas the second biopsy obtained 2 years later demonstrated a marked reduction in amyloid burden, particularly within the vascular compartments. This histopathological improvement corresponded with hematologic remission and stabilization of kidney function. The observed reduction in tissue amyloid deposits was presumed to result from suppression of amyloidogenic light chains, leading to inhibition of new fibril formation and subsequent tissue remodeling. Our findings provide direct pathological evidence that daratumumab-based combination therapy, through immune-mediated plasma cell depletion, may indirectly promote the regression of amyloid deposits and contribute to functional recovery.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520103","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

Intra-abdominal abscess caused by Rhodotorula mucilaginosa in a peritoneal dialysis patient: a case report. 腹膜透析患者由粘液红弧菌引起腹内脓肿1例。

IF 1

CEN Case Reports Pub Date : 2026-07-13 DOI: 10.1007/s13730-026-01158-7

Shinya Abe, Tomomi Tanaka, Nao Matsubara, Takuya Yamaguchi, Mizue Goto, Takahiro Nakayama

{"title":"Intra-abdominal abscess caused by Rhodotorula mucilaginosa in a peritoneal dialysis patient: a case report.","authors":"Shinya Abe, Tomomi Tanaka, Nao Matsubara, Takuya Yamaguchi, Mizue Goto, Takahiro Nakayama","doi":"10.1007/s13730-026-01158-7","DOIUrl":"10.1007/s13730-026-01158-7","url":null,"abstract":"Fungal intra-abdominal abscess (IAA) is an uncommon but serious complication in patients undergoing peritoneal dialysis (PD). Although Rhodotorula species are rare opportunistic yeasts known to cause PD-associated peritonitis, IAA due to Rhodotorula in PD patients has not been previously reported. We report the case of a 52-year-old man on PD for end-stage kidney disease who developed an IAA caused by Rhodotorula mucilaginosa (R. mucilaginosa). New-onset fever during intraperitoneal antibiotic therapy for bacterial peritonitis led to the identification of an IAA, and R. mucilaginosa was isolated from the abscess culture. The infection was successfully managed with open surgical drainage, removal of the PD catheter, and intravenous liposomal amphotericin B for 14 weeks. This case highlights the importance of considering the possibility of fungal IAA when PD patients develop fever during antibiotic therapy for peritonitis. Clinicians should recognize Rhodotorula species as rare but clinically significant pathogens in PD-associated infections. In cases with abscess formation, timely source control and appropriate antifungal therapy are crucial for favorable outcomes.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429859","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

Fulminant drug-induced immune thrombocytopenia in polycystic kidney disease with cyst infection. 伴有囊肿感染的多囊肾病的暴发性药物性免疫性血小板减少。

IF 1

CEN Case Reports Pub Date : 2026-07-13 DOI: 10.1007/s13730-026-01154-x

Narumichi Iwamura, Yuta Matsukuma, Kanako Iwamura, Yang Zhang, Shunsuke Yamada, Kuniyuki Nakamura, Teppei Sakoda, Sachiko Kanaji, Toshiaki Nakano, Tetsuro Ago

{"title":"Fulminant drug-induced immune thrombocytopenia in polycystic kidney disease with cyst infection.","authors":"Narumichi Iwamura, Yuta Matsukuma, Kanako Iwamura, Yang Zhang, Shunsuke Yamada, Kuniyuki Nakamura, Teppei Sakoda, Sachiko Kanaji, Toshiaki Nakano, Tetsuro Ago","doi":"10.1007/s13730-026-01154-x","DOIUrl":"10.1007/s13730-026-01154-x","url":null,"abstract":"A 65-year-old man with polycystic kidney disease who had undergone living-donor kidney transplantation presented with fever and left flank pain and was diagnosed with renal cyst infection. Combination antimicrobial therapy with levofloxacin, clindamycin, meropenem, and teicoplanin was initiated. His platelet count was 257,000/µL on day 5; however, it abruptly declined overnight to below the lower limit of detection (< 2,000/µL). He subsequently developed a massive retroperitoneal hematoma, presumably due to hemorrhage from the infected renal cyst, and required emergency selective arterial embolization. Drug-induced immune thrombocytopenia was strongly suspected, and all recently initiated medications were discontinued. He was treated with high-dose intravenous dexamethasone and intravenous immunoglobulin, leading to a transient recovery of the platelet count. However, thrombocytopenia recurred during prednisolone tapering. Although drug-dependent platelet-reactive antibodies were not detected in the patient's serum, teicoplanin was considered a plausible causative agent based on pharmacokinetic considerations and previous reports; however, the causative drug could not be definitively identified. This case illustrates fulminant thrombocytopenia highly suggestive of drug-induced immune thrombocytopenia in which the platelet count fell to an undetectable level overnight. In patients receiving multiple drugs, clinicians should remain vigilant for drug-induced immune thrombocytopenia and should closely monitor platelet counts during treatment.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429849","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

Monoclonal immunotactoid glomerulopathy with masked IgG associated with symptomatic multiple myeloma: a case report diagnosed by paraffin-immunofluorescence and mass spectrometry. 单克隆免疫球蛋白样肾小球病伴隐匿IgG伴症状性多发性骨髓瘤：用石蜡免疫荧光和质谱法诊断一例报告。

IF 1

CEN Case Reports Pub Date : 2026-07-13 DOI: 10.1007/s13730-026-01159-6

Koji Yoshimoto, Yosuke Osaki, Akira Takahashi, Ryo Tamura, Naoki Ishiuchi, Yujiro Maeoka, Kensuke Sasaki, Tetsumi Yoshida, Takao Masaki

{"title":"Monoclonal immunotactoid glomerulopathy with masked IgG associated with symptomatic multiple myeloma: a case report diagnosed by paraffin-immunofluorescence and mass spectrometry.","authors":"Koji Yoshimoto, Yosuke Osaki, Akira Takahashi, Ryo Tamura, Naoki Ishiuchi, Yujiro Maeoka, Kensuke Sasaki, Tetsumi Yoshida, Takao Masaki","doi":"10.1007/s13730-026-01159-6","DOIUrl":"10.1007/s13730-026-01159-6","url":null,"abstract":"Immunotactoid glomerulopathy (ITG) is a rare glomerulonephritis characterized by the deposition of hollow-centered microtubular structures on electron microscopy (EM), and by IgG, C3, and restricted light chain deposition on immunofluorescence (IF) staining. It is often associated with hematological malignancies, including lymphoma and lymphocytic leukemia. A 71-year-old Japanese woman presented with increased proteinuria (urine protein-to-creatinine ratio, 4.32 g/gCr) and impaired kidney function (serum creatinine, 1.24 mg/dL). A kidney biopsy was performed, and routine frozen-IF revealed positivity for C3 and κ-light chain along the glomerular basement membrane, while IgG was negative. EM demonstrated electron-dense deposits composed predominantly of microtubules with hollow centers measuring 15-20 nm in diameter and arranged in parallel arrays, raising suspicion of ITG. Mass spectrometry and paraffin-IF following pronase K pretreatment detected IgG2 along the capillary walls, leading to the diagnosis of monoclonal ITG with masked IgG. In addition, the presence of paraproteins in serum and urine prompted bone marrow examination, which confirmed symptomatic multiple myeloma. With chemotherapy, the M-protein level decreased, proteinuria improved to less than 0.5 g/gCr, and renal function remained stable. We describe a rare case of monoclonal ITG with masked IgG, diagnosed by mass spectrometry and paraffin-IF, in a patient with symptomatic multiple myeloma. Early diagnosis and therapy for multiple myeloma stabilized renal function and reduced proteinuria. When a discrepancy between IF and EM findings is observed, especially when false-negative immunoglobulin staining is suspected, restaining with paraffin-IF or evaluation by mass spectrometry should be considered to ensure accurate diagnosis and appropriate treatment.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429846","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

Non-catheter-adherent right atrial mural thrombus in a patient with systemic sclerosis undergoing hemodialysis: a case report. 非导管粘附性右心房附壁血栓在系统性硬化症患者接受血液透析：1例报告。

IF 1

CEN Case Reports Pub Date : 2026-07-07 DOI: 10.1007/s13730-026-01157-8

Masato Habuka, Sahoko Otsuka, Ryohei Kobayashi, Kazunori Satokata, Masataka Yonezawa, Asa Ogawa, Keiichi Tsuchida, Koji Shimada, Suguru Yamamoto

{"title":"Non-catheter-adherent right atrial mural thrombus in a patient with systemic sclerosis undergoing hemodialysis: a case report.","authors":"Masato Habuka, Sahoko Otsuka, Ryohei Kobayashi, Kazunori Satokata, Masataka Yonezawa, Asa Ogawa, Keiichi Tsuchida, Koji Shimada, Suguru Yamamoto","doi":"10.1007/s13730-026-01157-8","DOIUrl":"10.1007/s13730-026-01157-8","url":null,"abstract":"Catheter-related right atrial thrombosis is a rare, potentially fatal complication of central venous catheterization. While most reported cases involve thrombi attached to the catheter tip or mobile intracardiac masses, systemic sclerosis (SSc) is associated with endothelial injury and impaired vascular repair, presenting a unique risk profile characterized by increased susceptibility to thrombus formation. A 56-year-old woman on maintenance hemodialysis for 20 years for IgA nephropathy has had SSc for 10 years after developing digital ulcers. One year before presentation, she developed steal syndrome, causing the closure of her arteriovenous access. Consequently, a tunneled dialysis catheter was inserted via the right internal jugular vein. Transthoracic echocardiography performed 1 year later revealed a right atrial mass, prompting referral for further evaluation. Anticoagulation with warfarin was initiated for a suspected right atrial thrombus. However, the mass enlarged progressively, raising suspicion of a neoplastic lesion. Surgical resection identified a 20 × 20 mm mass attached to the posterior-inferior right atrial wall, which was confirmed as an organized thrombus on histopathological examination. Although the catheter tip was not adherent to the thrombus, repetitive contact between the catheter tip and the right atrial wall occurred during atrial motion. Thus, thrombus formation was attributed to chronic mechanical irritation from the catheter tip, exacerbated by systemic sclerosis-related endothelial vulnerability. This case highlights that chronic mechanical irritation from a deeply positioned dialysis catheter tip can cause a non-catheter-adherent mural right atrial thrombus. SSc-associated endothelial vulnerability may have contributed to impaired recovery from chronic endothelial injury.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396064","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 with superimposed minimal change disease complicated by acute kidney injury requiring temporary hemodialysis. 免疫球蛋白A肾病合并微小病变，并发急性肾损伤，需要临时血液透析。

IF 1

CEN Case Reports Pub Date : 2026-07-04 DOI: 10.1007/s13730-026-01155-w

Yuki Nagaike, Akifumi Tabei, Yu Shimizu, Shiori Mori, Hiroyuki Mori, Kengo Yoshida, Yoshinori Takei, Satoshi Furukata, Katsuhiko Takara, Nozomi Kadota, Kazuaki Mori, Shoki Ikeda, Muneharu Yamada, Yusuke Suzuki, Noriaki Hemmi

{"title":"Immunoglobulin A nephropathy with superimposed minimal change disease complicated by acute kidney injury requiring temporary hemodialysis.","authors":"Yuki Nagaike, Akifumi Tabei, Yu Shimizu, Shiori Mori, Hiroyuki Mori, Kengo Yoshida, Yoshinori Takei, Satoshi Furukata, Katsuhiko Takara, Nozomi Kadota, Kazuaki Mori, Shoki Ikeda, Muneharu Yamada, Yusuke Suzuki, Noriaki Hemmi","doi":"10.1007/s13730-026-01155-w","DOIUrl":"10.1007/s13730-026-01155-w","url":null,"abstract":"Immunoglobulin A (IgA) nephropathy (IgAN) with superimposed minimal change disease (MCD) is a rare but increasingly recognized clinicopathological phenotype that is generally associated with a favorable renal prognosis. We present a case of IgAN with MCD complicated by severe acute kidney injury (AKI) during the clinical course and requiring temporary renal replacement therapy. A 38-year-old man presented with acute nephrotic syndrome. Renal biopsy showed mesangial IgA deposition, and anti-galactose-deficient IgA1 antibody (KM55) staining demonstrated co-localization with IgA deposits, supporting the diagnosis of IgAN with superimposed MCD. Electron microscopy revealed foot process effacement, leading to a diagnosis of IgAN with MCD. High-dose prednisolone therapy was initiated; however, the patient subsequently developed severe AKI requiring hemodialysis (HD). Concurrent treatment with cyclosporine A and steroid pulse therapy was administered, ultimately allowing successful discontinuation of HD. This rare case was diagnosed as IgAN with MCD based on mesangial IgA deposition supported by KM55 staining and characteristic electron microscopic findings, and this case demonstrates that severe AKI requiring temporary HD may occur during the clinical course of IgAN with MCD. Although IgAN with MCD has been increasingly recognized, reports of cases complicated by severe AKI requiring HD remain limited in the literature. This patient showed subsequent improvements in renal function and proteinuria, suggesting that this condition may be reversible. These findings highlight the importance of careful clinical management with attention to the potential risk of AKI even in patients with IgAN with MCD.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387416","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

Denosumab increased bone mineral density but caused marked serum calcium fluctuations in a patient undergoing peritoneal dialysis. 在接受腹膜透析的患者中，Denosumab增加骨密度，但引起明显的血清钙波动。

IF 1

CEN Case Reports Pub Date : 2026-06-30 DOI: 10.1007/s13730-026-01142-1

Shunsuke Yamada, Soma Enomoto, Kana Matsuo, Yusuke Sonezaki, Kumiko Torisu

{"title":"Denosumab increased bone mineral density but caused marked serum calcium fluctuations in a patient undergoing peritoneal dialysis.","authors":"Shunsuke Yamada, Soma Enomoto, Kana Matsuo, Yusuke Sonezaki, Kumiko Torisu","doi":"10.1007/s13730-026-01142-1","DOIUrl":"10.1007/s13730-026-01142-1","url":null,"abstract":"Denosumab is increasingly used to treat osteoporosis in patients with advanced kidney disease, but clinically significant disturbances in calcium homeostasis remain a major concern. We report a peritoneal dialysis (PD) case in which denosumab administration was followed by pronounced calcium fluctuations requiring medication management. A 56-year-old woman with end-stage kidney disease due to lupus nephritis, receiving prednisolone (5 mg/day), had been on continuous ambulatory PD (1.5-L exchanges three times daily) for 5 years. Baseline intact parathyroid hormone was 176 pg/mL. Osteoporosis was confirmed by dual-energy X-ray absorptiometry (lumbar spine 68% and femoral neck 58% of the young adult mean [YAM]). Denosumab 60 mg was administered, and BMD increased within 10 months to 78% YAM at the lumbar spine and 77% YAM at the femoral neck (same facility, identical DXA equipment). To mitigate hypocalcemia, dialysate calcium was pre-emptively increased to two 3.5-mEq/L and one 2.5-mEq/L bags per day (albumin-corrected calcium 9.5 mg/dL at dosing). Nonetheless, symptomatic hypocalcemia developed (nadir 7.8 mg/dL on day 7), prompting escalation to three 3.5-mEq/L bags with intensified vitamin D therapy and calcium supplementation. Serum calcium then overshot, peaking at 13.8 mg/dL on day 29; therapy was de-escalated and calcium stabilized. This case highlights that while daily dialysate calcium exposure in PD may buffer early hypocalcemia, concurrent escalation of dialysate calcium, vitamin D therapy, and calcium supplementation can precipitate overshoot hypercalcemia. Frequent monitoring and staged, stepwise prescription changes during the first month after denosumab are essential. Standardized PD-specific post-denosumab calcium management protocols are urgently needed.","PeriodicalId":9697,"journal":{"name":"CEN Case Reports","volume":"15 4","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350707","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