NDT Plus - Advance Access

The administration of cinacalcet hydrochloride just before a haemodialysis session suppresses the transient rise in intact parathyroid hormone induced by a low-calcium dialysate: when should cinacalcet hydrochloride be administered?

Date, T., Kawashita, Y., Matsuzaki, M., Kobayashi, H., Nagano, N. — 2008-09-06

A rare cause of the pulmonary-renal syndrome: a case of atypical haemolytic-uraemic syndrome complicated by pulmonary haemorrhage

Derebail, V. K., Parikh, P., Jennette, J. C., Kshirsagar, A. V. — 2008-09-03

Pulmonary haemorrhage is a potentially life-threatening event that may occur in patients with pulmonary-renal syndromes. These syndromes have typically been thought to occur in small-vessel vasculitides, such as ANCA-mediated disease, Goodpasture's disease and other autoimmune conditions including systemic lupus erythematosus or anti-phospholipid antibody syndrome. Here, we present a rare cause for pulmonary haemorrhage with associated renal failure—atypical haemolytic-uraemic syndrome. In this case, renal biopsy was integral to providing a diagnosis and guiding therapy.

Pathologic improvement after high-dose melphalan and autologous stem cell transplantation for primary systemic amyloidosis

Hoshino, J., Ubara, Y., Ohashi, K., Takemoto, F., Takaichi, K. — 2008-09-01

Although primary systemic amyloid light-chain amyloidosis was considered intractable, recent advances in therapy have been reported to result in better clinical outcomes including remission of nephrotic syndrome. However, changes in renal pathologic findings after high-dose chemo- therapy have not been characterized. We describe a patient who underwent serial renal biopsies and had complete remission after high-dose melphalan and autologous stem cell transplantation for this form of amyloidosis. Successive renal biopsy specimens showed reduction in amyloid staining mainly in interlobular arterial and arteriolar walls. Thus, amyloid light-chain amyloidosis resolved both clinically and pathologically after high-dose chemotherapy.

How much is red blood cell fragmentation increased by the use of closed luer lock access devices on catheter hubs?

Eloot, S., De Vos, J.-Y., Hombrouckx, R. — 2008-09-01

Pan-ureteric transitional cell carcinoma in a patient of autosomal dominant polycystic kidney disease with chronic renal failure

Kumar, S., Mavuduru, R. S., Sharma, V. — 2008-09-01

Acute kidney failure and an epigastric mass

Van den Bergh, B., Oyen, R., Kuypers, D. R. — 2008-09-01

Lanthanum carbonate possibly responsible for acute liver failure in a patient with Child-Pugh stage A liver cirrhosis

De Leeuw, K., Woestenburg, A., Verbeelen, D. — 2008-09-01

The majority of patients with end-stage renal disease have hyperphosphataemia, which is associated with significant morbidity and mortality. Lanthanum carbonate has been introduced as a new treatment modality to lower serum phosphorus. But there has been ongoing concern about lanthanum accumulation in tissues, especially in liver. We describe the case of a woman with pre-existing liver disease, who presented with acute liver failure after introduction of lanthanum carbonate to her treatment. The condition was fully reversible after stopping lanthanum carbonate.

Whipple's disease: often a late diagnosis and a rare cause of nephropathy

Kramer, L. C., Manschot, T. A. J. M., Barendregt, J. N. M., Smit, J. M. — 2008-08-29

Acute renal failure and haemorrhagic syndrome secondary to toxin of caterpillars (Lonomia obliqua)

Riella, M. C., Chula, D., de Freitas, S., Mazza, M. M., Pachaly, M. A. — 2008-08-29

Secondary syphilis after renal transplantation

Ballout, A., Yombi, J.-C., Hassoun, Z., Goffin, E., Kanaan, N. — 2008-08-26

High mortality after pelvis and lower limb fractures in ESRD

Ouellet, G., Vallee, M., Senecal, L., Leblanc, M. — 2008-08-23

Effect of online haemodialysis vascular access flow evaluation and pre-emptive intervention on the frequency of access thrombosis

2008-08-22

Introduction. Guidelines advocate surveillance of vascular access to reduce incidences of thrombosis. However, the value of online vascular access flow monitoring is still under debate.

Methods. Through a systematic literature search, the effect of online access flow surveillance combined with pre-emptive intervention on thrombosis frequency is reviewed.

Results. Due to methodological differences, adequate comparison of the individual study results is not possible. Moreover, the methodological quality of most of the included studies is not suitable for an adequate statistical analysis of the results.

Conclusion. Until now, there is no conclusive evidence that online access flow evaluation has a significant effect on the rate of thrombosis. Future large-scale studies with adequate study design, adequate surveillance and intervention protocols and, possibly, better pre-emptive intervention alternative(s) are necessary.

Cystinuria-transitory recovery: is it possible?

Peres, L., Largura, A. — 2008-08-22

Massive uric acid nephrolithiasis with progressive renal failure due to spontaneous tumour lysis syndrome

Trachsler, J., Gaspert, A., Previsdomini, M., Wuthrich, R. P., Fehr, T. — 2008-08-22

Tumour lysis syndrome (TLS) is a constellation of meta- bolic complications due to the rapid destruction of malignant cells, causing renal, cardiac or cerebral dysfunction. Electrolyte abnormalities include hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia. TLS-induced renal failure is mainly caused by uric acid and calcium phosphate crystal deposition and usually develops following cytotoxic chemotherapy. Here, we present a case of spontaneous TLS in a patient with chronic myelomonocytic leukaemia (CMML) with massive uric acid stone and crystal formation and rapidly worsening renal failure. Autopsy revealed underlying tumourous kidney infiltration. Risk factors for occurrence of TLS and current therapeutic management are discussed.

End-stage renal disease after bariatric surgery

Crews, D. C., Fine, D. M., Racusen, L. C. — 2008-08-22

Mycophenolate mofetil as a possible therapeutic option for idiopathic membranoproliferative glomerulonephritis

Kazory, A., Racusen, L. C., Berliner, A. R., Gimenez, L. F., Jaar, B. G. — 2008-08-21

Vertebral fractures in patients on dialysis: a clinically relevant problem with insufficient investigation

Fusaro, M., D'Angelo, A., Gallieni, M. — 2008-08-12

Invasive maxillary sinus mass in a renal transplant patient

Johnson, M. D., Yeo, F. E. — 2008-08-12

Life at the UK renal registry--an unforgettable experience

Ben, T. — 2008-08-11

Particular cutaneous lesions and chronic renal failure

Meyrier, A. — 2008-08-11

Salvage of a radiocephalic fistula by the palmar arch

Knops, N., Beek, E. — 2008-08-08

We present a child with mild problems during haemodialysis due to stenosis of the proximal radial artery of his radiocephalic fistula. However, his problems spontaneously subsided. Follow-up sonography revealed arterial occlusion proximal to the fistula with retrograde flow in the distal segment. Kt/V and shunt flow were normal. Physical examination confirmed proximal radial artery occlusion with collateral blood supply via the palmar arch. There were no signs of steal. To our knowledge this is the first description of a patient experiencing adequate haemodialysis with arterial occlusion proximal to a radiocephalic fistula salvaged by collateral arterial supply via the palmar arch.

2,8-Dihydroxyadeninuria-induced progressive renal failure

Mac-Way, F., Desmeules, S., Latulippe, E., de Cotret, P. R., Agharazii, M. — 2008-08-08

Encapsulating peritoneal sclerosis following renal transplantation despite tamoxifen and immunosuppressive therapy

2008-08-08

Encapsulating peritoneal sclerosis (EPS) is a rare disease in patients who have undergone peritoneal dialysis (PD). We report a case of EPS following renal transplantation that highlights important clinical issues. Initially, a presumptive diagnosis of EPS was made following surgical and pathological findings at the time of cholecystectomy. CT imaging at this time did not confirm the diagnosis. The patient continued PD and commenced tamoxifen. Prior to and immediately following transplantation, further CT imaging demonstrated no evidence of EPS. Acute bowel obstruction occurred 5 months post-transplantation and a diagnosis of EPS was made both clinically and on CT imaging, despite immunosuppression and tamoxifen. The role of these therapies in managing EPS post-transplant is discussed, in addition to the need for a high index of clinical suspicion to make the diagnosis.

Chest pain and pseudoclubbing in a haemodialysis patient

Winn, S., DeSilva, V., Phanish, M. — 2008-08-04

Sweet and sour--a patient with life-threatening metabolic acidosis and acute renal failure

Schorn, R., Kalicki, R., Remschmidt, C., Schley, G., Hofliger, N., Aregger, F. — 2008-08-04

Medical complications of kidney transplantation

Peeters, P. — 2008-08-04

Abrupt and durable remission of Henoch-Schonlein purpura nephritis with cyclosporine A

Georgaki-Angelaki, E., Kostaridou, S., Lourida, A., Petraki, C, Lagona, E. — 2008-08-01

Henoch–Schönlein purpura glomerulonephritis (HSP-GN) is a common form of systemic small vessel vasculitis in children. Although prognosis is usually favourable, the disease is occasionally associated with a risk of renal insufficiency. Various immunosuppressive agents have been used in patients with severe HSP-GN, but none have shown convincing favourable effects. We report a case of biopsy-proven HSP-related GN in a 4-year-old girl that responded remarkably well to cyclosporine A (CsA), following failure to respond to other immunosuppressive agents. At 8 months post-CsA treatment, repeat renal biopsy findings were consistent with histological improvement. We conclude that CsA treatment not only exerts beneficial effects on resistant HSP-related GN but may also arrest progression of the disease.

Successful treatment of Henoch-Schonlein purpura nephritis with plasma exchange in an adult male

Chaudhary, K., Shin, J.-Y., Saab, G., Luger, A. M. — 2008-07-25

Henoch-Schonlein purpura (HSP) frequently occurs in children under 15 years of age but is quite rare in adults. Most children who develop HSP nephritis completely recover from the illness, whereas up to 40% of adults have persistent hematuria and 10% develop chronic renal failure. Plasma exchange alone has been shown to be beneficial in children who have HSP nephritis. Adults have been treated using immunosuppressive drugs such as cyclophosphamide but effects are not certain. Here, we present a case of a 59-year-old white male who developed HSP nephritis while undergoing treatment with steroids. The patient developed acute renal failure with proteinuria and hematuria ~2 weeks after being initially diagnosed with HSP by skin biopsy. Renal biopsy showed proliferative, exudative glomerulonephritis involving all 20 glomeruli; some with early crescent formation. Immunofluorescence staining showed 3+ IgA deposits in mesangium suggesting HSP-induced GN. The patient's serum creatinine rose to 2.5 mg/dl with ~5 g of proteinuria by dipstick. Steroids were continued and the patient received plasma exchange treatments. Due to a very low leukocyte count, immunosuppressive agents were not given. Subsequently, renal function improved and the creatinine level came down to 1.3 mg/dl and proteinuria to <1 g/24 h. Since then, 1 year after this event, his serum creatinine has continued to stay at 1.2 mg/dl and he has trace proteinuria while taking a low-dose ACE inhibitor. This case illustrates the usefulness of plasma exchange in adult onset HSP nephritis, even without concomitant use of cytotoxic agents.

Acute renal failure and multiple sites of ischaemia: what is the unifying diagnosis?

Doare, K. L., Ameli-Renani, S., Banerjee, D., Brecker, S. J. D., Eastwood, J. B. — 2008-07-18

Acute abdomen and acute kidney injury: a common entity, a not so rare link?

2008-07-15

Renal failure and abdominal pain as the presenting symptoms of a rare tumor of the aorta masquerading as a calcified plaque

Bayliss, G., Jacobs, W., Williams, M. — 2008-07-12

Vascular obstructive causes must be considered in chronic renal failure with no obvious cause. We present the case of a 74-year-old woman with smoldering renal failure who undergoes a renal biopsy that did not undercover a cause. As her symptoms persisted and renal function worsened, her nephrologist proposed magnetic resonance angiography with gadolinium and prophylactic initiation of hemodialysis. Imaging uncovered an occlusive aortic mass, which was removed surgically with improvement in renal function. The case discusses the nature of the mass and the need to weigh the risks and benefits of MR imaging with gadolinium and initiation of hemodialysis against the risk of nephrogenic systemic fibrosis.

Bilineal inheritance of type 1 autosomal dominant polycystic kidney disease (ADPKD) and recurrent fetal loss

Peces, R., Peces, C., Coto, E., Selgas, R. — 2008-07-11

We report for the first time a family with type 1 ADPKD in which the marriage between affected non-consanguinous individuals resulted in two live-born heterozygous offspring and two fetuses lost in mid-pregnancy. Given a 25% chance for mutant compound heterozygosity in the offspring of this family, our findings suggest that compound heterozygosity of PKD1 mutations in humans may be embryonically lethal.

Collapsing glomerulopathy presenting as the initial manifestation of systemic lupus erythematosus

Mallavarapu, R. K., Nandigam, S. C., Peskoe, S. T. — 2008-07-04

Membranoproliferative glomerulonephritis associated with an Epstein-Barr virus infection

Karamadoukis, L., Toth, T., Tomson, C. — 2008-07-04

Type 1 membranoproliferative glomerulonephritis (MPGN) is an immune complex-mediated disorder that has been associated with certain viral infections including hepatitis C, hepatitis B, hepatitis G, HIV and Hantavirus. We describe a patient with type 1 MPGN in native kidneys and nephrotic syndrome in whom there was strong evidence that a primary Epstein–Barr virus (EBV) infection played a causative role. This patient was treated with an angiotensin 2-receptor blocker and the nephrotic syndrome resolved within 6 months from presentation. Our case report suggests that MPGN presenting with nephrotic syndrome may have a relatively benign course when it is associated with an acute EBV infection.

Sustained low-efficiency dialysis (SLED) for acute lithium intoxication

Fiaccadori, E., Maggiore, U., Parenti, E., Greco, P., Cabassi, A. — 2008-07-03

Acute lithium intoxication may cause serious neurologic and cardiac manifestations, up to the patient's death. Owing to its low molecular weight, relatively small volume of distribution close to that of total body water, and its negligible protein binding, lithium can be efficiently removed by any extracorporeal modality of renal replacement therapy (RRT). However, the shift from the intracellular to the extracellular compartment, with the inherent rebound phenomenon after the end of RRT, might limit the efficacy of the conventional, short-lasting haemodialysis. There have been no published studies up to now concerning the use of sustained low-efficiency dialysis (SLED) in lithium intoxication. This report describes a woman with a voluntary acute lithium ingestion of 40 tablets of lithium carbonate (8.12 mEq lithium each). The lithium concentration increased up to 4.18 mEq/l about 24 h after admission, notwithstanding treatment with intravenous crystalloids and gastric lavage. She developed mental status changes, oliguria, hypotension and bradycardia. We started SLED (8 h) with a blood flow of 200 ml/min and countercurrent dialysate flow of 300 ml/ min. Lithium serum levels decreased by 86% during treatment, and the patient fully awoke recovering a normal mental status within the first 4 h of treatment. SLED was completed safely within the prescribed time. After the end of treatment, the rebound of lithium concentration was unremarkable. Renal function fully recovered, and the patient was transferred into a psychiatric facility 3 days after admission.

BK virus induced nephritis in a boy with acute myeloid leukaemia undergoing bone marrow transplantation

Hoefele, J., Russmann, D., Klein, B., Weber, L. T., Fuhrer, M. — 2008-07-03

BK virus (BKV) is a human polyomavirus. The primary infection occurs typically without specific signs or symptoms. Almost 80% of adults are seropositive. Clinically relevant infections are usually limited to individuals who are immunosuppressed. After primary infection, BKV remains latent in the kidneys and can be reactivated in the setting of immunosuppression. BKV is associated with tubulointerstitial nephritis and ureteric stenosis in renal transplant recipients. Furthermore, BKV-induced haemorrhagic cystitis (HC) is a severe complication of bone marrow transplantation (BMT) in children and adults. A combination of HC and tubulointerstitial nephritis in a patient has not been reported so far. We report on an 11-year-old boy with acute myeloid leukaemia undergoing BMT. BKV infection was reactivated during post-transplant immunosuppressive therapy causing HC associated with tubulointerstitial nephritis.

Octreotide scanning in the detection of metastatic renal cell carcinoma

McCloskey, M. C., Smyth, J., Marshall, W., Leonard, N. — 2008-07-02

The effect of angiotensin type 1 receptor blockade on adhesion molecules in patients with IgA nephropathy

Xydakis, D., Papadogiannakis, A., Sfakianaki, M., Kostakis, K., Sfyridakh, A. — 2008-06-30

A mysterious 'homesickness'

Jouret, F., Differding, S., Lhommel, R., Jadoul, M., Lambert, M. — 2008-06-25

Water intoxication induced by low-dose oral cyclophosphamide in a patient with anti-neutrophil cytoplasmic antibody-related glomerulonephritis

2008-06-24

We reported the case of a 70-year-old woman with moderate renal failure due to anti-neutrophil cytoplasmic antibody-related glomerulonephritis who developed symptomatic water intoxication (serum Na: 108 mEq/L) following treatment with oral low-dose cyclophosphamide (CY) (50mg/day). Estimated glomerular filtration rate was 29.5 mL/min/1.73 m². She had drunk >2 L of fluid in 12 h prior to the development of cerebral oedema. This rare case suggests that oral low-dose CY could be an occult cause of water intoxication in patients with chronic kidney disease taking large fluid volumes.

Treatment of metformin-associated lactic acidosis with sustained low-efficiency daily dialysis

Teutonico, A., Libutti, P., Lomonte, C., Antonelli, M., Casucci, F., Basile, C. — 2008-06-23

Permanent renal failure induced by pentastarch

Jamal, R., Ghannoum, M., Naud, J.-F., Turgeon, P.-P., Leblanc, M. — 2008-06-23

Background. Controversy exists with volume resuscitation using crystalloids or colloids. Renal dysfunction has been reported with some colloids and osmotic agents, but remains poorly defined.

Patient. We report the case of a 67-year-old male who had normal kidney function at baseline and who developed anuric ARF in relation to the administration of >10 litres of 10% pentastarch. A renal biopsy confirmed hydropic changes in tubular cells compatible with colloid-induced damage.

Conclusion. This case demonstrates that hydroxyethyl starch preparations may be associated with acute kidney injury, and one should carefully consider their use, especially in patients with pre-existing renal dysfunction. Osmotic tubular cell lesions may be long lasting and irreversible.

STIR(ing) appearance of rhabdomyolysis

Chakera, A., Cowan, N., Winearls, C. — 2008-06-19

Is adenine phophorybosiltransferase deficiency a still underdiagnosed cause of urolithiasis and chronic renal failure? A report of two cases in a family with an uncommon novel mutation

2008-06-19

We describe two patients that had a history of recurrent renal stones and chronic renal insufficiency. The first case was a 51-year-old man with an adenine phophoribosyltransferase (APRT) deficiency who was diagnosed only after he had been referred for severe renal failure requiring hemodialysis. This led to a screening of the entire family, which identified six carriers and an additional affected relative (a 41-year-old man and the second case reported herein). Genetic analysis of the APRT gene revealed an atypical mutation previously described only once in a compound heterozygote.

Rapamycin-induced remission of Kaposi's sarcoma is not associated with expansion of cytotoxic T-lymphocyte subsets

Walsh, S. B., Summers, S. A., Amlot, P. L., Sheaff, M. T., Neild, G. H. — 2008-06-16

We present a case of post-transplantation Kaposi's sarcoma (KS) successfully treated by conversion to rapamycin. Clinical and histological resolution was observed within 6 months of commencing rapamycin. Also, vascular endothelial growth factor (VEGF) staining in the biopsy samples resolved following rapamycin therapy. Interestingly there was no expansion in cytotoxic T-lymphocyte (CTL) subsets observed during this period, as might be expected if this remission was due to immune reconstitution following reduction in immunosuppression. These data suggest that the resolution of tumour with rapamycin could be the result of the antiangiogenic, antiproliferative effects of rapamycin.

Thalidomide: a treatment option for bleeding GI angiodysplasias in dialysed patients

Korzets, A., Gafter, U., Chagnac, A., Zingerman, B., Morduchovitz, V., Ori, Y. — 2008-06-05

Tracing chameleon: thallium-201 SPECT/CT for pheochromocytoma

Wang, Y.-F., Lan, S.-K., Chang, S.-M., Chiu, J.-S. — 2008-06-04

Two cases of iodixanol-induced pancreatitis

Kheda, M. F., Szerlip, H. M. — 2008-06-02

Diagnosis by inclusion

Ebah, L. M., Mapstone, N., Gibson, S. P., Woywodt, A. — 2008-05-28

Cinacalcet in HIV haemodialysis patients

Belmouaz, S., Bauwens, M., Chauvet, S., Bridoux, F., Touchard, G. — 2008-05-28

Purple urine bag syndrome (PUBS)

Liolios, A. C., Woess, E., Lhotta, K. — 2008-05-21

Obstructive nephropathy and kidney injury associated with ketamine abuse

Selby, N. M., Anderson, J., Bungay, P., Chesterton, L. J., Kolhe, N. V. — 2008-05-21

The pattern of proteinuria following karate (Kumite) competitions

Afshar, R., Sanavi, S., Fakharian, M. A., Ahmadzadeh, M. — 2008-05-21

Pulse oximetry is useful for screening sleep apnoea syndrome in dialysis patients

2008-05-13

Rapid remission of minimal change disease with angiotensin II antagonist treatment in a type 1 diabetic patient with no diabetic nephropathy

2008-05-13

Von Hansemann cells and Michaelis-Gutmann bodies in a retroperitoneal mass

Velez, C., Franco, O. A., Arias, L. F. — 2008-05-06

A 34-year-old man with membranous nephropathy, a rash, meningitis and ocular involvement

Bellomo, G., Verdura, C., Venanzi, S., Saronio, P., Timio, M. — 2008-05-06

Hyperparathyroidism in a diabetic patient on dialysis

Hori, M., Ubara, Y., Nakanishi, S., Inosita, N., Takaichi, K. — 2008-05-06

Reversible bilateral optic disc swelling in a renal patient treated with nitrofurantoin

Pringle, E., Ho, H., O'Sullivan, E., Soper, C. — 2008-05-06

Renal transplant malakoplakia: case report and review of the literature

Augusto, J.-F., Sayegh, J., Croue, A., Subra, J.-F., Onno, C. — 2008-04-03