NDT Plus - recent issues

Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit

Davenport, A., Tolwani, A. — Thu, 19 Nov 2009 11:11:32 PST

Continuous forms of renal replacement therapy (CRRT) have become established as the treatment of choice for supporting critically ill patients with acute kidney injury. Typically, these patients have activation of the coagulation cascades, peripheral mononuclear cells and platelets, but also a reduction in natural anticoagulants, and are therefore prothrombotic. For continuous modes of renal replacement therapy to be effective, in terms of both effective solute clearance and also fluid removal, the extracorporeal circuits must operate continuously. Thus, preventing clotting in the CRRT circuit is a key goal to effective patient management. As these patients may also be at increased risk of bleeding, regional anticoagulation with citrate is increasing in popularity, particularly following the introduction of commercially available CRRT machines and fluids specifically designed for citrate anticoagulation. Although regional anticoagulation with citrate provides many advantages over other systemic anticoagulants, excess citrate may lead to both metabolic complications, ranging from acidosis to alkalosis and may also potentially expose patients to electrolyte disturbances due to hyper- and hyponatraemia and hyper- and hypocalcaemia.

Renal involvement in Neimann-Pick Disease

Grafft, C. A., Fervenza, F. C., Semret, M. H., Orloff, S., Sethi, S. — Thu, 19 Nov 2009 11:11:32 PST

We describe the renal biopsy findings in a 14-year-old girl with Neimann-Pick disease. The renal biopsy showed chronic changes involving all components of the parenchyma, including focal global glomerulosclerosis, tubular atrophy, interstitial fibrosis and vascular sclerosis. On light microscopy, significant findings included foamy podocytes, vacuolated tubular epithelial cells and collections of foam cells in the interstitium. Electron microscopy was confirmatory which showed myelin-like inclusions in podocytes, endothelial cells, tubular epithelial cells and small nerves. The findings are similar to Fabry's disease, except that small nerve involvement appears to be unique to Neimann Pick disease.

Nephrotic syndrome associated with immune thrombocytopenia revealing Kimura's disease in a non-Asian male

Noel, N., Meignin, V., Rosenstingl, S., Ronco, P., Boffa, J.-J. — Thu, 19 Nov 2009 11:11:32 PST

We report the case of a young Caucasian man presenting with diffuse oedema and nephrotic syndrome. Clinical examination revealed multiple lymphadenopathies. Histological examination was consistent with the diagnosis of Kimura's disease. A renal biopsy showed focal segmental glomerulosclerosis. Immune thrombocytopenia and signs of humoral autoimmunity were discovered. Corticosteroid treatment induced remission of nephrotic syndrome but relapses occurred 12 and 18 months after onset of treatment while the patient was receiving 20 mg prednisone once a day. To our knowledge, this is the first case of Kimura's disease and nephrotic syndrome associated with B-cell autoreactivity.

Isolated microalbuminuria as the first clinical presentation of Fabry disease in an adult heterozygous female

Thu, 19 Nov 2009 11:11:32 PST

Fabry disease (FD) is a rare X-linked disorder characterized by low or absent activity of the lysosomal enzyme -glycosidase-A that leads to progressive accumulation of glycosphingolipids in different organs and tissues. Clinical manifestations vary from classic to atypical forms characterized by one prevalent organ involvement, and a renal variant has been described in men but not in women. However, little is known about renal manifestation in females affected by FD. We herein report a case of a 22-year-old female with isolated and persistent microalbuminuria as the only sign of FD. In light of the importance of early recognition and treatment of FD organ damage, this case should call for future studies to determine how to assess organ damage, investigate the existence of a ‘renal variant’ in FD female patients and determine when best to start enzyme replacement therapy (ERT).

A case of adult atypical haemolytic uraemic syndrome related to anti-factor H autoantibodies successfully treated by plasma exchange, corticosteroids and rituximab

Lionet, A., Provot, F., Glowacki, F., Fremeaux-Bacchi, V., Hazzan, M. — Thu, 19 Nov 2009 11:11:32 PST

Complement factor H auto-antibodies (CFH-ab) are a rare cause (6–10%) of atypical haemolytic uraemic syndrome (aHUS). All observations previously described were retrospective and occurred in children or teenagers. We report the first case of aHUS associated with anti-CFH antibodies in an adult patient who was successfully treated by plasma exchange, corticosteroids and rituximab.

MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits

Thu, 19 Nov 2009 11:11:32 PST

An elderly woman presented with haematuria and proteinuria accompanied by elevated serum myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). A renal biopsy revealed mild mesangial proliferation with fibrocellular crescent formation and a membranous glomerular lesion. Immunofluorescence microscopy using FITC-labelled rabbit anti-human MPO antibodies revealed granular MPO deposition along the glomerular capillary walls (GCW) with a staining profile similar to that of glomerular IgG deposition. The one-year follow-up renal biopsy revealed minimal IgG and undetectable MPO deposition. Both MPO and MPO-ANCA might have been responsible for the IgG immune depositions along the GCW in this patient.

Acute renal failure, systemic lupus erythematosus and thrombotic microangiopathy following treatment with beta-interferon for multiple sclerosis: case report and review of the literature

Hansen, T., New, D., Reeve, R., Donne, R., Stephens, W. — Thu, 19 Nov 2009 11:11:32 PST

We report a man with type 1 diabetes mellitus, autoimmune hypothyroidism and a tentative diagnosis of multiple sclerosis. Following treatment with beta interferon, he developed systemic lupus erythematosus with pericarditis, pleural effusions, cerebral infarction associated with anti-phospholipid antibody and acute renal failure due to thrombotic microangiopathy. He responded well to immunosuppression and anticoagulation. These complications may represent the most severe autoimmune reaction to beta interferon reported to date.

Recurrent intestinal bleeding treated by double-balloon endoscopy in haemodialysis patients

Yamazaki, O., Hanafusa, N., Yamada, A., Noiri, E., Fujita, T. — Thu, 19 Nov 2009 11:11:32 PST

Gastrointestinal (GI) bleeding is a common and troublesome complication of end-stage renal disease (ESRD). Patients often have various lesions in the small bowel and in either upper or lower GI tracts. Recently developed double-balloon endoscopy (DBE) enables observation of the entire small intestine through a combination of anterograde and retrograde approaches. Moreover, DBE is useful not only for diagnosis of small intestinal lesions; it provides a mode of treating the disease. This article presents patients with several small intestinal diseases from our facility. Their bleeding sources were identified using DBE. We also report two representative cases of angiodysplasia that had been diagnosed and treated successfully using DBE. One case particularly underscored the usefulness of the combination of capsule endoscopy (CE) and DBE as an electively diagnostic approach for patients with GI bleeding. Small intestinal bleeding is often observable repeatedly in a single patient, as described for case 1. In such circumstances, DBE can treat the lesions successfully without surgical procedures. In this report, ESRD patients, in whom comorbid conditions made it difficult to perform surgical procedures, receive great benefit from DBE.

Refractory uraemic pleuropericarditis treated successfully with corticosteroid therapy

Lee, S.-Y., Hong, G.-y., Chung, J. G., Yang, D. H., Kim, H.-J. — Thu, 19 Nov 2009 11:11:32 PST

Uraemic pleuritis and pericarditis are frequently observed in chronic renal failure patients and tend to improve with continued haemodialysis. However, certain cases have been reported that do not respond to continued haemodialysis alone. A 67-year-old female on long-term haemodialysis was diagnosed with uraemic pleuropericarditis and treated with intensive haemodialysis and given a non-steroidal anti-inflammatory drug to which she showed no response. We report a case of uraemic pleuropericarditis refractory to traditional therapy, which was treated successfully with corticosteroid therapy.

Renal clear cell carcinoma emerging in a transplanted kidney 3 years after return to dialysis. Case report and review of the literature

Elazary, R., Schlager, A., Appelbaum, L., Zamir, G., Nir, I. — Thu, 19 Nov 2009 11:11:32 PST

We present a female patient with end-stage renal disease who was referred to the emergency department with sudden, excruciating pain over the right lower abdomen and flank. Radiologic evaluation following admission revealed a mass, solid in nature, located at the upper pole of the transplanted kidney. The patient was treated with empiric antibiotics and analgesics, and her symptoms subsided over the course of the week. Based on the clinical course and radiological findings, a self-limiting, spontaneous haemorrhage was thought to be the cause of the patient's symptoms. Nevertheless, background malignancy could not be ruled out. Therefore, an interval, elective graft nephrectomy was scheduled. Pathology confirmed the diagnosis of renal clear cell carcinoma.

Improvement of cardiac function after kidney transplantation with dilated cardiomyopathy and long dialysis vintage

Mimura, I., Kawarazaki, H., Momose, T., Shibagaki, Y., Fujita, T. — Thu, 19 Nov 2009 11:11:32 PST

Patients with long dialysis vintage have low cardiac output for various reasons. Although kidney transplantation is known to improve cardiac mortality, patients are sometimes evaluated as contraindicated for transplantation because of cardiac risk. We successfully performed kidney transplantation for a patient with a long dialysis vintage and dilated cardiomyopathy. Sequential ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy suggested that amelioration of uraemia improved cardiac function. Kidney transplantation for patients with severely impaired cardiac function is safe and effective under careful perioperative monitoring irrespective of dialysis vintage. Sequential ¹²³I-MIBG scintigraphy can be used as an evaluation tool for the improvement in cardiac function.

Hereditary nephrogenic diabetes insipidus: a major conundrum during labour and delivery

Castillo, E., Magee, L. A., Bichet, D., Halperin, M. — Thu, 19 Nov 2009 11:11:32 PST

Star fruit: simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function

Thu, 19 Nov 2009 11:11:32 PST

C-peptide and combined kidney-pancreas transplantation

Bhargava, R., Mitsides, N., Saif, I., MacDowall, P., Woywodt, A. — Thu, 19 Nov 2009 11:11:32 PST

'Stone'-blindness

Sundaram, M., Mohapatra, A., John, G. T. — Thu, 19 Nov 2009 11:11:32 PST

The 'Double Dutch' Doppler

Mitsides, N., Maginnis, P., Woywodt, A. — Thu, 19 Nov 2009 11:11:32 PST

Secondary hyperoxaluria and urinary crystal casts after intestinal resection

Almeida, J. R., Lutz, F. B., de Carvalho, E. D., da Silva, P. R. A. — Thu, 19 Nov 2009 11:11:32 PST

Metastatic pulmonary calcification in a patient with long dialysis vintage

Yazawa, M., Shibagaki, Y., Konno, Y., Yasuda, T., Kimura, K. — Thu, 19 Nov 2009 11:11:32 PST

Haematuria and hydronephrosis caused by Castleman's disease

Lee, T. H., Kim, W., Jeong, Y. B., Jang, K. Y., Park, S. K. — Thu, 19 Nov 2009 11:11:32 PST

Calcification of the liver in a patient on renal replacement therapy diagnosed with systemic calciphylaxis

Ladino, M., Sadhu, S., Ortega, L. M. — Thu, 19 Nov 2009 11:11:32 PST

Occult hepatitis B virus infection in a Sicilian chronic dialysis population

Li Cavoli, G., Ferrantelli, A., Tralongo, A., Schillaci, O., Rotolo, U. — Thu, 19 Nov 2009 11:11:32 PST

H1N1 infection and acute kidney injury in the critically ill

Trimarchi, H., Greloni, G., Campolo-Girard, V., Rosa-Diez, G. — Thu, 19 Nov 2009 11:11:32 PST

Thalidomide-induced heart block in a dialysis patient

Anwar, S., Chawathey, K., Holt, S. — Thu, 19 Nov 2009 11:11:32 PST

Adherence to guideline recommendations for infection prophylaxis in peritoneal dialysis patients

Badve, S. V., Smith, A., Hawley, C. M., Johnson, D. W. — Thu, 19 Nov 2009 11:11:32 PST

A single-dose vancomycin application after standard protocol in peritoneal dialysis patients with recurrent peritonitis

Usta, M., Ersoy, A., Ucar, E. — Thu, 19 Nov 2009 11:11:32 PST

Biocompatibility of peritoneal dialysis solutions determined by genomics of human leucocytes: a cross-over study

Thu, 19 Nov 2009 11:11:32 PST

Crescentic glomerulonephritis in a patient with advanced lung cancer during erlotinib therapy

Kurita, N., Mise, N., Fujii, A., Ikeda, S., Sugimoto, T. — Thu, 19 Nov 2009 11:11:33 PST

The 2007 ERA-EDTA Registry Annual Report--a Precis

Stel, V. S., Kramer, A., Zoccali, C., Jager, K. J. — Thu, 19 Nov 2009 11:11:33 PST

Promoting scientific collaboration and education in cardiovascular-renal medicine: EURECAM: An ERA-EDTA-based working group

Thu, 19 Nov 2009 11:11:33 PST

SIADH and hyponatraemia: foreword

O'Donoghue, D., Trehan, A. — Fri, 16 Oct 2009 09:12:30 PDT

Hyponatraemia is common, affecting about one in five of all hospitalized patients. Minor degrees of chronic hyponatraemia cause cognitive and motor impairment, and severe hyponatraemia is associated with substantial morbidity and mortality. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of hyponatraemia and is often poorly understood and inappropriately treated. Clinical evaluation and simple biochemical assessment should guide management. The introduction of vasopressin antagonists, or vaptans, into clinical practice heralds the beginning of a new and exciting era for this important group of disorders.

SIADH and hyponatraemia: why does it matter?

Hoorn, E. J., van der Lubbe, N., Zietse, R. — Fri, 16 Oct 2009 09:12:30 PDT

The vasopressin-receptor antagonists have received approval for the treatment of hyponatraemia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). It is therefore necessary that physicians encountering hyponatraemia focus on SIADH. Recent studies show that hyponatraemia is often poorly managed—insufficient diagnostic tests are ordered and patients are undertreated. At the same time, it has become clear that chronic hyponatraemia causes neurological symptoms such as gait disturbances and attention deficits. However, physicians often tolerate chronic hyponatraemia as if it were benign, or as if its treatment would cause significant morbidity. Therefore, physicians must reconsider the diagnostic and therapeutic approaches to hyponatraemia and SIADH.

Current and future treatment options in SIADH

Zietse, R., van der Lubbe, N., Hoorn, E. J. — Fri, 16 Oct 2009 09:12:31 PDT

The treatment of hyponatraemia due to SIADH is not always as straightforward as it seems. Although acute treatment with hypertonic saline and chronic treatment with fluid restriction are well established, both approaches have severe limitations. These limitations are not readily overcome by addition of furosemide, demeclocycline, lithium or urea to the therapy. In theory, vasopressin-receptor antagonists would provide a more effective method to treat hyponatraemia, by virtue of their ability to selectively increase solute-free water excretion by the kidneys (aquaresis). In this review we explore the limitations of the current treatment of SIADH and describe emerging therapies for the treatment of SIADH-induced hyponatraemia.

The clinical challenge of SIADH--three cases

van der Lubbe, N., Thompson, C. J., Zietse, R., Hoorn, E. J. — Fri, 16 Oct 2009 09:12:31 PDT

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) remains a challenging disorder to diagnose and treat. Three cases are presented to illustrate these challenges. The first two cases had drug-induced SIADH secondary to a selective serotonin reuptake inhibitor (for depression) or carbamazepine (for trigeminal neuralgia). The third case had SIADH possibly secondary to bronchiectasis. The lowest serum sodium concentrations ranged between 118 and 124 mmol/L in the three cases. Hyponatraemia was not acute and severe symptoms were absent. However, several mild neurological symptoms were present. In the first case, hyponatraemia likely contributed to a fall, which resulted in a fracture of the odontoid process of the axis. The other two cases also had gait disturbances, in addition to nausea, headache, impaired memory, difficulty concentrating and confusion. In at least two of the cases, the underlying cause of SIADH was impossible to reverse. Traditional treatment for SIADH with fluid restriction and demeclocycline failed, caused side effects or increased duration of hospital stay. These examples suggest a need for better treatment options. The introduction of the vasopressin-receptor antagonists for SIADH may be a welcome new therapy to overcome some of these challenges.

A review of drug-induced hypernatraemia

Liamis, G., Milionis, H. J., Elisaf, M. — Tue, 22 Sep 2009 06:04:55 PDT

Drug-induced electrolyte abnormalities have been increasingly reported and may be associated with considerable morbidity and/or mortality. In clinical practice, hypernatraemia (serum sodium higher than 145 mmol/L) is usually of multifactorial aetiology and drug therapy not infrequently is disregarded as a contributing factor for increased serum sodium concentration. Strategies to prevent this adverse drug effect involve careful consideration of risk factors and clinical and laboratory evaluation in the course of treatment. Herein, we review evidence-based information via PubMed and EMBASE and the relevant literature implicating pharmacologic treatment as an established cause of hypernatraemia and discuss its incidence and the underlying pathophysiologic mechanisms.

A meta-analysis of the relative doses of erythropoiesis-stimulating agents in patients undergoing dialysis

Tue, 22 Sep 2009 06:04:55 PDT

Background. Erythropoiesis-stimulating agents (ESAs) such as epoetin alfa and beta, and darbepoetin alfa have improved the management of anaemia secondary to chronic kidney disease. Numerous studies have reported a dose reduction when patients receiving dialysis were converted from epoetin to darbepoetin alfa using the starting dose conversion of 200:1 as indicated on the prescribing label by the European Medicines Agency. The objective of this meta-analysis was to summarize the existing body of scientific evidence to evaluate the potential dose savings when comparing epoetin alfa or beta to darbepoetin alfa.

Method. Medline and EmBase were searched to identify all published trials investigating ESA treatment in anaemic patients receiving dialysis and converted from epoetins to darbepoetin alfa. We selected prospective randomized controlled, non-randomized and observational studies involving patients on dialysis that compared epoetin and darbepoetin alfa dosing.

Results. Of 573 articles identified, 9 studies met the eligibility criteria and were included in our analysis. The overall percentage dose savings attained when dialysis patients were converted from epoetin to darbepoetin alfa was 30% (range: 4%–44%). Greater dose savings were noted with intravenous administration (33%) compared with subcutaneous (27%) and between switch-over studies (31%) and RCTs (27%). In all studies, target haemoglobin levels were maintained before and after conversion.

Conclusion. This meta-analysis demonstrates that when using an initial 200:1 conversion ratio, as indicated on the European label, from epoetin to darbepoetin, a subsequent reduction in dose was observed and an average 30% dose savings could be achieved.

Urinanalysis (UA): a neglected but easy and inexpensive diagnostic tool

Gyorik, S., Jandus, P., Marone, C. — Tue, 22 Sep 2009 06:04:55 PDT

The case history of a 75-year-old woman, who was hospitalized with the diagnosis of an acute erosive colitis, is presented. The patient was treated with hysterectomy for an endometrial cancer in 2000 and had suffered from multiple sclerosis for 15 years. A persistent non-productive cough with fever requested a pneumological consultation. Multiple small alveolar opacities and cavitating lesions were found at chest imaging, but no precise diagnosis was possible. Only 3 weeks after hospitalization, we noticed that a urine analysis had been forgotten. This additional test clearly demonstrated a nephritic sediment and further analysis confirmed the diagnosis of a ANCA-positive microscopic polyangiitis, which promptly responded to immunosuppressive therapy. The necessity of a routine urine analysis in the majority of internal medicine patients and the possible link between small vessel vasculitis and multiple sclerosis are discussed.

Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS) syndrome refractory to complete serum vascular endothelial growth factor (VEGF) blockade: insights from sequential VEGF monitoring

Guitard, J., Pillet, A., Soubrier, M., Modesto, A., Chauveau, D. — Tue, 22 Sep 2009 06:04:55 PDT

Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS) syndrome is a systemic condition related to plasma cell dyscrasia. Increased vascular permeability is responsible for some of the hallmarks of this disorder that may include renal microangiopathy. Several lines of evidence suggest that vascular endothelial growth factor (VEGF) is central to the pathogenesis of POEMS syndrome. Thus, specifically targeting VEGF over-expression seems to be a promising treatment. Anti-VEGF therapies are yielding conflicting results. We report on a patient with POEMS syndrome treated with bevacizumab, an anti-VEGF monoclonal antibody. Sequential monitoring of serum VEGF showed sustained normalization of serum VEGF levels, without any beneficial effect on the patient's condition. Indications of this treatment should be chosen carefully.

Sacral radicular cysts in autosomal dominant polycystic kidney disease

Peces, R., Peces, C., Perez-Duenas, V., Vega-Cabrera, C., Campos, I. — Tue, 22 Sep 2009 06:04:55 PDT

This is the first report of a case of sacral radicular cysts in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 46-year-old woman with ADPKD was found to have bilateral sacral radicular cysts discovered incidentally by magnetic resonance imaging (MRI). Cysts arising from arachnoid or spinal meningeal sac should be considered one of the manifestations of a more widespread connective tissue disorder associated with ADPKD.

Renal infarction in patients presenting with suspected renal colic

Seetho, I. W., Bungay, P. M., Taal, M. W., Fluck, R. J., Leung, J. C. H. — Tue, 22 Sep 2009 06:04:55 PDT

Acute renal infarction is a serious medical emergency. The diagnosis is often delayed or missed as it is not common. Hence, the exact incidence of acute renal infarction is not known. Failure to consider renal infarction in the initial differential diagnosis results in a delay in diagnosis and treatment, which in turn leads to permanent loss of renal function. We present two cases of acute kidney infarction that were initially treated as renal colic. In addition, we present a third case when a kidney was saved with reperfusion therapy.

Blue kidney in a pale patient--a case for a causal association between renal haemosiderosis in paroxysmal nocturnal haemoglobinuria and chronic kidney disease

Asim, M., Iqbal, Z., Mujeeb, I. B. — Tue, 22 Sep 2009 06:04:56 PDT

A 50-year-old man presented with pancytopenia and chronic renal impairment. He had evidence of intravascular haemolysis. The direct antiglobulin (Coomb’s) test was negative. Paroxysmal nocturnal haemoglobinuria (PNH) was diagnosed by the Ham acid haemolysis test. There were no other clinical risk factors that could be implicated in chronic kidney disease (CKD). A renal biopsy revealed extensive haemosiderosis affecting proximal tubular cells and associated interstitial fibrosis as well as tubular atrophy. No glomerular or vascular lesions were seen. These findings strengthen the case for a causal relationship between renal haemosiderosis in PNH and CKD.

The combined use of sirolimus and cyclosporin in the management of refractory minimal change nephropathy: 'a novel use of sirolimus'

Davison, R., Fenwick, S. — Tue, 22 Sep 2009 06:04:56 PDT

Minimal change nephropathy (MCN) accounts for around 25% of adults presenting with a nephrotic syndrome. Although most patients respond to corticosteroid therapy, a significant number relapse frequently and may present a real therapeutic difficulty. We present a case of apparently refractory relapsing MCN that was successfully treated with a combination of sirolimus and cyclosporin, resulting in the longest period of steroid free remission that the patient has ever experienced. To our knowledge, this is the first documented use of this combination in this manner.

Kikuchi disease preceding systemic lupus erythematosus with membranous lupus nephritis

Ponnusamy, A., Woywodt, A., Reeve, R., Kondlapudi, J., Lewis, D. — Tue, 22 Sep 2009 06:04:56 PDT

Kikuchi disease (KD) is a rare form of necrotizing lymphadenitis. KD usually presents with cervical lymphadenopathy and fever in young women. It tends to run a benign course and resolve spontaneously within months. The aetiology of the disease is still unclear although a variety of infectious agents have been postulated. There is also a documented but rare association with systemic lupus erythematosus (SLE). We present the case of a young woman with biopsy-proven KD who subsequently developed SLE with biopsy-proven lupus nephritis. Nephrologists should be aware of KD as it may precede the development of SLE and lupus nephritis.

Renal biopsy in a patient with haemophilia A and cryoglobulinaemic membranoproliferative glomerulonephritis associated with hepatitis C virus infection

Tue, 22 Sep 2009 06:04:56 PDT

A renal biopsy was performed in a 47-year-old man with haemophilia A. Thirty minutes after administration of an intravenous bolus of 4000 units of recombinant factor VIII, which increased the activity to 74–91%, a needle renal biopsy was successfully performed, followed by administration of 3000 units of factor VIII in the evening, and then the subsequent morning and evening. The patient was diagnosed with hepatitis C virus-associated membranoproliferative glomerulonephritis. Treatment with interferon, ribavirin, prednisolone and cyclosporine A improved the nephrotic syndrome. This is the first report of a successful renal biopsy in a patient with haemophilia A after factor VIII injection.

An unusual cause of acute renal failure in sickle cell disease

Rockx, M.-A., Gibson, I. W., Reslerova, M. — Tue, 22 Sep 2009 06:04:56 PDT

A young female with sickle cell disease was treated for biopsy-proven IgA nephropathy. Serum creatinine levels resolved to normal range, but a year later, she presented with oedema, hypertension and acute renal failure. A repeat renal biopsy showed acute-on-chronic thrombotic microangiopathy (TMA). We suggest that circulating microparticles could be a pathophysiological link between sickle cell disease and the development of renal TMA. This case emphasizes the importance of a further biopsy for acutely declining renal function, even when a definite diagnosis has been made from a previous biopsy.

Renal involvement as the first manifestation of hypereosinophilic syndrome: a case report

Navarro, I., Torras, J., Goma, M., Cruzado, J. M., Grinyo, J. M. — Tue, 22 Sep 2009 06:04:56 PDT

Idiopathic hypereosinophilic syndrome is characterized by elevated and prolonged blood eosinophilia along with organ system involvement and malfunction. The heart is the most frequently involved organ, and renal participation is extremely rare. Herein, we report on a case of idiopathic hypereosinophilic syndrome with renal involvement as the first manifestation.

Clarithromycin-induced acute interstitial nephritis and minimal change disease

Russell, W., Smith, W. — Tue, 22 Sep 2009 06:04:56 PDT

Drug associated acute interstitial nephritis and minimal change disease has been well documented but the simultaneous presentation of both is rare and has not been reported with clarithromycin. We describe a case of simultaneous acute tubulointerstitial nephritis and minimal change disease induced by clarithromycin. The patient had acute kidney injury, nephrotic syndrome, eosinophilic pneumonitis and a maculopapular skin rash. The role of steroid therapy in acute interstitial nephritis is controversial but is accepted as beneficial in minimal change nephrotic syndrome. Steroid therapy in our patient resulted in complete clinical resolution.

Polymorphisms of the glucocorticoid receptor and avascular necrosis of the femoral heads after treatment with corticosteroids

Bouamar, R., Koper, J. W., van Rossum, E. F. C., Weimar, W., van Gelder, T. — Tue, 22 Sep 2009 06:04:56 PDT

A female patient developed avascular necrosis of the femoral heads after receiving low doses of glucocorticosteroids (GC) for 3 months. Genotyping of the GC receptor (GR) showed that she was heterozygous for the Bcl-1 allele and heterozygous for the N363S allele. Interestingly, these GR variants are both associated with higher sensitivity to glucocorticoids. It is not known whether the GR gene polymorphisms are causally related to osteonecrosis. However, the presence of these GR variants, as a combination present in only 1% of the normal Caucasian population, seems suggestive. Studies are warranted to investigate the importance of polymorphisms related to GC sensitivity.

Symptomatic uraemia from bilateral obstructive uropathy secondary to metastatic urinary bladder cancer showing only unilateral hydronephrosis: a case report

Onuigbo, M. A. C. — Tue, 22 Sep 2009 06:04:56 PDT

Bilateral hydronephrosis is classic for supravesical obstructive uropathy causing uraemia with dual functioning kidneys. Recently, a patient presented with uraemia and metastatic urinary bladder carcinoma but only unilateral right-sided hydronephrosis. A right ureteral stent was placed retrograde and no further intervention was planned since the left kidney appeared normal, and since the left ureteric orifice was not visualized. We insisted on a left percutaneous nephrostomy which was successful with prompt urine return. A left nephrostogram revealed unrecognized hydroureter/hydronephrosis. Following haemodialysis, kidney function normalized at 3 weeks. For symptomatic uraemia from obstruction, an antegrade and/or a retrograde decompression must be attempted bilaterally to improve renal salvage.

Peritonitis associated with Strongyloides stercoralis in a patient undergoing continuous ambulatory peritoneal dialysis

Sav, T., Yaman, O., Gunal, A. I., Oymak, O., Utas, C. — Tue, 22 Sep 2009 06:04:56 PDT

A 67-year-old male continuous ambulatory peritoneal dialysis (CAPD) patient presented with abdominal pain and pruritus. Strongyloides stercoralis larvae were seen on dialysate sediment and stool microscopic examination. Albendazole was given and improved the symptoms in 4 days. There was no episode of relapsing peritonitis after the therapy. This is the first report of S. stercoralis peritonitis in patients on CAPD. Strongyloides should be considered as a probable peritoneal pathogen in CAPD patients.

Worsening of hyperglycemia due to atorvastatin in a renal transplant patient

Nacasch, N., Korzets, Z. — Tue, 22 Sep 2009 06:04:56 PDT

New-onset diabetes mellitus post-renal transplantation [post-transplantation diabetes mellitus (PTDM)] and impaired glucose tolerance are among the most serious adverse metabolic disturbances of kidney transplants. We report a renal transplant patient whose mild post-transplant hyperglycaemia considerably worsened upon substituting atorvastatin for pravastatin. The patient was a 58-years-old Caucasian man who underwent living, non-related kidney transplantation. The mean blood sugar level (BSL) following transplantation was 113.8 mg/dl. In an attempt to reduce LDL cholesterol, atorvastatin 40 mg/day was substituted for pravastatin. Soon after commencement of atorvastatin, polydipsia and polyuria appeared. Both fasting and 2-h post-prandial BSL values increased, while there was no change in the patient's medications, dietary habits and renal function. Upon reverting back to pravastatin, BSL promptly declined to the previously mentioned baseline values. Since PTDM is a strong independent factor of graft failure, cardiovascular events and mortality, physicians should be made aware of this possible adverse effect of atorvastatin on glucose tolerance.

Recurrent idiopathic membranous nephropathy in the renal allograft: successful treatment with the anti-CD20 monoclonal antibody rituximab

Ladino, M., Roth, D. — Tue, 22 Sep 2009 06:04:56 PDT

Idiopathic membranous glomerulonephritis (IMGN) is one of the most common causes of nephrotic syndrome in adults. Disease progression is associated with the magnitude and duration of proteinuria [Reichert LJ, Koene RA, Wetzels JF. Prognostic factors in idiopathic membranous nephropathy. Am J Kidney Dis 1998; 31: 1–11]. Membranous nephropathy is also one of the glomerular diseases that is well described to recur in the transplanted kidney [Kotanko P, Pusey CD, Levy JB. Recurrent glomerulonephritis following renal transplantation. Transplantation 1997; 63: 1045]. There is no definitive therapy for primary membranous glomerulonephritis or recurrent disease in the graft. Cyclophosphamide plus steroids or cyclosporine [Cattran DC, Greenwood C, Ritchie S et al. Canadian Glomerulonephritis Study Group. A controlled trial of cyclosporine in patients with progressive membranous nephropathy. Kidney Int 1995; 47: 1130–1135] have been the preferred agents for the treatment of MGN involving the native kidneys. More recently, several reports have described the use of the anti-CD20 monoclonal antibody rituximab in patients with IMGN. In the current report, we present a patient with ESRD secondary to IMGN who developed nephrotic range proteinuria 5 months after receiving a kidney transplant from a deceased donor. A biopsy of the allograft demonstrated changes compatible with recurrent membranous glomerulonephritis. The patient was treated with four weekly infusions of rituximab over a 1-month period with a significant decrease in proteinuria and an improvement in renal function.

A case of successful kidney transplantation after an extremely long-term maintenance haemodialysis of 38 years

Okamoto, M., Suzuki, T., Nobori, S., Ushigome, H., Yoshimura, N. — Tue, 22 Sep 2009 06:04:56 PDT

We describe herein a case of kidney transplantation after extremely long-term haemodialysis. A 66-year-old male received a kidney transplant from a deceased donor after maintenance haemodialysis for 38 years and 2 months. In spite of long-term haemodialysis, he showed minimal calcification of the iliac vessels, and transplantation was carried out successfully. Other than some difficulties in vesical rehabilitation, his postoperative course was favourable and he was finally discharged from the hospital on the 84th postoperative day. On a review of the literature, this case might represent the longest period of haemodialysis ever prior to kidney transplantation in the world.

Hypocalcaemia and a low cardiac output after intravenous codeine phosphate injection: need for an additional mechanism to remove ionized calcium

Tue, 22 Sep 2009 06:04:56 PDT

Maltese cross-like crystals in the urinary sediment of a diabetic patient

Etter, C., Russi, R., Fogazzi, G. B., Wuthrich, R. P., Serra, A. L. — Tue, 22 Sep 2009 06:04:56 PDT

Severe hyperlactaemia in the setting of alkalaemia

Hall, A. M., Bending, M. R. — Tue, 22 Sep 2009 06:04:56 PDT

Bilateral spontaneous perirenal haemorrhage in a patient on haemodialysis

Ku, J. H., Kim, J.-K., Ha, S., Lee, J. W. — Tue, 22 Sep 2009 06:04:56 PDT

Mild chronic renal failure with a family history of kidney disease

Hubert, F., Dahan, K., Cosyns, J.-P., Devuyst, O., Pirson, Y. — Tue, 22 Sep 2009 06:04:56 PDT

The mineralogy and internal structure of kidney stones

Giannossi, M. L., Mongelli, G., Summa, V. — Tue, 22 Sep 2009 06:04:56 PDT

Autosomal dominant polycystic kidney disease complicating renal ectopia and managed with renal transplantation

Connor, A., Weston, C. E., Dick, C., Taylor, J. E. — Tue, 22 Sep 2009 06:04:56 PDT

A kidney gone astray under pressure

Wang, J. H., Rao, S. P. — Tue, 22 Sep 2009 06:04:56 PDT

A hidden cause of renal failure

Port, N., Hillier, L., Warwick, G. — Tue, 22 Sep 2009 06:04:56 PDT

Constrictive calcific pericarditis masked by haemodialysis

Solak, Y., Selcuk, N., Tekinalp, M., Ozbek, O., Atalay, H. — Tue, 22 Sep 2009 06:04:56 PDT

Spontaneously resolving large intrarenal artery aneurysm--a case report

Chen, Y. L., Chen, C. L., Chou, K. J., Fang, H. C. — Tue, 22 Sep 2009 06:04:56 PDT

Enoxaparin decreases serum MCP-1 concentration during haemodialysis--preliminary report

Rydzewska-Rosolowska, A., Borawski, J., Mysliwiec, M. — Tue, 22 Sep 2009 06:04:56 PDT

Brain renin-angiotensin system: Is it important in dialysis patients?

Demir, M., Kutlucan, A., Sezer, M. T., Turker, Y. — Tue, 22 Sep 2009 06:04:56 PDT

The incidence of biopsy-proven glomerulonephritis in Cairo University, Egypt: a 5-year study

Ibrahim, S., Fayed, A. — Tue, 22 Sep 2009 06:04:56 PDT

The safety of accelerated infusion versus standard rate infusion of low-molecular-weight iron dextran in patients with chronic kidney disease

Tue, 22 Sep 2009 06:04:56 PDT

Catheter-related Chryseobacterium meningosepticum bacteraemia in a haemodialysis patient

Tseng, M.-H., Diang, L.-K., Su, Y.-C., Lin, S.-H. — Tue, 22 Sep 2009 06:04:56 PDT

Altered mental status in a case of multiple myeloma not related to a metabolic cause

Sandhu, G., Farias, A. A., Ranade, A., Meisels, I. — Tue, 22 Sep 2009 06:04:56 PDT

Peripheral CD19+ B cells are increased in children with active steroid-sensitive nephrotic syndrome

Tue, 22 Sep 2009 06:04:56 PDT

Professor Franciszek Kokot, born November 24th 1929 in Olesno Slaskie

Tue, 22 Sep 2009 06:04:56 PDT