1/205. Glomerular thrombosis: an unusual cause of renal failure in systemic lupus erythematosus.The authors report an unusual case of acute renal failure occurring in a patient with systemic lupus erythematosus and antiphospholipid antibodies. kidney biopsy revealed glomerular thrombosis, in the absence of glomerulonephritis. The authors stress the clinical and biological signs that suggest the thrombotic nature of kidney failure in lupus patients.- - - - - - - - - - ranking = 1keywords = nephritis (Clic here for more details about this article) |
2/205. Cryosupernatant plasma exchange in the treatment of antiphospholipid antibody syndrome with lupus nephritis.We report a case of a 22-year-old female with antiphospholipid antibody syndrome (APS) associated with systemic lupus erythematosus in whom cryosupernatant plasma exchange was effective and improved both the refractory venous thrombosis in her legs and relapsing thrombocytopenia. A renal biopsy specimen showed not only features of active lupus nephritis but also renal arteriolar thrombosis which is considered to be a type of thrombotic microangiopathy (TMA). Because a pathological role of unusually large von willebrand factor (vWF) multimers has been reported in patients with TMA including thrombotic thrombocytopenic purpura, plasma exchange using replacement with cryosupernatant, which is free of unusually large vWF multimers, is likely to be an option of treatment modality for patients with refractory and chronic relapsing APS manifesting TMA.- - - - - - - - - - ranking = 5keywords = nephritis (Clic here for more details about this article) |
3/205. Demonstration of exclusive cilioretinal vascular system supplying the retina in man: vacant discs.PURPOSE: To report the fluorescein angiographic and Doppler ultrasonographic findings in a patient with apparent exclusive ciliary vascular supply of the retina of both eyes. methods: Case report. RESULTS: The ophthalmoscopic appearance of all arterial vessels emanating from both discs was consistent with a cilioretinal origin. Retinal veins also entered each disc peripherally near the margin, leaving the central part of each disc vacant. fluorescein angiography showed filling of all arterial vessels simultaneous with the early-phase choroidal background flush bilaterally. color and power Doppler ultrasonographic imaging demonstrated unequivocally the absence of central retinal vessels within the optic nerves. Both discs were normal in size and excavated with central glial tissue present. The clinical history of monocular, alternating episodes of failing vision with partial resolution and the retinal pigmentation patterns bilaterally were consistent with, though not conclusive for, previous episodes of serous retinal detachments. Coincident systemic anomalies consisted of small kidneys with reduced renal parenchyma discovered on ultrasonography, along with chronic interstitial nephritis. CONCLUSIONS: The ophthalmoscopic appearance of optic discs with apparent all-cilioretinal vascular supply has been reported previously, but proof of the absence of central retinal vessels requires Doppler ultrasonographic evidence corroborated by angiographic findings, as exemplified in our case report. We describe the association of this disc anomaly with renal parenchymal disease and its distinction from colobomatous defects.- - - - - - - - - - ranking = 1keywords = nephritis (Clic here for more details about this article) |
4/205. Clinical and radiological findings in patients with gas forming renal abscess treated conservatively.PURPOSE: Emphysematous pyelonephritis in diabetics is considered a potentially lethal infection. mortality rates of patients treated conservatively approaches 80% in some series. These patients often present with signs of sepsis or septic shock. In contrast, gas forming renal abscess is rare, with patients presenting entirely differently from those with emphysematous pyelonephritis. To our knowledge this process has been previously described only in isolated case reports. We describe a series of 5 patients with this distinct process. MATERIALS AND methods: We reviewed the clinical and radiological features of 5 patients with gas forming renal abscesses. RESULTS: Each patient presented with diabetes mellitus with initial blood glucose ranging from 313 to 552 mg./dl., fever (average 101F), flank or abdominal pain and pyuria. No patient had evidence of septic shock at hospitalization. escherichia coli was the documented organism in each case. Mild renal insufficiency was noted in most patients based on serum creatinine. Radiological evaluation revealed gas filled pockets within the renal parenchyma, which were most effectively shown by computerized tomography (CT) of the abdomen. There was no radiological evidence of pus. Percutaneous drainage of an abscess in 1 case did not produce any purulent material or alter the clinical course. Each patient responded to correction of the underlying metabolic abnormalities with intravenous antibiotics (average 23 days) followed by prolonged oral antibiotic therapy (average 9 weeks). In contrast to the management of emphysematous pyelonephritis, surgical or percutaneous drainage was not necessary. Serial CT revealed complete resolution of gas in the parenchyma within 6 months in patients with long-term followup. Of note, gas was persistent on CT months after infection had clinically resolved. CONCLUSIONS: We describe a unique entity within the spectrum of pyelonephritis. The clinical appearance of gas forming abscesses within the renal parenchyma without liquefaction in diabetic patients was remarkably benign compared to the radiographic appearance of the disease process. Conservative management with intravenous and oral antibiotics was successful in each patient, avoiding the need for invasive intervention.- - - - - - - - - - ranking = 4keywords = nephritis (Clic here for more details about this article) |
5/205. Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.- - - - - - - - - - ranking = 5keywords = nephritis (Clic here for more details about this article) |
6/205. Calyceal diverticula in children: unusual features and complications.Calyceal diverticulum is a relatively rare lesion that is usually asymptomatic but can assume clinical significance if drainage is impaired. Three patients are presented with unusual complications directly referable to a calyceal diverticulum. One child had a mobile calculus. In 2 others, intrarenal inflammatory masses developed in the area previously occupied by a calyceal diverticulum. One of these children had proved xanthogranulomatous pyelonephritis, and the other had an infected diverticulum.- - - - - - - - - - ranking = 1keywords = nephritis (Clic here for more details about this article) |
7/205. Severe interstitial nephritis in a patient with renal amyloidosis and exacerbation of Crohn's disease.A 57-year-old man with long-term untreated Crohn's disease presented with exacerbation of his bowel disease, volume depletion, nephrotic syndrome and rapid decline in renal function. Renal biopsy revealed amyloidosis and extensive interstitial infiltration. Initiation of steroid therapy was associated with improvement in renal function and postponement of dialysis, suggesting that control of interstitial inflammation might have a therapeutic role in renal amyloidosis. We hypothesize that volume depletion could magnify toxicity of proteinuria, thus augmenting interstitial inflammation and accelerating the deterioration in renal function.- - - - - - - - - - ranking = 4keywords = nephritis (Clic here for more details about this article) |
8/205. Renal mucormycosis in the hiv patient.mucormycosis is an increasingly recognized opportunistic infection. It usually affects patients with debilitating conditions such as cancer, diabetes mellitus, renal failure, and extensive burns. Mucor infection has also been described in human immunodeficiency virus (hiv) patients. The most common clinical presentations are the cerebral, cutaneous, and renal forms. We describe a unique case of bilateral renal mucormycosis presenting with renal failure in an hiv-infected patient. In the immunosuppressed host, a history of intravenous (IV) drug abuse associated with symptoms of pyelonephritis should alert the clinician to the possibility of mucor infection. Blood and urine culture are often negative. The diagnosis is made histologically in most cases. The treatment of hiv patients with mucormycosis and renal failure includes hemodialysis, nephrectomy, and intravenous amphotericin in addition to antiretroviral therapy. Bilateral renal involvement with Mucor carries a poor prognosis.- - - - - - - - - - ranking = 1keywords = nephritis (Clic here for more details about this article) |
9/205. Remission of nephrotic syndrome after removal of localized Castleman's disease.Renal complications of Castleman's disease are uncommon. Among the various renal disorders, including mesangial proliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease, nephrotic syndrome attributable to renal amyloidosis is very rarely reported. We report a case of mixed type of localized Castleman's disease complicated with nephrotic syndrome. Renal biopsy was performed. The deposition of AA amyloidosis was shown. After the removal of two mesenteric lymphoid masses, the proteinuria was gradually decreased and disappeared. Renal biopsy was repeated after 14 months, and, despite complete remission of nephrotic syndrome, no regression in amyloid deposition was found.- - - - - - - - - - ranking = 2keywords = nephritis (Clic here for more details about this article) |
10/205. Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy.Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. Bilateral emphysematous pyelonephritis is even more rare and is associated with high mortality. We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by klebsiella pneumoniae. diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.- - - - - - - - - - ranking = 8keywords = nephritis (Clic here for more details about this article) |
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