Cases reported "Kidney Diseases"

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1/13. 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.
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keywords = nephrolithiasis
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2/13. indinavir nephropathy revisited: a pattern of insidious renal failure with identifiable risk factors.

    indinavir is a well-known cause of crystal-induced acute renal failure, dysuria and flank pain, and nephrolithiasis. Recently a more insidious tubulointerstitial lesion has been recognized as secondary to the drug. We report a case of a hepatitis c-positive patient on long-term indinavir therapy for human immunodeficiency virus (hiv) who developed a slowly progressive rise in serum creatinine. Renal biopsy revealed a diffuse interstitial infiltrate with numerous eosinophils and scarring. The tubules showed focal necrosis and dilation with elongated crystals present within their lumina. The elevated serum creatinine decreased to a new baseline over several months with the discontinuation of indinavir. We review the literature of renal syndromes associated with indinavir focusing on chronic progressive tubulointerstitial injury and speculate on risk factors and potential mechanisms of indinavir-induced renal injury.
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keywords = nephrolithiasis
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3/13. A case of renal sarcoidosis: a special reference to calcium metabolism as a diagnostic and the therapeutic implications.

    sarcoidosis is a systemic granulomatous disease of unknown etiology and is associated with a wide variety of renal disorders including nephrolithiasis, hypercalciuria, hypercalcemia, nephrocalcinosis, tubular defect, glomerulonephritis, and granulomatous interstitial nephritis. We report a case of renal sarcoidosis in which we could not detect any evidence of extrarenal involvements that was diagnosed by renal biopsy and abnormal calcium metabolism incompatible with chronic renal insufficiency. On laboratory findings, decreased creatinine clearance, proteinuria, hypercalcemia, hypercalciuria, and mildly elevated serum angiotensin-converting enzyme (ACE) were seen. serum intact parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,alpha-25 vit D) were lower and higher than normal range, respectively, whereas the patient was already in chronic renal insufficiency. He was treated with oral corticosteroid. serum ACE tended to fall, and 1,alpha-25 vit D level decreased with substantial fall of serum calcium and daily calcium excretion. In contrast, intact PTH increased slowly in accordance with a fall of serum calcium compatible with the level of renal impairment. creatinine clearance and daily excretion of protein improved. The case reported here may propose that serial measurement of serum level of 1,alpha-25 vit D, calcium level, and magnitude of daily calcium excretion into urine is a simple and meaningful tool to detect the therapeutic response in sarcoidosis with abnormal calcium metabolism.
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keywords = nephrolithiasis
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4/13. The Alu insertion in the CLCN5 gene of a patient with Dent's disease leads to exon 11 skipping.

    Alu sequences are short, interspersed elements that have generated more than one million copies in the human genome. They propagate by transcription followed by reverse transcription and integration, causing mutations, recombination, and changes in pre-mRNA splicing. We have recently identified a 345-bp long Alu Ya5 element inserted in codon 650 within exon 11 of the chloride channel ClC-5 gene (CLCN5) of a patient with Dent's disease. A microsatellite pedigree analysis indicated that the insertion occurred in the germline of the maternal grandfather. Dent's disease is an X-linked renal tubular disorder characterized by low-molecular-weight proteinuria, hypercalciuria, nephrolithiasis, and nephrocalcinosis. Here, we found, by RT-PCR amplification of rna extracted from the patient's blood and subsequent dna sequencing, that the Alu insertion led to an aberrant splicing of the CLCN5 pre-mRNA that skipped exon 11. Using the ESE finder and RESCUE-ESE Web interfaces, we identified two high-score exonic splicing enhancer (ESE) sequences in the site of insertion. The functional significance of these ESE motifs is suggested by our observation that these sequences are highly conserved among mammal CLCN5 genes. Therefore, we suggest that the Alu insertion causes exon skipping by interfering with splicing regulatory elements. The altered splicing would predict a truncated ClC-5 protein that lacks critical domains for sorting and chloride channel function.
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keywords = nephrolithiasis
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5/13. Increased serum alkaline phosphatase activity: a possible indicator of renal damage.

    Increased levels of serum alkaline phosphatase (ALP) (E.C.3.1.3.1.) were observed in 25 patients with various urological conditions involving the kidneys: malignancy, complicated nephrolithiasis, and surgical and percutaneous manipulations. Other possible sources for increased ALP level, mainly hepatic and osseous, were excluded by history, laboratory tests, and liver and bone imaging. Studies of isoenzymes of ALP did not show a distinctive pattern. ALP levels returned to the normal range by treating the underlying lesions involving the kidney: nephrectomy, complete removal of stones, or removal of nephrostomy. The increase in serum ALP activity may be derived from the injury to the brush border membrane of the renal tubular cells. Renal function impairment and contrast media induced nephrotoxicity may also be responsible for the increased serum ALP. serum ALP may be a marker for involvement of the kidneys in pathological processes and an indicator of complete treatment. This clinical observation is worthy of further study.
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keywords = nephrolithiasis
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6/13. Computed tomography of renal sarcoidosis.

    Radiographic evidence of renal involvement by sarcoidosis is usually demonstrated as nephrocalcinosis or nephrolithiasis. We present a case of renal sarcoidosis manifested as noncalcified masses on contrast enhanced CT.
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keywords = nephrolithiasis
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7/13. The possibility of scar formation due to intrarenal reflux in analgesic nephropathy.

    Using an autopsy case of a 59-year-old man with analgesic nephropathy, papillary necrosis, and nephrolithiasis, it is shown that analgesic nephropathy may be complicated by damage resulting from intrarenal urine reflux. The morphologic alterations characteristic of intrarenal and/or pyelointerstitial reflux are caused by high intrapelvic pressure values during episodes of renal colic. Bacterially infected and possibly also sterile urine is then forced into the interstitium, directly within the papillary defect or indirectly via the tubular system after rupture of the tubule. The result is a severe interstitial process with inflammation, destruction, and scarring.
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keywords = nephrolithiasis
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8/13. Nephrobronchial fistula. Complication of perinephric abscess secondary to ureteral obstruction and pyonephrosis.

    A case of nephrolithiasis complicated by obstruction leading to pyonephrosis, perinephric abscess, and nephrobronchial fistula is presented. The patient was treated successfully by nephrectomy and drainage of the subphrenic space and the pleural cavity. Nephrobronchial fistula, while a rare complication of perinephric abscess, should be considered when a patient presents with perirenal suppurative process and chest x-ray findings consistent with pleural effusion or pulmonary infiltrates.
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ranking = 1
keywords = nephrolithiasis
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9/13. Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis.

    There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.
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ranking = 5
keywords = nephrolithiasis
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10/13. Systemic oxalosis: pathognomonic renal and specific extrarenal findings on US and CT.

    hyperoxaluria is characterized by nephrocalcinosis and nephrolithiasis on radiological examination and may also result in diffuse deposition of calcium oxalate crystals in multiple extrarenal organs (oxalosis). In two cases, the renal findings of primary hyperoxaluria were diagnosed by ultrasound and computed tomography scans. In addition to renal involvement, both patients had liver involvement, and one patient had cardiac involvement.
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ranking = 1
keywords = nephrolithiasis
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