scholarly journals An Unusual Initial Presentation of Lupus Nephritis as a Renal Mass

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Remi Goupil ◽  
Annie-Claire Nadeau-Fredette ◽  
Virginie Royal ◽  
Alexandre Dugas ◽  
Jean-Philippe Lafrance
Keyword(s):  
Lupus Nephritis ◽  
Renal Mass ◽  
Antinuclear Antibodies ◽  
Left Kidney ◽  
Immunosuppressive Treatment ◽  
Mass Effect ◽  
Initial Presentation ◽  
First Case ◽  
Overt Disease

Lupus nephritis is a frequent manifestation of systemic lupus erythematous. Lupus nephritis usually presents with abnormal urinalysis, proteinuria, and/or renal insufficiency. We report a case of a 48-year-old woman who underwent partial nephrectomy for a fortuitously discovered solid enhancing left kidney mass. No neoplastic cells were found in the biopsy specimen; however, the pathology findings were compatible with immune complex glomerulonephritis with a predominantly membranous distribution, a pattern suggestive of lupus nephritis. The mass effect was apparently due to a dense interstitial lymphocytic infiltrate resulting in a pseudotumor. Further investigation revealed microscopic hematuria with a normal kidney function and no significant proteinuria. Antinuclear antibodies were negative, although anti-DNA and anti-SSA/Rho antibodies were positive. A diagnosis of probable silent lupus nephritis was made and the patient was followed up without immunosuppressive treatment. After two years of follow-up, she did not progress to overt disease. To our knowledge, this represents the first case of lupus nephritis with an initial presentation as a renal mass.

scholarly journals Hydrocephalus presenting as idiopathic aqueductal stenosis with subsequent development of obstructive tumor: report of 2 cases demonstrating the importance of serial imaging

2017 ◽  
Vol 20 (4) ◽  
pp. 329-333 ◽  
Author(s):  
Jarod L. Roland ◽  
Richard L. Price ◽  
Ashwin A. Kamath ◽  
S. Hassan Akbari ◽  
Eric C. Leuthardt ◽  
...  
Keyword(s):  
Late Onset ◽  
Diagnostic Testing ◽  
Subsequent Development ◽  
Mass Effect ◽  
Aqueductal Stenosis ◽  
Pineal Region ◽  
Serial Imaging ◽  
Cerebrospinal Fluid Diversion ◽  
First Case

The authors describe 2 cases of triventricular hydrocephalus initially presenting as aqueductal stenosis that subsequently developed tumors of the pineal and tectal region. The first case resembled late-onset idiopathic aqueductal stenosis on serial imaging. Subsequent imaging revealed a new tumor in the pineal region causing mass effect on the midbrain. The second case presented in a more typical pattern of aqueductal stenosis during infancy. On delayed follow-up imaging, an enlarging tectal mass was discovered. In both cases hydrocephalus was successfully treated by cerebrospinal fluid diversion prior to tumor presentation. The differential diagnoses, diagnostic testing, and treatment course for these unusual cases are discussed. The importance of follow-up MRI in cases of idiopathic aqueductal stenosis is emphasized by these exemplar cases.

scholarly journals P0429OUTCOMES OF LUPUS NEPHRITIS OVER AN ERA OF EVOLVING IMMUNOSUPPRESSION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jason McMinn ◽  
Colin C Geddes ◽  
Emily McQuarrie
Keyword(s):  
Lupus Nephritis ◽  
Electronic Patient Record ◽  
Immunosuppressive Treatment ◽  
Complete Response ◽  
Histopathological Diagnosis ◽  
Class V ◽  
Remission Rates ◽  
Induction Regimen ◽  
Before And After

Abstract Background and Aims The reported incidence of lupus nephritis (LN) is approximately 6.1 cases per million population per year in Scotland based on Scottish Renal Registry biopsy data. Despite immunosuppressive treatment, approximately 10-30% of patients will progress to established renal failure (ERF) within 15 years. In December 2007, our unit moved from a protocol of Cyclophosphamide/ steroid induction with Azathioprine/ Prednisolone maintenance to Mycophenolate/ steroid induction and maintenance. We undertook this study to compare remission rates before and after this change. Method A retrospective electronic patient record analysis was performed for all patients in our centre with a documented native renal biopsy showing a histopathological diagnosis of LN, between 1 July 1993 and 31 December 2017. Repeat biopsies were excluded. Baseline demographics, histopathological class and first and second line induction and maintenance therapies were recorded. Endpoints analysed were; partial and complete response (as defined in KDIGO Clinical Practice Guideline for Glomerulonephritis 2012), time to achieve this response, relapse, progression to ERF and death. Results 120 patients who underwent a biopsy during the 24.5-year period received a diagnosis of lupus nephritis. 82.5% of patients were Caucasian. Median duration of follow-up was 72 months. 15% of patients died and 5% developed ERF within the follow-up period, representing one death per 56 patient years and one incident case of ERF per 168 patient years. There were 40 patients in the pre-December 2007 group and 80 in the post-December 2007 group. Those in the earlier group were younger, with a mean age of 35.4 years versus 44.8 years in the later group (p=0.002). 23% had class V in the earlier group compared to 15% in the later group (p=0.31). Proportions of female patients were 80% and 75% in the early and late groups respectively (p=0.54). Median creatinine was 106µmol/L in the pre-December 2007 group and 89.5 µmol/L in the post-December 2007 group (p=0.96). Patients in the pre- and post- December 2007 groups had comparable rates of complete response, at 72% and 71% respectively. However, those diagnosed before December 2007 were slower to respond, with a median time to achieve complete response of 10.5 months, compared to 6 months in those diagnosed after 1 December 2007 (p=0.007). Conclusion Following a change in our immunosuppressive induction regimen from Cyclophosphamide/ steroids to Mycophenolate/ steroids, our response rates have remained similar, however speed of attaining remission has improved.

scholarly journals A Bladder Wall Angiomyolipoma as a Manifestation of Tuberous Sclerosis: First Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mehmet Kalkan ◽  
Coşkun Şahin ◽  
Ömer Etlik ◽  
Ergun Uçmaklı
Keyword(s):  
Tuberous Sclerosis ◽  
Left Kidney ◽  
Bladder Wall ◽  
Hypovolemic Shock ◽  
Renal Angiomyolipoma ◽  
Lower Pole ◽  
Immunohistochemical Examination ◽  
First Case ◽  
Wall Mass

A 21-year-old female patient admitted to the emergency department complaining of left side pain. Hypovolemic shock, which was probably caused by retroperitoneal bleeding from left sided renal angiomyolipoma, was developed. Abdominal computed tomography showed multiple fat containing lesions in different, regions including right bladder wall, lower pole of left kidney, and right kidney. Some lesions compatible with tuberous sclerosis such as angiofibromas, Shagreen patches, myocardial, and brain hamartomas were also detected. Bladder wall mass showing intra- and extravesical extensions was seen at exploration. We removed the tumor completely preserving bladder trigone. Angiomyolipoma located at lower pole of left kidney was also removed. Diagnosis of bladder angiomyolipoma was confirmed by the immunohistochemical examination. Recurrent or residual mass was not detected at the three-months-follow-up. We report the first case of bladder angiomyolipoma confirmed by histopathologically as a tuberous sclerosis.

Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1303-1311 ◽  
Author(s):  
J C Ramirez-Sandoval ◽  
H Chavez-Chavez ◽  
M Wagner ◽  
O Vega-Vega ◽  
L E Morales-Buenrostro ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Immunosuppressive Treatment ◽  
Graft Loss ◽  
Matched Pair ◽  
Long Term Outcomes ◽  
Term Survival

Kidney transplant for patients with lupus nephritis (LN) has satisfactory outcomes in studies with short-term or mid-term follow up. Nevertheless, information about long-term outcomes is scarce. We performed a retrospective matched-pair cohort study in 74 LN recipients compared with 148 non-LN controls matched by age, sex, immunosuppressive treatment, human leukocyte antigen (HLA) matches, and transplant period in order to evaluate long-term outcomes of kidney transplant in LN recipients. Matched pairs were predominantly females (83%), median age at transplant surgery of 32 years (interquartile range 23–38 years), and 66% received a graft from a living related donor. Among LN recipients, 5-, 10-, 15-, and 20-year graft survival was 81%, 79%, 57% and 51%, respectively, and it was similar to that observed in controls (89%, 78%, 64%, and 56%, respectively). Graft loss (27% vs. 21%, p = 0.24) and overall survival ( p = 0.15) were not different between LN recipients and controls. Also, there was no difference in episodes of immunological rejection, thrombosis, or infection. Only six LN recipients had biopsy-proven lupus recurrence and three of them had graft loss. In a cohort with a long follow up of kidney transplant recipients, LN recipients had similar long-term graft survival and overall outcomes compared with non-lupus recipients when predictors are matched between groups.

scholarly journals Necrotizing Anterior Scleritis in a Woman with Terrien’s Marginal Degeneration: A Case Report

2021 ◽  
Vol 15 (1) ◽  
pp. 318-321
Author(s):  
María Alejandra Fonseca-Mora ◽  
Paula Tatiana Muñoz-Vargas ◽  
Juliana Reyes-Guanes ◽  
William Rojas-Carabali ◽  
Miguel Cuevas ◽  
...  
Keyword(s):  
Case Report ◽  
Systemic Disease ◽  
Immunosuppressive Treatment ◽  
Disease Association ◽  
Slit Lamp ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Anterior Scleritis ◽  
Inflammatory Component

Purpose: The aim of the study was to report the first case of a patient with Terrien’s Marginal Degeneration (TMD) who developed necrotizing anterior scleritis without systemic disease association, requiring systemic immunosuppressive treatment. Case Report: A 32-year-old female consulted for bilateral ocular burning and hyperemia. Initially, she was diagnosed with conjunctivitis and treated with topical antibiotics and corticosteroids, with mild transitory improvement but the progression of the disease. Years later, she attended the ocular immunology consultation for a second opinion where TMD with ocular inflammatory component OU was diagnosed. Seven months later, she presented with severe pain, decreased visual acuity, and photophobia in OS. At the slit-lamp examination, necrotizing anterior scleritis with a high risk of perforation in OS was observed. The patient was referred to the rheumatologist and started treatment with systemic corticosteroids and cyclophosphamide, exhibiting a clinical improvement. The patient did not meet the criteria for any systemic illness associated with scleritis, such as autoimmune diseases or vasculitis. Thus, scleritis was related to the adjacent inflammatory process associated with TMD, as an atypical presentation of this disease. Conclusion: Although an inflammatory type of TMD has been proposed, it is essential to follow up closely these patients and consider necrotizing anterior scleritis, a severe ocular disease that requires prompt immunosuppressive management, as a possible atypical associated presentation of this disease.

scholarly journals P0266PREDICTIVE FACTORS OF COMPLETE RENAL RESPONSE IN PROLIFERATIVE LUPUS NEPHRITIS: A COLLABORATIVE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Beatriz Sanchez Alamo ◽  
Clara Maria Cases Corona ◽  
Serena Gatius ◽  
Patricia Dominguez Torres ◽  
Elena Valdes ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Lupus Nephritis ◽  
Kidney Biopsy ◽  
Univariate Analysis ◽  
Immunosuppressive Treatment ◽  
Collaborative Study ◽  
Class Iii ◽  
Renal Response ◽  
Proliferative Lupus Nephritis

Abstract Background and Aims Proliferative lupus nephritis (class III and IV) is the most severe form of lupus nephritis and requires prompt diagnosis and treatment with immunosuppressive therapy. Since it represents the most serious entity and has the greatest functional consequences there is a need to determine which factors in proliferative lupus nephritis are most predictive of good long-term renal function. Method Methods We analysed the data of 49 biopsy-proven proliferative lupus nephritis (18,4% class III and 81,6% class IV) of three different Spanish hospitals to find prognostic factors for complete renal response (CRR), defined as loss of <25% of eGFR and the absence of proteinuria and microhematuria at the end of the follow up. Sociodemographic, clinical, laboratory, and treatment-related data at the time of kidney biopsy and during follow-up were obtained. We performed univariate analysis and logistic regression to identify independent risk factors. Results The median follow-up was 8 years (IQR: 3-12,5), during which time 18 patients (36,7 %) achieved CRR. In the univariate analysis complete renal response was related to: (1) at the diagnosis to: age [40,52 (11,29) years vs 29,92 (11,93) p=0,004]; (2) in kidney biopsy to less leukocyte infiltration (42,3% p=0,05); (3) during the follow up to: less comorbities (27,8% vs 64,3% p=0,02), less infections (27,8% vs 58,6% p=0,04) and less hospitalizations due to infections (0% vs 33,3% p=0,010), less prevalence of high BP (22,2% vs 60,7% p=0,01), (4) at the end of follow up to : serum albumin [3,97 (0,59) vs 4,31(0,19) mg/dL p=0,03]. In the logistic regression comorbidies (HR : 5,71 95%IC: 1,56-20,93 p=0,008) and age at the moment of diagnosis (HR : 1,046 95%IC:1,001-1,071 p=0,04) were related to complete renal response. We didn´t find any differences concerning treatments. Conclusion Proliferative lupus nephritis is one of the most severe manifestations of lupus nephritis, resulting in increased morbidity and mortality. Traditionally it has been thought that older patients have a worst prognosis, however we demonstrated that they achieved more frequently CRR. In the management of the patients traditional reno protective measures like strict control of BP must be considered since it is a predictive factor of CRR. We shouldn´t forget about the implications of an aggressive immunosuppressive treatment such as hospitalizations due to infections and comorbities.

scholarly journals Long Term Follow-up Results of Ablation Treatment for Patients with Small Renal Mass

2020 ◽  
Author(s):  
Bilal Gumus ◽  
Ali Albaz ◽  
Fatih Düzgün ◽  
Oktay Ucer ◽  
Gokhan Temeltas ◽  
...  
Keyword(s):  
Renal Mass ◽  
Demographic Data ◽  
Left Kidney ◽  
Treatment Success ◽  
Minor Bleeding ◽  
Small Renal Mass ◽  
The Mean ◽  
The Right

Objective: The aim of this study is to evaluate the outcome of ablation therapy in our clinic for the treatment of patients with small renal mass Materials and Methods: We retrospectively evaluated the technic and follow-up data of 30 patients with 36 tumors who underwent Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) in our clinic. Demographic data, ablation type, tumor characteristics, peroperative and postoperative complications and treatment success of the patients were evaluated. Results: A total of 36 tumors who underwent ablation treatments, 23 were treated with RFA, 13 with MWA. The mean tumor size was 28.9 ± 6.92 mm in RFA and 29.3 ± 7.70 mm in MWA. 12 (52.1%) of the RFA procedures were applied to the right kidney while 11 (47.8%) were applied to the left kidney. 6 (46.1%) of the MWA procedures were performed on the right kidney and 7 (53.8%) on the left kidney. Of the 36 tumors, 4 (11.1%) were located central and 32 (88.8%) were peripheral. Complications occurred in 2 patients. In one of these patients, acute renal failure and urea creatinine were found to be elevated. In the other patient, local pain was found in the ablation side and minor bleeding was detected at the ablation site in USG. The mean follow-up period was 49.6 ± 24.7 months in patients with RFA and mean follow-up was 16 ± 8,05 months in MWA treatments. The overall success in MWA administration was calculated as 76.9%, while the overall success in RFA was 80%. Conclusion: Long-term oncologic efficacy of RFA appears to be successful in the treatment of T1a renal carcinomas. Further studies can be conducted to elucidate the influence of MWA on long-term oncological outcomes.

Lupus-like membranous nephropathy. Is it lupus? Report of 5 cases in a reference hospital in Mexico

Lupus ◽  
2021 ◽  
pp. 096120332110135
Author(s):  
Luis Manuel Ramírez-Gómez ◽  
Ivette Ruiz-Leija ◽  
David Martínez-Galla ◽  
Jaime Antonio Borjas-García ◽  
Carlos Abud-Mendoza ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Mycophenolic Acid ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Classification Criteria ◽  
Normal Limits ◽  
Extrarenal Manifestations

Introduction: Lupus nephritis requires antinuclear antibodies as classification criteria. There is a group of patients with nephrotic syndrome and conclusive histopathological findings for lupus nephritis, without classification criteria for systemic lupus erythematosus (SLE) or extrarenal manifestations. These groups of patients have been described as “lupus-like” nephritis or “renal-limited lupus nephritis”. Methods: Renal biopsy with histopathological evaluation with “full-house” immune-reactants in patients with negative antinuclear antibodies. Results: We report four cases with nephrotic syndrome and one with hematuria-proteinuria syndrome: two with impaired glomerular filtration rate and three with preserved renal function; urinary sediment with hematuria without dysmorphia and without extrarenal manifestations for autoimmune disease, negative antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA); normal C3 and C4 complement levels. Renal biopsy in all cases was consistent for lupus nephritis class V. All patients received treatment as lupus nephritis protocol; only one case received induction with cyclophosphamide and methylprednisolone boluses, the rest received mycophenolic acid and prednisone as induction and maintenance. Two of the cases induced with mycophenolic acid relapsed, requiring cyclophosphamide for 6 months, achieving complete remission. All patients received renin-angiotensin-aldosterone system blockade and hydroxychloroquine. At follow-up, 4 cases still have negative antibodies and are without extrarenal manifestations for SLE classification criteria. The other case, during pregnancy several years after initial diagnosis, had preeclampsia with nephrotic proteinuria and a new determination of positive ANA and anti-dsDNA antibodies, complement levels below normal limits. Conclusion: The follow-up of patients with membranous glomerulopathy must be close; lupus like nephritis may be the first manifestation of the disease.

scholarly journals Imaging findings and 4 years follow-up of adrenal cavernous hemangioma: a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Valentina Testini ◽  
Laura Eusebi ◽  
Willy Giannubilo ◽  
Vincenzo Ferrara ◽  
Francesco Bartelli ◽  
...  
Keyword(s):  
Cavernous Hemangioma ◽  
Mass Effect ◽  
Histopathological Diagnosis ◽  
Case Presentation ◽  
First Case ◽  
Appropriate Treatment ◽  
Cavernous Hemangiomas ◽  
Adrenal Masses ◽  
Rule Out

Abstract Background Adrenal hemangioma is a rare and non-functional benign tumor. Since the first case in 1955, approximately 90 cases have been reported in literature frequently presenting as a large and incidentally discovered retroperitoneal mass or as a result of hemorrhage caused by spontaneous rupture. Case presentation A 69-year-old man was admitted to our hospital for right hypocondrium pain and anemia. A computed tomography (CT) scan was performed and a large right adrenal mass measured 18 cm was found. The patient underwent laparoscopic right adrenalectomy. Histopathological diagnosis revealed a cavernous adrenal hemangioma. Conclusion Cavernous hemangiomas are uncommon tumors. We reported a case of adrenal cavernous hemangioma incidentally discovered by ultrasound and CT. In the case of finding adrenal masses, cavernous hemangiomas, although rare, should be considered a possible diagnosis. The appropriate treatment is surgical resection to rule out any potential for malignancy, to relieve symptoms secondary to the mass effect, and to prevent complications such as retroperitoneal bleeding.

scholarly journals Primary myxoid temporal bone tumor: A rare neurosurgical manifestation of Carney complex?

2020 ◽  
Vol 11 ◽  
pp. 166
Author(s):  
Tobechi Nwankwo Mbadugha ◽  
Kohei Kanaya ◽  
Tetsuyoshi Horiuchi ◽  
Mai Iwaya ◽  
Samuel Chukwunonyerem Ohaegbulam ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Bone Tumor ◽  
Bone Lesion ◽  
Mass Effect ◽  
Carney Complex ◽  
Spindle Cell Neoplasm ◽  
First Case ◽  
Primary Bone ◽  
Temporal Bone Tumor

Background: Carney complex (CNC) is a rare autosomal dominant syndrome, manifesting mainly with cardiac, cutaneous, and mucosal myxomas. Osteochondromyxoma is known as an extremely rare bone lesion of CNC which usually appears early in life; however, there were no reports of primary bone myxoma of the skull in the patients with CNC. We present the first case of primary myxoid skull tumor in the patient with CNC. Case Description: We report the left temporal bone tumor with significant intracranial mass effect in a 58-year- old woman already diagnosed with CNC. Complete resection of the tumor with skull bone reconstruction was carried out. Pathological diagnosis was labeled the lesion as an atypical myxoid spindle cell neoplasm. The features were different from atrial myxoma and osteochondromyxoma which has been described in CNC. There have been no signs of recurrence in 9 years follow-up. Conclusion: To the best of our knowledge, there have been no reports of the primary myxoid tumors in the skull in the patients with CNC. This paper highlighted a possible important association between CNC and primary intracranial myxoid tumors.

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