scholarly journals Reversal of Gastric Bypass Resolves Hyperoxaluria and Improves Oxalate Nephropathy Secondary to Roux-en-Y Gastric Bypass

2016 ◽  
Vol 6 (3) ◽  
pp. 114-119 ◽  
Author(s):  
Varun Agrawal ◽  
Jonathan B. Wilfong ◽  
Christopher E. Rich ◽  
Pamela C. Gibson
Keyword(s):  
Gastric Bypass ◽  
Kidney Biopsy ◽  
Tubulointerstitial Nephritis ◽  
Gastrointestinal Symptoms ◽  
Kidney Injury ◽  
Urine Dipstick ◽  
Limited Efficacy ◽  
Risk Of Progression ◽  
Urine Oxalate ◽  
Oxalate Nephropathy

Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) increases the risk for kidney injury. Medical therapies for hyperoxaluria have limited efficacy. A 65-year-old female was evaluated for acute kidney injury [AKI, serum creatinine (Cr) 2.1 mg/dl, baseline Cr 1.0 mg/dl]. She did not have any urinary or gastrointestinal symptoms or exposure to nephrotoxic agents. Sixteen months prior to this evaluation, she underwent RYGB for morbid obesity. Her examination was unremarkable for hypertension or edema and there was no protein or blood on urine dipstick. Kidney biopsy revealed acute tubulointerstitial nephritis with oxalate crystals in tubules. The concurrent finding of severe hyperoxaluria (urine oxalate 150 mg/day) confirmed the diagnosis of oxalate nephropathy. Despite medical management of hyperoxaluria, her AKI worsened. Laparoscopic reversal of RYGB was performed and within 1 month, her hyperoxaluria resolved (urine oxalate 20 mg/day) and AKI improved (Cr 1.7 mg/dl). Surgical reversal of RYGB may be considered in patients with oxalate nephropathy at high risk of progression who fail medical therapy. Physicians need to be aware of the possibility of oxalate nephropathy after RYGB and promptly treat the hyperoxaluria to halt further kidney damage.

Tubulitis in a patient treated with nivolumab: Case report and literature review

2018 ◽  
Vol 2 (2-3) ◽  
pp. 107-112
Author(s):  
Viral Vakil ◽  
Mark Birkenbach ◽  
Katti Woerner ◽  
Lihong Bu
Keyword(s):  
Acute Kidney Injury ◽  
Immune Checkpoint Inhibitors ◽  
Kidney Biopsy ◽  
Tubulointerstitial Nephritis ◽  
Checkpoint Inhibitors ◽  
Kidney Injury ◽  
Programmed Death Ligand 1 ◽  
Programmed Death ◽  
Metastatic Urothelial Carcinoma ◽  
Programmed Death 1

Kidney injury associated with use of immune checkpoint inhibitors that target the programmed death-1 molecule commonly manifests as acute tubulointerstitial nephritis on kidney biopsy. We present a case of a 66-year-old man who developed acute kidney injury at 6 months after initiation of treatment with anti-programmed death-1 antibody, nivolumab, for treatment of metastatic urothelial carcinoma. A renal biopsy showed focal moderate-to-severe lymphocytic tubulitis with minimal interstitial inflammation. Programmed death ligand-1 immunopositivity was detected only in tubules exhibiting lymphocytic tubulitis. The patient’s renal function improved to baseline with conservative management consisting of discontinuation of nivolumab followed by prednisone treatment.

scholarly journals Oxalate nephropathy is a major cause of kidney injury in surgically treated pancreatic adenocarcinoma patients

2019 ◽  
Vol 12 (6) ◽  
pp. 821-828
Author(s):  
Geoffroy Desbuissons ◽  
Hassan Izzedine ◽  
Armelle Bardier ◽  
Olivier Dubreuil ◽  
Jean Christophe Vaillant ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Renal Function ◽  
Pancreatic Surgery ◽  
Kidney Biopsy ◽  
Therapeutic Option ◽  
Kidney Injury ◽  
Real Risk ◽  
Left Pancreatectomy ◽  
Oxalate Nephropathy

Abstract Background Despite new therapeutics, the prognosis for pancreatic cancer remains poor. Pancreatic surgery is a therapeutic option in non-metastatic forms. The consequences for renal function are poorly described. Methods Patients who underwent surgery for pancreatic cancer between 1 January 2010 and 1 January 2017 and who experienced kidney biopsy in the Pitié-Salpêtrière Hospital were analysed. Results Two hundred and ninety-four patients had pancreatic surgery during the period of analysis and five of them had a kidney biopsy (mean ± SD 20 months ±13.6 months after surgery) during the post-operative follow-up. Among these patients, three exhibited oxalate nephropathy (ON), indicating that the prevalence of ON in patients with pancreatectomy is at least 1%. ON may be insidious, with chronic renal failure without urinary abnormalities. All patients had a high oxalate-to-creatinine ratio in urine sample. Renal function improved after specific management of ON in two patients. Pancreaticoduodenectomy may represent a higher risk of ON than left pancreatectomy. Conclusion Although rare and underestimated, ON appears to be a real risk after pancreatic resection. Early detection may preserve renal function.

scholarly journals Acute tubulointerstitial nephritis due to the use of rifampicin. Case report

Case reports ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. 44-51
Author(s):  
Juan Camilo Motta ◽  
Camilo Andrés Rodríguez ◽  
Camilo Cortes ◽  
Jaime Escobar
Keyword(s):  
Acute Kidney Injury ◽  
Case Report ◽  
Side Effects ◽  
Pulmonary Tuberculosis ◽  
Fanconi Syndrome ◽  
Kidney Biopsy ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
History Of ◽  
Or History

Introduction: Rifampin is a cornerstone for the first phase of the treatment of pulmonary tuberculosis. This report presents the case of a patient with allergic tubulointerstitial nephritis (ATIN) due to rifampin, situation that has not been reported in Colombia.Case presentation: A male patient with a history of pulmonary tuberculosis treated with rifampin developed acute kidney injury. On admission, no evidence of abnormalities or history to explain the injury was found, but he did present tubular acidosis and associated Fanconi syndrome. The kidney injury was temporarily consistent with rifampicin use, and a kidney biopsy confirmed ATIN. The drug was suspended, resulting in improved kidney function.Discussion: ATIN as a side effect of rifampin is a scarcely reported disease. The risk of developing this condition should be considered when starting and restarting treatments with this medication.Conclusion: ATIN is one of the side effects of tuberculosis treatment. Albeit rare, it should be considered when starting tuberculosis medications.

scholarly journals Nephrotic syndrome and acute kidney injury following CoronaVac anti-SARS-CoV-2 vaccine

2021 ◽  
Author(s):  
Suat Unver ◽  
Aptullah Haholu ◽  
Sukru Yildirim
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Kidney Biopsy ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Minimal Change Nephrotic Syndrome ◽  
Minimal Change ◽  
Oral Steroids ◽  
Tubulointerstitial Inflammation

Abstract A 67-year-old female with type 2 diabetes mellitus developed nephrotic syndrome with in one week of receiving the first dose of SARS-CoV-2 CoronaVac vaccine. A kidney biopsy was consistent with minimal change nephrotic syndrome and treatment was symptomatic with antiproteinurik therapy and improvement in proteinuria. Edema returned within one week of the second dose of CoronaVac. In this occasion acute kidney injury and massive proteinuria were noted. In kidney biopsy, glomeruli were normal, but tubulointerstitial inflammation consistent with acute tubulointerstitial nephritis were noted. Pulse followed by oral steroids were followed by recovery of kidney function. Proteinuria decreased after initiation of cyclosporine A.

scholarly journals Parvovirus B19-Infected Tubulointerstitial Nephritis in Hereditary Spherocytosis

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Kei Nishiyama ◽  
Yuka Watanabe ◽  
Masataka Ishimura ◽  
Kenichi Tetsuhara ◽  
Takashi Imai ◽  
...  
Keyword(s):  
Kidney Biopsy ◽  
Hereditary Spherocytosis ◽  
Tubulointerstitial Nephritis ◽  
Parvovirus B19 ◽  
Kidney Injury ◽  
Histopathological Diagnosis ◽  
Tubular Epithelial Cells ◽  
Continuous Hemodiafiltration ◽  
Aplastic Crisis ◽  
Virus Capsid Protein

Abstract Background Human parvovirus B19 (B19V) causes glomerulopathy or microangiopathy, but not tubulopathy. We experienced an 11-year-old girl with spherocytosis who developed acute kidney injury on a primary infection of B19V. She presented with anuria, encephalopathy, thrombocytopenia, and coagulopathy, along with no apparent aplastic crisis. Methods Continuous hemodiafiltration, immunoglobulin, and intensive therapies led to a cure. Results A kidney biopsy resulted in a histopathological diagnosis of tubulointerstitial nephritis without immune deposits. The virus capsid protein was limitedly expressed in the tubular epithelial cells with infiltrating CD8-positive cells. Conclusions Viral and histopathological analyses first demonstrated B19-infected tubulointerstitial nephritis due to the aberrant viremia with hereditary spherocytosis.

scholarly journals Acute interstitial nephritis and drug-induced systemic lupus erythematosus due to chlorthalidone and amiodarone: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091002 ◽  
Author(s):  
Umut Selamet ◽  
Ramy M Hanna ◽  
Anthony Sisk ◽  
Lama Abdelnour ◽  
Lena Ghobry ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Interstitial Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Systemic Lupus ◽  
Drug Induced ◽  
Systemic Manifestations

Drug-induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. It can occur with a wide variety of agents that result in the generation of anti-histone or other types of antibodies. Systemic manifestations of drug-induced systemic lupus erythematosus may include renal dysfunction due to circulating immune complexes or due to other immune reactions to the culprit medication(s). Acute interstitial nephritis occurs due to DNA–drug or protein–drug complexes that trigger an allergic immune response. We report a patient who developed acute kidney injury, rash, and drug-induced systemic lupus diagnosed by serologies after starting chlorthalidone and amiodarone. A renal biopsy showed acute interstitial nephritis and not lupus-induced glomerulonephritis. It is important to note that systemic lupus erythematosus and acute interstitial nephritis can occur together, and this report highlights the role of the kidney biopsy in ascertaining the pathological diagnosis and outlining therapy in drug-induced lupus erythematosus.

scholarly journals COVID-19 in CKD Patients: Lessons from 553 CKD Patients with Biopsy-Proven Kidney Disease

2021 ◽  
pp. 1-8
Author(s):  
Juan León Román ◽  
Clara García-Carro ◽  
Irene Agraz ◽  
Nestor Toapanta ◽  
Ander Vergara ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Kidney Biopsy ◽  
Cox Regression ◽  
Gastrointestinal Symptoms ◽  
Bivariate Analysis ◽  
Chronic Obstructive ◽  
Nasopharyngeal Swab ◽  
Obstructive Pulmonary Disease ◽  
Immunosuppressed Patients

<b><i>Introduction:</i></b> Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. <b><i>Methods:</i></b> Data included patients who underwent kidney biopsy at the Vall d’Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. <b><i>Results:</i></b> Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (<i>p</i> = 0.01), hypertensive (<i>p</i> = 0.005), and immunosuppressed (<i>p</i> = 0.01) patients, those using RAS-blocking drugs (<i>p</i> = 0.04), and those with gastrointestinal symptoms (<i>p</i> = 0.02) were more likely to be tested for CO­VID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (<i>p</i> = 0.03), cardiovascular disease (<i>p</i> = 0.05), chronic obstructive pulmonary disease (<i>p</i> = 0.05), and low hemoglobin levels (<i>p</i> = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. <b><i>Conclusions:</i></b> Patients with CO­VID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.

scholarly journals Staphylococcus-associated acute glomerulonephritis in a patient with dermatomyositis

2021 ◽  
Vol 14 (1) ◽  
pp. e236695 ◽  
Author(s):  
Rasmi Ranjan Sahoo ◽  
Sourav Pradhan ◽  
Akhil Pawan Goel ◽  
Anupam Wakhlu
Keyword(s):  
Infective Endocarditis ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Staphylococcal Infection ◽  
Left Knee ◽  
The Body ◽  
Acute Glomerulonephritis ◽  
Disease Course ◽  
Rheumatological Disease ◽  
Per Se

Staphylococcus-associated glomerulonephritis (SAGN) occurs as a complication of staphylococcal infection elsewhere in the body. Dermatomyositis (DM) can be associated with glomerulonephritis due to the disease per se. We report a case of a 40-year-old male patient with DM who presented with acute kidney injury, and was initially pulsed with methylprednisolone for 3 days, followed by dexamethasone equivalent to 1 mg/kg/day prednisolone. He was subsequently found to have SAGN on kidney biopsy along with staphylococcus bacteraemia and left knee septic arthritis. With proof of definitive infection, intravenous immunoglobulin 2 g/kg over 2 days was given and steroids were reduced. He was treated with intravenous vancomycin. With treatment, the general condition of the patient improved. On day 38, he developed infective endocarditis and died of congestive heart failure subsequently. Undiagnosed staphylococcal sepsis complicating a rheumatological disease course can lead to complications like SAGN, infective endocarditis and contribute to increased morbidity and mortality, as is exemplified by our case.

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