Case Report: Pediatric Renal Sarcoidosis and Prognostic Factors in Reviewed Cases

Background: Pediatric sarcoidosis is a complex inflammatory disorder with multisystemic manifestations. Kidney involvement in children is rare, and prognostic factors are unknown.Case Report and Methods: We report the case of a 16-year-old girl with multiorgan sarcoidosis and renal involvement. The patient presented with tubulointerstitial nephritis, acute kidney injury (AKI), chest CT disseminated noduli, granulomatous iridocyclitis, giant-cell sialadenitis, and arthralgia. The kidney biopsy revealed non-granulomatous interstitial nephritis. Treatment consisted of initial high-dose methylprednisolone pulse followed by oral prednisolone and methotrexate. Full remission was achieved. In addition, we performed a literature review using PubMed and analyzed data on pediatric renal sarcoidosis cases.Results: We identified 36 cases of pediatric sarcoidosis with renal involvement on presentation and data on the end-of-follow-up glomerular filtration rate (GFR). The data from the literature review showed that renal involvement was slightly more prevalent in males (60%). AKI was present in most of the described patients (84%). Oral prednisolone was used in 35 of 36 cases; in more severe cases, other immunosuppressants were used. We newly identified renal concentration impairment and granulomatous interstitial nephritis as factors with a clear trend toward GFR loss at the end of follow-up, emphasizing the importance of kidney biopsy in symptomatic patients. In contrast, higher GFR at presentation and hypercalcemia were rather favorable factors. According to the identified predictive factors, our patient has a good prognosis and is in remission.Conclusion: The factors indicating a trend toward an unfavorable renal outcome in pediatric sarcoidosis are renal concentration impairment and granulomatous interstitial nephritis at presentation, while a higher GFR is beneficial.

Download Full-text

Small intestine duplication cyst with recurrent hematochezia: a case report and literature review

BMC Gastroenterology ◽

10.1186/s12876-021-01627-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhicheng Zhang ◽

Xiaowei Huang ◽

Qian Chen ◽

Demin Li ◽

Qi Zhou ◽

...

Keyword(s):

Small Intestine ◽

Case Report ◽

Literature Review ◽

Ct Scan ◽

Duplication Cyst ◽

Abdominal Ct ◽

Case Presentation ◽

Abdominal Ct Scan ◽

Capsule Endoscopes

Abstract Background Small intestine duplication cysts (SIDCs) are rare congenital anatomical abnormalities of the digestive tract and a rare cause of hematochezia. Case presentation We describe an adult female presented with recurrent hematochezia. The routine gastric endoscope and colonic endoscope showed no positive findings. Abdominal CT scan indicated intussusception due to the "doughnut" sign, but the patient had no typical symptoms. Two subsequent capsule endoscopes revealed a protruding lesion with bleeding in the distal ileum. Surgical resection was performed and revealed a case of SIDC measuring 6 * 2 cm located inside the ileum cavity. The patient remained symptom-free throughout a 7-year follow-up period. Conclusion SIDCs located inside the enteric cavity can easily be misdiagnosed as intussusception by routine radiologic examinations.

Download Full-text

Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

BMC Nephrology ◽

10.1186/s12882-020-02213-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Katarzyna Szajek ◽

Marie-Elisabeth Kajdi ◽

Valerie A. Luyckx ◽

Thomas Hans Fehr ◽

Ariana Gaspert ◽

...

Keyword(s):

Acute Kidney Injury ◽

Interstitial Nephritis ◽

Kidney Biopsy ◽

Kidney Diseases ◽

Case Reports ◽

Kidney Injury ◽

Maculopapular Rash ◽

Tubular Injury ◽

Granulomatous Interstitial Nephritis ◽

First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

Download Full-text

Different renal manifestations associated with very early onset pediatric inflammatory bowel disease: case report and review of literature

BMC Nephrology ◽

10.1186/s12882-021-02358-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

A. Angeletti ◽

S. Arrigo ◽

A. Madeo ◽

M. Molteni ◽

E. Vietti ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Interstitial Nephritis ◽

Inflammatory Bowel Diseases ◽

Bowel Disease ◽

Early Onset ◽

Renal Involvement ◽

Granulomatous Interstitial Nephritis ◽

Disease Case ◽

Bowel Diseases ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel diseases are characterized by chronic inflammation of the gastrointestinal tract. In particular, Crohn disease and ulcerative colitis represent the two most common types of clinical manifestations. Extraintestinal manifestations of inflammatory bowel diseases represent a common complications, probably reflecting the systemic inflammation. Renal involvement is reported in 4–23% of cases. However, available data are limited to few case series and retrospective analysis, therefore the real impact of renal involvement is not well defined. Case presentation We report the case of a 10-years old male affected by very early onset unclassified-Inflammatory bowel diseases since he was 1-year old, presenting with a flare of inflammatory bowel diseases associated with acute kidney injury due to granulomatous interstitial nephritis. Of interest, at 7-year-old, he was treated for IgA nephropathy. To our knowledge, no previous reports have described a relapse of renal manifestation in inflammatory bowel diseases, characterized by two different clinical and histological phenotypes. Conclusions The link between the onset of kidney injuries with flares of intestinal inflammation suggest that nephritis maybe considered an extra-intestinal manifestation correlated with active inflammatory bowel disease. However, if granulomatous interstitial nephritis represents a cell-mediated hypersensitivity reaction than a true extraintestinal manifestation of inflammatory bowel diseases is still not clarified. We suggest as these renal manifestations here described may be interpreted as extraintestinal disorder and also considered as systemic signal of under treatment of the intestinal disease.

Download Full-text

Nitrofurantoin-Associated Acute Granulomatous Interstitial Nephritis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211001659 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110016

Author(s):

B. K. Anupama ◽

Parth Sampat ◽

Harvir S. Gambhir

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Case Report ◽

Interstitial Nephritis ◽

Visual Hallucination ◽

Kidney Injury ◽

Corticosteroid Administration ◽

Granulomatous Interstitial Nephritis ◽

Rare Association ◽

New Onset

We report the case of a 71-year-old female who was incidentally found to have nonoliguric acute kidney injury on a routine workup for new-onset visual hallucination. Further history revealed inadvertent usage of nitrofurantoin for 3 months for an anticipated urological procedure. Renal biopsy demonstrated acute granulomatous interstitial nephritis. The renal function significantly improved following discontinuation of nitrofurantoin and corticosteroid administration. We highlight a rare association of nitrofurantoin with acute granulomatous interstitial nephritis through this case report.

Download Full-text

Ameloblastic fibro-odontoma in a child patient: case report and literature review

Research Society and Development ◽

10.33448/rsd-v10i2.12430 ◽

2021 ◽

Vol 10 (2) ◽

pp. e26610212430

Author(s):

Gustavo Zanna Ferreira ◽

Carolina Ferrairo Danieletto-Zanna ◽

Liogi Iwaki Filho ◽

Rômulo Maciel Lustosa ◽

Willian Pecin Jacomacci ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Bone Regeneration ◽

Clinical Characteristics ◽

Patient Case ◽

Lesion Pattern ◽

Local Bone ◽

Ameloblastic Fibroma ◽

Child Patient

The ameloblastic fibro-odontoma (AFO) is a mixed odontogenic tumor, with characteristics of ameloblastic fibroma, presenting enamel and dentin, which occurs more frequently in individuals aged 5 to 17 years. This paper reports na extensive case of ameloblastic fibro-odontoma in the mandible of a 3-year-old patient, discussed in comparison to cases selected from a brief literature review on the clinical characteristics, Evolution and therapeutic options for this lesion. In the last years, there was no consensus in the literature concerning its etiopathogenesis and classification, yet recently the AFO was classified as a developing odontoma. This case is in accordance with the 7 cases reported in the literature of AFO in the mandible of children aged 10 years or younger, especially concerning the lesion pattern and evolution and treatment adopted. The patient did not present relapse and exhibited local bone regeneration at the 3-year follow-up.

Download Full-text

Effective Treatment With Everolimus for Recurrent Granulomatous Interstitial Nephritis in a Renal Transplant Recipient: A Case Report

Transplantation Proceedings ◽

10.1016/j.transproceed.2016.01.034 ◽

2016 ◽

Vol 48 (3) ◽

pp. 946-948

Author(s):

J. Teranishi ◽

Y. Hattori ◽

T. Mochizuki ◽

T. Kawahara ◽

K. Makiyama ◽

...

Keyword(s):

Case Report ◽

Renal Transplant ◽

Transplant Recipient ◽

Effective Treatment ◽

Renal Transplant Recipient ◽

Interstitial Nephritis ◽

Granulomatous Interstitial Nephritis

Download Full-text

Laparoscopic Resection of a Giant Dedifferentiated Primary Retroperitoneal Mucinous Cystadenoma (PRMC) in a Young Woman: A Case Report and Literature Review

Journal of Clinical Case Studies ◽

10.16966/2471-4925.215 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Wu L ◽

Li X ◽

Li J ◽

Lai Y

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Literature Review ◽

Benign Tumor ◽

Laparoscopic Resection ◽

Abdominal Cavity ◽

Mucinous Cystadenoma ◽

Rare Benign Tumor ◽

Primary Retroperitoneal

Background: PRMC is a very rare benign tumor of the abdominal cavity that usually occurs in women, and PRMC demonstrate no specific findings on CT. There are many reports on the differential diagnosis and discussion of PRMC imaging, but there are few reports on the treatment of dedifferentiated PRMC using laparoscopic resection and postoperative follow-up.

Download Full-text