Acute Respiratory Distress Syndrome after Rotavirus Infection in a C1q Nephropathy Patient: A Case Report

C1q nephropathy is a rare glomerulopathy that typically presents with nephrotic syndrome in children. Treatment with immunosuppressive agents renders patients vulnerable to infection and its complications. Gastroenteritis is common in children, and rotavirus is a leading cause. Extraintestinal manifestations of rotavirus have recently been reported; however, there is a paucity of cases exploring the involvement of a rotavirus on the respiratory system. Acute respiratory distress syndrome (ARDS) is a rapid onset respiratory failure characterized by noncardiogenic pulmonary edema and hypoxemia. Causes of ARDS include sepsis, pneumonia, pancreatitis, aspiration, and trauma. In this paper, we report a case of ARDS after rotavirus infection in a child with C1q nephropathy who had been treated with immunosuppressive agents.

Case Report: Complete Remission of C1q Nephropathy Treated With a Single Low-Dose Rituximab, a Reality or Coincidence?

C1q nephropathy is a glomerulopathy that is characterized by large amount of C1q deposits in the glomerular mesangium. It is a diagnosis of exclusion after ruling out systemic lupus erythematosus and membranoproliferative glomerulonephritis by systemic and serological examination. The pathogenesis of C1q nephropathy is unclear. In addition, there is very little generalizability in the treatment and prognosis for pediatric C1q nephropathy due to diversities in clinical manifestations and pathological types. Rituximab is a human/mouse chimeric monoclonal antibody against CD20, which is primarily used for treating lymphomas and, most recently, has been used to treat certain kidney diseases including C1q nephropathy. In this report, we used one quarter of the typical dose of rituximab for lymphoma treatment to achieve complete remission in a C1q nephropathy patient, significantly reducing deposition of immune complexes and glomerular damage. This case indicates that dosage reconsiderations may be necessary for rituximab in treatment of pediatric C1q nephropathy.

P1827SIMPLE METHOD OF RENAL BIOPSY WITHOUT ADMISSIN IN CHILDREN

Background and Aims Renal biopsy is an essential procedure for diagnosis and prognosis of the glomerular diseases, however needs a lot of skill and experience to do and usually requires admission for a couple of days, unless sometimes needs an embolization, transfusion, nephrectomy etc. We have an experience of more than 3,000 cases of renal biopsy without major complications such as bleeding, embolization, nephrectomy etc.. Recently we performed 309 cases of renal biopsies, whose age is under 20 year old, at the OPD level without admission. Method Before renal biopsy we checked bleeding tendencies and blood thinning agents were hold for more than 1 week. Kidney biopsy was done under local lidocain anesthetic at biopsy site and IV ketamine in uncooperative children. Biopsy needle was inserted under the ultrasound guide(GE LogiQ E9) at the lower pole of the kidney. We checked renal hematoma, AV-fistula formation etc. by ultrasound 3 times every one hour until go home. Biopsy materials were sent to H.S.Lee’s pathology lab. All patients went home in 6 hours after procedure. As far as we know, our clinic is the world’s first time try doing kidney biopsy at OPD plus pathology together, although some kidney pathology reading centers are available in some place. IF results were reported by on-line on the day of kidney biopsy after 5 hours and LM and EM were reported by on-line within two days. All cases went home after 6 hours of procedure. Results We performed 309 cases of renal biopsy at OPD level without any major complications, of which 43 cases were follow up renal biopsies. No major complications were noted such as bleeding, AV fistular, embolization, nephrectomy etc.. Male to female ratio was 1.24. Age distribution was from 2 to 20 year-old. Biopsy results were as follows; mesangial proliferative glomerulonephritis 82 cases(26.51%), IgA nephropathy 81 cases(26.2%), mild focal nonspecific glomerulonephritis 45 cases(14.6%), HSP 23 cases(7.4%), focal segmental glomerulosclerosis 17 cases(5.5%), podocyte disease 13 cases (4.2%), Alport’s syndrome 10 cases(3.2%), minor glomerular change 10 cases (3.2%), MPGN 8 cases (2.6%), membranous nephropathy 6 cases(1.9%), and Lupus nephritis, C1q nephropathy, C3 nephropathy, obesity related nephropathy were 11 cases respectively and others include acute PSGN, chronic tubulointerstitial nephritis. Conclusion OPD level percutaneous renal biopsy in children is no more a dangerous procedure if performed exactly at lower pole of the kidney, with close follow up for 6 hours by ultrasound examination.

Other primary glomerular diseases

This chapter covers the other primary glomerular diseases, including their pathologies, treatment options for their management, and risk factors. Some of these primary glomerular diseases are quite rare. This chapter covers fibrillary glomerulonephritis (FGN), collagenofibrotic glomerulopathy, thin basement membrane nephropathy (TBMN), lipoprotein glomerulopathy (LPG), ‘pure’ mesangial proliferative glomerulonephritis (MesPGN), IgM nephropathy, C1q nephropathy, idiopathic nodular glomerulosclerosis, and C4 glomerulopathy. It describes the use of light microscopy, immunofluorescence, electron microscopy, and immunochemistry where applicable. For each disease, the natural history, clinical presentation, pathogenesis, and pathology are described, and, where applicable, specific studies are discussed. Any specific treatments are outlined for each.