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Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (173-179)

The significance of atypical morphology in the changes of spectrum of postinfectious glomerulonephritis

Y.K. Wen¹ and M.L. Chen²

¹Division of Nephrology, Department of Internal Medicine, and ²Department of Pathology, Changhua Christian Medical Center, Changhua, Taiwan
Background: The characteristics of post infectious glomerulonephritis (PIGN) now differ from what were described decades ago. After encountering several patients of PIGN with atypical morphology, we conducted this retrospective study to determine the significance in the changes of clinicopathological spectrum of the disease. Methods: Between July 2000 and February 2009, 21 cases of PIGN were identified at a medical center in Taiwan. The patients’ records were reviewed with respect to clinical presentation, microbiology, serology, morphology of renal biopsy, and clinical course. Results: The mean age was 60.4 years. All patients developed acute renal failure and the majority (66.7%) required dialysis support. Hypocomplementemia was present in 61.9% of patients. The most frequently identified infectious agent was Staphylococcus (57.1%). Histological characteristics showed two distinct patterns of PIGN. One was diffuse endocapillary proliferation typical of PIGN (61.9%) and the other was atypical pattern of focal mesangial proliferation (38.1%). In comparison, glomerular neutrophil infiltration was more commonly present in typical pattern (p = 0.018). Glomerular IgA dominant or co-dominant deposition was more frequently seen in atypical pattern (p = 0.032). However, there were no statistically significant differences in the clinical presentation and outcome between the two groups. Our data also showed that the percentage of patients with atypical morphology PIGN significantly increased over time. Conclusions: Atypical pattern of focal mesangial proliferative glomerulonephritis may represent a resolution stage of PIGN. The nature of subclinical infection with a more protracted course may contribute to the increasing recognition of this resolving PIGN at the time of renal biopsy. Another possible explanation is that the atypical morphology may be a peculiar pattern of poststaphylococcal glomerulonephritis which was increasingly identified in PIGN over the past 10 years.Correspondence to:
Dr. Y.K. Wen
Division of Nephrology
Department of Medicine
Changhua Christian Hospital
135 Nanhsiao Street
Changhua, 500, Taiwan
Email: wensnake1100@yahoo.com.tw

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (180-189)

NMR identifies atherogenic lipoprotein abnormalities in early diabetic nephropathy that are unrecognized by conventional analysis

H.Z. Al-Shahrouri¹, P. Ramirez¹, P. Fanti¹, H. Abboud¹, C. Lorenzo² and S. Haffner²

¹Division of Clinical Nephrology and ²Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA
Lipoprotein abnormalities are likely contributors to the high risk of cardiovascular disease in the chronic kidney disease (CKD) population, although information is limited. Specifically, little is known about lipoprotein abnormalities during the early stages of diabetic kidney disease. The aim of this study was to investigate the relationship between lipoproteins and early manifestations of CKD in the 517 Type 2 diabetes mellitus (T2DM) patients who participated in the Insulin Resistance Atherosclerosis Study (IRAS). Methods: Lipoprotein abnormalities were measured by conventional lipid analysis, nuclear magnetic resonance (NMR) spectroscopy, gel gradient electrophoresis (GE), immunoprecipitation (IP), and ELISA. We grouped the cases into albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) quartiles. Results: In the conventional lipid analysis, triglycerides (TG) correlated directly with ACR and inversely with eGFR quartiles (p = 0.01), while LDL, HDL cholesterol did not correlate with change in ACR or eGFR. ACR was directly associated with apoB, total VLDL, medium VLDL, IDL and small LDL particle concentrations (p ≤ 0.03), and inversely with large LDL particles (p = 0.01) and LDL size (p = 0.008). Estimated GFR quartiles were inversely associated with total VLDL, small VLDL, IDL, and medium HDL particles (p ≤ 0.01). Conclusion: In subjects with T2DM, mild albuminuria and reduction in eGFR were associated with numerous atherogenic lipoprotein abnormalities that were detected by the combination of NMR spectroscopy, gel gradient electrophoresis, immunoprecipitation and ELISA but not by the standard clinical lipid analysis.Correspondence to:
H.Z. Al-Shahrouri, MD
Department of Medicine/Division of Nephrology
Mail Code 7882
University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive
San Antonio, TX, 78229, U.S.A.
Email: alshahrouri@uthscsa.edu

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (190-196)

Screening for chronic kidney disease in the ambulatory HIV population

T. Fulop¹, J. Olivier², R.S. Meador¹, J. Hall³, N. Islam⁴, L. Mena⁵, H. Henderson⁵ and D.W. Schmidt¹

¹Division of Nephrology, Department of Internal Medicine, University of Mississippi Health Care, Jackson, MS, USA, ²NSW Injury Risk Management Research Center & School of Mathematics and Statistics, University of New South Wales, Sydney, Australia, ³Southwest Mississippi Nephrology Group, Brookhaven, MS, ⁴Department of Family Medicine, University of Mississippi Health Care and ⁵Division of Infectious Disease, Department of Internal Medicine, University of Mississippi Health Care, Jackson, MS, USA
Background: In 2005, the Infectious Disease Society of America published a guideline recommending that all patients with human immunodeficiency virus (HIV) be screened for kidney disease. We initiated a screening program for kidney disease in a dedicated HIV clinic that follows 1,631 patients. Methods: The screening consisted of a serum creatinine, an estimated glomerular filtration rate (eGFR) as defined by the abbreviated Modification of Diet in Renal Disease equation, and a standard urinalysis for proteinuria. Subjects were identified as having a positive screen if they had 1+ proteinuria or greater on a standard urinalysis or an eGFR of less than 60 ml/min/ 1.73 m². After 1 year of screening, a retrospective chart review was conducted to determine the efficacy of screening. Bivariate associations were assessed for each outcome. A multiple logistic regression analysis was conducted first with main effects models and then for all variables and interactions. Results: 941 subjects that did not have previously documented chronic kidney disease were screened and 96 (10.2%) met the definition of CKD. 9% of subjects had proteinuria and 2.4% had a qualifying eGFR. In multivariate analysis diabetes, hypertension, and low CD4 count (< 200 cells per mm³), low viral load (< 400 copies/ml) displayed strong associations with proteinuria. In the case of reduced eGFR, diabetes and age retained strong associations while the association with hypertension had borderline significance. Conclusion: This study emphasizes the potential of similar screening programs to identify early or mild CKD in an ambulatory population of patients with HIV.Correspondence to:
T. Fulop, MD
Department of Medicine – Division of Nephrology
University of Mississippi Health Care
2500 North State Street
Jackson, MS 39216, USA
Email: tfulop@medicine.umsmed.edu

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (197-203)

Bone density in renal transplant recipients and in patients with chronic kidney disease: a follow-up study in children and adolescents

S. Cvijetic¹, J. Slavicek², I. Karacic², Z. Puretic² and P. Kes²

¹Institute for Medical Research and Occupational Health, Zagreb, ²Department for Dialysis, University Clinical Hospital Rebro, Zagreb, Croatia
Aims: Disturbances in mineral and bone metabolism are common in patients with chronic kidney disease. The purpose of this follow-up study was to compare the change of bone mineral density in patients with chronic kidney disease to those who have received the renal transplant. Methods: The study included 47 children and adolescents: 16 with mild to moderate kidney disease, 14 on dialysis and 17 patients with renal transplant. At the baseline and follow-up visits, regular biochemistry, anthropometry and bone mineral density were measured. To minimize the effect of skeletal size, bone mineral apparent density (BMAD; g/cm³) was calculated. Results: The mean height was below one standard deviation from reference values in patients on dialysis and in those with renal transplant. After correction for age, baseline and follow-up BMAD did not differ significantly between patients after transplantation and those with chronic kidney disease. The increase of BMAD between two measurements (mean period 16.0 ± 4.4 months) was not significantly higher in patients with kidney transplant compared to those with chronic kidney disease. The significant predictors of BMAD were PTH in patients with chronic kidney disease and duration of steroid therapy in patients with renal transplant. Conclusions: The results showed that bone density in children and adolescents, even several years after kidney transplantation, did not significantly change over time comparing to patients with chronic kidney disease. Hyperparathyroidism and steroid therapy were the most important risk factors for the slow increase of bone density.Correspondence to:
S. Cvijetic, MD, PhD
Institute for Medical
Research and Occupational Health
Ksaverska cesta 2
10001 Zagreb, Croatia
Email: cvijetic@imi.hr

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (204-209)

Charlson comorbidity index using administrative database in incident PD patients

S.-H. Jang, J.-W. Chea and K.-B. Lee

Division of Nephrology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Aims: Mortality risks in ESRD (end stage renal disease) patients are related to comorbid diseases. The Charlson Comorbidity Index (CCI) has been reported to be a strong predictor of survival in incipient ESRD patients. The authors studied the validity of CCI using administrative database according to International Classification of Disease, 10th revision (ICD-10) codes, to devise a more straightforward method of determining CCI than that based on medical records review. Subjects and methods: Incident peritoneal dialysis patients (N = 134) were enrolled from 1997 through 2007. We compared CCI scored by the administrative database (A-CCI) with CCI scored by medical records review (R-CCI). These CCI scores and patients’ outcomes were analyzed. Results: For all patients, mean A-CCI and R-CCI were 5.3 ± 2.1 (range 2 – 11) and 5.4 ± 2.1 (range 2 – 11), respectively. High correlation was found between A-CCI and R-CCI scores (r = 0.88, p < 0.01). The sensitivity of A-CCI was high (0.57 – 1.00) for nine comorbidities, but sensitivities for chronic pulmonary disease and peptic ulcer disease were poor (< 0.50). However, specificity was excellent for most comorbidities. Three comorbidity groups were established by tertile ranking: low comorbidity (score = 2 – 4), moderate comorbidity (score = 5 – 6), and high comorbidity (score = 7-11). The mortality rates were; 7.17, 15.96, and 23.07/100 patient-years by A-CCI, and 6.69, 13.58 and 28.16/100 patient-years by R-CCI, respectively. Conclusion: CCI scores from administrative database using ICD-10 were similar to CCI scores by medical records review. This method is simple and valid to predict the outcomes of incipient PD patients.Correspondence to:
K.-B. Lee, MD
Department of Internal Medicine
Kangbuk Samsung Hospital
108, Pyung-Dong, Jongro-Ku, Seoul, Korea
Email: kyubeck.lee@samsung.com

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (210-215)

Oxidative stress, inflammation and nutritional status during darbepoetin α treatment in peritoneal dialysis patients

S. Malgorzewicz¹,³, M. Lichodziejewska-Niemierko¹,², S. Lizakowski¹, T. Liberek¹, W. Lysiak-Szydlowska³ and B. Rutkowski¹

¹Department of Nephrology, Transplantation and Internal Medicine, ²Department of Palliative Medicine, ³Department of Clinical Nutrition, Medical University Gdansk, Gdansk, Poland
Recombinant human erythropoetin β (rHuEPO) has not only an erythropoietic effect but also appears to affect production of cytokines and may improve nutritional status of dialysis patients. Darbepoetin α is a new erythropoiesis-stimulating protein with a threefold longer serum half-life when compared with rHuEPO. The objective of this prospective study was to assess oxidative stress, inflammation, nutrition and hematological response in peritoneal dialysis (PD) patients who were switched from rHuEPO β to darbepoetin α. 12 stable PD patients (6 M, 6 F; mean age 56.2 ± 15.1 yr.) were evaluated during this study together with 22 healthy volunteers serving as a control group. All patients had been receiving erythropoetin β subcutaneously once a week before they were reassigned to darbepoetin. The new drug was administered every other week for 6 months, in a dose equivalent to a weekly dose of previously taken rHuEPO. Hematology, iron status and biochemical profiles were evaluated monthly. Markers of oxidative stress: malondialdehyde/ 4-hydroxynoneal (MDA/4HNE), carbonyl groups (CG), oxyLDL and AGEs and markers of inflammation: CRP, TNF α, IL-6 were measured on rHuEPO β before the switch to darbepoetin, and after 1th and 6th month of darbepoetin treatment. The assessment of nutritional status was determined by body mass index (BMI), serum albumin concentration and Subjective Global Assessment (SGA). Results: Mean levels of Hb and Hct were stable during 6 months of observation and not significantly different from the data observed for on rHuEPO. Nutritional status was good in 9 patients, 3 patients were malnourished at the beginning of this study as assessed by SGA and this status persisted to the end of observation. The levels of markers of oxidative stress and inflammation were statistically higher than in the control group (p < 0.05). Conclusion: Darbepoetin α given subcutaneously once every 2 weeks is effective for the treatment of anemia in PD patients. Less frequent administration of darbepoetin has a biological response similar to weekly administration of rHuEPO.Correspondence to:
S. Malgorzewicz, PhD
Department of Clinical Nutrition
Medical University of Gdansk
Debinki 7, 80-211 Gdansk, Poland
Email: sylwia@tetra.pl

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (216-220)

Seasonal changes in blood pressure in chronic kidney disease patients

S.-H. Bi, L.-T. Cheng, D.-X. Zheng and T. Wang

Division of Nephrology, Peking University Third Hospital, Beijing, China
Background: Seasonal variation in blood pressure (BP) in different populations has been described. However, no study has concentrated on the change of blood pressure in chronic kidney disease (CKD) patients, a large and growing population worldwide. Furthermore, the role of volume status in seasonal blood pressure variations remains controversial. Methods: 109 CKD patients in a single center were followed between January 1, 2007 and December 31, 2007. Systolic and diastolic blood pressure, level of serum creatinine and body weight were measured in these patients and studied along with climatology data obtained from Beijing Weather Bureau. Results: Blood pressure varied throughout the year, following a cyclic pattern. It increased from the autumn months toward winter, and decreased toward the spring and warmer months. The seasonal variation of blood pressure in CKD patients appeared not to correlate with CKD stage and similar seasonal variations were observed. Blood pressure values in the cohort of CKD patients were inversely correlated with outdoor temperatures (SBP: r = –0.882, p < 0.001; DBP: r = –0.860, p < 0.001). Furthermore, there was no significant difference in body weight between summer and winter (p > 0.05) in this group of CKD patients. Conclusions: Our results suggest that the blood pressure of CKD patients varied with the seasonal variation. The seasonal variation of blood pressure in CKD patients seemed to have no correlation with stage of CKD or change of body weight but was inversely associated with outdoor temperatures. These results suggested that volume status might not be a key mechanism causing seasonal variation in blood pressure.Correspondence to:
T. Wang, MD, PhD
Division of Nephrology
Peking University Third Hospital
49 North Garden Rd, Haidian District
Beijing 100191, P.R. China
Email: wangt@bjmu.edu.cn

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (221-228)

Atorvastatin-induced modulation of monocyte respiratory burst in vivo in patients with IgA nephropathy: a chronic inflammatory kidney disease

S. Lundberg¹, J. Lundahl², I. Gunnarsson³ and S.H. Jacobson⁴

¹Nephrology Unit, ²Unit of Clinical Immunology and Allergy and ³Rheumatology Unit, Division of Medicine, Karolinska University Hospital and ⁴Department of Nephrology, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
Background: IgA nephropathy (IgAN), the most common chronic inflammatory kidney disease, implies a considerable risk of renal failure and premature cardiovascular disease. Metabolic activation of monocytes has been suggested to be an important link between chronic inflammation, oxidative stress and the development of atherosclerosis. Oxidative stress is also involved in the progression of kidney disease. In this study we investigated the degree of monocyte activation, measured by monocyte respiratory burst in patients with IgAN, since these patients represent a fairly homogenous group of patients with chronic kidney disease, and compared the results to those in healthy subjects. As anti- inflammatory effects have been ascribed to HMG-reductase inhibitors, we also examined whether treatment with atorvastatin influenced monocyte respiratory burst. Methods: Monocyte respiratory burst, unstimulated and stimulated by fMLP and PMA, was measured by flow cytometry in 16 patients with biopsy proven IgAN before and after 1 month of treatment with 20 mg atorvastatin/ day. Baseline values were compared to measurements in healthy subjects. Blood and urine samples, before and after statin treatment, were also analyzed for ox-LDL, inflammatory markers (CRP, MCP-1, ICAM-1, TNFR II and NGAL/MMP-9) and renal functional parameters. Results: At baseline, respiratory burst of PMA-stimulated monocytes was higher in patients with IgAN as compared to that in healthy subjects (p = 0.002). After atorvastatin treatment there was a significant reduction of unstimulated, fMLP- and PMA-stimulated monocyte respiratory burst compared to baseline values (p = 0.03, p = 0.003 and p = 0.002, respectively). For ox-LDL and inflammatory serum markers we observed no significant changes. Conclusion: Our study demonstrates a higher monocyte respiratory burst in patients with IgAN compared to in cells from healthy controls as well as a significant reduction of this parameter after short time and low dose atorvastatin treatment.Correspondence to:
S. Lundberg
Department of Nephrology
Karolinska University Hospital
17176 Stockholm, Sweden
Email: sigrid.lundberg@karolinska.se

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (229-237)

Do Platelet Function Analyzer-100 testing results correlate with bleeding events after percutaneous renal biopsy?

N. Islam¹*, T. Fulop²*, L. Zsom², E. Miller³, C.D. Mire⁴, C.J. LeBrun⁵ and D.W. Schmidt²

¹Department of Family Medicine, ²Department of Internal Medicine (Nephrology), University of Mississippi Medical Center, Jackson, MS, ³Southwest Mississippi Nephrology, Brookhaven, MS, ⁴Nephrology Associates, Mobile, AL, and ⁵Nephrology Associates, Columbus, MS, USA
Background: Predicting bleeding after percutaneous kidney biopsy (PKB) is difficult. The value of Platelet Function Analyzer-100 (PFA-100) is not studied in this setting. Methods: We undertook a prospective study of PFA-100 collagen/epinephrine (CEPI) and collagen/adenosine diphosphate (CADP) closure times among 56 participants (35 males and 21 females) undergoing PKB under real-time ultrasound (US) visualization at a tertiary teaching hospital. We collected data on age, sex, weight, height, blood pressure (BP), serum creatinine, random urine protein/creatinine ratio, electrolytes, PT/PTT, complete blood count, administration of desmopressin acetate and renal biopsy characteristics. Major outcomes were hematoma formation on US, packed red blood (PRBC) transfusions and hematuria. Data were analyzed with SPSS 16. Results: PFA-CEPI was abnormal in 5 (8.93%) and PFA-CADP abnormal in 8 (14.3%) participants. Post-biopsy hematoma formation on US was detected in 11 (19%) participants, 5 (8.9%) had macroscopic hematuria and 4 (7%) required PRBC transfusion. Bleeding events did not correlate with body mass index, baseline BP or with each other. Hematuria and US-observed hematomas did not appear to be clinically relevant. PRBC transfusions showed a significant association with elevated baseline BUN (p = 0.031), creatinine (p = 0.011) and the number of biopsy passes (p = 0.008). PFA-100 CEPI and CADP did not associate with any of the bleeding complications after PKB (p = NS). Conclusions: Measuring PFA-100 is unlikely to add to the care of patients undergoing routine PKB. ClinicalTrials.gov NCT00334204.

*These authors have contributed to this article equally.Correspondence to:
T. Fulop, MD
Internal Medicine
University of Mississippi Medical Center
2500 North State Street
Jackson, MS 39216, USA
Email: tfulop@medicine.umsmed.edu

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (238-240)

Are low concentrations of serum triiodothyronine a good marker for long-term mortality in hemodialysis patients?

M.J. Fernández-Reyes¹, J.J. Diez², A. Collado³, P. Iglesias², M.A. Bajo⁴, P. Estrada⁴, G. del Peso⁴, M. Heras¹, A. Molina¹ and R. Selgas⁴

¹Servicio de Nefrología H General Segovia, Segovia, ²Servicio Endocrinología Hospital Ramón y Cajal, Madrid, ³Servicio de Bioquímica Hospital Universitario La Paz, and ⁴Servicio de Nefrología Hospital Universitario La Paz, Madrid, Spain
Introduction: Low serum free triiodothyronine (FT3) concentrations have been reported in a high percentage of chronic renal failure patients and have been considered as an independent predictor of mortality in dialysis patients. Objective: Our aim has been to evaluate the prognostic value of FT3 levels for long-term mortality in stable hemodialysis patients surviving at least 12 months. Patients and measurements: We retrospectively analyzed 89 stable hemodialysis patients (50 males; mean age 67.9 ± 11.8 years). All patients had a baseline clinical and analytical evaluation. We analyzed the relationship between baseline FT3 and mortality by means of survival analysis (Kaplan-Meier) and Cox regression analysis. Results: Mean values of thyroid function test were: thyrotropin (TSH) 2.02 ± 1.5 µU/ml, free thyroxine (FT4) 1.26 ± 0.23 ng/dl, and FT3 2.7 ± 0.4 pg/ml. During a median follow-up time of 33.6 ± 14.9 (12 – 62) months, 41 patients died. FT3 was similar in patients who died or survived (2.6 ± 0.5 vs. 2.7 ± 0.4 pg/ml ns). Kaplan-Meier analysis did not show significant differences in mean survival according to tertiles of FT3. In multivariate Cox regression analysis, FT3 was not a predictor of mortality (RR 0,001; 95% CI; 0.000 to 1.73). Conclusions: These data suggest that low FT3 levels are not predictive for mortality in a subgroup of stable HD patients who could survive more than 12 months.Correspondence to:
M.J. Fernández-Reyes, MD
Department Nephrology
Hospital General de Segovia
Carretera de Avila s/n
40002 Segovia, Spain
Email: mfernandez@hgse.sacyl.es

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (241-243)

Quinolone-resistant Aeromonas hydrophila peritonitis in a CAPD patient

I. Sahin¹ and H.S. Barut²

¹Department of Internal Medicine, Nephrology Division, Inonu University School of Medicine, Malatya, and ²Department of Infectious Disease, Gaziosmanpasa University School of Medicine, Tokat, Turkey
Peritonitis is a major cause of morbidity in continuous ambulatory peritoneal dialysis (CAPD). Aeromonas hydrophila is a rare cause of peritonitis in patients on CAPD. We herewith report a 44-year-old female patient on CAPD with Aeromonas hydrophila peritonitis. Peritoneal fluid grew Aeromonas hydrophila. The patient reported that she had accidentally dropped her peritoneal dialysis catheter into the toilet. Susceptibility testing revealed that it is susceptible to ceftazidime, but resistant to ciprofloxacin. The patient was treated successfully with intravenous ceftazidime for 2 days followed by intraperitoneal ceftazidime for 12 days. She was discharged with complete recovery after 2 weeks of antibiotic treatment.Correspondence to:
Associate Prof. I. Sahin
Inonu University
School of Medicine
Department of Internal Medicine
Nephrology Division
44280, Malatya, Turkey
Email: sahinidris@hotmail.com

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (244-246)

Acute pancreatitis preceding an acute episode of thrombotic microangiopathy

H.-H. Chang¹, M.L. Chen³ and C.-C. Chang¹,²

¹Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, ²College of Health Sciences, Institute of Medical Research, Chang Jung Christian University, Tainan, and ³Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
Thrombotic microangiopathy (TMA) is a rarely reported complication of acute pancreatitis. The prognosis is generally good, if diagnosis is made early and treatment is adequate. We present the case of a 74-year-old man who visited our emergency department due to acute abdominal pain. He had no history of alcohol abuse or pancreatitis. Blood tests indicated elevated lipase and amylase. An abdominal computerized tomography (CT) indicated mild pancreatitis. After admission, the patient suffered a seizure and developed anemia, thrombocytopenia, elevated lactic dehydrogenase (LDH) and elevated unconjugated bilirubin. A peripheral blood smear indicated fragmented red blood cells. We diagnosed the patient as having TMA. After plasma exchange and plasma infusion therapy, the LDH and platelet levels gradually improved. A differential diagnosis of disseminated intravascular coagulation (DIC) and TMA following pancreatitis is necessary because of the different treatment strategies. Our patient had a good prognosis following therapy for TMA. Such therapy may include plasma exchange, plasma infusion, corticosteroid therapy and splenectomy.Correspondence to:
C.-C. Chang
Department of Internal Medicine
Changhua Christian Hospital
No 135 Nan-Siau Street
Changhua, 500 Taiwan
Email: 27509@cch.org.tw

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (247-249)

Acute tubulointerstitial nephritis complicated by Salmonella enteritidis gastroenteritis

H.E. Yim, K.H. Yoo, Y.S. Hong and J.W. Lee

Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
Invasive non-typhoidal salmonellosis may occur in otherwise healthy children. We report an immunocompetent 3-year-old boy with Salmonella enteritidis gastroenteritis complicated by acute tubulointerstitial nephritis who presented with fever, bloody diarrhea and gross hematuria. This case is the first report of non-typhoidal salmonellosis associated with biopsy-proven tubulointerstitial nephritis in a child.Correspondence to:
K.H. Yoo, MD, PhD
Department of Pediatrics, Guro Hospital
Korea University Medical Center, #80
Guro-Dong, Guro-Gu, Seoul, 152-703, Korea
Email: guroped@korea.ac.kr

Abstract

Clinical Nephrology, Vol. 73 – No. 3/2010 (250-252)

Relapsing tubulointerstitial nephritis in an adolescent with inflammatory bowel disease without aminosalicylate exposure

H.S. Shahrani Muhammad¹, C. Peters¹, L.F. Casserly², A.M. Dorman³ and M. Watts¹

¹Department of Medicine, ²Department of Nephrology, Mid-Western Regional Hospital, Dooradoyle, Limerick and ³Department of Renal Pathology, Beaumont Hospital, Dublin, Ireland
A 14-year-old boy presented with ongoing constipation as a manifestation of newly diagnosed Crohn’s disease (CD) and a concomitant decline in renal function with biopsy-proven interstitial nephritis. Initiation of steroid therapy and mesalazine was associated with an improvement in symptoms and renal function. We describe a rare case of a 5-aminosalicylic acid (5-ASA)-naïve patient who developed interstitial nephritis in association with CD with no evidence of other primary glomerulopathy. A unique feature of the case being a profound systemic inflammatory response at the time of diagnosis and a relapse in nephritis 2 months after cessation of mesalazine in the absence of any macroscopic colitis.Correspondence to:
H.S. Shaharani Muhammad, MD
Courtfields, Raheen, Limerick, Ireland
Email: nurulislahtaib@hotmail.com

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Volume 73, No. 3/2010(March)