Volume 79 (2013), No. 2/2013(February)
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Original
Implication of combined urinary biomarkers in early diagnosis of acute kidney injury following percutaneous coronary intervention
Qun Luo, Fangfang Zhou, Hong Dong, Lingping Wu, Lingxiong Chai, Kai Lan and Minxiang Wu
Page No. 85
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (85-92)
Implication of combined urinary biomarkers in early diagnosis of acute kidney injury following percutaneous coronary intervention
Qun Luo, Fangfang Zhou, Hong Dong, Lingping Wu, Lingxiong Chai, Kai Lan and Minxiang Wu
Division of Nephrology, Ningbo NO.2 Hospital, Affiliated Hospital of Ningbo University school of Medical, Ningbo city, Zhejiang province, PR China
Background: Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and interleukin 18 (IL-18) are three of the most promising biomarkers for the early detection of acute kidney injury. In the present study, to determine whether a combination of the three biomarkers enhances their predictive value, representing an ideal indicator for the early detection of Acute Kidney Injury (AKI) we examined 118 adults undergoing elective percutaneous coronary intervention (PCI). Methods: We performed a single center, nested case-control study. Urinary KIM-1, NGAL and IL-18 were measured by enzyme-linked immunosorbent assay before and 6 h, 24 h, 48 h postcontrast. Serum creatinine was measured before and 24 h, 48 h postcontrast. Results: 12 patients (10.1%) were identified with AKI. 30 patients were selected as controls, matched with cases at an attempted 2.5 : 1 ratio. Compared to the non-AKI group, urinary NGAL were significantly higher at all the time-points. Urinary KIM-1 and IL-18 levels were significantly higher at 24 h and 48 h postcontrast. In the AKI group, Urinary NGAL peaked at 6 h postcontrast, and then decreased. Both KIM-1 and IL-18 peaked at 24 hours postcontrast, remained markedly elevated up to 48h. By applying area under the receiver operator characteristic curve, the combination of KIM-1, NGAL and IL-18 had the most powerful diagnostic power (AUC = 0.99, (95%CI: 0.90 – 1.00), p = 0.0001) for diagnosis of AKI at 24 h postcontrast, superior to that for single detection and serum creatinine. Conclusions: KIM-1, NGAL and IL-18 were increased in tandem after PCI. The combination of urinary biomarkers may allow for early detection of AKI following PCI, better than serum creatinine, and the individual biomarkers.Correspondence to:
Dr. Qun Luo
NO.41, Xibei street
Ningbo city, Zhejiang province 315010, PR China
Email: [email protected]
Original
Chronic kidney disease at presentation is not an independent risk factor for AIDS-defining events or death in HIV-infected persons
Tahira P. Alves, Pingsheng Wu, T. Alp Ikizler, Timothy R. Sterling, Samuel E. Stinnette, Peter F. Rebeiro, Suvro Ghosh and Todd Hulgan
Page No. 93
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (93-100)
Chronic kidney disease at presentation is not an independent risk factor for AIDS-defining events or death in HIV-infected persons
Tahira P. Alves1, Pingsheng Wu2, T. Alp Ikizler3, Timothy R. Sterling4, Samuel E. Stinnette4, Peter F. Rebeiro4, Suvro Ghosh1 and Todd Hulgan4
1University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Nephrology, San Antonio, TX, 2Department of Biostatistics, 3Department of Medicine, Division of Nephrology and 4Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
Studies have documented an association between chronic kidney disease (CKD) and increased risk of end stage renal disease, death and comorbidities, including cardiovascular disease and metabolic syndrome, in the general population. However, there is little data on the relationship between CKD and ADE (AIDS defining event), and to our knowledge, no studies have analyzed death as a competing risk for ADE among HIV-infected persons. An observational cohort study was performed to determine the incidence and risks for developing an ADE or death among HIV-infected persons with and without CKD from 1998 – 2005. CKD was defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 using the CKDEpidemiology Collaboration (CKD-EPI) equation. Log rank test and Cox regression which determined time to development of ADE and/or death as combined and separate outcomes, and competing risk models for ADE versus mortality, were performed. Among the 2,127 persons that contributed to the 5,824 person years of follow-up: 22% were female, 34% African American, 38% on HAART, and 3% had CKD at baseline. ADE occurred in 227 (11%) persons and there were 80 (4%) deaths. CKD was not significantly associated with ADE/death (HR 1.3, 95% CIs: 0.5, 3.2), ADE (HR 1.0, 95% CIs: 0.4, 3.1), or death (HR 1.6, 95% CIs: 0.4, 3.1). Competing risk analyses confirmed no statistically significant associations between CKD and these outcomes. CKD was uncommon in HIV-infected persons presenting for care in this racially diverse cohort, and was not independently associated with risk of developing an ADE or dying during follow-up.Correspondence to:
Tahira Palmer Alves, MD, MPH, Assistant Professor of Medicine
Division of Nephrology
University of Texas at San Antonio Health Science Center and
Audie L. Murphy Veteran’s Administration Hospital
Medical Director, University Health System Dialysis South Clinic
7703 Floyd Curl Drive, Suite 5.080R
San Antonio, TX 78229, USA
Email: [email protected]
Original
Patients with adult minimal change nephrotic syndrome treated with long-term cyclosporine did not experience a reduction in their eGFR
Makoto Inoue, Wako Yumura, Yoshiyuki Morishita, Chiharu Ito, Yoshiaki Hamano, Yasuhiro Ando, Shigeaki Muto and Eiji Kusano
Page No. 101
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2012 (101-106)
Patients with adult minimal change nephrotic syndrome treated with long-term cyclosporine did not experience a reduction in their eGFR
Makoto Inoue, Wako Yumura, Yoshiyuki Morishita, Chiharu Ito, Yoshiaki Hamano, Yasuhiro Ando, Shigeaki Muto and Eiji Kusano
Jichi Medical University, Department of Medicine, Division of Nephrology, Tochigi, Japan
Background: The long-term efficacy and safety of cyclosporine (CyA) in the treatment of adult minimal change nephrotic syndrome (MCNS) was examined. Methods: The medical record of 15 patients diagnosed with MCNS by renal biopsy and treated with CyA for at least 2 years were reviewed. Results: The mean administration period of CyA was 78.3 months. The mean CyA dose for the induction period was 2.1 ± 0.9 mg/kg and 1.7 ± 1.0 mg/kg for the maintenance period. The mean dose of prednisolone used during the induction period was 20.3 mg and 2.7 mg during the maintenance. The frequency of MCNS relapse was decreased to 0.5 times/year in patients treated with CyA, compared to treatment without CyA (2.4 times/y). Two cases of mild liver damage and 3 cases of elevated blood pressure were observed during the administration of CyA. These adverse effects improved after reducing the CyA dose or treatment with an antihypertensive agent. A decrease in the estimated glomerular filtraion rate (eGFR) was not associated with long-term CyA use. Conclusion: At our institution, patients who were treated for MCNS with CyA for at least 2 years experienced no deterioration in renal function.Correspondence to:
Makoto Inoue, MD
Jichi Medical University
Department of Medicine, Div. of Nephrology
3311-1 Yakushiji, Shimotsuke
Tochigi, 329-0498, Japan
Email: [email protected]
Original
Optical measurement of creatinine in spent dialysate
Ruth Tomson, Ivo Fridolin, Fredrik Uhlin, Jana Holmar, Kai Lauri and Merike Luman
Page No. 107
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (107-117)
Optical measurement of creatinine in spent dialysate
Ruth Tomson1, Ivo Fridolin1, Fredrik Uhlin1,2, Jana Holmar1, Kai Lauri1 and Merike Luman3
1Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Tallinn, Estonia, 2Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Nephrology UHL, County Council of Östergötland, Linköping, Sweden, and 3Center of Nephrology, North Estonia Medical Center, Tallinn, Estonia
Aim: The aim of the study was to develop an optical method for the estimation of creatinine (Cr) removal during dialysis using UV-absorbance. Material and methods: 29 hemodialysis patients on chronic 3-times-a-week hemodialysis were studied in 6 separate studies. Double-beam pectrophotometer was used for the determination of UV-absorbance in the collected spent dialysate samples. A single wavelength (SW) and a multi-wavelength (MW) model were developed using stepwise regression utilizing Cr values from the laboratory as the dependent parameter. The reduction ratio (RR) and total removed Cr (TRCr) were estimated. Results: For blood-Cr RRb (mean ± SD) was 60.9 ± 5.0% (calibration set) and 58.1 ± 6.0% (validation set), for SW UVabsorbance RR_SW was 61.5 ± 5.9% and 57.3 ± 6.0%, and for MW UV-absorbance RR_MW was 65.8 ± 5.8% and 61.7 ± 6.4% respectively. RR_SW and RRb were not statistically different. RR_MW was higher compared to RRb (p < 0.05). TRCr_lab was 13.8 ± 3.8 mmol, TRCr_SW 14.5 ± 2.5 mmol and TRCr_MW 13.8 ± 2.6 mmol, being not statistically different. Conclusion: In summary, creatinine removal during dialysis can be estimated as reduction ratio and total removed creatinine with the UV-absorbance technique.Correspondence to:
Ruth Tomson
Department of Biomedical Engineering
Technomedicum, Tallinn University of Technology
Ehitajate Rd 5, 19086 Tallinn, Estonia
Email: [email protected]
Original
Ultrasound guided ureteroscopy in pregnancy
Levi A. Deters, Gabriel Belanger, Ojas Shah and Vernon M. Pais
Page No. 118
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (118-123)
Ultrasound guided ureteroscopy in pregnancy
Levi A. Deters1, Gabriel Belanger2, Ojas Shah3 and Vernon M. Pais1
1Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 2Maine Medical Center, Portland, ME and 3NYU Langdone Medical Center, New York, NY, USA
Introduction: Management of renal colic and suspected urolithiasis in pregnancy remains a controversial topic. Competing concerns of operative fluoroscopy and prolonged duration of ureteral stent or nephrostomy tube fuel arguments for expectant management versus early surgical intervention. To address these concerns, we have offered ultrasound guided ureteroscopy for definitive management of suspected urolithiasis during pregnancy. We herein review our experience with this approach. Methods: We performed a multi-center retrospective review of all pregnant patients undergoing ureteroscopy for suspected urolithiasis between 2008 and 2010. All pregnant patients who had undergone ultrasound guided ureteroscopy were included in this study. We evaluated presence of stone, stone size, operative time, stent duration, and post-operative course. Results: Seven pregnant patients underwent ultrasound guided ureteroscopy. The mean age was 28 years, mean gestation 24 weeks, with stone sizes ranging from 5 to 22 mm. All patients had undergone preoperative stenting. Ureteral stones were identified and removed in four patients. Post-operative imaging confirmed that there was no residual hydronephrosis or significant ipsilateral renal stone burden. Average stent duration was 7.3 days. Preterm labor occurred in one case. Discussion: In our experience, ultrasound guided ureteroscopy is a viable option in pregnancy to manage patients with suspected urolithiasis after failed expectant therapy. This method avoids fetal exposure to ionizing radiation, yet allows intraoperative radiographic monitoring. With this approach it is possible to render the patient stone free, obviating the need for ureteral stents for the duration of the pregnancy.Correspondence to:
Levi A. Deters, MD
Dartmouth Hitchcock
Lebanon, NH 03756, USA
Email: [email protected]
Original
Renal lymphatic ligation aggravates renal dysfunction through induction of tubular epithelial cell apoptosis in mononephrectomized rats
Jing Cheng, Jianping Wang, Yuan-tao Liu,Taoyan Zhang, Aili Sun, Weiwei Wang, Shasha Lv, Shanshan Liu and Guangju Guan
Page No. 124
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (124-131)
Renal lymphatic ligation aggravates renal dysfunction through induction of tubular epithelial cell apoptosis in mononephrectomized rats
Jing Cheng1, Jianping Wang2, Yuan-tao Liu1,Taoyan Zhang3, Aili Sun1, Weiwei Wang1, Shasha Lv1, Shanshan Liu1 and Guangju Guan1
1Department of Nephrology, the second affiliated hospital of Shandong University, Jinan, 2Department of hemodialysis, Yuhuangding hospital of Yantai city, Yantai City, and 3Jinan nursing vocational College of Shandong province, China
Aims: To further explore the mechanisms of apoptosis in mononephrectomized rats with renal lymph circulation disorder. Methods: Animals were divided into three groups: rats with left renal lymph ligation and right nephrectomy (KL), rats with only right nephrectomy (KN) and sham-operated rats (sham). 24-h proteinuria and serum creatinine level were monitored. Indexes of oxidative stress were measured. Renal apoptosis was examined. Further biochemical analysis was provided using real-time PCR, western blot and Elisa techniques. Results: Our results showed that renal lymphatic ligation induced renal tubular epithelial cell apoptosis and aggravated renal dysfunction in mononephrectomized rats. In addition, renal lymphatic ligation increased the activities of caspase-3, caspase-8 and caspase-9. Further investigation of mechanisms showed that renal lymphatic ligation up-regulated Fas expression, increased the ratio of Bax/Bcl-2, and also increased the levels of reactive oxygen species (ROS), malondialdehyde (MDA) while reducing superoxide dismutase (SOD) activity. Conclusion: These results indicated that disturbance of renal lymphatic circulation might lead to tubular epithelial cell apoptosis through activation of intrinsic and extrinsic apoptotic pathways, suggestive of an essential role of renal lymphatic circulation in the maintenance of tubular integrity and function.Correspondence to:
Guangju Guan
Department of Nephrology
The Second Hospital of Shandong University
247 Beiyuan Street, Jinan, Shandong, 250033, China
Email: [email protected]
Original
Implementation of a focused curriculum on flexible ureteroscopic surgery: a multi-institutional collaborative effort
Leticia Ruiz, Elias Hyams, Ricardo Donderis, Angel Alvarado, Ingrid Persky, Sonia Ruiz and Brian R. Matlaga
Page No. 132
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (132-135)
Implementation of a focused curriculum on flexible ureteroscopic surgery: a multi-institutional collaborative effort
Leticia Ruiz2, Elias Hyams1, Ricardo Donderis2, Angel Alvarado2, Ingrid Persky2, Sonia Ruiz1 and Brian R. Matlaga1
1James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA, and 2Department of Urology, Hospital Punta Pacifica, Panama City, Panama
Introduction: Flexible ureteroscopy with Holmium:YAG laser lithotripsy (Flex URS/Laser) has a known learning curve; although this laser is the safest flexible intracorporeal lithotrite, complications have been reported to occur with greater frequency early in its adoption. Herein, we review the implementation of a didactic and practical curriculum to introduce the Holmium:YAG laser for flexible URS. Following the initial tutorial period, we assessed procedure outcomes and complications. Methods: In September 2009 a 15 Watt Holmium:YAG laser was introduced to the operating suite at Hospital Punta Pacifica, a newly developed hospital affiliated with Johns Hopkins Medicine International. We developed a curriculum that included both classroom-based lectures and live surgical experience. The lectures were designed to review the laser’s properties as well as its surgical applications; live surgeries were then performed, initially as demonstrations and then as mentored procedures. The medical records of all patients undergoing Flex URS/Laser in the 12 months following this program were reviewed, to assess for outcomes and complications. Results: A total of 32 Flex URS/Laser procedures were performed. Mean age was 44.1 years, and there were 19 males, 13 females. Five stones were located in the ureter, with the remainder in the kidney. All stones were accessed and fragmented with the laser, and no peri-operative or post-operative complications were encountered. Conclusions: A focused didactic and practical curriculum can simplify the introduction of Flex URS/Laser, and permit the rapid achievement of acceptable results. An emphasis on limiting active fragment extraction will reduce the likelihood of ureteral injuries, a potentially devastating complication which may be more likely to occur early in the adoption of Flex URS/Laser.Correspondence to:
Brian R Matlaga, MD, MPH
James Buchanan Brady Urological Institute
Johns Hopkins Medical Institutions
600 N Wolfe Street, Park 221
Baltimore, MD 21287, USA
Email: [email protected]
Original
Effect of lanthanum carbonate on phosphate control in continuous ambulatory peritoneal dialysis patients in Korea: a randomized prospective study
Yong Kyu Lee, Hoon Young Choi, Sug Kyun Shin and Ho Yung Lee
Page No. 136
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (136-142)
Effect of lanthanum carbonate on phosphate control in continuous ambulatory peritoneal dialysis patients in Korea: a randomized prospective study
Yong Kyu Lee2, Hoon Young Choi3, Sug Kyun Shin2 and Ho Yung Lee1
1Department of Internal Medicine, Nephrology Division, Severance Hospital, Yonsei University, College of Medicine, 2Department of Internal Medicine, Nephrology Division, National Health Insurance Corporation (NHIC), Ilsan Hospital, and 3Department of Internal Medicine, Nephrology Division, Kangnam Severance Hospital, School of Medicine, Yonsei University College of Medicine, Seoul, Korea
Background: Hyperphosphatemia is a common complication in end-stage renal disease (ESRD) patients. Reducing the serum phosphate level is crucial in management of ESRD. Methods: This study was a randomized prospective study, designed to compare patients with hyperphosphatemia undergoing peritoneal dialysis while taking lanthanum carbonate or calcium carbonate. We divided 72 continuous ambulatory peritoneal dialysis (CAPD) patients whose serum phosphate levels were over 5.6 mg/dl into two groups to receive either lanthanum carbonate or calcium carbonate. Serum calcium, phosphate and PTH levels were examined serially for 24 weeks. Results: Both lanthanum carbonate and calcium carbonate reduced serum phosphate levels, from 6.79 ± 1.05 to 5.44 ± 1.44 and from 6.31 ± 1.13 to 4.74 ± 0.78 mg/dl, respectively. The calcium × phosphate product level was reduced in the lanthanum carbonate and calcium carbonate groups from 60.23 ± 10.23 to 46.97 ± 16.42 and from 57.92 ± 11.05 to 44.50 ± 7.74 mg2/dl2, respectively. The serum parathyroid hormone (PTH) level in the lanthanum carbonate group did not change significantly compared to baseline during the study, but in the calcium carbonate group, the serum PTH level decreased significantly. Gastrointestinal complications were the main adverse effects of lanthanum carbonate and 11 out of 35 patients dropped out of the study due to this complication. Conclusions: Lanthanum carbonate was as effective as calcium carbonate in reducing serum phosphate level, and serum PTH level tended to be steadier in the lanthanum carbonate group compared to the calcium carbonate group. Though the ifference was not significant, lanthanum carbonate tended not to elevate serum calcium level in CAPD patients compared to calcium carbonate. The high incidence of gastrointestinal adverse effect in the lanthanum carbonate group will need further evaluation.Correspondence to:
Ho Yung Lee, MD, PhD
Seodaemungu yonseiro 50
Severance Hospital, Yonsei University
College of Medicine, 120–749, Seoul, Korea
Email: [email protected]
Amendment (Table and Supplement)
Immunosuppressive treatment of idiopathic membranous nephropathy: the dilemma continues
Edward J. Filippone
Page No. 143
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (143-153)
Immunosuppressive treatment of idiopathic membranous nephropathy: the dilemma continues
Edward J. Filippone
Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
Here you get the table 1 and the supplement as pdf for free.Correspondence to:
Edward J. Filippone, MD,
Clinical Associate Professor of Medicine
Division of Nephrology, Department of Medicine
Thomas Jefferson University
2228 South Broad St, Philadelphia, PA, 19145, USA
Email: [email protected]
Nephrology Education
Advanced native kidney renal cell carcinoma in renal transplant recipients: role of sirolimus as dual anti-cancer and anti-rejection agent
Muhammad M. Javaid, Simon Chowdhury, Alastair Henderson and Jonathon Olsburgh
Page No. 154
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (154-160)
Advanced native kidney renal cell carcinoma in renal transplant recipients: role of sirolimus as dual anti-cancer and anti-rejection agent
Muhammad M. Javaid1, Simon Chowdhury2, Alastair Henderson3 and Jonathon Olsburgh4
1Department of Nephrology, Dartford and Gravesham NHS Trust, Darent Valley Hospital, Dartford, 2Department of Medical Oncology, 3Department of Urology, and 4Department of Nephrology and Transplantation, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
The incidence of native kidneyrenal cell carcinoma (RCC) in renal transplantrecipients is 15 times higher than thegeneral population. These tumors are oftenfound incidentally when imaging is performedfor another indication. At that stagetumors are usually small and asymptomaticbut it is possible that they may escape detectionuntil a more advanced stage. Early stageRCC can be treated with radical nephrectomybut the treatment of advanced RCCmay be more complicated and is associatedwith a poorer prognosis. RCC in context ofrenal transplant presents a special therapeuticchallenge; balancing treatment of a potentiallylethal malignancy in a redundant organwhilst maintaining good allograft function.We describe 2 cases of advanced renal cellcarcinoma of native kidneys in renal transplantrecipients and present our experiencewith sirolimus as a dual immunosuppressiveand anti-tumor agent.Correspondence to:
Muhammad M. Javaid
Department of Nephrology, Darent Valley Hospital
Darenth Wood Road, Dartford, DA2 8DA, UK
Email: mmjavaid@ doctors.org.uk
Nephrology Education
A case of IgA nephropathy associated with mycosis fungoides that developed into rapidly progressive glomerulonephritis
Masaki Hara, Tetsuo Nemoto, Tsunekazu Hijima, Ken Tsuchiya, Kosaku Nitta and Minoru Ando
Page No. 161
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (161-165)
A case of IgA nephropathy associated with mycosis fungoides that developed into rapidly progressive glomerulonephritis
Masaki Hara1,3, Tetsuo Nemoto2, Tsunekazu Hijima2, Ken Tsuchiya3, Kosaku Nitta3 and Minoru Ando1,3
1Department of Nephrology, 2Department of Pathology, Tokyo Metropolitan Komagome Hospital and 3Department IV, Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan
A 53-year-old Japanese malewas diagnosed with atopic dermatitis and initiatedtreatment with a local dermatologist inFebruary 2001. A routine medical check-uprevealed proteinuria, microscopic hematuriaand slight elevation of serum creatinine levelin spring 2006. He was referred to our hospitalfor nephrology consultation and followup.In December 2009, he developed a suddenhigh fever of greater than 39 °C with sorethroat. In addition, his serum creatinine levelgreatly increased to 4.6 mg/dl. His prevalentrenal illness was thought to be rapidly progressiveglomerulonephritis (RPGN). Soonafter admission, kidney and skin biopsieswere performed. The kidney specimensshowed that the glomeruli had proliferativemesangial cells strongly positive for anti-IgAantibody, 75% of which manifested fibrocellularcrescentic formation surrounding theBowman’s capsules. His skin disease waspathologically proven to be mycosis fungoides(MF). It is likely that his kidney diseasewas exacerbated by the upper respiratorytract infection and converted to RPGN. Ashis kidney function rapidly declined, hemodialysistherapy was initiated and he remainson chronic dialysis therapy. This is a seriouscase of IgA nephropathy associated with MF,which developed into RPGN and subsequentend-stage renal disease.Correspondence to:
Minoru Ando, MD, PhD
Division of Nephrology
Tokyo Metropolitan Komagome Hospital
3-18-22, Honkomagome,
Bunkyo-Ku, Tokyo, 1138677 Japan
Email: [email protected]; [email protected]
Nephrology Education
Factitious proteinuria – the most dominant feature in a young female patient with Munchausen syndrome
Ivana Vuković Lela, Sandra Karanović, Danica Matišić, Duško Kuzmanić, Marijana Čorić, Mirjana Šimić and Bojan Jelaković
Page No. 166
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (166-170)
Factitious proteinuria – the most dominant feature in a young female patient with Munchausen syndrome
Ivana Vuković Lela1,2, Sandra Karanović1,2, Danica Matišić1,3, Duško Kuzmanić1,2, Marijana Čorić1,4, Mirjana Šimić5 and Bojan Jelaković1,3
1School of Medicine, University of Zagreb, 2Department for Nephrology, Arterial Hypertension and Dialysis, 3Clinical Department for Laboratory Diagnosis, 4Department for Pathology, University Hospital Center Zagreb, and 5Institute of Immunology, Zagreb, Croatia
Munchausen syndrome is afactitious disorder with predominantly physicalsigns and symptoms, resulting from thepatient’s high motivation for assuming asick role, without any external incentives orboundaries. We report the case of a young femalepatient with factitious proteinuria in thenephrotic range and a fairly eventful medicalhistory. After performing many expensive andunnecessary investigations and procedures,the real origin of the proteinuria was determined;it was found to be caused by the patientcarefully adding calibrated egg albuminto her urine samples. This discovery rousedsuspicions about multiple, non-corroboratedconditions from her history (e.g., multiplemiscarriages, breast cancer, and thyroid disorders).The diversity of diseases presented by asingle Munchausen patient tends to be bizarre,and thus is a challenge for health care providersto diagnose the condition. Teamwork istherefore of the utmost necessity to diagnoseMunchausen syndrome.Correspondence to:
Ivana Vukovic Lela, MD
School of Medicine, University of Zagreb
Salata 3, 10000 Zagreb, Croatia
Email: [email protected]
Nephrology Education
Type III membranoproliferative glomerulonephritis in a patient with primary Sjögren’s syndrome
In O Sun, Yu Ah Hong, Hoon Suk Park, Sun Ryoung Choi, Seok Hui Kang, Byung Ha Chung, Bum Soon Choi, Yeong Jin Choi, Chul Woo Yang, Yong Soo Kim and Cheol Whee Park
Page No. 171
Abstract
Clinical Nephrology, Vol. 79 – No. 2/2013 (171-174)
Type III membranoproliferative glomerulonephritis in a patient with primary Sjögren’s syndrome
In O Sun1, Yu Ah Hong1, Hoon Suk Park1, Sun Ryoung Choi1, Seok Hui Kang1, Byung Ha Chung1, Bum Soon Choi1, Yeong Jin Choi2, Chul Woo Yang1, Yong Soo Kim1 and Cheol Whee Park1
1Division of Nephrology, Department of Internal Medicine, and 2Department of Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Renal involvement in the form of glomerulonephritis in Sjögren’s syndrome (SS) is less common and usually a latent sequel in the course of the disease. We report a patient with Type III membarnoproliferative glomerulonephritis (MPGN) with hypothyroidism, which precedes the onset of the clinical manifestation of SS. She received immunosuppressions consisting of i.v. cyclophosphamide and high-dose corticosteroid and subsequently oral corticosteroid resulting in complete remission of nephrotic syndrome. To our knowledge, this is the first report of successfully treated Type III MPGN associated with SS.Correspondence to:
Cheol Whee Park, MD
Department of Internal Medicine
Seoul St. Mary’s Hospital
505 Banpo-Dong, Seocho-Ku, 137-040, Seoul, Korea
Email: [email protected]
