Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
141,211
result(s) for
"NEPHROLOGY"
Sort by:
Idiopathic erythrocytosis as a potential early manifestation with IgA nephropathy: A case report and systematic review
IgA nephropathy (IgAN) is the most common primary glomerulonephritis, characterized by mesangial IgA immune complex deposition, potentially leading to chronic kidney disease. Idiopathic erythrocytosis, an unexplained elevation of red blood cell mass, has rarely been reported in association with IgAN. We present a systematic literature review and a new case highlighting the temporal relationship between IgAN and idiopathic erythrocytosis. A PubMed search identified four relevant studies detailing IgAN accompanied by unexplained erythrocytosis. The literature suggests an association predominantly observed in male patients, typically concurrent with or subsequent to an IgAN diagnosis. In our case, however, idiopathic erythrocytosis was detected 2 years prior to the onset of clinical signs of IgAN. The patient, initially treated with phlebotomy, presented 2 years later with significant proteinuria, leading to a renal biopsy confirming IgAN. This temporal progression raises the hypothesis that polymeric IgA1 immune complexes may influence erythropoiesis prior to evident renal involvement. Clinicians should consider underlying glomerular disease in patients with unexplained erythrocytosis, even in the absence of overt renal symptoms.
Journal Article
Anti-Glomerular Basement Membrane Disease without Linear IgG Deposits in an Elderly Patient with Metastatic Rectal Cancer: A Case Report
Introduction: Anti-glomerular basement membrane (anti-GBM) disease is classically diagnosed based on presence of rapidly progressive glomerulonephritis, circulating anti-GBM antibodies, and the hallmark finding of linear IgG deposition along the glomerular basement membrane on kidney biopsy. These deposits are considered a defining feature of the disease, aiding in its differentiation from other pauci-immune glomerulonephritis. However, rare cases lacking IgG deposits on kidney biopsies challenge this paradigm, complicating both diagnosis and management. Case Presentation: We report the case of an 80-year-old male with metastatic rectal cancer, who presented with acute kidney injury, hematuria, and proteinuria. Serological testing confirmed elevated anti-GBM antibody levels. Surprisingly, renal biopsy revealed crescentic glomerulonephritis without characteristic linear IgG deposition, which raised diagnostic uncertainty. Despite the absence of this classic finding, the patient’s clinical course was consistent with anti-GBM disease. Given his malignancy, treatment was tailored to balance immunosuppression with oncologic and infectious considerations. The patient received a modified immunosuppressive regimen, including plasma exchange and corticosteroids, but IV cyclophosphamide was withheld due to recurrent infections. Initially, from a nephrology standpoint, his clinical course was notable for partial renal recovery, resolution of hematuria, and improvement in both creatinine and proteinuria levels. However, he ultimately passed away due to severe infectious complications. Conclusion: This case underscores the diagnostic challenges and therapeutic decision-making in patients who present with features suggestive of anti-GBM disease, characterized by positive anti-GBM antibodies but absent immune deposits, especially when accompanied by malignancy, prior exposure to immunosuppressive therapy, and concurrent infections.
Journal Article
Multiple Myeloma With Renal Pathological Findings of Both Light Chain-Only Variant of Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits (PGNMID-LC) and Light Chain Deposition Disease (LCDD)
Light chain-only variant of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID-LC) and light chain deposition disease (LCDD) are both renal disorders caused by the overproduction of monoclonal immunoglobulin light chains and their deposition in renal tissues. However, the renal pathological features of these two entities are characteristically distinct. We report a rare case of multiple myeloma presenting with renal pathology exhibiting overlapping features of both PGNMID-LC and LCDD. A 54-year-old woman presented with nephrotic syndrome. Renal biopsy revealed glomerular lesions resembling type III membranoproliferative glomerulonephritis on light microscopy. Immunofluorescence microscopy demonstrated κ light chain deposition along the glomerular capillary walls as well as in the mesangial areas, Bowman's capsule, and tubular basement membranes. C3 was also deposited in the glomeruli, while IgG and λ light chain staining were negative. Electron microscopy revealed dense deposits in the mesangial, subepithelial, and subendothelial areas, along with powdery deposits within the glomerular basement membrane, tubular basement membranes, and Bowman's capsule. Monoclonal κ light chains were detected in both serum and urine, and bone marrow examination showed 30.6% monoclonal plasma cells. The patient was diagnosed with multiple myeloma-associated kidney disease due to monoclonal light chain deposition and was treated with bortezomib and dexamethasone, resulting in improved renal function and a marked reduction in proteinuria. This case highlights a rare pathological overlap between PGNMID-LC and LCDD, underscoring the importance of comprehensive renal pathological evaluation in patients with monoclonal gammopathies.
Journal Article
Impact of Urate-Lowering Agents on Renal Outcomes in Chronic Kidney Disease: A Systematic Review
Chronic kidney disease (CKD) poses a significant global health burden, with hyperuricemia emerging as a potential modifiable risk factor for disease progression. Urate-lowering agents (ULAs) have been hypothesized to preserve renal function by reducing serum uric acid (SUA) levels and mitigating associated pathogenic mechanisms. However, clinical evidence regarding their efficacy remains inconsistent. This systematic review aimed to evaluate the effects of ULAs on renal outcomes in CKD patients by synthesizing evidence from recent placebo-controlled randomized trials. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and ClinicalTrials.gov was conducted to identify randomized controlled trials (RCTs) published between 2020 and 2025. Ten studies met the inclusion criteria, assessing allopurinol, febuxostat, verinurad, and topiroxostat. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (ROB 2) tool (London, United Kingdom). Data were synthesized narratively due to clinical and methodological heterogeneity. Febuxostat demonstrated potential renal benefits, with significant estimated glomerular filtration rate (eGFR) preservation in three studies. Allopurinol showed neutral effects on eGFR decline in large trials. Albuminuria reduction was observed with verinurad plus febuxostat but not with other ULAs. Safety profiles were favorable across studies, with no significant differences in adverse events versus placebo. While febuxostat may slow CKD progression in select populations, evidence for allopurinol and combination therapies remains inconclusive. Heterogeneity in outcomes underscores the need for personalized treatment and further research to identify optimal candidates for ULA therapy.
Journal Article
Peritoneal Dialysis-Related Peritonitis Caused by Staphylococcus caprae: A Case Report
Herein, we report a case of peritoneal dialysis (PD)-related peritonitis caused by
(
). An 88-year-old man who had been receiving PD presented with cloudy effluent and an elevated dialysate white blood cell (WBC) count of 800/μL. He was diagnosed with PD-related peritonitis and treated with intraperitoneal cefazolin and ceftazidime, which promptly cleared the effluent by day 3 and reduced the WBC count in the dialysate to 0/μL by day 5. Culturing of the effluent identified
(methicillin-resistant coagulase-negative
), so the antibiotic regimen was switched to intraperitoneal vancomycin. The infection resolved without recurrence, and the patient was discharged on day 17 of his hospitalization without requiring catheter removal. Although
has been implicated in infections of various organs, reports of PD-related peritonitis caused by this bacterium are rare in the literature. This case suggests that
-related PD peritonitis responds well to antibiotic therapy with intraperitoneal vancomycin and that patients with this infection have a generally favorable prognosis.
Journal Article
Risk Factors Affecting Mortality in Asian Hemodialysis Patients: A 15-Year Study From Pakistan
Background End-stage renal disease (ESRD) impacts millions worldwide, with higher mortality rates despite progress in renal replacement therapy. Although numerous risk variables have been recognized, comprehensive long-term data from South Asia remain scarce. Various studies have been done to identify risk factors causing mortality in ESRD patients on hemodialysis (HB), including diabetes, cardiovascular disease, infections, age and dialysis prescription, and its compliance, and efforts to improve the outcome in this vulnerable population. However, the majority of these studies are shorter. We conducted this study for 15 years to see the effect of various risk factors on mortality and to identify modifiable risk factors to improve survival in this patient population. Materials and methods Retrospective cohort research was undertaken at the dialysis unit of a tertiary care hospital, analyzing risk variables and mortality in patients with ESRD undergoing maintenance HD from January 2006 to December 2021. Data were gathered utilizing a pre-structured questionnaire encompassing demographics, comorbidities, dialysis frequency, vascular access type, and survival outcomes. Statistical analysis utilized SPSS (IBM SPSS Statistics for Windows, IBM Corp., Version 25, Armonk, NY), employing chi-square tests for categorical variables and Cox regression for survival analysis, with p < 0.05 deemed significant. Results Nine hundred sixty-nine patients were enrolled, 326 were lost to follow, and 84 (13%) expired. The study comprised 54.8% (46) male and 45.2% (38) female, with an average survival period of 28.4 months. The results indicated that thrice-weekly HD had significantly improved survival compared to twice-weekly HD (p < 0.05). The utilization of CVC is associated with an elevated mortality risk (HR = 2.18, p < 0.05) in comparison to AV fistula. Male sex and diabetes were independent predictors of mortality (p < 0.05). The predominant causes of mortality were undetermined (34.5%), infections/sepsis (28.6%), and heart conditions (26.2%). Conclusion This 15-year study identifies modifiable risk factors influencing mortality in Pakistani patients with ESRD. Enhancing HD frequency and circumventing CVC utilization may markedly increase survival rates. The results highlight the necessity for timely AV fistula development and adequate dialysis frequency in resource-constrained environments.
Journal Article
A Case of Peritoneal Dialysis-Related Peritonitis Caused by Kocuria rhizophila
A 63-year-old woman undergoing peritoneal dialysis (PD) presented to our hospital with abdominal pain, diarrhea, and cloudy PD effluent. An elevated white blood cell count in the PD effluent led to a diagnosis of PD-associated peritonitis. She was subsequently started on intraperitoneal cefazolin and ceftazidime, after which her condition improved rapidly. The peritonitis resolved after 21 days of therapy, with no subsequent relapse. Centrifuged PD effluent samples identified
as the causative organism. Reports of PD-associated peritonitis caused by
are rare, with reported adult cases requiring PD catheter removal due to relapse. In contrast, this case was successfully resolved without catheter removal. The increasing use of advanced technologies, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, is expected to lead to more reports of
-associated PD peritonitis in the future. Although biofilm formation by
is known to increase the risk of recurrent peritonitis, this case suggests that catheter removal may not always be necessary.
Journal Article
A Case of Peritoneal Dialysis-Related Peritonitis Due to Moraxella osloensis
A 46-year-old woman on peritoneal dialysis (PD) had cloudy peritoneal dialysis effluent that had persisted for 10 days by the time she visited our hospital. The white blood cell count in the effluent was elevated to 1500/μL, leading to a diagnosis of peritoneal dialysis-associated peritonitis. The effluent cleared within two days with treatment using cefazolin and ceftazidime, and the white blood cell count dropped to 0/μL by day 6. Culture of the effluent revealed the presence of
. The patient's treatment was switched to ceftazidime monotherapy, and antibiotic therapy for 21 days resulted in the resolution of the peritonitis. Reports of peritonitis caused by
are rare; however, with the spread of diagnostic methods, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry, an increase in reported cases is expected. Unlike previous cases, in this case, the interval from onset to treatment initiation was longer. However, similar to reported cases, in this case, the infection was cured with antibiotic treatment without the need for PD catheter removal.
Journal Article
The Underutilization of Urea in the Treatment of SIADH – An Efficacious but Overlooked Solution
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a frequent cause of hyponatremia that presents substantial management challenges in clinical settings. Despite a range of treatment options, including fluid restriction, demeclocycline, and vasopressin antagonists, urea remains underutilized, particularly in North America, despite its well-documented efficacy, safety, and cost-effectiveness. Urea corrects hyponatremia by promoting osmotic diuresis without causing significant fluid shifts, making it an ideal treatment for both acute and chronic SIADH. Comparative studies have demonstrated urea's effectiveness, particularly in contrast to vasopressin antagonists, which are costly and pose risks such as hepatotoxicity and rapid sodium overcorrection. However, barriers to urea's utilization include limited clinician familiarity, lack of advocacy in guidelines, and patient adherence issues due to its unpalatable taste, although flavored formulations now address this issue. Increased awareness, training, and guideline inclusion could promote urea as a viable, primary treatment for SIADH. This editorial advocates for the expanded adoption of urea in clinical practice to enhance patient outcomes, especially in resource-limited settings where high-cost treatments may not be feasible.
Journal Article