A Case of Renal Metastasis from a 1-cm Squamous Cell Carcinoma of the Lung Masquerading as Renal Cell Carcinoma / 대한내과학회지

Symptomatic renal metastasis from a primary lung malignancy elsewhere in the body is an uncommon feature in disseminated cancer. We report a case of a 1-cm primary squamous cell carcinoma (SCC) of the lung with renal metastasis initially misdiagnosed as primary renal cell carcinoma in a 65-year-old man who presented with left lower quadrant pain.

A case of delayed perirenal hematoma after percutaneous renal biopsy / 대한내과학회지

Percutaneous renal biopsy is essential in the diagnosis of renal parenchymal disease, providing diagnostic and prognostic information to nephrologists. Percutaneous renal biopsy is considered to be a relatively safe procedure, and catastrophic complications are rare. The post-biopsy care of patients typically consists of bed rest and observation for 24 hours. Additionally, recent reports have suggested that most complications after percutaneous renal biopsy are apparent within 24 hours; however, perinephric hematomas have been demonstrated at 24 to 72 hours after percutaneous renal biopsy in over 90% of cases. We report an unusual case of delayed perirenal hematoma that occurred 5 days after percutaneous renal biopsy.

Clinical Characteristics of Renal Insufficiency Patients with Clostridium difficile-Associated Pseudomembranous Colitis / 대한신장학회지

PURPOSE:Clostridium difficile-associated diarrhea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patient with chronic renal failure. The aim of this study was to investigate clinical characteristics of renal insufficiency patients with clostridium difficile-associated pseudomembranous colitis. METHODS:We reviewed charts of fifty-six patients with clostridium difficile-associated pseudomembranous colitis, who have clostridial toxin A assay in stool and a diagnosis made on histology of colonic biopsies. RESULTS:There was no difference in age, serum albumin, C-reactive protein (CRP) and negative incidence of clostridial toxin A between patients who had renal insufficiency with serum creatinine more than 1.5 mg/dL and those who did not. But duration of antibiotic use administered prior to development of the clostridium difficile infection was more shorter in patients with impaired renal function than in patients with normal renal function. CONCLUSION:These data suggest that it may take a short period to development of the clostridium difficile infection in patients with impaired renal function, and histologic evaluation by sigmoidoscopy should be performed to make a diagnosis in CDAD-suggested patients, who have impaired renal function and even negative clostridial toxin A.

A Case of Chylothorax Associated with Idiopathic Stenosis of Left Subclavian Vein in a Patient Undergoing Maintenance Hemodialysis / 대한신장학회지

Chylothorax is defined as the accumulation of chyle-containing lymphatic fluid within the pleural space. The causes of chylothorax are various and usually attributable to 1 of 4 categories: malignancy, trauma (including surgery), miscellaneous disorders, and idiopathy. Occurrence of chylothorax in patients on hemodialysis is very uncommon and it may have resulted from multiple iatrogenic vascular trauma conducive to venous thrombosis and stenosis when hemodialysis catheters required frequent changes or long term indwelling. Local thrombosis and stenosis may increase the venous hydrostatic pressure and hinder the discharge of thoracic duct lymph into the venous system. Hence, chylous lymphatic fluid leak into the pleural space. Treatment of chylothorax may range from nonoperative management to elective surgery. We report a case of a patient on hemodialysis who developed chylothorax secondary to a subclavian vein stenosis without any other symptoms such as arm edema and successfully treated with nonoperative management.

Cerebral sinovenous thrombosis associated with nephrotic syndrome / 대한내과학회지

Nephrotic syndrome is associated with proteinuria, hypoalbuminemia, edema, hyperlipidemia, and thromboembolic complications. Thromboembolic complications of nephrotic syndrome are common, especially in the renal vein, while cerebral venous thrombosis is a less frequent complication of minimal change nephrotic syndrome. The pathophysiology remains unclear, but various changes in coagulant and anticoagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with nephrotic syndrome. A 19-year-old man was admitted with a headache and nausea. Cerebral thrombosis was diagnosed on brain computed tomography and magnetic resonance imaging. He recovered gradually after treatment with anticoagulants and achieved control of the nephrotic syndrome. A discussion of this case, coupled with a review of the literature, emphasizes that an early diagnosis is essential for anticoagulation therapy and a successful outcome.

A Case of Newly Detected Ectopic Mediastinal Parathyroid Gland in Chronic Renal Failure Patient after Parathyroidectomy / 대한신장학회지

Hyperparathyroidism is one of the most serious complications for hemodialysis patients. Parathyroidectomy is indicated in patients with severe hyperparathyroidsm refractory to medical treatment. An 39- year-old man who were maintained by hemodialysis underwent parathyroidectomy due to tertiary hyperparathyroidism. The level of intact PTH fell after parathyroidectomy but subsequently rose. We checked up the parathyroid gland by MIBI scan and CT. As a result, a mass was found in the anterior mediastinum. So it is important to suspect the ectopic parathyroid gland when the PTH level elevation is persistent after parathyroidectomy in chronic renal failure patient.

A Case of Sub-acute Bacterial Endocarditis associated with a Positive ANCA Serology / 대한신장학회지

Antineutrophil cytoplasmic antibodies (ANCA) directed against either proteinase-3 or myeloperoxidase are associated with a limited group of small vessel vasculitic syndromes. C-ANCA is regarded as highly specific for idiopathic ANCA-associated vasculitis (AAV). However, C-ANCA is not specific for Wegeners granulomatosis and has been reported in the course of a variety of infectious conditions. Sub-acute bacterial endocarditis is a notable concern because it may be associated with C-ANCA. The misdiagnosis of bacterial endocarditis as AAV and the administration of immunosuppressive treatment could aggravate the infection. We describe a patient with sub-acute bacterial endocarditis who presented with features mimicking vasculitis and positive C-ANCA by indirect immunofluorescence and for anti-PR3 antibodies by antigen-specific ELISA.

A Case of Acute Interstitial Nephritis Complicated with Continuous Rifampin Therapy / 대한신장학회지

Acute renal failure caused by rifampin typically occurs on intermittent administration or reintroduction of the drug. However, acute kidney injury (AKI) due to rifampin has been rarely reported to occur in patients receiving a continuous rifampin therapy. We have experienced a case of acute interstitial nephritis during the first course of standard anti-tuberculous therapy, including continuous rifampin therapy in daily dose. Forty-five-year-old male, who had been being treated with anti-tuberculous medication including rifampin (600 mg/day), was admitted to our hospital because of generalized edema and dyspnea by acute renal failure. His past medical history was unremarkable. Since the creatinine level was still elevated in 10 days after cessation of rifampin, we performed renal biopsy. The renal pathologic findings revealed acute interstitial nephritis. After that, the patient symptom was relieved and serum creatinine level was decreased without specific therapy. The renal function was recovered at 1 month after withdrawal of rifampin. We report a case of acute interstitial nephritis complicated with the first daily rifampin therapy, along with the review of literature.