IgA Nephropathy may be a Disease Related to Crohn's Disease.

IgA nephropathy (IgAN) is the commonest form of glomerulonephritis worldwide and 15–30% of patients will ultimately develop end-stage renal failure. IgAN can be primary (in most cases) or secondary (associated with seronegative arthritis, cirrhosis, coeliac disease, vasculitis, HIV), but is rarely associated with Crohn’s disease (CD). We describe a case of 22 year-old man with CD associated with IgAN. After the patient underwent surgical resection of right colon due to suspected colon tumor, CD was diagnosed. 5 years after right hemicolectomy, microscopic hematuria was developed and a renal biopsy had revealed IgAN (type III). Patients with CD who present with hematuria more commonly have urological complications, but the possibility of renal parenchymal disease should also be considered.

Outcomes of Acute Kidney Injury Patients with and Without Cancer: A Single Center Study.

Background: Acute kidney injury (AKI) is a frequent complication in hospitalized patients. Incidence of AKI in hospitalized patients with cancer is increasing, but there have been few studies on AKI in patients with cancer. The purposes of this study were: 1. To evaluate and compare the characteristics and outcomes of cancer and non-cancer AKI patients; 2. To determine the impact of cancer diagnosis on hospital mortality of AKI patients; and 3. To compare outcome predictors between the two groups of AKI patients. Methods: We conducted a retrospective cohort study in a South Korean tertiary care hospital. A total of 2211 consecutive patients (without cancer 61.5%; with cancer 38.5%) were included over a 140-month period. Predictors of all-cause death were examined using the Kaplan-Meier method and the Cox proportional hazards model. Results: The main contributing factors of AKI were sepsis (31.1%) and ischemia (52.7%). AKI was multifactorial in 78% of patients with cancer and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (42.8%) than in patients without cancer (22.5%) (P = 0.014). In multivariate analyses, diabetes mellitus (DM) and cancer diagnosis were associated with hospital mortality. Cancer diagnosis was independently associated with mortality [odds ratio = 3.010 (95% confidence interval, 2.340-3.873), P = 0.001]. Kaplan-Meier analysis revealed that subjects with DM and cancer (n = 146) had lower survival rates than subjects with DM and without cancer (n = 687) (log rank test, P = 0.001). Conclusion: The presence of DM and cancer were independently associated with mortality in AKI patients both with and without cancer. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.

Impact of Cancer on Survival of Patients with AKI on CRRT.

Background: Few studies have examined cancer patients with acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT). The aim of this study was to compare the characteristics and outcomes of patients with and without cancer requiring CRRT for AKI in general intensive care units (ICUs). Methods: We studied a retrospective cohort study in an ICU. A total of 200 patients (without cancer 79%; with cancer 21%) were included over a 24 month period. Predictors of all-cause death were examined using Kaplan-Meier and Cox proportional hazards analyses in both treatment groups for statistical analysis. Results: The 1st contributing factors of AKI was cardiac dysfunction (40%) and 2nd factors was sepsis (38%). The cause of AKI was multifactorial in 78% of cancer patients and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (69%) than in patients without cancer (49.4 %) (P = 0.023). In multivariate analyses, older age, medical admission, poor chronic health status, comorbidities, ICU days until RRT start, number of associated organ dysfunctions, and diagnosis of cancer were associated with hospital mortality. The diagnosis of cancer was independently associated with mortality [odds ratio = 1.68 (95% confidence interval, 1.10–2.59), P = 0.017]. Conclusions: The presence of cancer may be independently associated with mortality in our study.

Uremic Encephalopathy with Basal Ganglia Lesions in a Diabetic Predialysis Patient.

Syndromes associated with acute bilateral lesions of the basal ganglia in diabetic uremic patients are uncommon, and usually have reversible clinical and imaging findings. Such syndromes are seen almost exclusively in patients with diabetes mellitus and renal failure. Previously reported cases have described diabetic men with uremia on dialysis. Here, we report a case of uremic encephalopathy with lesions of the basal ganglia in a diabetic predialysis patient. A 44-year-old man with uremic encephalopathy presented with dysarthria, chorea, and right upper extremity paresthesia. Magnetic resonance imaging of the brain showed classic findings of hyper intensity in the bilateral basal ganglia. The patient had no family history of psychiatric or neurological disease. Laboratory findings revealed elevated levels of blood urea nitrogen, creatinine, and glucose. Haloperidol and ropinirole therapy was continued, resulting in significant improvement without dialysis. The patient recovered from his episode without apparent sequelae.

A Case of the Syndrome of Acute Bilateral Basal Ganglia Lesions due to Hypoglycemia in Hemodialysis Patient.

Patients with chronic kidney disease may have neurological complications including uremic encephalopathy, stroke, neuropathy and myopathy. Rarely, acute movement disorder associated with bilateral basal ganglia lesion is seen in patients with end stage kidney disease. The hallmarks of this condition include reversible and uniform lesions of the basal ganglia on MRI which stand for decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images, and the clinical presentation includes acute parkinsonism and/or involuntary movements. This syndrome has been reported mainly in Asian patients, typically in the setting of long-standing diabetes. We report a case of bilateral basal ganglia lesions in a patient with chronic renal failure, poorly controlled diabetes, and incidents of severe hypoglycemia. In our case, there was no evidence of acute metabolic disorders. Most reported patients with acute basal ganglia lesions in uremia also had diabetes and/or abnormal blood glucose levels. Our case had previously experienced occasional hypoglycemia before the onset of involuntary choreic movements. MRI of our patient showed acute bilateral basal ganglia lesion, corresponding to cytotoxic edema. This pattern was also observed in patients with hypoglycemic encephalopathy.