Immunoglobulin a nephropathy and malaria falciparum infection; a rare association

Glomerular involvement occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Here, we report a rare case of falciparum malaria-associated IgA nephropathy. A 28-year-old man was admitted because of fever and abdominal pain. Ultrasound and computed tomography [CT] showed right kidney pyonenphrosis. Despite placing a nephrostomy tube, fever continued. Repeated CT was in favor of focal pyelonephritis. In addition, peripheral blood smear suggested malaria. Anti-malarial drugs were initiated and right nephrectomy was performed. One year after recovery from malaria, a persistent rise in serum creatinine was detected. A left kidney biopsy showed mesangial proliferation and dominant IgA deposits in immunofluorescence study while C[1q] was not deposited. The impression was IgA nephropathy with M[1]E[0]S[0]T[0] of Oxford classification. The patient was prescribed a combination of low dose prednisolone and angiotensin converting enzyme inhibitor. Six months after treatment serum creatinine decreased from 1.6 mg/dL to 1.3mg/dL and urine abnormalities were disappeared. Our findings suggest that malaria infection might be associated with IgA nephropathy

Efficacy of terazosin as a facilitator agent for expulsion of the lower ureteral stones

To determine the efficacy of terazosin as a facilitator agent for the passage of lower ureteral stones. Since February 2004 to December 2004, 64 patients with lower ureteral stones who came to the emergency department were enrolled in this study. Exclusion criteria were the presence of urinary tract infection, severe hydronephrosis, elevated serum creatinine, hypertension, history of peptic ulcer disease and history of spontaneous stone passage. Patients were randomized into 2 groups of 32. Group 1 patients received terazosin tablets, 10 mg daily and analgesic [indomethacin capsules] for a maximum of 4 weeks, but patients in Group 2 received only analgesic. In cases of incomplete pain control, intravenous pethidine was administered. The 2 groups were compared with regard to stone passage rate, time to stone passage, the amount of received pethidine and the need for intervention. Statistical analysis was performed by student t-test. The mean age of Group 1 was 44 years and Group 2 was 39 years. The median stone size was 6.9 +/- 2.3 mm in Group 1 and 6.6 +/- 3.1 mm in Group 2, which was not significantly different. Stone expulsion rate was 90.62% in Group 1 and 62.5% in Group 2, with a significant statistical difference [p=0.041]. The mean expulsion time was 76.3 +/- 60 hours and 141 +/- 64 hours in Groups 1 and 2, [p=0.001]. Extra analgesic [pethidine] requirement averaged 34.4 +/- 12.7 mg and 62.1 +/- 10.5 mg in Groups 1 and 2 [p=0.036]. Seven patients in Group 1 and 15 patients in Group 2 required ureteroscopy after 4 weeks due to lack of the stone passage. Terazosin is a safe and effective treatment for lower ureteral stones. By using this medication, stone passage rate increases and the time of stone passage and the need for intervention decreases