[52-year-old patient with painful ascites following fall from a bicycle]. / 52-jähriger Patient mit schmerzhaftem Aszites nach Fahrradsturz.

A 52-year-old patient presented with a ruptured abdominal aortic aneurysm after bicycle trauma. He was treated with a vascular prosthesis. His postoperative recovery was complicated by acute renal failure with anuria for which he was commenced on dialysis. His main persistent symptoms were severe abdominal pain, nausea and vomiting as well as massive ascites. Despite several attempts of a diagnostic and therapeutic ascitic tap, we were initially unable to make a diagnosis. Following each attempted paracentesis, symptoms initially improved. Ascites did reaccumulate, however, and we had to continue with his dialysis. Measurement of creatinine in the ascitic fluid was the key to the correct diagnosis. The ascitic fluid creatinine was nearly 3 times higher than the serum creatinine. The consequent MRI scan of the abdomen with excretion urogram demonstrated a leakage of the left ureter at the junction of the proximal and the middle third of the ureter with contrast leaking into the surrounding fluid.

High-dose intravenous immunoglobulin pulse therapy in patients with progressive immunoglobulin A nephropathy: a long-term follow-up.

In progressive immunoglobulin A nephropathy (IgAN), intravenous immunoglobulin (IVIg) treatment has been used to delay disease progression, but the long-term efficacy is largely unknown. We report the clinical outcomes after IVIg therapy in six male patients with progressive IgAN [median glomerular filtration rate (GFR) 31 ml/min per 1.73 m(2)] followed for a median observation period of 8 years. In this single-arm, non-randomized study, IVIg was given monthly at a dose of 2 g/kg body weight for 6 months. The course of renal function was assessed by linear regression analysis of GFR and proteinuria, and was compared to eight patients with IgAN (median GFR 29 ml/min per 1.73 m(2)) without IVIg as a contemporaneous control group. IgAN disease progression was delayed after IVIg therapy on average for 3 years. The mean loss of renal function decreased from -1.05 ml/min per month to -0.15 ml/min per month (P = 0.024) and proteinuria decreased from 2.4 g/l to 1.0 g/l (P = 0.015). The primary end-point (GFR < 10 ml/min or relapse) occurred 5.2 years (median; range 0.4-8.8) after the first IVIg pulse, and after 1.3 years (median; range 0.8-2.4) in the control group (P = 0.043). In Kaplan-Meier analysis, the median renal survival time with IVIg was prolonged by 3.5 years (IVIg 4.7 years versus control 1.2 years; P = 0.006). IVIg pulse therapy may be considered as a treatment option to reduce the loss of renal function and improve proteinuria in patients with progressive IgAN.

[Minimal Change Glomerulonephritis]. / Minimal Change Glomerulonephritis.

We report two cases of minimal change glomerulonephritis (synonyms: idiopathic nephrotic syndrom, minimal change disease). A 47-year old female patient was admitted to our unit with a relapsing nephrotic syndrome since childhood. Another patient, a 22-year old female, presented with moderately swollen legs that developed over several months and a complaint of frequent upper respiratory tract infections during the last year. In both cases we suspected a minimal change glomerulonephritis which can only be proven by renal biopsy. Therapeutic options comprise steroids, cyclosporin, tacrolimus or even cyclophosphamide, depending on the clinical presentation of the disease in the individual case.