ABSTRACT
A case of post-partum SLE in a 25-year-old Mexican-American woman is presented. The disease was associated with systemic vasculitis and diffuse proliferative glomerulonephritis. Abundant evidence for the deposition of complement activating immune complexes was found in skin and kidney biopsies, but no circulating immune complexes could be measured. Therapeutic modalities including corticosteroids administered both orally and intravenously, azathioprine, antihypertensives, and hemodialysis failed to effectuate lasting benefit. Large volume plasmapheresis led to immediate improvement and a dramatic return of renal function. A mechanism of action for the resulting effect is considered.
Subject(s)
Antigen-Antibody Complex/analysis , Glomerulonephritis/therapy , Lupus Erythematosus, Systemic/immunology , Plasmapheresis , Adult , Female , Glomerulonephritis/etiology , Glomerulonephritis/immunology , Humans , Lupus Erythematosus, Systemic/complicationsABSTRACT
A rarely diagnosed nodular glomerulopathy is presented arising secondary to kappa light chain deposition and clinically characterized by hypertension, congestive heart failure, massive proteinuria and slowly progressive azotemia. Kappa light chains were detected in the urine, the glomerular nodules, and the basement membranes of both glomeruli and tubules. A malignant proliferation of plasma cells could not be detected. Two morphologic features were unusual: the presence of microaneurysms, and the deposition of immunoglobulin and complement in a similar pattern to the kappa light chains. Noteworthy clinical aspects included the elusiveness of the proper diagnosis, the massive proteinuria in the absence of amyloid deposits, and the remarkable improvement in renal function following intermittent chemotherapy.
Subject(s)
Immune Complex Diseases/drug therapy , Immunoglobulin Light Chains , Immunoglobulin kappa-Chains , Kidney Failure, Chronic/drug therapy , Aged , Female , Humans , Immune Complex Diseases/pathology , Kidney Failure, Chronic/pathology , Kidney Glomerulus/pathology , Melphalan/therapeutic use , Prednisone/therapeutic use , Renal Dialysis , Vincristine/therapeutic useABSTRACT
When prescribing mannitol to decrease intraocular pressure, the physician must be alert to potential complications. A 72-year-old woman suffered obtundation, intractable pulmonary edema, acidemia, and irreversible renal insufficiency despite vigorous hemodialysis. When renal function is compromised, careful monitoring of electrolyte levels, daily urine output, and renal function is necessary with mannitol therapy.
Subject(s)
Anuria/chemically induced , Glaucoma/drug therapy , Mannitol/adverse effects , Pulmonary Edema/chemically induced , Aged , Aphakia, Postcataract/complications , Female , Glaucoma/complications , Humans , Intraocular Pressure/drug effects , Mannitol/pharmacology , Mannitol/therapeutic useABSTRACT
Eleven patients with chronic renal failure and presumed secondary hyperparathyroidism developed a syndrome of medial calcinosis of the arteries and painful ischemic ulcers of the fingers, legs, or thighs, or any combination of the three. Five patients required maintenance hemodialysis; six had functioning renal homografts. Severe hyperphosphatemia had existed in each; seven showed roentgenographic evidence of subperiosteal resorption. Similarities are evident between the lesions and experimentally produced calciphylaxix. The lesions demonstrated a relentless, progressive course, with serious morbidity and mortality. Hyperplastic or adenomatours parathyroid tissue was removed from ten of 11 patients unergoing surgical procedures; healing followed in seven patients. Treatment with phosphate-binding antacids to lower serum phosphorus levels may prevent this syndrome. Total or subtotal parathyroidectomy should be considered when ischemic skin lesions appear in uremic patients or in renal transplant recipients.