ABSTRACT
A 61-year old African-American woman presented with abdominal pain, tender splenomegaly, anemia, and renal insufficiency. Bone marrow biopsy demonstrated systemic mastocytosis. She was treated with mediator-specific therapy and imatinib, but her renal and hepatic function deteriorated and she required maintenance hemodialysis. Renal biopsy demonstrated interstitial infiltration with mast cells and acute tubular necrosis. Acute kidney injury in the setting of systemic mastocytosis and imatinib therapy is discussed.
Subject(s)
Acute Kidney Injury/etiology , Kidney/pathology , Mastocytosis, Systemic/complications , Oliguria/etiology , Acute Kidney Injury/diagnosis , Acute Kidney Injury/drug therapy , Antineoplastic Agents/therapeutic use , Benzamides , Biopsy , Bone Marrow/pathology , Diagnosis, Differential , Fatal Outcome , Female , Follow-Up Studies , Humans , Imatinib Mesylate , Mastocytosis, Systemic/diagnosis , Mastocytosis, Systemic/drug therapy , Middle Aged , Oliguria/diagnosis , Oliguria/drug therapy , Piperazines/therapeutic use , Protein-Tyrosine Kinases/antagonists & inhibitors , Pyrimidines/therapeutic useABSTRACT
A patient with end-stage renal disease on maintenance hemodialysis developed sudden severe abdominal pain and distension. He suffered a decline in his hematocrit and subsequent abdominal imaging revealed a large left-sided retroperitoneal hemorrhage in the setting of atrophic, severely cystic kidneys. He underwent selective left renal artery angiography and embolization due to continued hemorrhage with stabilization in his condition. However, he became paraparetic within hours of the embolization procedure due to spinal cord infarct. Acquired cystic kidney disease is a very common entity in patients with chronic kidney disease. Complications include cystic hemorrhage or infection, erythrocytosis, and renal cell carcinoma. Screening of patients for cystic disease and malignant transformation remains a controversial topic; however, most advocate abdominal imaging after 3 to 5 years on dialysis.
Subject(s)
Hemorrhage/etiology , Kidney Diseases, Cystic/complications , Retroperitoneal Space/pathology , Diagnostic Imaging , Embolization, Therapeutic , Hemorrhage/complications , Hemorrhage/therapy , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , Paraparesis/etiology , Renal DialysisABSTRACT
Vaults are abundant large ribonucleoprotein particles. They frequently colocalize with microtubules and accumulate in filamentous actin-rich lamellipodia. To examine the movement of vaults in living cells, a chimera between the green fluorescent protein and the major vault protein was created. This fusion protein assembled into vault particles as assayed by biochemical fractionation and direct observation of living or fixed cells. By fluorescence recovery after photobleaching, we analyzed the bulk transport of vault particles into neuritic tips of PC12 cells treated with nerve growth factor. Confocal laser scanning microscopy demonstrated co-localization of the major vault protein and microtubules. Video microscopy indicated that, whereas the majority of vault particles were stationary, some individual vault particles moved rapidly, consistent with the action of a microtubule-based or actin-based molecular motor.