ABSTRACT
A 60-year-old man, who had been diagnosed as having paroxysmal nocturnal hemoglobinuria(PNH) in 1994, was admitted to our hospital with general fatigue, and dark urine after a common-cold in January 2001. In the peripheral blood, the red blood cell count was 136 x 10(4)/microl, hemoglobin 4.0 g/dl and hematocrit 12.4%. The serum creatinine level was 9.9 mg/dl. Kidney biopsy revealed focal and segmental proliferation of mesangial cells, mesangial matrix expansion, acute tubular necrosis, interstitial fibrosis and hemosiderine deposits in the tubular epithelial cells confirmed by Berlin-blue staining. Immunofluorescence microscopy showed IgA and C3 deposition in the mesangium. Electron microscopy revealed electron dense deposits in the mesangial area and heavy electron-dense hemosiderin pigments in proximal tubular epithelial cells. After the transfusion of six units of washed red blood cells and two sessions of hemodialysis, the renal function returned to the levels before admission.
Subject(s)
Acute Kidney Injury/etiology , Glomerulonephritis, IGA/complications , Hemoglobinuria, Paroxysmal/complications , Hemolysis , Acute Kidney Injury/diagnosis , Acute Kidney Injury/pathology , Acute Kidney Injury/therapy , Histocytochemistry , Humans , Kidney/pathology , Male , Middle Aged , Renal Dialysis , Treatment OutcomeABSTRACT
BACKGROUND: To investigate cellular mechanisms responsible for the development of crescentic glomerular lesions, we have studied the effects of complete adjuvant (CA) on subnephritogenic nephrotoxic serum (NTS) nephritis (NTS-N) in Brown Norway rats. METHODS: A subnephritogenic dose of NTS, 0.02 ml per rat, was intravenously injected into rats that were previously (14 days earlier) treated intradermally with CA, incomplete adjuvant, or PBS. RESULTS: Proteinuria developed by day 2 only in CA-treated rats. Also, severe glomerular lesions associated with cellular crescent formation developed by day 2 only in the CA-treated rats. The glomerular extent of infiltration of IL-1beta-positive cells, MCP-1 expression level, and the number of ED1 and PCNA double-positive activated macrophages peaked on day 4 and decreased thereafter. The numbers of T lymphocytes and polymorphonuclear neutrophils did not significantly increase throughout the experiments. CONCLUSIONS: These results indicate that CA can potently induce crescentic NTS-N characterized by the infiltration of activated macrophages, which presumably bind to rabbit IgG on the glomerular basement membrane and may play a critical role in the development of severe NTS-N associated with crescent formation.
