ABSTRACT
Primary membranous nephropathy (PMN) is a major cause of nephrotic syndrome in adults. Studies have shown that one-third of PMN cases undergo spontaneous remission, among which are some cases of infection-related complete remission. Herein, we report the case of a 57-year-old man who achieved complete remission of PMN shortly after the onset of acute hepatitis E infection. At the age of 55 years, the patient developed a nephrotic syndrome, and renal biopsy revealed membranous nephropathy, Ehrenreich-Churg stage 1. Treatment with prednisolone (PSL) reduced urinary protein from 7.8 g/gCre to approximately 1 g/gCre but did not lead to complete remission. However, 7 months after starting treatment, he developed an acute hepatitis E infection after consuming wild boar meat. Immediately after the onset of acute hepatitis E, the patient's urinary protein levels decreased to < 0.3 g/gCre. The PSL dose was subsequently reduced and discontinued after 2 years and 8 months, and complete remission was maintained thereafter. We considered that an increase in the number of regulatory T cells (Tregs) caused by acute hepatitis E infection was associated with PMN remission in this patient.
Subject(s)
Glomerulonephritis, Membranous , Hepatitis E , Nephrotic Syndrome , Humans , Male , Middle Aged , Acute Disease , Glomerulonephritis, Membranous/diagnosis , Glomerulonephritis, Membranous/drug therapy , Glomerulonephritis, Membranous/complications , Hepatitis E/complications , Hepatitis E/diagnosis , Hepatitis E/drug therapy , Nephrotic Syndrome/diagnosis , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/etiology , Prednisolone/therapeutic use , Remission InductionABSTRACT
BACKGROUND: Anterior chest wall arteriovenous graft (ACWAVG) is one option for haemodialysis patients when vessels of the upper extremities become exhausted. We report here the long-term outcomes of ACWAVG with polyurethane. METHODS: From April 2005 to October 2015, nine ACWAVGs with polyurethane grafts were created. We observed patients until April 2019 and evaluated graft patency, interval from operation to first cannulation, and numbers of interventions and complications. RESULTS: Primary patency rate and secondary patency rate of 6, 12 and 24 months were 55.3%, 33.3%, 33.3% and 77.8%, 55.6%, 55.6% respectively. Mean interval from operation to first cannulation was 3 days. Infection rate and kinking formation rate were slightly higher than previous reports of ACWAVGs with expanded polytetrafluoroethylene (ePTFE). However, one patient was able to keep using a single graft for 166 months with multiple interventions. CONCLUSIONS: Slight disadvantage are seen with patency rate and complication rate in polyurethane ACWAVG compare to ePTFE. However, when early cannulation is required, polyurethane is worth to consider for creating ACWAVG.
Subject(s)
Arteriovenous Shunt, Surgical , Blood Vessel Prosthesis Implantation , Thoracic Wall , Humans , Arteriovenous Shunt, Surgical/adverse effects , Polyurethanes , Vascular Patency , Blood Vessel Prosthesis/adverse effects , Polytetrafluoroethylene , Renal Dialysis/adverse effects , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Blood Vessel Prosthesis Implantation/adverse effectsSubject(s)
Cystitis/etiology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Renal Dialysis/adverse effects , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cystitis/diagnostic imaging , Cystitis/therapy , Female , Follow-Up Studies , Humans , Kidney Failure, Chronic/diagnosis , Male , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/methods , Renal Dialysis/methods , Risk Assessment , Sampling Studies , Tomography, X-Ray Computed/methods , Treatment Outcome , Urinary Catheterization/methods , Urinary Retention/diagnostic imaging , Urinary Retention/etiologyABSTRACT
Abdominal aortic occlusions are rare, but occasionally life threatening. A 48-year-old man was hospitalized due to acute heart failure accompanied by acute kidney injury (AKI). Abdominal ultrasound revealed deteriorating blood flow in the bilateral renal arteries. Subsequent abdominal aortography showed abdominal aortic occlusion just below the right renal artery and an occluded left renal artery. Dilated superior and inferior mesenteric arteries functioning as collateral feeding arteries suggested chronic occlusion. A hypercoagulation workup led to a diagnosis of antiphospholipid antibody syndrome (APS). This case report describes rare chronic juxtarenal abdominal occlusion in a patient with APS.
ABSTRACT
BACKGROUND: Metabolic acidosis is known to accelerate the progression of chronic kidney disease (CKD). However, whether undetermined anions as indicated by the adjusted anion gap (aAG) are associated with estimated glomerular filtration rate (eGFR) decline in patients with CKD is unclear. METHODS: Data from 42 patients with CKD (baseline eGFR, 7.1-52.0 ml/min/ 1.73 m2) without massive proteinuria (urinary protein-creatinine ratio, UPCR <3.5) were retrospectively analyzed. aAG was calculated from serum sodium, serum chloride, serum bicarbonate, serum albumin, serum potassium, serum calcium and serum phosphate. The association between the percentage of the 6-month change of eGFR (%ΔeGFR/6m) and aAG was examined. RESULTS: The mean baseline eGFR was 27.5 ± 11.1 ml/min/1.73 m2 and the mean %ΔeGFR/6m was 13.8 ± 10.3. UPCR and aAG were 1.13 ± 0.93 and 9.48 ± 1.88, respectively. %ΔeGFR/6m was associated with aAG (r = 0.438, p < 0.005), but not with UPCR (r = 0.194, p = 0.218). In multivariate linear regression analyses, aAG remained significantly associated with %ΔeGFR/6m (ß = 0.45, p < 0.01) after controlling for age, baseline eGFR, UPCR and HCO3- concentration. CONCLUSION: These data suggest that aAG appears to be associated with the progression of CKD. aAG might be an independent predictor of CKD progression.
