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  • Hyperreninemic hypertension is a clinical condition in which the kidneys produce too much renin autonomously and independently of angiotensin II and aldosterone levels. This Case Study reports the case of a previously normotensive 18-year-old man who developed renin-dependent hypertension following presumed sports-related blunt renal trauma. The diagnosis, treatment and management of this patient are discussed.

    • Eduardo Pimenta
    • Richard D. Gordon
    • Michael Stowasser
    Case Study
  • This article reports the case of a 73-year-old man who developed spondylodiscitis as a result of methicillin-sensitiveStaphylococcus aureusbacteremia. The patient's catheter was identified as the source of bacteremia, which had spread to the vertebral discs as confirmed by microbiological tests and MRI. The authors also discuss the characteristics of 12 other patients with spondylodiscitis and describe the risk factors for developing this condition and its most appropriate management.

    • Masoud Afshar
    • Robert F. Reilly
    Case Study
  • This article reports the case of a 50-year-old man who had undergone kidney and pancreas transplantation and developed pancytopenia following treatment with azathioprine. A genotype test for thiopurineS-methyltransferase (TPMT) showed that the patient was homozygous for TPMT*3A, which accounted for the susceptibility to azathioprine-related myelosuppression. The authors discuss the importance of TPMT testing and describe the tools available for monitoring for adverse effects from treatment.

    • Pooja Budhiraja
    • Mordecai Popovtzer
    Case Study
  • Cinacalcet, a calcimimetic drug, is an attractive treatment for renal transplant patients who experience persistent hyperparathyroidism and hypercalcemia. In this article, however, Seikrit et al. present the case of a 47-year-old man who experienced fulminant renal allograft failure after receiving cinacalcet soon after transplantation. The authors also discuss the possible pathophysiological connection between cinacalcet administration and failure of the transplanted kidney.

    • Claudia Seikrit
    • Anja Mühlfeld
    • Jürgen Floege
    Case Study
  • This article reports the case of a 57-year-old woman who was diagnosed with primary aldosteronism after renal transplantation. The authors discuss the challenges of diagnosing this syndrome in patients with chronic kidney disease, the importance of identifying this condition owing to its association with cardiovascular risk and renal function impairment, and available treatment options.

    • Ewout J. Hoorn
    • Dennis A. Hesselink
    • Robert Zietse
    Case Study
  • This article considers the case of a 52-year-old man who presented with life-threatening anion gap metabolic acidosis after drinking a large quantity of vodka. The authors discuss the role of thiamine deficiency in the development of severe lactic acidosis in alcohol-dependent individuals and conclude that early intervention can lead to excellent outcomes.

    • Philip D. Shull
    • Jayson Rapoport
    Case Study
  • This article reports the case of a 62-year-old man with end-stage renal disease on continued ambulatory peritoneal dialysis who presented with epigastric pain. Physical examination, imaging of the abdomen and cultures of peritoneal dialysis fluid led to a diagnosis of rare, fungal peritonitis caused byHistoplasma capsulatum. Removal of the peritoneal catheter and a switch to hemodialysis led to resolution of the patient's symptoms.

    • Adeel Ijaz
    • Devasmita Choudhury
    Case Study
  • This article reports the case of a 36-year-old man on hemodialysis who presented to an intensive care unit with a large serum anion gap and symptoms such as hypotension and an altered mental state. For the previous 6 weeks, he had received linezolid to treat vancomycin-resistant bacteremia. Discontinuation of linezolid led to resolution of his symptoms and to normalization of the serum anion gap and serum lactate levels. The authors conclude that the patient had suffered from lactic acidosis caused by linezolid.

    • Juan Carlos Q. Velez
    • Michael G. Janech
    Case Study
  • This article reports the case of a 49-year-old woman who presented to hospital with symptoms associated with severe hyponatremia. For the previous 6 years, she had been treated for lumbago with lumbar facet joint injections of triamcinolone acetonide every 10–12 weeks. Laboratory analyses and nonresponse to the corticotropin-releasing-hormone-stimulation test led to the conclusion that triamcinolone acetonide treatment had caused the development of secondary adrenal insufficiency, which in turn had led to upregulation of antidiuretic hormone and the development of hyponatremia.

    • Stefan Reuter
    • Niklas Scholten
    • Eckhart Büssemaker
    Case Study
  • This article considers the case of a 25-year-old woman with a medical history notable for joint laxity and hypermobility syndrome. She had recurrent episodes of severe, right-sided abdominal and flank discomfort, intermittent gross hematuria, and sensation of a mass on her right side. Intravenous pyelography led to a diagnosis of nephroptosis.

    • Barbara A. Clark
    • Amandeep Sekhon
    Case Study
  • In this Case Study, Hladunewich and colleagues describe the case of a woman with a twin pregnancy with a single fetal demise who presented earlier than 20 weeks' gestation with severe nephrotic syndrome, hypertension and renal insufficiency. The authors describe how aberrant levels of anti-angiogenic and angiogenic factors helped confirm the diagnosis of pre-eclampsia in this complex renal presentation, allowing for the rapid discontinuation of unnecessary immunosuppressive agents and the avoidance of the potential risks inherent with diagnostic renal biopsy.

    • Michelle A. Hladunewich
    • Guy Steinberg
    • Johannes Keunen
    Case Study
  • Interferon, which is widely used to treat chronic hepatitis C virus infection, plays a critical role in the pathogenesis and perpetuation of certain autoimmune diseases, including systemic lupus erythematosus. In this Case Study, Agarwal and colleagues present the case of a patient on hemodialysis who experienced systemic lupus erythematosus exacerbation with cerebritis following treatment of her hepatitis C virus infection with pegylated interferon monotherapy.

    • Sanjay Kumar Agarwal
    • Charanjeet Lal
    • Sabahat Husain Zaidi
    Case Study
  • Zuber and colleagues from Paris describe a case of diabetes that developed after renal transplantation in a young, white, nonobese man. Genetic screening detected a newly described deletion in the gene encoding hepatocyte nuclear factor 1 homeobox B,HNF1B, indicating that mutations in HNF1Bmight account for some 'unexpected' cases of new-onset diabetes after transplantation. Minimization of tacrolimus exposure and withdrawal of steroids markedly reduced the patient's insulin requirement.

    • Julien Zuber
    • Christine Bellanné-Chantelot
    • Danièle Dubois-Laforgue
    Case Study
  • The lesions associated with the rare granulomatosus disease malacoplakia, which can result in serious complications, are often mistaken for renal abscesses or malignant growths. Sanchez and colleagues describe the presentation of a woman whose malacoplakia involved both ureters and the bladder and required the placement of bilateral percutaneous nephrostomy tubes.

    • Lorin M. Sanchez
    • Sean I. Sanchez
    • James L. Bailey
    Case Study
  • Prakash and colleagues highlight the case of a 60-year-old man who was referred to a nephrology clinic with an elevated serum creatinine level. Investigations revealed that he had been taking a herbal remedy containing a large amount of lead. Following discontinuation of the remedy and several sessions of lead chelation, his creatinine level declined. This case highlights the need for clinicians to consider lead in the differential diagnosis and prognosis of patients with chronic kidney disease.

    • Suma Prakash
    • German T. Hernandez
    • Vivek Bhalla
    Case Study
  • Fabry disease, a rare lysosomal storage disorder, predominantly affects males due to its X-linked inheritance pattern. Here, Abaterusso and colleagues describe a heterozygous female who developed severe Fabry disease-related renal disease with neither proteinuria nor microalbuminuria. This case highlights the importance of considering heterozygous females not merely as 'carriers' of Fabry disease, and emphasizes that the absence of microalbuminuria and proteinuria does not rule out chronic kidney disease in Fabry disease.

    • Cataldo Abaterusso
    • Vincenzo De Biase
    • Giovanni Gambaro
    Case Study
  • Kidney involvement can be a serious complication of hematopoietic stem cell transplantation. In this Case Study, Fofi and colleagues describe a rare case of focal segmental glomerulosclerosis occurring as a complication of chronic graft-versus-host disease following peripheral blood stem cell transplantation.

    • Claudia Fofi
    • Simona Barberi
    • Paolo Menè
    Case Study
  • Authors from the University of Colorado describe a 31-year-old white female with tuberous sclerosis complex who was diagnosed with very large bilateral angiomyolipoma of the kidneys after developing symptoms of urinary tract infection and septic shock. The lack of surveillance throughout the course of the patient's disease prevented early intervention before the development of end-stage renal disease and the need for bilateral nephrectomy. This case illustrates the importance of regular follow-up in patients with tuberous sclerosis complex.

    • Mohammad Sarraf
    • Amirali Masoumi
    • Robert W Schrier
    Case Study
  • In this Case Study, Dukkipati et al. describe a patient who sustained acute kidney injury as a consequence of hemoglobinuria secondary to intravascular hemolysis caused by the use of a percutaneous thrombectomy device to treat bilateral pulmonary emboli. The patient recovered normal renal function after management including hemodialysis and continuous venovenous hemodiafiltration, but the authors conclude that patients should be warned of the risk of acute kidney injury before mechanical thrombectomy is carried out using this device.

    • Ramnath Dukkipati
    • Eric H Yang
    • Janine Vintch
    Case Study
  • In this issue, Vilayur et al. describe the case of a patient with monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic leukemia (CLL). Although 'conventional; immunosuppression with cyclophosphamide and prednisone was unsuccessful, two courses of rituximab reversed the clinical manifestations of CLL-associated glomerulopathy, and resulted in complete clearance of the glomerular deposits.

    • Eswari Vilayur
    • Paul Trevillian
    • Mark Walsh
    Case Study