Reviews & Analysis

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.

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.

Renal manifestations in Crohn's disease—a chronic relapsing inflammatory disease characterized by mucosal ulcerations of the digestive tract—are rare. Tubulointerstitial nephritis has been reported in Crohn's disease, but most cases have occurred in patients treated with 5-aminosalicylic acid derivatives, which are known to be nephrotoxic. In this Case Study, Waters et al. present two cases of tubulointerstitial nephritis occurring in patients with Crohn's disease, and emphasize that physicians should be aware of this serious and under-recognized complication.

This article reports on a case of biopsy-proven nodular glomerulosclerosis in a patient with progressively worsening renal function, metabolic syndrome, but no evidence of diabetes. The authors conclude that screening patients with the metabolic syndrome—even those without diabetes—for evidence of impaired renal function and treating eventually detected albuminuria could help prevent progressive kidney disease and reduce the associated morbidity and mortality risks.

In this Case Study, Iwatani and colleagues describe two cases of valvular injury associated with noninfective endocarditis in patients with proteinase 3 antineutrophil cytoplasmic antibody-associated glomerulonephritis. Diagnosis, treatment and management of such cases is discussed, and the importance of distinguishing between noninfective and infective endocarditis is emphasized.

The role of antineutrophil cytoplasmic antibodies (ANCA) in the development of the pauci-immune vasculitide Churg–Strauss syndrome is unclear. Chemmalakuzhy et al. report the case of a 36-year-old man diagnosed with Churg–Strauss syndrome, whose presentation was notable for two atypical features: first, the absence of asthma and second, the presence of glomerulonephritis in the absence of ANCA. The latter observation challenges current thinking about the role of ANCA in the pathogenesis of the syndrome.

Juxtaglomerular cell tumors usually occur during adolescence and early adulthood and are generally deemed benign. Beaudoin et al. report the case of a 51-year-old woman with a juxtaglomerular cell tumor of large size (9.8 cm versus the usual 2–3 cm), which showed histological signs of vascular invasion. Although no other evidence of malignancy was found, this case suggests that adult patients with large juxtaglomerular cell tumors should undergo follow-up after nephrectomy to enable detection of tumor recurrence and metastasis.

Rhodococcus equiis an animal pathogen that sometimes causes opportunistic infections in immunocompromised patients. Speck et al. present the case of a 62-year-old male renal transplant recipient who presented with fever, hemoptysis and left-sided pleuritic chest pain. After numerous investigations, a diagnosis of R. equi infection with bacteremic pleuropneumonia and pseudotumor was made. This Case Study describes the diagnosis and management of R. equiinfection, which has a very varied clinical presentation in humans.

Renal involvement in type I cryoglobulinemia is uncommon, and management of such disease is difficult and remains poorly defined. Pandrangi and colleagues describe their experience of using rituximab—a chimeric anti-CD20 monoclonal antibody that selectively depletes CD20⁺B cells—as a novel approach for treating the renal disease of a patient with type I cryoglobulinemia-associated glomerulonephritis.

Venous thrombosis is a common complication of nephrotic syndrome, and most often occurs in the renal veins or in the veins of the lower limbs. Portal vein thrombosis is quite uncommon in patients with nephrotic syndrome, and usually only occurs during treatment or recurrence of the condition. In this Case Study, Sun and Xu present a 52-year-old man in whom portal vein thrombosis was the first sign of nephrotic syndrome.

Polyomavirus-associated nephropathy (PVAN), an important cause of allograft failure in renal transplant recipients, is usually diagnosed within 12 months of renal transplantation. Bansal et al. present a case of PVAN that developed more than 80 months after transplantation, however, highlighting the fact that PVAN can occur late after transplantation and should be considered in any renal transplant recipient who experiences a change in renal function.

Ozturk et al. present the case of a schizophrenic male who developed hyponatremia due to fluoxetine-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and psychogenic polydipsia. The Case Study highlights the need for routine monitoring of electrolyte levels in patients with schizophrenia who are taking selective serotonin (5-HT) reuptake inhibitors such as fluoxetine.

This Case Study describes a female with autosomal dominant polycystic kidney disease (ADPKD) whose renal function was followed over the course of four pregnancies. The first three pregnancies were unsuccessful, but the fourth resulted in a live birth. Following the birth, the patient's renal function deteriorated, and she eventually commenced hemodialysis. The authors highlight the fact that renal function might deteriorate more rapidly in women with ADPKD who become pregnant than it would do otherwise.

In this article, Segal describes the case of an 89-year-old man with a history of prostate cancer who presented with hyperkalemia and kidney failure. The patient was ultimately diagnosed with acute kidney injury due to both upper and lower urinary tract obstruction. A series of schematic diagrams illustrating an interpretation of the events that occurred in the patient is presented.

Diffuse infiltrative lymphocytosis syndrome (DILS) is an autoimmune syndrome characterized by the oligoclonal expansion of CD8⁺ lymphocytes in response to HIV antigens. Izzedine et al. describe the case of an HIV-infected patient who developed acute granulomatous interstitial nephritis secondary to DILS. The pathogenesis of DILS is unclear, but the clinical spectrum of the disease and its diagnosis and treatment are discussed in detail.

Autoantibody production is common in HIV-infected individuals. In this Case Study, Wechsler and colleagues describe a case of anti-glomerular basement membrane disease in a 55-year-old HIV-positive male. Treatment with steroids, intravenous immunoglobulin, mycophenolate mofetil and rituximab resulted in improved renal function and disappearance of the autoantibodies.