Catheter‐directed therapy for acute renal vein thrombosis in systemic lupus erythematosus: A case report

We report our experience using catheter‐directed thrombectomy/thrombolysis (CDT) to treat a patient with acute renal vein thrombosis (RVT) associated with systemic lupus erythematosus (SLE). A 34‐year‐old woman presented with persistent left flank pain, and a renal ultrasonography examination revealed an enlarged left kidney. Contrast‐enhanced computed tomography confirmed the presence of acute left RVT. Because medical treatment failed to relieve her pain and the renal function was deteriorating, we attempted to salvage the occluded left renal vein using an endovascular approach. The pain was completely relieved after a CDT and an overnight urokinase infusion. A follow‐up computed tomography examination revealed the complete resolution of the thrombus. The creatinine level returned to normal (1.7–0.4 mg/dL), along with contrast enhancement in the left kidney, and this suggested the preservation of renal function. To our knowledge, this is the first report utilizing CDT to treat SLE‐associated RVT. When the renal function is deteriorating, CDT is worth considering for RVT if conventional medical treatment has failed. © 2016 Wiley Periodicals, Inc.     

Rhabdomyolysis and unilateral renal infarction after a motor vehicle crash

A 46-year-old man with no previous history of abnormal urinalysis findings or renal dysfunction was admitted to a local hospital because of a motor vehicle crash. An open laparotomy was performed to treat a perforation of the small intestine. After operation, oliguria and renal dysfunction developed, and he was admitted to our hospital because of acute renal failure after trauma. Acute renal failure was assumed to be due to rhabdomyolysis with elevated serum creatinine, blood urea nitrogen, and creatine kinase levels and myoglobinemia. Left flank pain occurred several days after admission, and the serum alkaline phosphatase level increased between days 5 and 12 following admission. Although hemodialysis was performed 9 times and the urine output was satisfactory, the creatinine clearance levels increased only to about 50 mL/min/1.73 m2 (0.84 mL/s/m2) at 6 weeks following admission. As a result, a diagnosis of renal infarction due to acute renal artery occlusion was considered. The left kidney was atrophic on an abdominal computed tomographic scan and was nonfunctioning on a renogram. This case shows the importance of not overlooking the possibility of a renal infarction associated with rhabdomyolysis after a motor vehicle crash. In particular, the changes in the serum alkaline phosphatase levels were important in making a correct diagnosis in this case.     

Case report: renal lymphangiectasia

Renal lymphangiectasia is a rare renal condition. We present a case of bilateral renal lymphangiectasia in a 52-year-old man who presented with bilateral flank pain and gross hematuria. The clinical features, diagnosis and characteristic imaging findings are reviewed. This condition should be considered in the differential diagnosis of cystic renal masses in both children and adults.     

Renal Vein Thrombosis in a Newborn With Abnormal Factor VIII Level: Clinical Case Report

Renal vein thrombosis (RVT) in neonates is a rare condition of low mortality but significant morbidity due to renal impairment.We report the case of a male term newborn with left RVT and elevated serum factor VIII (FVIII).The main symptoms of the patient and the important clinical findings: prompt diagnosis of RVT was possible because the classic clinical presentation of macroscopic hematuria, thrombocytopenia, and palpable flank mass were present in this newborn infant.The main diagnoses: finally, the reason of RVT was established when the infant was 3 months of age: the increased level of FVIII was confirmed. We discuss the diagnosis, therapy, and outcome of the patient and compare with the literature.Therapeutics interventions: however, despite anticoagulant therapy the left kidney developed areas of scarring and then atrophy.Conclusions and outcomes: Prothrombotic defects should be considered in all patients with perinatal RVT. Elevated factor VIII as a reason of RVT in neonatal period is particularly rare. Given a poor renal outcome in children associated with elevated levels of factor VIII, consideration could be given to more aggressive antithrombotic therapy in such cases.     

Successful treatment for rupture of pancreaticoduodenal artery aneurysm: two case reports

We report 2 cases of ruptured pancreaticoduodenal artery aneurysm (PDAA) treated by transcatheter embolization (TAE). In the first case, a 63-year-old man complained of sudden abdominal pain and was transferred to our hospital because he collapsed in a state of shock. Abdominal computed tomography (CT) revealed retroperitoneal hematoma and ascites. Abdominal angiography showed bleeding from one of the branches of the inferior pancreaticoduodenal artery. The ruptured PDAA was terminated by TAE. In the second case, a 65-year-old man experienced sudden abdominal pain. Abdominal CT revealed a retroperitoneal hematoma. He received TAE to terminate bleeding from a PDAA, but his abdominal pain worsened. At operation, ileus caused by the hematoma compressing the transverse colon was diagnosed, and cecostomy was performed. He recovered well and was discharged a few days later. In summary, a patient with a ruptured PDAA should first be treated by TAE, followed if necessary by surgery.     

Orchiectomy for tuberculous epididymitis: a report of two cases with intractable to antituberculosis treatment]

This paper describes two cases with tuberculous epididymitis. The first case was a 69-year-old man who was admitted to our hospital because of ulceration or right scrotum. Physical examination revealed a hard, rounded, a little bigger than egg-sized mass in the right scrotum. The second case was a 40-year-old man who was admitted to our hospital because of cough, fever and body weight loss. He was treated for pulmonary tuberculosis with isoniazid, rifampicin, streptomycin and pyrazinamide. Six months after admission, he complained of a painless swelling of the right scrotum. Physical examination revealed a hard, rounded, more than egg-sized mass in the right scrotum. Right orchiectomy was performed in these two cases, and they were cured.     

Spontaneous rupture of a renal artery pseudoaneurysm in a hemodialysis patient: A case report

Rationale:Renal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported.Patient concerns:A 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior.Diagnosis:Contrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms.Interventions:On renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed.Outcomes:Post-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization.Lessons:When maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.     

Chromophobe renal cell carcinoma presenting as hemorrhagic shock: case report

The majority of patients with chromophobe renal cell carcinoma (CRCC) are determined to be asymptomatic, with a small minority of patients having the classic triad of flank pain, hematuria, and abdominal mass. This case report describes a 56-year-old man first seen with hemorrhagic shock from retroperitoneal bleeding attributable to a large renal mass. An emergent exploratory laparotomy and radical nephrectomy were performed and the patient has since remained disease free at 3 year follow-up.     

Ischemic Colitis in a 33-Year-Old Woman on Danazol Treatment for Endometriosis

A 33-yr-old Japanese woman, married, no parity, was treated for endometriosis. Danazol 400 mg a day was initiated on September 25, 1986, for 21 consecutive days. She became severely constipated and had left lower abdominal colic pain. Five days later, she had to be admitted to the hospital, because she had had no bowel movements for 12 days and the abdominal pain was severe. On the day after admission, she had frequent painful bowel movements. The stool was blood-tinged, but pathogenic bacteria were nil. Ischemic colitis of the stricture type was identified. She was treated with hyperalimentation and anticholinergic agents. At 3 months and 5 days after discharge from hospital, danazol 400 mg per day was readministered, and 11 days later, the patient again became constipated and complained of the same pain in the left flank. We consider that danazol-induced constipation played a role in the onset of the ischemic colitis.     

A case of octreotide acetate-induced acute pancreatitis]

A 56-year-old man was admitted to our hospital in July 2000 because of epigastralgia and back pain with past history of repeated upper abdominal pain due to acute pancreatitis since 1995. Abdominal computed tomography on admission showed a swelling in the pancreas head and several large pancreatic pseudocysts. He was diagnosed as acute pancreatitis based on abdominal pain, elevated pancreatic enzymes and computed tomography finding, and given 50 microg octreotide subcutaneously for the treatment of pancreatic pseudocysts. Within 3 hours after octreotide injection, he complained of upper abdominal pain and had an elevated serum amylase level. Abdominal pain disappeared after cessation of octreotide injection and the patient was discharged free from abdominal pain. Octreotide might cause acute pancreatitis by inducing spasm of the sphincter of Oddi. Careful check-up of the patients might be needed during treatment with octreotide.     

Silent ST segment elevation myocardial infarction with multi-segmental renal infarction: an unusual presentation

A 36-year-old diabetic man came to our institution presenting with constant left flank pain. Left renal embolic infarction was found by abdominal computed tomography. Silent ST segment elevation myocardial infarction was noted on 12-lead electrocardiogram. Emergent coronary angiography revealed large thrombus burdens with complete occlusion at the left anterior descending artery ostium, which may be the embolic origin. Silent ST segment elevation myocardial infarction with acute flank pain and multiple segmental renal infarction is an unusual presentation. High vigilance may prevent delay of the "golden hour" to treat acute myocardial infarction.     

Bilateral Acute Renal Infarction Due to Paradoxical Embolism in a Patient with Eisenmenger Syndrome and a Ventricular Septal Defect

A 52-year-old man who was diagnosed with Eisenmenger syndrome due to a muscular-type ventricular septal defect 30 years previously, visited our emergency room after experiencing six hours of severe left flank pain and vomiting. On laboratory examination, azotemia and microscopic haematuria were identified. Contrast-enhanced computed tomography also revealed pulmonary embolism (PE) and bilateral acute renal infarction. The flank pain resolved after heparin was administered for anti-coagulation and aspiration thrombectomy was performed. The patient was discharged on warfarin as anticoagulant therapy. In this case, a paradoxical embolism was considered to have been the cause of PE and bilateral acute renal infarction in a patient with Eisenmenger syndrome.     

A case of hepatic portal venous gas caused by chemo-radiation therapy for an advanced esophageal cancer

Hepatic portal venous gas(HPVG)is a rare condition with a poor prognosis. A 40-year-old man underwent esophagectomy for stage IV esophageal cancer followed by chemotherapy. Four months later, he admitted to our hospital because of the increases of residual tumors and started chemoradiotherapy(CRT)with 5-FU, CDDP and radiation. Computed tomography(CT)scan revealed PR, and blood examination showed decreases in WBC and platelet counts. Fourty days after CRT, he suddenly complained severe pain in the left chest and abdomen, and vomiting. CT scan showed HPVG in the left lobe of the liver and pneumatosis cystoides intestinalis in the wall of the gastric tube. He died of multiple organ failure. To our knowledge, this is a first case of HPVG associated with CRT for esophageal cancer.     

Renal Primitive Neuroectodermal Tumor: A Case Report

Primitive neuroectodermal tumor (PNET) is a malignant small round cell tumor and typically arises from bone or soft tissue in adolescents and young adults. Renal PNET is extraordinarily rare and exhibits highly aggressive biological behavior with poor prognosis.We present here a new case of renal PNET in a 31-year-old female. The patients were referred to our hospital because of left flank pain with nausea and vomiting for 1 week. A computed tomography scan revealed a 14.7 × 12.7 cm well-defined, unevenly mass lesion with both solid and cystic components and the tumor was not enhanced uniformly.A preoperative diagnosis of cystic renal cell carcinoma and urinary tract infection was made. The patient undergone anti-inflammatory therapy followed by a left radical nephrectomy. Taken with morphological pattern and immunohistochemical markers, a diagnosis of renal PNET was made. Two cycles of combined chemotherapy were executed. At the 14-month follow-up, no evidence of metastasis or recurrence was indicated.This case reminds clinicians that for adolescents and young adults with a suspicious renal mass, a diagnosis of renal PNET should be always considered. An initial surgery followed by radiotherapy and chemotherapy is suggested for the therapeutic management.     

Two cases of acute renal failure associated with nonfulminant acute hepatitis A]

We report two cases of acute renal failure in patients with nonfulminant acute hepatitis A. First case is a healthy 25 year-old man complained of myalgia and jaundice. Initial laboratory results showed BUN 40 mg/dL, creatinine 5.23 mg/dL, AST 2,220 IU/L, ALT 3,530 IU/L, total bilirubin 6.26 mg/dL, and positive anti-HAV IgM antibody. Supportive treatments including fluid therapy were started. Serum creatinine and total bilirubin levels were 7.98 mg/dL and 7.66 mg/dL respectively on the 5th hospital day, and decreased gradually. He was discharged on the 12th hospital day, and was being followed up in outpatient department. Second case is a 33 year-old woman who admitted for bilateral flank pain, high fever, nausea, and vomiting. She was diagnosed as acute pyelonephritis and acute hepatitis A. On admission, BUN 13 mg/dL, creatinine 0.74 mg/dL, AST 3,720 IU/L, ALT 2,280 IU/L, total bilirubin 0.9 mg/dL were noted, and acute renal failure developed next day. Fluid therapy with antibiotics administration were started, and maximal BUN and creatinine was 41.7 and 8.09 mg/dL respectively on the 8th day. She recovered without dialysis and was discharged on the 19th hospital day. Proper and prompt comprehensive supportive measures would decrease the need for dialysis in patient of acute renal failue associated with acute hepatitis A.     

Renal vein thrombosis in nephrotic syndrome--a prospective study of 54 cases

Recent advance of radiographic technique makes antemortem diagnosis of renal vein thrombosis (RVT) possible. However the incidence of RVT in patients with nephrotic syndrome(NS) is still not known. This study was designed to investigate the incidence, clinical presentation and radiological features of RVT in NS patients in China. A prospective study including clinical, and pathological examination as well as renal venogram was carried out in all our hospitalized NS patients except those having contradiction for renal venogram. RVT was found in 23 of the 54 cases (42%) and there was obstruction in 34 renal vein branches. RVT was more common in left (19) than right side (15), in upper (19) than middle and lower branches (10). It is interesting that in our group not only membranous but also minimal change as well as mesangium proliferative glomerulonephritis had high incidence of RVT (47%, 45% and 36% respectively) Only 6 cases (26%) had a typical acute presentation with severe loin pain, significant increase of urinary protein, enlargement of involved kidney. Occasionally fever, deterioration of renal function and sterile urinary white cells were also present. The remaining patients (74%) had latent onset of RVT which could hardly be identified in the clinical course of the underlying NS. For the high incidence and atypical clinical course of RVT shown in our study, it is recommended that due attention should be paid of this complication during management of NS and interpretation of therapeutic response.     

Two cases of pulmonary disease with perinuclear anti-neutrophil cytoplasmic antibody]

We encountered two cases of perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA). The first was a case of idiopathic interstitial pneumonia diagnosed in a 73-year-old man since 1998. He was admitted to our hospital because of renal failure and anemia. The serum level of p-ANCA on admission was 264 EU, and specimens obtained by percutaneous renal biopsy showed crescentic glomerulonephritis and vasculitis due to p-ANCA. He was treated with prednisolone pulse therapy and prednisolone (PSL), however interstitial pneumonia occurred during PSL tapering. We treated him for pulmonary fibrosis with plasmapheresis, methylprednisolone (mPSL) and cyclophosphamide (CPA), which suppressed the progress of the interstitial pneumonia. The second case was one of massive pulmonary hemorrhage in a 68-year-old man who was admitted to our hospital. Physical examination revealed anemia: the laboratory data, renal failure; and the serum level of p-ANCA was elevated to 611 EU. The specimens obtained by percutaneous renal biopsy showed crescentic glomerulonephritis and vasculitis. The renal failure was not improved by PSL, but, together with the inflammation, responded to the combination of PSL and CPA. However, both patients died of serious infection. They were regarded as compromised patients because of the therapy mentioned above. No standard therapy has been established against p-ANCA positive pulmonary disease with renal failure. The treatment should control the progression of interstitial pneumonitis and pulmonary hemorrhage. It is important to consider the possibility of serious infection.     

Tuberculosis-associated chronic kidney disease

Extrapulmonary tuberculosis (TB) account for approximately 15-20% of TB cases in immunocompetent patients. The genitourinary system is the third most commonly affected site. We report the case of a 20-year-old man admitted with fever, chills, dry cough, right flank pain, and oliguria who developed renal function loss. The pyelogram evidenced silence of the right kidney, and the abdominal and pelvic magnetic resonance showed significant dilation of the right pyelocaliceal system and proximal ureter. Biopsies of renal cortex and retroperitoneal lymph nodes showed caseous granuloma consistent with TB. Treatment was started with rifampicin, isoniazid, pyrazinamide, and ethambutol, and the patient presented a favorable outcome but with non-dialytic chronic kidney disease. This case illustrates a case of chronic kidney disease secondary to TB in a young, otherwise healthy man.     

Spontaneous perirenal hematomas in patients taking anticoagulation medication or having a bleeding diathesis

Spontaneous perirenal hematoma is a rare condition. The clinical features are acute flank or abdominal pain, haematuria, hypotension and shock. Bleeding is most commonly caused by renal tumours, especially angiomyolipomas. Other known causes are long-term haemodialysis, arteriosclerosis or arteritis. A total of 6 patients with spontaneous perirenal haemorrhage have been treated in our hospital since 2003. Nearly all patients had been taking anticoagulation medication. One had a bleeding diathesis. One of the patients died immediately after admission at the hospital. All other patients had an exploratory laparotomy. In three cases total nephrectomy had to be performed, two other patients could be treated with partial nephrectomy. In patients with non-traumatic acute flank or abdominal pain it is important to determine whether the patient has been taking anticoagulation medication or suffers from bleeding diathesis because there is a high incidence of bleeding complications in these cases. If an emergent laparotomy is not necessary we recommend that these cases should be treated surgically after clinical stabilisation because tumours are the main reason for the haematomas and the patients have an urgent need for further anticoagulation therapy.     

Acute tumor lysis syndrome in the setting of advanced gastric cancer

A 69-year-old man was admitted with right flank pain. The patient was diagnosed with advanced gastric cancer with multiple metastases in the liver and abdominal lymph nodes and underwent chemotherapy. Three days following the initial administration of S-1 plus cisplatin, the patient developed tumor lysis syndrome (TLS) with increased LDH, hyperuricemia, hyperkalemia, and elevated creatinine. Although rare, TLS following chemotherapy for solid tumors is a potentially fatal complication, and high physician awareness is required, especially in patients with risk factors, such as bulky disease.