Acute renal failure in a patient with hemophagocytic syndrome

Acute renal failure (ARF) occurred in a 47-year-old man with hemophagocytic syndrome. Histological findings of the kidney revealed diffuse infiltration of interstitium by phagocytosing cells mixed with atypical lymphoid cells of varying size. The cytological features of the lymphoid population in liver and spleen were consistent with a diagnosis of peripheral T-cell lymphoma. We believe that this ARF could have been exacerbated by the interstitial infiltration of phagocytosing cells, reactive lymphoid cells, and T-cell lymphoma cells. Received: September 25, 1998 / Accepted: July 22, 1999     

Acute renal failure in a patient with severe hemolysis

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder of bone marrow. It is characterized by blood cells lacking membrane proteins that are normally attached by the glycosylphosphatidylinositol (GPI) anchor. The cellular defect arises in a hematopoetic stem cell and is due to somatic mutation of the Phosphatidylinositol-glycan protein-A gene (PIG-A gene), encoding a protein needed for the biosynthesis of the anchor GPI. Paroxysmal nocturnal hemoglobinuria is presented by intravascular hemolysis, cytopenias, frequent infections, bone marrow hypoplasia, and a high incidence of life threatening venous thrombosis. Kidney involvement is usually benign and secondary to chronic tubular deposition of hemosiderin. Acute renal failure may occur in association with a hemolytic crisis. Here we report a case of 40-year-old woman with hematuria, pancytopenia, and acute renal failure due to PNH.     

Acute renal failure in a patient with phosphofructokinase deficiency

A 16-year-old Caucasian girl was admitted to hospital with acute renal failure and hemolytic anemia due to rhabdomyolysis following a 3-km walk. ³¹P-magnetic resonance spectroscopy provided characteristic spectra of type VII glycogen storage disease (phosphofructokinase deficiency).     

Acute renal failure in a hypothyroid patient with rhabdomyolysis

A 49-year-old hypothyroid man developed rhabdomyolysis and acute renal failure. He had been on thyroid replacement therapy for 17 years following removal of a benign pituitary tumor. Rhabdomyolysis was diagnosed by elevated liver enzymes, CPK, and creatinine. The case illustrates how hypothyroidism can cause rhabdomyolysis and subsequently, acute renal failure.     

Acute renal failure in a patient with Rosai-Dorfman disease

Acute renal failure developed in a 57-year-old woman who had Rosai-Dorfman disease diagnosed 1 year previously on a cervical lymph node. Organ imaging showed diffuse masses infiltrating both kidneys. The renal biopsy showed a lymphoplasmacytic and histiocytic process extensively replacing the parenchyma, which is in keeping with Rosai-Dorfman disease of the kidneys. However, the typical lymphophagocytic cells were lacking. This case illustrates that diagnosis of Rosai-Dorfman disease in renal biopsy can be very difficult, requiring both exclusion of many benign and malignant lesions and a high index of suspicion for this condition. In particular, lymphoma was excluded based on the mixed polyclonal composition of inflammatory cells and the absence of atypical lymphoid proliferation. The renal function partially recovered after a course of therapy combining VP-16 (etoposide) and dexamethasone and remained stable over 4-year follow-up. This report emphasizes the importance of early diagnosis and intervention to safeguard renal function in extensive Rosai-Dorfman disease.     

Acute renal failure after exercise in a patient with renal hypouricemia

A 22-year-old man had recurrent exercise-induced acute renal failure (ARF). He was found to have isolated renal hypouricemia: serum uric acid level was 0.7–1.0 mg/dl and fractional excretion of uric acid (FE_UA) was 37%–43%. He showed no suppression of FE_UA following the the administration of pyrazinamide, and no increase of FE_UA after benzbromarone, suggesting a subtotal defect. We investigated renal function, FE_UA, and serum nitric oxide after a treadmill exercise test in our patient and two control subjects. On the day after the exercise test, plain and enhanced abdominal computed tomography (CT) scans were performed in our patient. During the arterial phase, early equilibration phase, equilibration phase, and 2, 6, and 24 h after the injection of contrast medium, renal CT scans were performed at the same slice level. Although ARF was not induced by this level of exercise, the CT scans showed patchy contrast enhancement 2, 6, and 24 h after contrast medium administration. This finding suggests that patchy renal vasoconstriction may occur in patients with renal hypouricemia after strenuous exercise, even in the setting of normal creatinine clearance. Received: June 19, 1998 / Accepted: September 4, 1998     

Acute renal failure in a patient with paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder characterized by low-grade, chronic hemolytic anemia accompanied by either thrombocytopenia or leucopenia. Kidney involvement is usually benign and secondary to chronic tubular deposition of hemosiderin. Acute renal failure may occur in association with a hemolytic crisis. We report the case of a 70-year-old Caucasian woman with PNH who developed reversible acute renal failure requiring hemodialysis following a gastointestinal illness. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition, but no evidence of vascular thrombosis.     

Acute non-dilating obstructive renal failure in a patient with AIDS

A 30-year-old male who presented with acute renal failure was found to have acquired immunodeficiency syndrome (AIDS). Although sonography and computerized tomography did not show urinary tract dilatation, obstructive renal failure was demonstrated by retrograde pyelography. Relief of obstruction(s) due to encasement of the renal pelves and ureters with histiocytic lymphoma led to immediate return of normal renal function. Although the etiology of renal failure in this patient is highly unusual, the high incidence of lymphoma in patients with AIDS should make tumor-related renal disease a consideration in all such patients with renal dysfunction.     

Acute renal failure in a patient with paroxysmal cold hemoglobinuria

Acute renal failure following auto-immune hemolysis is rare. We report a child with acute paroxysmal cold hemoglobinuria (PCH) complicated by renal failure. She was treated by peritoneal dialysis and red blood cell transfusion. After 2 weeks she had made a complete recovery with a normal blood count and renal profile, and the peritoneal dialysis catheter was removed. Extensive investigation, including an analysis of heme oxygenase-1 gene promoter region polymorphisms, failed to identify a cause for the renal failure in this patient.     

Acute renal failure and myalgia in a transplant patient

A 64-yr-old man with kidney transplant for ESRD as a result of diabetic nephropathy presented with acute renal failure, weakness, myalgia, and pigmented urine. His medications included mycophenolate, cyclosporine, prednisone, furosemide, diltiazem, aspirin, simvastatin, an angiotensin receptor blocker, and insulin. A renal biopsy was performed. Pathologic findings and differential diagnosis are discussed, and the literature is reviewed.     

Acute renal failure in a young woman with Fisher-Evans' syndrome

A young female with Fisher-Evans' syndrome and a previous melanoma developed acute renal failure with generalized lymphoadenopathy and fever. The appearance of renal lesions is common in the course of several hematological disorders, but is unusual in Fisher-Evans' syndrome. Fisher-Evans' syndrome, defined as Coombs' positive hemolytic anemia and immune thrombocytopenia, is more frequently associated with the other autoimmune diseases, but not with renal involvement. In our case report, having excluded amyloidosis, myeloma, interstitial nephritis and sepsis, the rapid involvement of renal function with enlarged renal size seemed to suggest renal lymphoma. However, the lack of a monoclonal T-lymphocyte population in the renal tissue and peripheral blood, along with a clinical course characterized by a rapid reversibility of acute renal failure made this diagnosis rather an unlikely one. Polyclonal lymphocyte infiltration in a patient with a persistent autoimmune disease made us suspect a hyperimmune reaction. This syndrome is a non-neoplastic proliferation of B-cells involving an exaggeration of lymphocyte transformation. However, the clinical course is progressive and fatal, and can trigger a lymphoproliferative systemic disease. In our patient, two elements led us to suspect it was not a typical hyperimmune syndrome: first, polyclonal lymphocytes had massively infiltrated the kidney and, secondly, the clinical outcome was extremely favorable. Therefore, we were faced with an "atypical" and "singular" hyperimmune reaction with renal involvement, polyclonal proliferation of T-lymphocytes that had exhausted itself over time. Infective or toxic agents or drugs such as cyprofloxacin could have triggered the phenomenon, in the presence of a favorable condition such as Fisher-Evans' syndrome.     

Functional acute renal failure in a patient with carcinoid syndrome

Acute renal failure occurred in a patient with a carcinoid syndrome whenever he developed a flushing episode. Renal biopsy performed during one of these oliguric episodes did not reveal any lesions which could explain this reversible form of renal insufficiency. Urinary indices were not conclusive. Alteration of intrarenal hemodynamics by vasoactive compounds is proposed to be the causative mechanism of this relapsing acute oliguric renal failure.     

Acute renal failure due to tumor lysis syndrome in a HIV seropositive patient with Castleman's disease

Sir, Castleman's disease (CD), a rare lymphoproliferative disorder,is characterized by histological features of lymph node hyperplasiaand capillary proliferation. Conditions such as minimal-change,membranous, mesangioproliferative, membranoproliferative glomerulonephritis,thrombotic microangiopathy and renal amyloid have been reportedwith CD [1]. Acute renal failure (ARF) due     

Acute renal failure with glomerular thrombosis in a patient with chronic scleroderma

A 48-year-old woman with a 20-year history of scleroderma presented with malignant hypertension, thrombocytopenia, and acute renal failure. Renal biopsy demonstrated vascular changes consistent with scleroderma and glomerular thrombi. Her clinical course was consistent with hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP)-like syndrome. Plasma exchange therapy was associated with an improvement in renal function and rise in platelet count. This case suggests that acute renal failure in patients with scleroderma can be associated with glomerular thrombi and may improve with plasma exchange therapy.     

Nephrotic syndrome and renal failure in a patient with metastatic breast cancer

This report presents a case of nephrotic syndrome and renal failure that developed in a 53-year-old female with metastatic breast carcinoma. She was diagnosed to have osteolytic bone metastases 5?years prior to admission, and had been administered pamidronate with a total dose of approximately 6800?mg. A renal biopsy revealed tubulointerstitial damage and marked wrinkling and retraction of the glomerular basement membrane with hypertrophy and hyperplasia of the epithelial cells, compatible with the collapsing form of focal segmental glomerulosclerosis (FSGS). Despite the discontinuation of pamidronate after admission, her renal function gradually decreased. She was finally managed with continuous palliative care for advanced malignancy through a shared effort, and died 96?days after undergoing the renal biopsy. Although the clinical impact of the pamidronate-associated kidney injury on the longitudinal changes in renal function remains to be delineated, it is therefore reasonable to consider that the collapsing FSGS associated with tubulointerstitial damage may have resulted in the irreversible renal injuries that were observed in the current case. Further studies and accumulated experience with renal biopsy are required to better determine the relationship between pathological alterations and prognostic characteristics among patients with pamidronate-associated renal impairments.