The Use of Low-Calcium Hemodialysis in the Treatment of Hypercalcemic Crisis

Background: We reviewed the results of low-calcium hemodialysis (LCHD; 1.25 mmol/L) in the treatment of 42 cases admitting with hypercalcemic crisis. Methods: All patients (>= 18 years) who started LCHD due to hypercalcemia between 2002 and 2017 were retrospectively analyzed. Biochemical data were obtained at the beginning of the first hemodialysis and at the end of the last hemodialysis. "Refractory" cases were defined as patients having albumin corrected serum total calcium (SCatotal) levels above 10.2 mg/dL despite of all medical, surgical, and hemodialysis treatments. Results: By acceptance of 3 cases admitted again over 6 months as new cases, a total of 42 cases (male, 57.1%) with a mean age of 55.9 +/- 14.8 years underwent urgent hemodialysis. Most of the patients (82.1%) had malignancies. The mean SCatotal level at the beginning of hemodialysis sessions was 15.89 +/- 2.53 mg/dL. The mean decline of SCatotal level was 4.63 +/- 2.72 mg/dL. Refractory cases received hemodialysis after admission significantly later than improved cases (48 [interquartile ranges (IQR) 24-168] vs. 24 [IQR 12-48] h, p = 0.010). Serum creatinine and SCatotal levels at the last visit were significantly more in refractory cases than improved cases (1.92 [IQR 0.81-3.41] vs. 1.30 [IQR 0.81.7] mg/dL, p = 0.031 and 12.43 +/- 2.53 vs. 8.86 +/- 0.67 mg/dL, p = 0.000 respectively). Mortality was significantly higher in refractory cases than improved cases (58.8 vs. 10.5%, p = 0.002). Overall mortality rate was 33.3%. Conclusion: Hypercalcemic crisis is a life-threatening condition and should be managed immediately. (C) 2018 S. Karger AG, Base

A Rare Presentation of Immunoglobulin A Nephropathy: Acute Kidney Injury

Background: Acute kidney injury (AKI) is known as an uncommon presentation in immunoglobulin A nephropathy (IgAN). The aim of our study was to analyze the clinical data and biopsy findings in IgAN patients presenting with AKI. Methods: We performed a retrospective analysis of all subjects who had biopsy-proven IgAN and presented with AKI during June 2002 September 2015. The following data were obtained from medical records. Results: A total of 15 patients of 123 patients (12.2%) with primary IgAN admitted with AKI. Patients were generally male (73.3%), with a median age of 38 (interquartile range; IQR, 2,944) years. The serum creatinine at admission was above the normal range (median 2.3 [IQR, 2.14.7] mg/dL]). On histology, cellular/fibrocellular crescents were present in 6 patients. In most cases (53.3%), pathologic abnormalities associated with acute tubular injury/necrosis were defined. Red blood cell casts in tubules were present in 6 cases (40%). In all cases, interstitial mixed inflammatory cell infiltration was observed. In 4 cases, admixed eosinophils were also found. In 3 patients, biopsy specimens showed acute thrombotic microangiopathy lesions (20%). Median follow-up time was 13 (IQR, 346) months. Six patients (40%) progressed to end-stage renal disease ESRD). Among patients diagnosed with primary IgAN and presenting without AKI, only 4 patients progressed to ESRD. The proportion of patients who progressed to ESRD presenting with AKI was significantly higher than the patients presenting without AKI (p = 0.000). Conclusions: In conclusion, AKI complicates IgAN more often. (C) 2017 S. Karger AG, Base

Candidal psoas abscess following persistent pyuria in a renal transplant recipient

Candidal infections occur commonly in renal transplant recipients especially in genitourinary system. Although the epidemiology of candiduria has not been well characterized in renal transplant population, it is the most common cause of fungal infections. However, candidal psoas abscess is very rare in the literature. We report a 42-year-old male renal transplant recipient with prolonged pyuria and candiduria followed by candidal psoas abscess formation. The treatment consisted of prolonged antifungal therapy along with percutaneous drainage. However, eventually, a surgical drainage had to be performed for the successful eradication