Unexpected cause of acute renal failure in an 85-year-old woman

Acute postinfectious glomerulonephritis (APIGN) is usually diagnosed in young people, while in elderly people rapidly progressive forms appear to be the most important glomerular disease causing acute renal failure. We report on a 85-year-old woman with acute renal failure due to APIGN. An 85-year-old woman with a history of hypertension and cerebrovascular disease was hospitalized because of diarrhea and syncope associated with atrial fibrillation. She was found to have left lower lobe pneumonia. Serum creatinine was over 2 mg/dL. Fluids were given, without improvement in renal function but leading to volume overload instead. Within a few days serum creatinine reached a level of 5.4 mg/dL with reduction of urine output despite administration of diuretics. The patient developed hematuria and purpura of the feet. Serum IgA was high and the urine sediment showed casts. Methylprednisolone 125 mg i.v. was given for three days followed by prednisone 50 mg daily. The patient's clinical condition gradually improved and serum creatinine decreased to 1.9 mg/dL. Renal biopsy showed APIGN. During hospitalization, three major complications occurred: hemodynamic instability due to atrial fibrillation, Clostridium difficile colitis and urinary tract infections due to Enterococcus faecalis and Candida tropicans, all successfully treated. APIGN should be taken into account as a cause of acute renal failure in hospitalized elderly patients with many comorbidities

L'interessamento renale nella sindrome di Sjogren

Il coinvolgimnto renale è abbastanza frequente in corso di Sindrome di Sjogren. Nella maggioranza dei casi decorre in modo subclinico e asintomatioco. La lesione istopatologica più frequente è la nefrite tubulointerstiziale. Rara è la glomerulonefrite, segnalata per lo più in presenza di crioglobuline

Effects of spermidine synthase inhibition in cultured chick embryo fibroblasts.

The administration of bis-cyclohexylammonium sulfate (BCHS), a spermidine synthase inhibitor, to in vitro cultures of chick embryo fibroblasts caused a decrease in cellular spermidine levels and an increase in putrescine and spermine. Cell proliferation rate and DNA synthesis were also inhibited. As protein synthesis did not change, it would seem that low levels of cellular spermidine inhibit cell growth depressing DNA synthesis

Effects of spermidine synthase inhibition on cytoskeletal organization in cultured chick embryo fibroblasts.

The administration of bis-cyclohexylammonium sulphate (BCHS), an inhibitor of spermidine synthase, to cultured chick embryo fibroblasts provoked alterations in cell morphology, a marked disorganization of microfilaments and changes in microtubule network structure. In addition, the rate of microtubule reappearance, after disrupting them with colchicine, was impaired by BCHS. These responses to BCHS were prevented by spermidine addition, which thus suggests an involvement of spermidine in microtubule and microfilament organization

Fibrillary comma-shaped electron-dense organized glomerular deposits associated with cryoglobulinaemia

We describe a very particular electron microscopy finding in cryoglobulinemi

Light chain deposition disease presenting as paroxysmal atrial fibrillation: A case report

Introduction: Light chain deposition disease (LCDD) can involve the heart and cause severe heart failure. Cardiac involvement is usually described in the advanced stages of the disease. We report the case of a woman in whom restrictive cardiomyopathy due to LCDD presented with paroxysmal atrial fibrillation. Case presentation: A 55-year-old woman was admitted to our emergency department because of palpitations. In a recent blood test, serum creatinine was 1.4 mg/dl. She was found to have high blood pressure, left ventricular hypertrophy and paroxysmal atrial fibrillation. An ACE-inhibitor was prescribed but her renal function rapidly worsened and she was admitted to our nephrology unit. On admission serum creatinine was 9.4 mg/dl, potassium 6.8 mmol/l, haemoglobin 7.7 g/dl, N-terminal pro-brain natriuretic peptide 29894 pg/ml. A central venous catheter was inserted and haemodialysis was started. She underwent a renal biopsy which showed kappa LCDD. Bone marrow aspiration and bone biopsy demonstrated kappa light chain multiple myeloma. Echocardiographic findings were consistent with restrictive cardiomyopathy. Thalidomide and dexamethasone were prescribed, and a peritoneal catheter was inserted. Peritoneal dialysis has now been performed for 15 months without complications. Discussion: Despite the predominant tubular deposition of kappa light chain, in our patient the first clinical manifestation of LCDD was cardiac disease manifesting as atrial fibrillation and the correct diagnosis was delayed. The clinical management initially addressed the cardiovascular symptoms without paying sufficient attention to the pre-existing slight increase in our patient's serum creatinine. However cardiac involvement is a quite uncommon presentation of LCDD, and this unusual case suggests that the onset of acute arrhythmias associated with restrictive cardiomyopathy and impaired renal function might be related to LCDD

Fistola artero-venosa renale iatrogenain sindrome di Wegener: embolizzazione percutanea

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