Andrew Redfern1, Huda Mahmoud1, Tom McCulloch2, Adam Shardlow1, Matthew Hall3, Catherine Byrne3, Nicholas M Selby4. 1. Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom; 2. Department of Histopathology, Nottingham University Hospitals, Nottingham, United Kingdom; 3. Department of Renal Medicine, Nottingham City Hospital, Nottingham University Hospitals, Nottingham, United Kingdom; and. 4. Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom; Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom nicholas.selby@nottingham.ac.uk.
Abstract
BACKGROUNDS AND OBJECTIVES: This report describes six patients with AKI stages 2-3 (median admission creatinine level, 2.75 mg/dl [range, 1.58-5.44 mg/dl]), hematuria (five with hemoproteinuria), and unremarkable imaging with an unusual and unexplained histologic diagnosis on renal biopsy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The patients were young adults who presented to two neighboring United Kingdom nephrology centers over a 40-month period (between July 2010 and November 2013). Four were male, and the median age was 22.5 years (range, 18-27 years). Their principal symptoms were flank pain or lower back pain. All had consumed alcohol in the days leading up to admission. RESULTS: Renal biopsy demonstrated microthrombi in the renal arcuate veins with a corresponding stereotypical, localized inflammatory infiltrate at the corticomedullary junction. All patients recovered to baseline renal function with supportive care (median, 17 days; range, 6-60 days), and none required RRT. To date, additional investigations have not revealed an underlying cause for these histopathologic changes. Investigations have included screening for thrombophilic tendencies, renal vein Doppler ultrasonographic studies, and testing for recreational drugs and alcohol (including liquid chromatography-mass spectrometry of urine) to look for so-called designer drugs. Inquiries to the United Kingdom National Poisons Information Centre have identified no other cases with similar presentation or histologic findings. CONCLUSIONS: Increased awareness and additional study of future cases may lead to a greater understanding of the underlying pathophysiologic mechanisms that caused AKI in these patients.
BACKGROUNDS AND OBJECTIVES: This report describes six patients with AKI stages 2-3 (median admission creatinine level, 2.75 mg/dl [range, 1.58-5.44 mg/dl]), hematuria (five with hemoproteinuria), and unremarkable imaging with an unusual and unexplained histologic diagnosis on renal biopsy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The patients were young adults who presented to two neighboring United Kingdom nephrology centers over a 40-month period (between July 2010 and November 2013). Four were male, and the median age was 22.5 years (range, 18-27 years). Their principal symptoms were flank pain or lower back pain. All had consumed alcohol in the days leading up to admission. RESULTS: Renal biopsy demonstrated microthrombi in the renal arcuate veins with a corresponding stereotypical, localized inflammatory infiltrate at the corticomedullary junction. All patients recovered to baseline renal function with supportive care (median, 17 days; range, 6-60 days), and none required RRT. To date, additional investigations have not revealed an underlying cause for these histopathologic changes. Investigations have included screening for thrombophilic tendencies, renal vein Doppler ultrasonographic studies, and testing for recreational drugs and alcohol (including liquid chromatography-mass spectrometry of urine) to look for so-called designer drugs. Inquiries to the United Kingdom National Poisons Information Centre have identified no other cases with similar presentation or histologic findings. CONCLUSIONS: Increased awareness and additional study of future cases may lead to a greater understanding of the underlying pathophysiologic mechanisms that caused AKI in these patients.
Authors: Nicholas M Selby; Lisa Crowley; Richard J Fluck; Christopher W McIntyre; John Monaghan; Nigel Lawson; Nitin V Kolhe Journal: Clin J Am Soc Nephrol Date: 2012-02-23 Impact factor: 8.237
Authors: Waldemar E Wysokinski; Izabela Gosk-Bierska; Eddie L Greene; Diane Grill; Heather Wiste; Robert D McBane Journal: Am J Kidney Dis Date: 2008-02 Impact factor: 8.860