Introduction: Chlorprothixene is a typical antipsychotic, primarily used in the treatment of psychotic disorders. Overdose may result in severe cardiovascular and central nervous system toxicity. Evidence on the effectiveness of extracorporeal elimination is scarce. Case Presentation: A 19-year-old female ingested 5 g of chlorprothixene in a suicide attempt. Upon admission to the intensive care unit, she was awake, responsive, and oriented. Initial management included 50 g of activated charcoal. As doses of >2 g chlorprothixene can cause severe intoxication and death, attempts to enhance drug elimination by extracorporeal therapy were undertaken. Therapeutic plasma exchange (TPE) was initiated approximately 3 h after admission, exchanging 5,096 mL of plasma with albumin solution and FFP over 3 h 10 min. This was followed by a 10 h 10 min prolonged intermittent kidney replacement therapy (PIKRT). Serial blood, apheresis, and dialyzate samples were collected to quantify drug removal. Both procedures were well tolerated. The patient remained clinically stable and was transferred to a psychiatric facility 24 h post-admission. Conclusion: Although chlorprothixene plasma levels decreased, the amount of chlorprothixene removed by TPE and PIKRT was negligible, classifying the drug as “not dialyzable” per EXTRIP criteria. Given the limited clinical evidence and the pharmacokinetic properties of chlorprothixene, TPE cannot be recommended for the management of chlorprothixene overdose and should not be regarded as a standard treatment option. According to the available literature, this is the first description of chlorprothixene intoxication managed with both TPE and high-flux hemodialysis, highlighting the limited extracorporeal removal of this drug.

Acute kidney injury (AKI) is defined as an increase in serum creatinine with or without a reduction in urine output, according to the Kidney Disease: Improving Global Outcomes guidelines. Oxalate nephropathy (ON) is a rare cause of AKI in children. We report a case of oliguric AKI associated with exposure to a cosmetic hair-treatment product leading to ON. To our knowledge, there are limited reports of similar pediatric cases in Saudi Arabia. An 8-year-old previously healthy girl presented with facial edema, abdominal distension, oliguria, and hypertension 2 days after a single application of an unidentified hair-treatment product. Laboratory evaluation confirmed severe AKI. Renal biopsy demonstrated acute tubular necrosis with calcium oxalate crystal deposition, confirming ON. She was managed conservatively with cautious fluid administration, intravenous furosemide, correction of electrolyte abnormalities, antihypertensive therapy, and a low-oxalate diet. Renal function normalized within 1 month, with sustained recovery and no evidence of recurrence on subsequent follow-up. Exposure to certain cosmetic hair-treatment products may cause secondary hyperoxaluria and AKI in children, underscoring the need for heightened awareness and stricter regulation of unlabeled cosmetic products to prevent potential nephrotoxicity.

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune vasculitis that often leads to rapidly progressive glomerulonephritis and poor renal prognosis. Standard treatment typically involves plasmapheresis, corticosteroids, and cyclophosphamide. However, the therapeutic role of obinutuzumab, a B-cell-depleting monoclonal antibody, remains under-explored in anti-GBM disease. Case Presentation: We report a 20-year-old male with isolated renal anti-GBM disease following a dental infection, who presented with severe acute kidney injury (creatinine >700 μmol/L), high anti-GBM antibody titers, and crescentic glomerulonephritis on biopsy. Despite initial therapy with plasmapheresis, corticosteroids, and cyclophosphamide, renal function deteriorated. Obinutuzumab (500 mg IV) was administered as adjunct therapy, leading to rapid antibody clearance within 1 month. Remarkably, the patient achieved partial renal recovery and was dialysis-independent by 3 months, with stable stage 3 chronic kidney disease at 5-month follow-up. Conclusion: This case underscores the potential role of obinutuzumab as an innovative adjunctive therapy in severe anti-GBM disease, even in patients with traditionally poor prognostic markers. Early and aggressive multimodal treatment, including B-cell targeting, may improve outcomes in selected cases.

Introduction: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic autoimmune disease characterized by diverse clinical manifestations. Central diabetes insipidus resulting from pituitary involvement in AAV is exceedingly rare. Case Presentation: This article presented a rare case of a young patient with a medical history of 8 years, who presented with sinusitis, pituitary microadenoma with central diabetes insipidus, acute renal injury, right abducens nerve paralysis (strabismus, diplopia), and most cases were not accompanied by an increase of ANCA titer. Conclusion: Our case showed that granulomatosis with polyangiitis (GPA) has a variety of clinical manifestations and rapid progression. The patient was diagnosed with GPA and treated with glucocorticoids combined with cyclophosphamide and desmopressin. Following treatment, his renal impairment, diabetes insipidus, and diplopia improved, achieving clinical remission. This case underscores the importance of timely diagnosis and treatment for the patient’s prognosis.

Introduction: IgA nephropathy with minimal change disease (MCD-IgAN) is a rare subtype of IgAN with a high rate of response to corticosteroids but a poor prognosis in steroid-dependent (SD) patients. Case Presentation: A young male patient with SD-MCD-IgAN, who was treated sequentially with rituximab (RTX) and later with obinutuzumab (OBZ) over a 10-year follow-up period, initially presented with nephrotic syndrome and achieved rapid complete remission (CR) with full-dose corticosteroids. However, during the first 2 years, the patient experienced four relapses despite the addition of various immunosuppressants. These relapses were accompanied by complications such as skin infections, acute kidney injury, and serosal effusions. The initial renal biopsy revealed MCD-IgAN, while a repeat biopsy 8 months later revealed IgAN with focal segmental glomerulosclerosis. RTX (375 mg/m2) was introduced after remission was achieved with full-dose corticosteroids. The patient remained in CR with RTX administered based on CD19+ B-cell counts for an initial period of 3 years. Following discontinuation of medication for the subsequent 3 years, the patient experienced a relapse but achieved CR again with low-dose corticosteroids and a single dose of RTX (1.0 g). However, the patient experienced a further relapse after another 3 years of medication cessation. Subsequently, OBZ (1.0 g) was administered along with low-dose corticosteroids, leading to rapid CR and long-term medication-free status. Conclusion: In SD-MCD-IgAN, anti-CD20 maintenance therapy during CR reduces relapse and enables long-term steroid-free remission. If relapse occurs later, it can be controlled with low-dose steroids and resumed anti-CD20 therapy, re-establishing sustained remission.

Introduction: Chronic kidney disease (CKD) in children poses unique challenges, especially in resource-poor developing countries, with limited facilities for renal replacement therapy (RRT). We present three cases of children with end-stage renal disease from Sri Lanka in whom traditional access has been exhausted secondary to sepsis and thrombosis. Case Presentations: Three patients were not candidates for peritoneal dialysis, and several attempts for tunnelled and non-tunnelled catheters limited the ability to continue RRT until the donor work-up for transplantation was completed. Therefore, surgical placement of a vascular catheter (vascath) to enter the inferior vena cava (IVC) directly was performed under general anaesthesia. Patient 1, a nine-year-old boy, successfully maintained dialysis through the IVC catheter until transplantation. Patient 2, a fourteen-year-old boy with extensive thrombosis, underwent successful cannulation with good outcomes at 4 months’ follow-up. Patient 3, a twelve-year-old girl post-nephrectomy, initially dialysed successfully but later died due to cardiac failure unrelated to the access site. This procedure provided effective haemodialysis access, mitigating severe volume overload and hyperkalaemia. They also tolerated subsequent dialysis sessions well. Conclusion: This case series highlights the critical role of unconventional dialysis access methods in resource-constrained settings, where advanced interventional radiology options may be unavailable. While IVC cannulation for haemodialysis is more commonly described in adults, these are the first reported cases of vascath insertion into the IVC in paediatric patients. Additionally, these findings underscore the importance of innovative strategies to manage paediatric CKD in low-resource settings, pending definitive renal transplantation.

Introduction: Peritoneal dialysis (PD)-associated peritonitis caused by rare non-fermenting Gram-negative organisms represents a diagnostic and therapeutic challenge, particularly in patients with prolonged antibiotic exposure and biofilm-associated catheter infections. Case Presentation: We report the case of a 44-year-old male PD patient who developed relapsing polymicrobial PD-associated peritonitis involving Elizabethkingia miricola, Brevundimonas diminuta, Stenotrophomonas maltophilia, and Staphylococcus haemolyticus. Despite repeated susceptibility-guided intraperitoneal antibiotic therapy, inflammatory markers and dialyzate leukocytosis persisted. Multiple cultures consistently identified rare non-fermenting Gram-negative pathogens. Following prolonged discussion, the PD catheter was removed, and the patient transitioned to hemodialysis, followed by targeted oral antimicrobial therapy. Clinical and laboratory resolution occurred within 3 weeks after catheter removal. Conclusion: Rare environmental non-fermenting Gram-negative pathogens should be recognized as clinically relevant causes of relapsing PD-associated peritonitis. Persistent or polymicrobial infections should prompt early consideration of catheter removal in accordance with current ISPD recommendations.

Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is the most common plasma cell dyscrasia, defined by clonal monoclonal immunoglobulin (MIg) in serum and/or urine in the absence of end-organ damage caused by plasma cell proliferation. By contrast, monoclonal gammopathy of renal significance (MGRS) encompasses a spectrum of kidney disorders directly or indirectly driven by MIg, with clinical phenotypes ranging from insidious proteinuria to rapidly progressive glomerulonephritis. The diagnostic ambiguity arising when MGUS coexists with renal dysfunction remains a major clinical challenge. Here, we report a rare case of a patient initially suspected to have MGRS complicated by pauci-immune crescentic glomerulonephritis (PICGN). However, this diagnosis was ultimately excluded by the absence of MIg deposits in renal tissue on histopathological examination. Case Presentation: We describe a female with concurrent PICGN and MGUS, presented with acute kidney injury, proteinuria, and hematuria, with renal biopsy revealing type III crescentic glomerulonephritis and immunofluorescence showing weak positivity for κ and λ MIg deposits. Despite initial suspicion of MGRS, immuno-electron microscopy did not confirm monoclonal light chain deposition, leading to a final diagnosis of PICGN and MGUS. Conclusions: This case underscores the importance of integrating serological, histopathological, and advanced imaging techniques to distinguish between autoimmune and plasma cell dyscrasias in renal pathology. It also emphasizes the limitations of immunofluorescence alone in diagnosing MGRS and the necessity of immuno-electron microscopy for definitive exclusion. This report calls for further research into the pathophysiological interactions between ANCA-associated vasculitis and monoclonal gammopathies, particularly in cases with overlapping renal injury features.

Karger Publishers and the editors of Case Reports in Nephrology and Dialysis would like to thank the reviewers for their ongoing support in reviewing manuscripts for our Journal in 2025. This year we have chosen not to disclose the names of our reviewers to preserve the principle of anonymity inherent to the single-blind peer-review we follow. Even so, this should not be in our way to sincerely thank all contributing reviewers who have volunteered their time, effort, and expertise in benefit of the quality of the manuscripts we received and published in 2025. Individual reviewers can still claim their personal “Certificate of Review” via the Journal’s manuscript submission system.

Introduction: Latex allergy is a leading cause of perioperative anaphylaxis, yet the risk of graft-mediated exposure during solid organ transplantation is poorly characterised. Case Presentation: We report the case of a 45-year-old man with end-stage renal disease and confirmed latex allergy who underwent kidney transplantation with a graft that had been handled with latex gloves during procurement. Following multidisciplinary discussion, the graft was repeatedly rinsed with preservation solution to reduce antigenic load. The operating theatre was prepared as latex-free, and the anaesthesia team implemented enhanced readiness for anaphylaxis. The surgery and perioperative course were uneventful, and the patient was extubated in theatre and transferred to intensive care without complication. Conclusion: This case underscores the potential for graft-mediated anaphylaxis due to latex contamination during procurement. Systematic latex avoidance from organ retrieval to implantation, along with communication between procurement and implant teams, is crucial to mitigate risk in sensitised recipients.