Progressive Acute Renal Failure Research Articles

Antineutrophil cytoplasmic antibody-associated vasculitis with systemic sclerosis: a fatal case report

Introduction and importance: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare co-occurrence with systemic sclerosis, in around 2.5–9% of patients. The clinical manifestations and prognosis of vasculitis in systemic sclerosis depend on organ involvement. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers get along with purpuric vasculitis in some cases reports. Reports had found that survival in those with pulmonary-renal syndrome is poor. However, high-dose corticosteroids and cyclophosphamide increase the survival percent in those patients. Case presentation: An 81-year-old female was admitted for newly diagnosed acute renal failure and highly elevated C-reactive protein levels. She was diagnosed with systemic sclerosis 8 years previously, with a 3-year history of interstitial lung disease, and a 2-year history of pulmonary hypertension. Treatment included home oxygen on demand, prednisone 5 mg/day, and azathioprine 75 mg daily. On physical examination, she had sclerodactyly, both extremities ulcers, severe livedo reticularis, and hyperpigmented papules on her hand and feet. Laboratory findings included a markedly positive MPO (p-ANCA), and anti-Scl-70. She was treated with pulse methylprednisolone without any improvement. After a day, she developed anuria and became comatose. Then, she developed cardiac arrest, leading to death. Clinical discussion: The presence of ANCA in systemic sclerosis patients ranges from 2.5 to 9% of systemic sclerosis patients. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers. The treatment with high-dose corticosteroids and cyclophosphamide is benefit. Survival in those with pulmonary-renal syndrome is poor. Conclusion: The presence of ANCA-associated vasculitis is rarely reported with scleroderma. It occurs most commonly in women with limited or Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) variants of scleroderma, as well as those with overlap features. Severe manifestations including pulmonary-renal syndrome and death may occur.

#4852 LATE REFERRAL OF PATIENTS WITH AN UNKNOWN CAUSE OF CHRONIC KIDNEY DISEASE AND MALIGNANT HYPERTENSION

Abstract Introduction Systemic sclerosis (SS) is a rare connective tissue disorder characterized by widespread vascular dysfunction and progressive skin and internal organ fibrosis. Scleroderma renal crisis (SRC) is a life-threatening complication of SS. The estimated incidence of SSc is approximately 20 cases per million per year, and SRC affects about 5-15% of those patients. Case Description A 32-year-old female was admitted to the hospital with dyspnea, edema, HTN, COPD. 4 months before the hospitalization, she had an abrupt onset of HTN (230/120 mm/Hg) and seizures (no abnormal waveforms on EEG). Vital signs: HR 90’, RR 22’, BP 197/121 mmHg, SpO2 90% on room air. PEx: severe jugular venous dilation, crackles in both lungs, 3+ pitting edema bilaterally. The skin appeared abnormal with a modified Rodnan score “9” out of “51” with puffy hands, sclerodactyly, telangiectasia, and Raynaud's phenomena. Lab: creatinine 406 mcmol/L, urea 20.8 mmol/L, T.Ca 2.04 mmol/L, P 1.71 mmol/L, PTH 255.5 pg./mL, Alb 33 g/L, LDH 596 U/L. Urinalysis: UPCR of 4.169 mg/mg creat. microhematuria ANA were positive for centromere pattern with a titer of >400 AU/mL (N <40), CENP-B +++, negative for anti-Scl70, anti-dsDNA, ANCA, Anti-GBM, anti-CCP, RF, anti-Jo1 and anti-Smith antibodies. A kidney biopsy showed acute tubular injury in the early stage, and later stages of interstitial fibrosis and tubular atrophy; chronic active thrombotic microangiopathy (TMA), vascular abnormalities including intimal accumulation of myxoid material, thrombosis, fibrinoid necrosis consistent with Scleroderma Renal Crisis (Fig.3; 4; 5; 6; 7) The patient started treatment with losartan 100mg. 3 months later she started hemodialysis due to diuretic refractory overhydration with severe pulmonary edema resulting in multiple hospital readmissions. Discussion SRC is a dreaded complication of systemic sclerosis that is characterized by new-onset malignant hypertension and progressive acute renal failure, often with associated microangiopathic hemolytic anemia and thrombocytopenia, occurring in ≈ 5–15% of cases, of which 2% occur with the Limited cutaneous systemic sclerosis (lcSS) and 12% in the Diffuse cutaneous systemic sclerosis (dcSS). Histopathologically SRC can be divided into narrowly defined nd-SRC and SSc-associated TMA: nd-SRC is a typical type of SRC, which shows acute renal failure and abrupt onset of moderate-to-significant hypertension. The pathology of nd-SRC shows injured endothelial cells and subsequent intimal thickening in the arcuate and interlobular arteries. The pathology of SSc-TMA shows abnormalities in the capillary wall which eventually leads to microvascular thrombosis. Our case demonstrates severe damage to the kidney, presenting with combined nd-SRC and SSc-TMA, inevitabley leading to irreversible changes resulting in CKD. Notably, until the kidney histopathology workup, neither clinical presentation nor lab tests revealed typical TMA. SRC was at one time almost uniformly fatal, with death often occurring within a few weeks. With the development of ACE-I, survival has improved dramatically, but death rates remain unacceptably high. Unfortunately, some will require chronic dialysis. However, when timely and appropriately managed, renal function can improve considerably, although it may take several months to years, allowing for discontinuation of dialysis. Conclusion SSc should be considered in any patient presenting with malignant hypertension and AKI. SRC can occur in patients without evidence of skin thickening or other manifestations of SSc. Early diagnosis improves outcome. Kidney biopsy should be gold standard in all patients with ``unknown'' causes of the CKD. ACEi remains the cornerstone of the treatment. Renal Transplantation: to discuss after two years after start of dialysis.

Pathogenetic relationship between kidney pathologies and the microcirculatory capillary layer in dogs under the influence of Babesia canis

With babesiosis in dogs, the capillary network is especially strongly affected due to the stimulation of the hemostasis system and the development of thrombus formation in the microvasculature. Acute renal failure and even death of animals are caused by shock phenomena and the syndrome of disseminated intravascular coagulation. Clinical, laboratory (hematological, biochemical, coagulometric, hemodynamic, enzyme immunoassay) methods of research were conducted. Dogs with babesiosis have fever, anemia, and hemoglobinuria, hematologically established anemia, systemic inflammation, thrombotic condition. Hemodynamic parameters determine the state of shock, which in dynamics becomes decompensated and irreversible. The appearance of poikilocytes in the blood of sick dogs indicates significant metabolic disorders in their body. The coagulogram reveals the syndrome of disseminated intravascular coagulation. Syndrome markers significantly changed with a trend to increase during nephropathy. In addition, uremia, hyperuricemia, hyperkalemia, hyponatremia, hyperphosphatemia, creatininemia were found in the sick dogs, which are reliable indicators and determine the development of an acute form of glomerulonephritis and progressive acute renal failure. According to the study of the general biochemical status in animals, hepatopathy in the form of acute hepatitis and pancreatitis, and general intoxication syndrome were established. In our findings: during acute spontaneous babesiosis, dogs developed nephropathy, which has two clinical stages: hemoglobinuria and oliguria/anuria. The pathogenetic basis for the development of glomerulonephritis and acute renal failure is the syndrome of disseminated intravascular coagulation in response to the influence of a pathogen, which causes shock, forming a vicious circle of shock. Under such conditions, renal failure increases and eventually leads to the death of the animal. The studied data will contribute to the expansion of the conceptual understanding of the pathogenesis of canine babesiosis and determine the leading role of complications in the development of kidney failure.

ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19) AND LITERATURE REVIEW

The coronavirus disease 2019 (COVID-19) outbreak has quickly become a global pandemic. Most patients with COVID-19 have mild symptoms, but develop severe symptoms as well, which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Renal involvement is common, with a clinical presentation ranging from mild proteinuria to progressive acute renal failure requiring renal replacement therapy (RRT). An understanding of the pathophysiology and mechanisms of kidney injury and ARI in the context of critical illness and COVID-19 We conducted a literature review to identify the impact of COVID 19 infection on the occurrence of acute renal failure. We specifically analyzed kidney functions in COVID-19 patients and their relationship to mortality. Only acute renal failure (ARI) directly linked to SARS-CoV 2 infection is considered other causes of renal failure of hemodynamic, iatrogenic or other origin are excluded.

Ovarian Hyperstimulation Syndrome (OHS): A Rare Cause of Acute Renal Failure: A Case Report

We report in this work, the evolution and management of a case of ovarian hyperstimulation syndrome (OHS) complicated by severe acute renal failure (ARI). A young 31-year-old patient pregnant with twins after 17 weeks of amenorrhea was admitted to nephrology department for rapidly progressive acute renal failure (AKI) (creatinine increases in 48 hours from 28mg/l to 55mg/l) and was complicated by major hydro-electrolyte disorders and multi-organ failure. Her past medical history revealed an ovulation induction before her last pregnancy and a spontaneous abortion seven years ago before her hospitalization which occurred in the 2nd trimester of her 1st twin pregnancy obtained by medically assisted reproduction. Despite optimal care, the patient improves her renal function and her multiorgan failure after abortion in gynecological intensive care. Because of worldwide increase of infertility cases and the use of new ovulation induction techniques with these risks of serious complications, we report this interesting clinical case of OHS.

Light chain deposition disease involving kidney and liver in a patient with IgD myeloma

BackgroundIgD multiple myeloma (MM) is a rare subtype of MM and light chain deposition disease (LCDD) outside the kidney is also a rare and has scarcely been reported. We report herein the details of the first reported case of LCDD involving the kidney and liver co-occurring with IgD myeloma.Case presentationA 66-year-old female with IgD MM presented with rapidly progressive acute renal failure, ascites and pleural effusion. Immunofluorescent study of revealed the characteristic linear deposition of Igκ light chain along the glomerular and tubular basement membrane in kidney. Electron microscopy showed the powdery electron-dense deposits along the tubular and glomerular basement membrane consistent with the diagnosis of LCDD. Laser microdissection followed by mass spectrometry identified only Igκ light chain with more than 95% probability confirm the diagnosis of κ-LCDD but not heavy/light chain deposition disease. Liver biopsy with immunofluorescence study revealed the linear deposition of Igκ chain along the perisinusoidal space indicating the hepatic involvement of κ-LCDD. The patient was successfully treated with combination therapy with bortezomib, cyclophosphamide, dexamethasone, and daratumumab.ConclusionsThis report emphasizes that prompt biopsy of affected organs and initiation of clone directed therapy led to the correct diagnosis and favorable outcome in patient with LCDD who has extrarenal involvement.

HIV-Associated Nephropathy in Africa: Pathology, Clinical Presentation and Strategy for Prevention.

The human immunodeficiency virus (HIV) infection can lead to progressive decline in renal function known as HIV-associated nephropathy (HIVAN). Importantly, individuals of African ancestry are more at risk of developing HIVAN than their European descent counterparts. An in-depth search on Google Scholar, Medline and PubMed was conducted using the terms “HIVAN” and “pathology and clinical presentation”, in addition to “prevalence and risk factors for HIVAN”, with special emphasis on African countries for any articles published between 1990 and 2017. HIVAN is characterized by progressive acute renal failure, proteinuria and enlarged kidneys. A renal biopsy is necessary to establish definitive diagnosis. Risk factors are male gender, low CD4 counts, high viral load and long use of combined antiretroviral medication (cART). There is a wide geographical variation in the prevalence of HIVAN as it ranges from 4.7% to 38% worldwide and little published literature is available about its prevalence in African nations. Microalbuminuria is a common finding in African populations and is significantly associated with severity of HIV disease progression and CD4 count less than 350 cells/µL. Other clinical presentations in African populations include acute kidney injury (AKI), nephrotic syndrome and chronic kidney disease. The main HIV-associated renal pathological lesions were focal segmental glomerulosclerosis, mainly the collapsing form, acute interstitial nephritis (AIN), and immune complex-mediated glomerulonephritis (ICGN). HIV infection-induced transcriptional program in renal tubular epithelial cells as well as genetic factors is incriminated in the pathogenesis of HIVAN. This narrative review discusses the prevalence, presentation, pathogenesis and the management of HIVAN in Africa. In low resource setting countries in Africa, dealing with HIV complications like HIVAN may add more of a burden on the health system (particularly renal units) than HIV medication itself. Therefore, the obvious recommendation is early use of cART in order to decrease risk factors that lead to HIVAN.

Renal biopsy: Still a landmark for the nephrologist.

Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefits must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.

Atypical Haemolytic Uraemic Syndrome Associated with Cabazitaxel in Advanced Prostate Cancer

Atypical haemolytic uraemic syndrome, (aHUS) is a rare but potentially lifethreatening condition with clinical manifestations of haemolytic anaemia, thrombocytopenia, and renal failure. We report the first case of aHUS secondary to cabazitaxel in the setting of metastatic castrate resistant prostate cancer. In July 2015, a 73 year old male presented with acute on chronic back pain, in the context of metastatic castrate-resistant prostate cancer with known pulmonary and skeletal metastases. He was day 3 into his first cycle of cabazitaxel. Within 24 hours of admission, he acutely deteriorated with progressive drowsiness and the development of an acute kidney injury. During this period, he developed acute thrombocytopenia, falling to 58 x 109/L and haemolytic anaemia. He had a coagulopathy, with an elevated INR 1.5, but with a normal APTT and fibrinogen levels. He was subsequently diagnosed with an atypical haemolytic uraemic syndrome. In light of his rapid decline and poor prognosis he was managed with conservative treatment. Over the next 24 hours, he developed progressive acute renal failure and ongoing haemolysis. There was further neurological deterioration which culminated in his passing away three days following his initial presentation. With the

Development of Acute Renal Failure after Magnetic Resonance with Gadopentetate

Gadolinium (Gd) based contrast materials are traditionally considered non nephrotoxic. In the past, acute renal failure (ARF) has been reported after gadolinium administration in some publications. A 65 year old female patient was underwent upper abdominal MR examination. She had no history of diabetes, hypertension and kidney problems. Neither there was any history of NSAIDs nor nephrotoxic agents. During examination process, 50mg gadopentetate was used. Three days later, rapidly progressive anuric acute renal failure developed. In anesthesia intensive care unit, she was underwent dialysis for six sessions. Her renal biopsy was carried out and its results turned out to be acute tubular necrosis and acute intersistial nephritis. Acute renal failure improved after subsequent hemodialysis sessions. General condition and laboratory values improved, all treatment was gradually withdrawn and and the patient was discharged without any complications.

A Transient Proteinuria: An Unusual Complication of Hypothyroidism

Background: Although the effect of thyroid hormones is very important on renal function and glomerular filtration rate, it is often overlooked. Hypothyroidism is sometimes accompanied by a decrease in the glomerular filtration rate and hyponatremia. Observation: A33-year-old man was admitted in intensive care unit for an inaugural diabetic ketoacidosis in December 2012. He has been diagnosed as hypothyroidism case since 2005. He had a replacement therapy that he had given up in 2011. On The physical examination he exhibited a general fatigue with fever and sweats. He suffered from myalgia and proximal muscle weakness, edema of renal type and a few crackles. The biology showed ketoacidosis, progressive acute renal failure of deterioration associated with important rhabdomyolysis and proteinuria of 5.7 g/24 h. Normal eye fundus was able to rule out diabetic nephropathy. In addition to the treatment of ketoacidosis, lung disease and the fluid overload, hormone replacement therapy was reinstituted. The evolution was marked bythe disappearance of edema, fever, rhabdomyolysis and proteinuria. Discussion: The rhabdomyolysis, secondary to hypothyroidism, is atthe origin of renal failure. In this case, proteinuria is exceptional. Themajor part of the renal manifestations during thyroid dysfunctions isreversible with hormone therapy. Conclusion: Transient proteinuria isexceptional in hypothyroidism. It is another face of kidney involvementin thyroid disorders.

Successful treatment of methemoglobinemia and acute renal failure after indoxacarb poisoning

Context. We report a case of systemic toxicity induced by indoxacarb, an oxadiazine insecticide. Previous reports have suggested the occurrence of methemoglobinemia after indoxacarb ingestion, but no case of indoxacarb-induced systemic toxicity, such as acute renal failure, has been reported thus far. Case details. A 71-year-old woman presented with indoxacarb poisoning, resulting in methemoglobinemia and acute renal failure. The methemoglobinemia improved after methylene blue administration, but rapidly progressive acute renal failure occurred 7 h after admission. She was treated with continuous veno-venous hemofiltration and intravenous sodium bicarbonate and recovered successfully. Discussion. Ingestion of indoxacarb may produce not only methemoglobinemia, but also systemic toxicities like acute renal failure, which can be successfully treated with aggressive therapy such as continuous veno-venous hemofiltration. Physicians should be alert to acute renal failure as a possible complication of indoxacarb ingestion, and treat it accordingly.

Spontaneous tumor lysis syndrome with resolution of pancytopenia and disappearance of lymphadenopathy in a patient with peripheral T cell lymphoma unspecified

Tumor lysis syndrome is a well-described, serious complication of chemotherapy administered to treat malignancies. However, a very rare event resulting in the spontaneous necrosis of a tumor prior to therapy can also occur, which is termed spontaneous tumor lysis syndrome (STLS). We present a case of a 27-year-old male who presented to the hospital with epistaxis, dyspnea, and cervical lymphadenopathy. Laboratory findings included progressive pancytopenia, hyperuricemia, and acute renal failure. Bone marrow biopsy showed a T cell lymphoid neoplasm that had entirely infiltrated the marrow stroma. The patient was diagnosed with STLS in the setting of a T cell lymphoma with bone marrow infiltration. The patient was immediately treated with a blood transfusion and hemodialysis. After this urgent treatment, the patient's pancytopenia resolved and the lymphadenopathy disappeared spontaneously. One month post-treatment, the patient's cervical lymphadenopathy recurred and peripheral T cell lymphoma, not otherwise specified, was confirmed. STLS has previously been reported, however, most known cases of STLS did not show a decreased tumor burden resulting from massive tumor cell death. We present a rare case of STLS with resolution of pancytopenia and disappearance of lymphadenopathy in a patient with peripheral T cell lymphoma not otherwise specified.

HIV-Associated Nephropathy: Clinical Presentation, Pathology, and Epidemiology in the Era of Antiretroviral Therapy

The classic kidney disease of human immunodeficiency virus (HIV) infection, HIV-associated nephropathy, is characterized by progressive acute renal failure, often accompanied by proteinuria and ultrasound findings of enlarged, echogenic kidneys. Definitive diagnosis requires kidney biopsy, which shows collapsing focal segmental glomerulosclerosis with associated microcystic tubular dilatation and interstitial inflammation. Podocyte proliferation is a hallmark of HIV-associated nephropathy, although this classic pathology is observed less frequently in antiretroviral-treated patients. The pathogenesis of HIV-associated nephropathy involves direct HIV infection of renal epithelial cells, and the widespread introduction of combination antiretroviral therapy has had a significant impact on the natural history and epidemiology of this unique disease. These observations have established antiretroviral therapy as the cornerstone of treatment for HIV-associated nephropathy in the absence of prospective clinical trials. Adjunctive therapy for HIV-associated nephropathy includes angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, as well as corticosteroids in selected patients with significant interstitial inflammation or rapid progression.

Pathogenesis and Treatment of Hepatorenal Syndrome

Hepatorenal syndrome (HRS) is a functional renal failure that frequently develops in patients with advanced cirrhosis and severe impairment in systemic circulatory function. Traditionally it has been considered to be the consequence of a progression of the splanchnic arterial vasodilation occurring in these patients. However, recent data indicate that a reduction in cardiac output also plays a significant role. There are two different types of HRS. Type-2 HRS consists of a moderate and steady or slowly progressive renal failure. It represents the extreme expression of the circulatory dysfunction that spontaneously develops in patients with cirrhosis. The main clinical problem in these patients is refractory ascites. Type-1 HRS is a rapidly progressive acute renal failure that frequently develops in closed temporal relationship with a precipitating event, commonly spontaneous bacterial peritonitis. In addition to renal failure, patients with type-1 HRS present deterioration in the function of other organs, including the heart, brain, liver, and adrenal glands. Type-1 HRS is the complication of cirrhosis associated with the worst prognosis. However, effective treatments of HRS (vasoconstrictors associated with intravenous albumin, transjugular intrahepatic portacaval shunt, albumin dialysis) that can improve survival have recently been introduced.

Crataegus Orientalis Associated Multiorgan Hypersensitivity Reaction and Acute Renal Failure

Patients, especially those with chronic disease and disorders are increasingly relying on complementary and alternative medical therapies (CAMT). Because the use of CAMT is escalating worldwide, it is essential to be aware of the clinical and adverse effects, doses and potential drug-herb interactions. Crataegus orientalis or hawthorn is a small tree with red fruits. A number of studies appear to demonstrate that Crataegus spp. have a clinically detectable positive cardiac inotropic action. The ingredients, characteristics of metabolism and elimination, and adverse effects of hawthorn remain largely unknown. We report a case of multisystem hypersensitivity reaction and progressive acute renal failure associated with the consumption of Crataegus orientalis.

Iron Exchange and Prediction of Multiple Organ Dysfunctions in Sepsis

Objective: to define the mechanisms of impaired biological rhythms of iron exchange and lipid peroxidation (LPO) and to develop criteria for predicting the outcomes of pyoseptic complications. Subjects and methods. A hundred and seventeen patients with a good course of sepsis and its complication as multiple organ dysfunction (MOD) (a study group) and 108 healthy males (a control group) were examined. Twenty-four changes in the concentrations of total and ferrous iron (Fe2+) in the serum and urine, in those of OZhSS, malonic dialdehyde (MDA), MSM260 and MSM280 in the serum, urine, and red blood cells were studied. Results. With the good course of sepsis, iron exchange desynchronism was shown to be caused by elevated Fe2+ and MDA concentrations and enhanced proteolysis. The processes of renal MSM detoxification and elimination were ascertained to play an important role in the prediction of a good outcome of sepsis. With the poor course of sepsis and its complication as MOD, considerable rises in Fe2+, MDA, and MSM mesors were followed by their rhythm inversion and diminished MSM excretion due to progressive acute renal failure. Conclusion. The desynchronized exchange of iron was found to be due to the intensive increase in its fraction that triggers LPO and membrane destructive processes. On this basis, the authors have developed a procedure for predicting the course of sepsis and its complication as MOD, which allows the risk of complications and death rates to be substantially reduced during pyoseptic processes.

Renal Tubular Necrosis and Interstitial Hemorrhage (“Turkey-Egg Kidney”) in a Circovirus-Infected Yorkshire Cross Pig

A juvenile Yorkshire cross pig with rapidly progressive acute renal failure was submitted for necropsy. There was marked edema and disseminated petechiation of both kidneys, producing the "turkey-egg" appearance that is characteristic of exotic diseases such as African and classical swine fever. Microscopic findings included renal tubular epithelial necrosis with extensive interstitial edema and hemorrhage; lymphoplasmacytic, eosinophilic, and histiocytic tubulointerstitial nephritis; and numerous botryoid intracytoplasmic inclusions within the renal tubular epithelium and interstitial macrophages. Porcine circovirus 2 (PCV2) was readily identified within these lesions by both PCV2-specific immunohistochemistical staining and electron microscopy. Tests for African and classical swine fever viruses, as well as bacterial cultures, were negative. The striking renal lesions in this pig were attributed to PCV2 infection and are distinct from those that are typical of other PCV2-associated diseases.

Acute myopia and progressive acute renal failure in a 28-year old active horsewoman

A 28-year old active sportswoman was admitted to hospital suffering from fever, menigeal irritation, acute myopia and progressive acute renal failure. Showing signs of polyserositis in combination with pulmonary granulomatous changes a collagenosis as well as an atypical pneumonia was excluded first. Due to the renal loss of function a renal biopsy was taken with the typical histological result of a hantavirus infection. This could be confirmed serologically in the following. With symptomatic treatment the patient had an uneventful complete recovery during the next four weeks.

Acute renal failure after successful cardiopulmonary resuscitation.

To assess the frequency and independent predictors of severe acute renal failure in patients resuscitated from out-of-hospital ventricular fibrillation cardiac arrest. A cohort study with a minimum follow-up of 6 months. Emergency department of a tertiary care 2200-bed university hospital. Consecutive adult (> 18 years) patients admitted from 1 July 1991 to 31 October 1997 after witnessed ventricular fibrillation out-of-hospital cardiac arrest and successful resuscitation. Acute renal failure was defined as a 25% decrease of creatinine clearance within 24 h after admission. Out of 187 eligible patients (median age 57 years, 146 male), acute renal failure occurred in 22 patients (12%); in 4 patients (18%) renal replacement therapy was performed. Congestive heart failure (OR 6.0, 95% CI 1.6-21.7; p = 0.007), history of hypertension (OR 4.4, 95% CI 1.3-14.7; p = 0.02) and total dose of epinephrine administered (OR 1.1, 95% CI 1.0-1.2; p = 0.009) were independent predictors of acute renal failure. Duration of cardiac arrest, pre-existing impaired renal function and blood pressure at admission were not independently associated with renal outcome. Severe progressive acute renal failure after cardiopulmonary resuscitation (CPR) is rare. Pre-existing haemodynamics seem to be more important for the occurrence of acute renal failure than actual hypoperfusion during resuscitation.