Progressive Acute Renal Failure Research Articles

Rapidly progressive systemic sclerosis and acute renal failure associated with a renal cell carcinoma

Rapidly progressive systemic sclerosis and acute renal failure associated with a renal cell carcinoma

Rapidly Progressive Acute Renal Failure Due to Acyclovir: Case Report and Review of the Literature

Acyclovir nephrotoxicity has been described since the inception of the drug's use more than a decade ago. Acute renal failure mediated by this compound is characterized by abrupt elevations in serum creatinine and a gradual return to baseline renal function on discontinuation of the drug. Drug crystal formation in collecting tubules resulting in an intraparenchymal form of obstructive nephropathy has been suggested as the mechanism for acyclovir nephrotoxicity. The patient we present developed rapidly progressive acute renal failure with concomitant mental status changes in the setting of treatment with high-dose parenteral acyclovir. Acyclovir therapy was discontinued and an open renal biopsy was obtained to further evaluate our patient's diminishing renal function. Pathologic examination of the biopsy specimen revealed loss of proximal tubule brush border and dilated proximal and distal tubules with flattening of lining cells and focal nuclear loss. No crystals were noted. These changes were consistent with acute tubular necrosis with regeneration. Over the next 4 days our patient's renal and neurologic levels recovered to their prehospitalization statuses. It appears that our patient was affected by acyclovir-mediated nephrotoxicity that manifested on biopsy by acute tubular necrosis and the absence of crystalluria or crystal deposition. Intravenous acyclovir treatment can therefore produce rapidly progressive acute neurologic and renal toxicity that is usually reversible. The pathologic changes of acute tubular necrosis must now be included as part of the spectrum of renal damage associated with acyclovir therapy.

Crescentic IgA Nephropathy as a Manifestation of Human Immune Deficiency Virus Infection

A 37-year-old Caucasian male homosexual presented with hematuria and rapidly progressive acute renal failure. He was found to have proteinuria and microscopic hematuria as well as RBC casts. Investigations revealed polyclonal gammopathy with five times normal serum IgA levels as well as elevated serum IgG. Renal biopsy showed evidence of crescentic IgA nephropathy with ultrastructural changes of tubuloreticular inclusions described in HIV nephropathy. He was found to be positive for human immunodeficiency viral antibodies. Renal function improved during follow-up after two doses of 1 g each of methylprednisone. In our opinion, this is the first case of HIV-related crescentic IgA nephropathy. HIV testing should be performed more frequently in patients presenting with acute glomerular diseases.

DNA synthetic phase duration of mouse ileal epithelium in acute renal failure

The effect of progressive acute renal failure on the DNA synthetic phase duration of ileal epithelium was assessed by a double labelling method using H3-thymidine approximately 18 hours after urinary outflow obstruction in mice. Controls were subjected to sham operation. Animals were injected intraperitoneally with H3-thymidine 17 hours after operation and groups of mice killed after 45 minutes. The remaining control and uraemic animals received a second injection of H3-thymidine in the same dosage 18.5 and 19.5 hours after operation, respectively, and were killed 45 minutes later. The percentage of labelled crypt cells was obtained for the groups killed at each time interval, and the duration of the DNA synthetic phase estimated. Calculation gave a DNA synthetic phase duration (mean ± S.D.) of 5.5±1.9 hours for the controls and 9.8±2.7 hours for the uraemic group. The difference was 4.3±3.3 hours which is not significant statistically (P>0.05). Demonstration of statistically significant differences in the mean DNA synthetic phase duration using this method is more difficult than with conventional double labelling techniques. The less marked prolongation of DNA synthesis found in comparison to the results of previous percentage labelled metaphase analysis suggests that the DNA synthetic phase may become more prolonged with increasing severity of acute renal failure.