1581/2426. Reversible renal failure due to isolated renal sarcoidosis. Renal impairment in sarcoidosis is usually due to hypercalcaemia and nephrocalcinosis but can also be caused by granulomatous nephritis or interstitial nephritis without sarcoid granulomata. A variety of types of glomerulonephritis have also been described in sarcoidosis but these rarely cause impaired renal function. Renal failure as an isolated manifestation of sarcoidosis is uncommon. A 66-year-old woman presented with a 1-year history of lethargy, polyuria and nocturia. Clinical examination was unremarkable and she had impaired renal function (urea 18 mmol/l (108 mg%) and creatinine 380 mumol/l (4.3 mg%)). As her kidneys were normal in size, she underwent renal biopsy, which revealed granulomatous interstitial nephritis. Reevaluation showed no other evidence of sarcoidosis and she had impaired urinary acidification and concentrating capacities. Therapy with corticosteroids produced a marked improvement in symptoms and renal function. This case confirms the view that granulomatous sarcoid nephritis is steroid sensitive and that full recovery can be expected provided interstitial fibrosis and scarring do not occur. ( info) |
1582/2426. Idiopathic hypergammaglobulinaemia associated with nephrogenic diabetes insipidus and distal renal tubular acidosis. Renal tubular dysfunction may be recognized in patients suffering from urinary light chain disease or non-myelomatous hypergammaglobulinaemia. We report a patient who has the combination of distal renal tubular acidosis and nephrogenic diabetes insipidus in association with hypergammaglobulinaemia due solely to increased IgG. We postulate that the abnormalities of distal nephron function resulted from cell-mediated immune damage. ( info) |
1583/2426. Renal scarring and vesicoureteric reflux. A review of 105 children with urinary tract infection showed an increasing prevalence of grades II-III vesicoureteric reflux with diminishing age. During infancy reflux was almost always severe, and affected boys as often as girls. Radiologically scarred kidneys were drained by refluxing ureters in 98% of cases. The prevalence of scars also rose significantly with increasinglyly severe reflux. Deterioration of existing scars or new scar formation was seen in 15 children; 18 out of 20 affected kidneys (90%) were associated with grade III vesicoureteric reflux. 2 out of 5 children who developed new scars did so after 5 years of age. Because severe reflux may occasionally be seen in the presence of a normal intravenous urogram, and since the finding of grades II-III vesicoureteric reflux is an indication for chemoprophylaxis, we consider cystourethrography essential in children of all ages with recurrent urinary tract infection. In children under 5 years the increased prevalence of both severe reflux and renal scarring are arguments for regarding cystourethrography as a necessary initial investigation. ( info) |
1584/2426. Isolated adrenal mineralocorticoid deficiency due to amyloidosis associated with familial mediterranean fever. A patient with familial mediterranean fever (FMF) associated with renal amyloidosis, presented with hyperkalemia and acidosis which were excessive to his moderate degree of azotemia. The cause of this abnormality was isolated hypoaldosteronism with otherwise normal adrenal function and tubular capacity to transport potassium. This selective involvement of the zona glomerulosa stands in marked contrast to the usual sparing of the glomerulosa seen in post mortem studies of patients with FMF and amyloidosis reported from this country. ( info) |
1585/2426. Excision of pulmonary and renal aspergillomas. Its use in treating chronic granulomatous disease of childhood. Renal and pulmonary aspergillus granulomas in two 6-year-old boys with chronic granulomatous disease were treated by nephrectomy and lobectomy as well as intravenous amphotericin b and granulocyte transfusion. After lobectomy two smaller pulmonary aspergillomas resolved with medical therapy. The second child's condition improved after nephrectomy, but he died with disseminated aspergillus infection. This experience suggests that surgical excision of localized aspergillus granulomas in conjunction with specific antimicrobial therapy provides temporary clinical improvement and may prevent further blood-borne dissemination of the fungus. ( info) |
| hemorrhage within a renal angiomyolipoma alters its characteristic appearance. We present a case diagnosed preoperatively with computerized tomography and ultrasound. ( info) |
1587/2426. Primary renal candidiasis in two preterm neonates. Report of cases and review of literature on renal candidiasis in infancy. Primary renal candidiasis and hydronephrosis were diagnosed in two premature neonates in whom systemic hypertension developed. The clinical course in these patients and in 16 patients with renal candidiasis described in the literature indicated that prematurity, use of broad-spectrum antibiotics, and use of intravenous (IV) catheters are predisposing factors. anuria and flank mass were the initial manifestations in the reviewed cases. Only four of the 16 patients survived following either antifungal therapy or nephrectomy. Both of our patients survived after antifungal therapy with amphotericin b and flucytosine for systemic effect as well as topical instillation of amphotericin b solution via a nephrostomy. We believe that a high index of suspicion in infants at risk and early institution of antifungal therapy for systemic as well as topical effect can improve the outcome in infants with renal candidiasis. ( info) |
1588/2426. Juvenile gouty arthritis. Two cases associated with mild renal insufficiency. Two patients had onset of juvenile gouty arthritis at ages 16 and 1 1/2 years, respectively. Both had mild renal insufficiency, with creatinine clearances of 46 and 54 mL/min/1.73 sq m, respectively. Their presenting hyperuricemia (13.8 and 11 mg/dL, respectively) was out of proportion to the degree of renal insufficiency. Clinical and laboratory studies did not suggest an inborn error of purine metabolism, glycogen storage disease type i, or any myeloproliferative disorder. Neither patient had a family history of gout or inherited renal disease. Although juvenile gouty arthritis is rare, it must be considered in the differential diagnosis of episodic arthritis in children, especially if renal impairment, even mild, is present. ( info) |
1589/2426. The clinical significance of candidal casts. Examination of the urinary sediment for fungal casts is a new and simple approach for assessing renal involvement in fungal infections. Identification of candidal casts was used to diagnose renal fungal involvement in five immunocompromised patients. In three cases, the examination of the urinary sediment permitted the diagnosis of early and presumably noninvasive renal candidal infections that cleared easily with relatively low doses of antifungal therapy. In two other cases, the recognition of candidal casts confirmed renal involvement in patients with disseminated disease. ( info) |
1590/2426. Nontropical chyluria secondary to massive mesenteric adenitis. Case report with metabolic and immunologic studies. This report describes metabolic and immunologic studies in a 17-year-old white man with nontropical chyluria secondary to massive mesenteric adenitis. Numerous red cells and mature lymphocytes were observed in the urine, and cystoscopic examination demonstrated chyle emanating from both ureteral orifices. Retrograde studies demonstrated pyelolymphatic backflow, and lymphangiography revealed prominent lymphaticocaliceal communications. Twenty-four-hour urinary studies showed proteinuria and lipiduria, which decreased after lymphangiography and a low-fat diet. skin tests for delayed hypersensitivity were nonreactive, the lymphocyte count was decreased, and lymphocyte responses to phytohemagglutinin and pokeweed mitogen were normal. Chyluria ceased after interruption and ligation of the renal and mesenteric lymphatics. ( info) |