Search

Mantle cell lymphoma (MCL) is a rare aggressive lymphoproliferative disorders (LPD) of B-cell lymphoma, which usually presents in advanced stages at initial diagnosis. Renal involvement in MCL is very rare, especially the combined presence of both glomerular and interstitial disease. We report on a patient with lymphomatous interstitial nephritis (LIN) coexistent with paraneoplastic crescentic membranoproliferative glomerulonephritis (MPGN), subsequently diagnosed to have disseminated MCL with bone marrow and lymph nodal infiltration. He was treated with rituximab-based chemotherapy and went into complete renal remission at 6-months of follow up.

The evaluation of donor-specific antibodies by Luminex single-antigen bead assay (in addition to other crossmatch tests) to assess pretransplant immunological risk should be performed in recipients (especially with a history of prior sensitization) even in resource-constrained settings as this approach can help in better risk stratification, to decide on transplant eligibility, selection of immunologically favorable donor, to plan desensitization protocol and induction therapy that can lead to the reduction of posttransplant rejection rates and better graft survival. Despite the cost, it is justified to use these sensitive assays in selected cases even in a cost-limited setting as this enables earlier and better-matched transplant, and avoidance of morbidity and poor graft survival.

Renal transplantation (RT) is the current treatment of choice for patients with end-stage renal disease (ESRD). Innovations in RT and immunosuppressive regimens have greatly improved both the patient and graft survival. A successful RT offers enhanced quality and duration of life and is more effective (medically and economically) than long-term dialysis therapy for patients with ESRD. Close follow-up and monitoring treatment are the important part of the management of RT recipients (RTRs). Cardiovascular disease, infections, and drug toxicity play a key role in the long-term morbidity and mortality of this patient population. As RTRs survive for longer periods of time with functioning allografts, physicians will likely become more involved in their management, mandating at least a basic understanding of management of an adult RTR.

Diabetic nephropathy (DN) is characterized by gradually progressive renal failure and proteinuria. Various types of nondiabetic kidney diseases may superimpose on DN, and affect the natural course, prognosis, and management. Collapsing glomerulopathy (CG) is a form of glomerular proliferative injury, characterized by rapid progression and associated with poor prognosis. CG may be idiopathic or secondary to other causes, and it has also been described with other forms of glomerular diseases. The association of CG with DN has not been reported widely. We report on a patient with DN who has undergone renal biopsy due to massive proteinuria and rapid loss of renal function. Renal biopsy was suggestive of CG superimposed on DN. He was treated conservatively, however, progressed to end-stage renal disease rapidly.

Background Isolated renal mucormycosis (IRM) is a potentially fatal disease affecting immunocompromised hosts. IRM affecting apparently immunocompetent patients is rare, with few previous reports, mostly from India. We describe 10 cases of bilateral IRM with no underlying risk factors. Methods We performed a retrospective analysis of cases of IRM from our hospital information system admitted between 2009 and 2016. We analyzed the data of this cohort of IRM, including epidemiological characteristics, clinical presentation, diagnostic procedures, treatment details and outcome. Results In all, 10 cases of bilateral IRM were identified. All of them were males with a mean age of 24.7 years (range 10–42). Most patients were initially managed as acute bacterial pyelonephritis with acute kidney injury. A total of eight patients were diagnosed antemortem. Diagnostic clues include sepsis not controlled with broad-spectrum antibiotics and enlarged kidneys with or without hypodensities on ultrasound/computed tomography imaging. Three patients also gave a specific history of passing white flakes in their urine. Eight patients received specific antifungal therapy with amphotericin B with or without posaconazole. Three patients in whom the disease was apparently confined to the pelvicalyceal system underwent local irrigation with Amp-B. One patient underwent bilateral nephrectomy. Four patients succumbed to the disease while five patients were successfully treated. One patient was discharged against medical advice. Conclusions IRM is a rare, life-threatening disease associated with high mortality even in immunocompetent individuals. Typical clinical and radiological findings and a high index of suspicion may help in early diagnosis, but definitive diagnosis requires histopathological and/or microbiological confirmation. Early and rapid diagnosis along with aggressive multidisciplinary management including initiation of specific antifungal therapy with or without surgical debridement is vital for a successful outcome.

Background Proteinuria and renal dysfunction is common in diabetic patients and may occur due to variety of causes. Nondiabetic renal diseases (NDRD) account for 30% of the renal biopsies, and idiopathic membranous nephropathy (iMN) is a common non diabetic glomerular disease that can exist alone or in combination with diabetic nephropathy (DN). Immunosuppressants used in iMN may be associated with complications of worsening glycemic control and recurrent infections. There is a paucity of literature on the clinical course, outcomes and treatment adverse effects of patients with iMN and diabetes. Methods We retrospectively analyzed the data of all diabetics, evaluated for NDRD and found to have iMN, between January 2000 and June 2015 in our institute. Results A total of 134 patients with diabetes were biopsied for NDRD and 16 patients had iMN. Mean ± standard deviation age was 54 ± 11.77 years and the median duration of diabetes was 9.4 years. Twelve patients had isolated iMN and four patients had iMN coexisting with DN. Response rates of 18%, 35.71% and 63.63% were seen with Modified Ponticelli (MP) regimen, tacrolimus and mycophenolate mofetil (MMF), respectively. Five patients developed treatment-related adverse effects significant enough to necessitate a treatment change. Worsening glycemic control was the most common side effect. Adverse effects were less with the MMF compared with the MP regimen and tacrolimus. Conclusion Patients with iMN coexisting with diabetes exhibit a poor response to the MP regimen. Treatment-related toxicity is less common with MMF in comparison with the MP regimen and tacrolimus-based regimen. An almost similar response was noted with MMF and tacrolimus-based regimen but there was more withdrawal from treatment due to toxicities observed in the latter.

Emphysematous pyelonephritis (EPN) is a rare gas forming, necrotizing infection of the renal parenchyma. It is potentially lethal, if not recognized and treated promptly. EPN-affecting renal allografts has been reported infrequently. We report a case of 34-year-old male renal allograft recipient presented with urosepsis and acute graft dysfunction, found to have EPN. He was treated conservatively with antibiotics and ureteral stenting along with reduction of immunosuppression, with complete recovery.

Acute pancreatitis (AP) is a rarely encountered complication in patients following kidney transplantation and is associated with significant morbidity and mortality. The diagnosis is often difficult due to the lack of classic symptoms and laboratory findings. Herein, we report the case of azathioprine-induced AP leading to acute kidney injury in a kidney transplant recipient, in whom we have encountered diagnostic difficulty. Patient spontaneously recovered after drug withdrawal. We propose a step-wise diagnostic algorithm for the evaluation of AP in kidney transplant recipients.

BK-virus-associated nephropathy (BKVN) is one of the most common causes of viral nephropathy in renal-transplant recipients. The intensity of immunosuppression is the most important risk factor for BKVN. Combined BKVN and rejection can occur rarely, which is difficult to diagnose and manage. Ureteritis, leading to ureteric stenosis, can result in secondary to both rejection and BK-virus (BKV) infection. We herein report a case of BKVN coexistent with the features of acute cellular rejection in a patient with ureteric stenosis probably induced by BKV infection, which was managed successfully with step-wise modification of immunosuppression along with double–J stenting, leading to stabilization of graft function.

Guillain–Barre syndrome (GBS) is an extremely rare complication after solid organ transplantation (SOT) and its clinical course can be more severe in them. Most of the cases of GBS in SOT have been associated with Cytomegalovirus infection. GBS presenting after an ABO-incompatible (ABOi) transplant and during pregnancy has never been reported in the past among SOT recipients. We report a case of a 27-year-old female ABOi renal transplant recipient who presented with acute flaccid paralysis all four limbs during the second trimester of pregnancy, diagnosed to have GBS. Pregnancy and vaccination might have played a role in precipitating GBS in our patient. She was treated with plasma exchange and experienced GBS treatment-related fluctuations but finally recovered completely without any adverse pregnancy outcome.

Renal transplantation is the treatment of choice in most patients with end-stage renal disease, especially with improvement in surgical techniques and immunosuppressive regimens; however, the long-term graft survival remains to be improved. Immunological graft injury leading to rejection plays a major role in long-term graft loss. With pretransplant immunological evaluation using various crossmatch tests, identification of donor-specific antibodies, a better understanding of renal allograft pathology and its standardization with the Banff classification having regular updates led to prevention, early and accurate diagnosis of rejection and its histological differentiation. Some newer biomarkers are in pipeline may enable early and accurate identification of graft pathology noninvasively.

Concurrent thrombotic and hemorrhagic manifestations are uncommon in patients with Antiphospholipid Syndrome.A 10-year-old girl with fever, edema, rash and joint pains, who later developed deep venous thrombosis (DVT), stroke, thrombotic microangiopathic hemolytic anemia and pulmonary hemorrhage. Investigations confirmed Antiphospholipid syndrome associated with systemic lupus erythematosus.She went into complete remission with intravenous immunoglobulins, plasmapheresis, immunosuppression and anticoagulation.Thrombotic microangiopathic hemolytic anemia and anti-phospholipid syndrome can be the presenting manifestations of systemic lupus erythematosus.

Background and Aim: This study aims to study the long-term outcomes of hepatitis C virus (HCV)-infected renal allograft recipients, which is still debatable. Materials and Methods: In this study (study period - January 2003 to December 2013), we studied long-term outcomes of 106 living donor renal allograft recipients - 53 HCV-infected (33 genotype 3 and 20 genotype 1) and 53 age- and gender-matched HCV-noninfected patients. Results: Thirty-nine (73.6%) patients detected HCV positive during dialysis, while 14 (26.4%) before the start of dialysis. Forty (75.5%) patients were positive for both anti-HCV and HCV RNA, while 13 (24.5%) were HCV RNA positive and anti-HCV negative. Twelve and nine patients died among HCV positive and negative groups, respectively. Major cause of death was sepsis in both groups. Hepatic failure contributed to mortality in four HCV-positive patients, two of them also had graft failure. Patient and death noncensored graft survival rates at 1, 5, and 10 years of follow-up in HCV-positive group were 100% and 100%; 79.8% and 70.8%; 58.9% and 37.8%; respectively; and in HCV-negative group were 100% and 100%; 95.9% and 91.8%; 58.9% and 27.4%; respectively. Conclusions: The long-term survival of HCV-positive renal transplant recipients was not inferior to that of HCV-negative recipients.

A 53-year-old diabetic man, with end-stage renal disease and on maintenance hemodialysis through arteriovenous fistula since 6 months, presented with a 6-week history of fever, multiple swellings over chest and lower limbs, cough, and dyspnea. On examination, multiple fluctuant swellings with palpable crepitus were noted over anterior chest wall and lower limbs (Figure 1). Chest X-ray showed massive left pleural effusion. On thoracocentesis, empyema was noted; cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Aspiration of the swellings over his chest and foot also showed MRSA infection. Blood cultures and sputum cultures were also positive for MRSA. Computed tomography (CT) of the chest was suggestive of large loculated left pleural effusion and thick-walled collections involving right sternoclavicular and manubriosternal joints, which were subluxated with air pockets within the collections and extended retrosternally abutting major vessels (Figure 2). In view of disseminated MRSA infection with bacteremia, an echocardiogram was performed, which was suggestive of endocarditis with vegetations over posterior leaflet of aortic valve. The patient was treated with vancomycin and amikacin, left-sided pleural drain, and drainage of abscesses with subsequent improvement that was confirmed on repeat echocardiogram and chest CT. This patient illustrates the high infectious risk associated with hemodialysis, which is a common cause of mortality in these patients. Early diagnosis and aggressive treatment are required.