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A case of fever and unexplained acute renal failure.

Sakhuja V, Agarwal R, Kalra N - Indian J Nephrol (2008)

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Investigations revealed leukocytosis, anemia, azotemia, and hypoalbuminemia... He was found to have enlarged kidneys with doubtful mild hydronephrosis... He was also found to have portal hypertension with high SAAG ascites, and developed SBP during the hospital stay... Chronic obstructive pulmonary disease Chronic liver disease - HBV-related Spontaneous bacterial peritonitis Acute pyelonephritis Acute renal failure - acute interstitial nephritis/acute tubular necrosis In summary, the patient was a 45-year-old male with history of hypertension and old-treated pulmonary tuberculosis (PTB); a long-time smoker with history suggesting chronic bronchitis... The patient presented with bilaterally enlarged kidneys and ARF... There is neither a history of diabetes mellitus nor the investigations reveal any hyperglycemia... Similarly, the ultrasound of the kidneys did not reveal any cysts... However, ARF can be the presenting feature if there is superadded renal insult such as infection or uncontrolled hypertension... However, these patients have significant history of weakness, weight loss, and bone pain, which this index case did not give... Dr. K Joshi, Professor and Head of Histopathology: Actually when Dr. Naveen Kalra showed CT, I thought, despite not being a clinician that when in bilaterally enlarged kidneys, you see an extension into the perinephric areas, then isolated renal zygomycosis becomes a differential diagnosis, as we have seen in our previous cases... But this is a subacute/chronic granulomatous type of renal zygomycosis, but in areas of infarction the number of fungi would probably be much more than seen in a granulomatous reaction... Dr. Kalra: As has already been highlighted, CECT would have shown us either presence of abscesses or bilateral enlarged non-functional kidneys as we have seen in previous cases of renal zygomycosis... Another thing is the host response, there is a lot of reaction surrounding these granulomas, the fibrinoid areas, you see there are so many types of granulomatous responses, also you can see so many vessels are involved and have fibrinoid necrosis of vessel wall, so this is a true infection (zygomycosis) related vasculitis.

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Microscopy showed evidence of pulmonary hemorrhage (A) and thromboembolism (B)
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Figure 0014: Microscopy showed evidence of pulmonary hemorrhage (A) and thromboembolism (B)


A case of fever and unexplained acute renal failure.

Sakhuja V, Agarwal R, Kalra N - Indian J Nephrol (2008)

Microscopy showed evidence of pulmonary hemorrhage (A) and thromboembolism (B)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC2813127&req=5

Figure 0014: Microscopy showed evidence of pulmonary hemorrhage (A) and thromboembolism (B)

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Investigations revealed leukocytosis, anemia, azotemia, and hypoalbuminemia... He was found to have enlarged kidneys with doubtful mild hydronephrosis... He was also found to have portal hypertension with high SAAG ascites, and developed SBP during the hospital stay... Chronic obstructive pulmonary disease Chronic liver disease - HBV-related Spontaneous bacterial peritonitis Acute pyelonephritis Acute renal failure - acute interstitial nephritis/acute tubular necrosis In summary, the patient was a 45-year-old male with history of hypertension and old-treated pulmonary tuberculosis (PTB); a long-time smoker with history suggesting chronic bronchitis... The patient presented with bilaterally enlarged kidneys and ARF... There is neither a history of diabetes mellitus nor the investigations reveal any hyperglycemia... Similarly, the ultrasound of the kidneys did not reveal any cysts... However, ARF can be the presenting feature if there is superadded renal insult such as infection or uncontrolled hypertension... However, these patients have significant history of weakness, weight loss, and bone pain, which this index case did not give... Dr. K Joshi, Professor and Head of Histopathology: Actually when Dr. Naveen Kalra showed CT, I thought, despite not being a clinician that when in bilaterally enlarged kidneys, you see an extension into the perinephric areas, then isolated renal zygomycosis becomes a differential diagnosis, as we have seen in our previous cases... But this is a subacute/chronic granulomatous type of renal zygomycosis, but in areas of infarction the number of fungi would probably be much more than seen in a granulomatous reaction... Dr. Kalra: As has already been highlighted, CECT would have shown us either presence of abscesses or bilateral enlarged non-functional kidneys as we have seen in previous cases of renal zygomycosis... Another thing is the host response, there is a lot of reaction surrounding these granulomas, the fibrinoid areas, you see there are so many types of granulomatous responses, also you can see so many vessels are involved and have fibrinoid necrosis of vessel wall, so this is a true infection (zygomycosis) related vasculitis.

No MeSH data available.


Related in: MedlinePlus