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Acquired Fanconi syndrome in patients with Legionella pneumonia.

Kinoshita-Katahashi N, Fukasawa H, Ishigaki S, Isobe S, Imokawa S, Fujigaki Y, Furuya R - BMC Nephrol (2013)

Bottom Line: In addition, they had the generalized dysfunction of the renal proximal tubules presenting decreased tubular reabsorption of phosphate (%TRP), increased fractional excretion of potassium (FEK) and uric acid (FEUA), low-molecular-weight proteinuria, panaminoaciduria and glycosuria.Therefore, they were diagnosed as Fanconi syndrome.Treatment for Legionella pneumonia with antibiotics resulted in the improvement of all serum electrolyte abnormalities and normalization of the %TRP, FEK, FEUA, low-molecular-weight proteinuria, panaminoaciduria and glycosuria, suggesting that Legionella pneumophila infection contributed to the pathophysiology of Fanconi syndrome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan. knstnk1984@yahoo.co.jp

ABSTRACT

Background: Hyponatremia is often observed in patients with Legionella pneumonia. However, other electrolyte abnormalities are uncommon and the mechanism remains to be clarified.

Case presentation: We experienced two male cases of acquired Fanconi syndrome associated with Legionella pneumonia. The laboratory findings at admission showed hypophosphatemia, hypokalemia, hypouricemia and/or hyponatremia. In addition, they had the generalized dysfunction of the renal proximal tubules presenting decreased tubular reabsorption of phosphate (%TRP), increased fractional excretion of potassium (FEK) and uric acid (FEUA), low-molecular-weight proteinuria, panaminoaciduria and glycosuria. Therefore, they were diagnosed as Fanconi syndrome. Treatment for Legionella pneumonia with antibiotics resulted in the improvement of all serum electrolyte abnormalities and normalization of the %TRP, FEK, FEUA, low-molecular-weight proteinuria, panaminoaciduria and glycosuria, suggesting that Legionella pneumophila infection contributed to the pathophysiology of Fanconi syndrome.

Conclusion: To the best of our knowledge, this is the first report demonstrating Fanconi syndrome associated with Legionella pneumonia.

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Related in: MedlinePlus

Clinical course in Patient 1 (A) and Patient 2 (B). Definition of the abbreviations: CRP = C-reactive protein, eGFR = estimated glomerular filtration rate, FEUA = fractional excretion of uric acid, GRNX = garenoxacin mesilate hydrate, LVFX = levofloxacin hydrate, Pi = phosphate (inorganic), PZFX = pazufloxacin mesilate, S-Sodium = serum sodium, UA = uric acid, U-β2-MG = urinary β2-microglobulin, %TRP = tubular reabsorption of phosphate.
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Figure 1: Clinical course in Patient 1 (A) and Patient 2 (B). Definition of the abbreviations: CRP = C-reactive protein, eGFR = estimated glomerular filtration rate, FEUA = fractional excretion of uric acid, GRNX = garenoxacin mesilate hydrate, LVFX = levofloxacin hydrate, Pi = phosphate (inorganic), PZFX = pazufloxacin mesilate, S-Sodium = serum sodium, UA = uric acid, U-β2-MG = urinary β2-microglobulin, %TRP = tubular reabsorption of phosphate.

Mentions: He was treated for Legionella pneumonia with pazufloxacin mesilate (PZFX) at 1,000 mg per day. After treatment, his physical status recovered and his electrolyte abnormalities improved. Furthermore, his %TRP, FEUA, urinary β2-MG and NAG normalized, and the panaminoaciduria became undetectable (Figure 1A).


Acquired Fanconi syndrome in patients with Legionella pneumonia.

Kinoshita-Katahashi N, Fukasawa H, Ishigaki S, Isobe S, Imokawa S, Fujigaki Y, Furuya R - BMC Nephrol (2013)

Clinical course in Patient 1 (A) and Patient 2 (B). Definition of the abbreviations: CRP = C-reactive protein, eGFR = estimated glomerular filtration rate, FEUA = fractional excretion of uric acid, GRNX = garenoxacin mesilate hydrate, LVFX = levofloxacin hydrate, Pi = phosphate (inorganic), PZFX = pazufloxacin mesilate, S-Sodium = serum sodium, UA = uric acid, U-β2-MG = urinary β2-microglobulin, %TRP = tubular reabsorption of phosphate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750396&req=5

Figure 1: Clinical course in Patient 1 (A) and Patient 2 (B). Definition of the abbreviations: CRP = C-reactive protein, eGFR = estimated glomerular filtration rate, FEUA = fractional excretion of uric acid, GRNX = garenoxacin mesilate hydrate, LVFX = levofloxacin hydrate, Pi = phosphate (inorganic), PZFX = pazufloxacin mesilate, S-Sodium = serum sodium, UA = uric acid, U-β2-MG = urinary β2-microglobulin, %TRP = tubular reabsorption of phosphate.
Mentions: He was treated for Legionella pneumonia with pazufloxacin mesilate (PZFX) at 1,000 mg per day. After treatment, his physical status recovered and his electrolyte abnormalities improved. Furthermore, his %TRP, FEUA, urinary β2-MG and NAG normalized, and the panaminoaciduria became undetectable (Figure 1A).

Bottom Line: In addition, they had the generalized dysfunction of the renal proximal tubules presenting decreased tubular reabsorption of phosphate (%TRP), increased fractional excretion of potassium (FEK) and uric acid (FEUA), low-molecular-weight proteinuria, panaminoaciduria and glycosuria.Therefore, they were diagnosed as Fanconi syndrome.Treatment for Legionella pneumonia with antibiotics resulted in the improvement of all serum electrolyte abnormalities and normalization of the %TRP, FEK, FEUA, low-molecular-weight proteinuria, panaminoaciduria and glycosuria, suggesting that Legionella pneumophila infection contributed to the pathophysiology of Fanconi syndrome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan. knstnk1984@yahoo.co.jp

ABSTRACT

Background: Hyponatremia is often observed in patients with Legionella pneumonia. However, other electrolyte abnormalities are uncommon and the mechanism remains to be clarified.

Case presentation: We experienced two male cases of acquired Fanconi syndrome associated with Legionella pneumonia. The laboratory findings at admission showed hypophosphatemia, hypokalemia, hypouricemia and/or hyponatremia. In addition, they had the generalized dysfunction of the renal proximal tubules presenting decreased tubular reabsorption of phosphate (%TRP), increased fractional excretion of potassium (FEK) and uric acid (FEUA), low-molecular-weight proteinuria, panaminoaciduria and glycosuria. Therefore, they were diagnosed as Fanconi syndrome. Treatment for Legionella pneumonia with antibiotics resulted in the improvement of all serum electrolyte abnormalities and normalization of the %TRP, FEK, FEUA, low-molecular-weight proteinuria, panaminoaciduria and glycosuria, suggesting that Legionella pneumophila infection contributed to the pathophysiology of Fanconi syndrome.

Conclusion: To the best of our knowledge, this is the first report demonstrating Fanconi syndrome associated with Legionella pneumonia.

Show MeSH
Related in: MedlinePlus