Limits...
Membranoproliferative glomerulonephritis in patients with chronic venous catheters: a case report and literature review.

Sy J, Nast CC, Pham PT, Pham PC - Case Rep Nephrol (2014)

Bottom Line: Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus.We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome.We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, UCLA-Olive View Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA.

ABSTRACT
Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus. We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome. We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa. The importance of routine monitoring of kidney function and urinalysis among patients with chronic central venous catheterization is highlighted as kidney injury may herald or coincide with overtly infected chronic indwelling central venous catheters.

No MeSH data available.


Related in: MedlinePlus

Glomerular features of second renal biopsy. (a) Lobular hypercellular glomerulus with capillary wall double contours (periodic acid methenamine silver ×600). (b) Capillary wall with subendothelial deposits and peripheral mesangial migration and interposition producing a double contour (×7200).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3926371&req=5

fig2: Glomerular features of second renal biopsy. (a) Lobular hypercellular glomerulus with capillary wall double contours (periodic acid methenamine silver ×600). (b) Capillary wall with subendothelial deposits and peripheral mesangial migration and interposition producing a double contour (×7200).

Mentions: He was lost to follow-up for several years until February 2010 when he presented with upper extremity edema and chills. On admission he had anemia, reduced kidney function, and hypoalbuminemia. Again, he was found to be infected with coagulase negative staphylococcus bacteremia (S. epidermidis). His spot urine protein to creatinine ratio at presentation was 2.4 g/g creatinine but increased to 5.8 g/g over several days without associated blood pressure changes. Routine laboratory investigations revealed creatinine of 2.2 mg/dL, BUN 19 mg/dL, WBC 4,400/mm3, and hemoglobin 5.9 g/dL. Urinalysis revealed 300 mg/dL protein, large blood, large leukocyte esterase, 196 WBC/high power field (HPF), 224 RBC/HPF, 33 hyaline casts, few WBC clumps, 14 granular casts, and 24 cellular casts. He was treated with vancomycin pending repeat evaluation of the underlying nephrotic syndrome. Of interest, the patient commented that “every time I swell up, they give me antibiotics and the swelling goes away.” Further evaluation of his renal disease was again pursued as all his previous medical records were lost in a hospital fire. Serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), serum protein immunofixation (SPIF), urine protein immunofixation (UPIF), antineutrophil cytoplasmic antibody (ANCA), RPR, ANA, and HIV were all negative. C3 was low at 71 mg/dL with normal C4 of 23 mg/dL. A kidney ultrasound revealed normal sized kidneys (right 11.0 cm and left 11.7 cm) without structural abnormalities. Evaluation for subacute bacterial endocarditis was negative. His Hickman catheter was replaced and subsequent blood cultures confirmed resolution of his bacteremia. His proteinuria improved markedly (greater than 50% reduction) within a few days of antibiotic therapy initiation. Serial creatinine measurements documented improvement in his creatinine to 1.75 mg/dL within 20 days of presentation. A repeat kidney biopsy performed in June 2010 confirmed MPGN type I (Figure 2), with acute tubulointerstitial nephritis and mild-to-moderate chronic renal parenchymal injury.


Membranoproliferative glomerulonephritis in patients with chronic venous catheters: a case report and literature review.

Sy J, Nast CC, Pham PT, Pham PC - Case Rep Nephrol (2014)

Glomerular features of second renal biopsy. (a) Lobular hypercellular glomerulus with capillary wall double contours (periodic acid methenamine silver ×600). (b) Capillary wall with subendothelial deposits and peripheral mesangial migration and interposition producing a double contour (×7200).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3926371&req=5

fig2: Glomerular features of second renal biopsy. (a) Lobular hypercellular glomerulus with capillary wall double contours (periodic acid methenamine silver ×600). (b) Capillary wall with subendothelial deposits and peripheral mesangial migration and interposition producing a double contour (×7200).
Mentions: He was lost to follow-up for several years until February 2010 when he presented with upper extremity edema and chills. On admission he had anemia, reduced kidney function, and hypoalbuminemia. Again, he was found to be infected with coagulase negative staphylococcus bacteremia (S. epidermidis). His spot urine protein to creatinine ratio at presentation was 2.4 g/g creatinine but increased to 5.8 g/g over several days without associated blood pressure changes. Routine laboratory investigations revealed creatinine of 2.2 mg/dL, BUN 19 mg/dL, WBC 4,400/mm3, and hemoglobin 5.9 g/dL. Urinalysis revealed 300 mg/dL protein, large blood, large leukocyte esterase, 196 WBC/high power field (HPF), 224 RBC/HPF, 33 hyaline casts, few WBC clumps, 14 granular casts, and 24 cellular casts. He was treated with vancomycin pending repeat evaluation of the underlying nephrotic syndrome. Of interest, the patient commented that “every time I swell up, they give me antibiotics and the swelling goes away.” Further evaluation of his renal disease was again pursued as all his previous medical records were lost in a hospital fire. Serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), serum protein immunofixation (SPIF), urine protein immunofixation (UPIF), antineutrophil cytoplasmic antibody (ANCA), RPR, ANA, and HIV were all negative. C3 was low at 71 mg/dL with normal C4 of 23 mg/dL. A kidney ultrasound revealed normal sized kidneys (right 11.0 cm and left 11.7 cm) without structural abnormalities. Evaluation for subacute bacterial endocarditis was negative. His Hickman catheter was replaced and subsequent blood cultures confirmed resolution of his bacteremia. His proteinuria improved markedly (greater than 50% reduction) within a few days of antibiotic therapy initiation. Serial creatinine measurements documented improvement in his creatinine to 1.75 mg/dL within 20 days of presentation. A repeat kidney biopsy performed in June 2010 confirmed MPGN type I (Figure 2), with acute tubulointerstitial nephritis and mild-to-moderate chronic renal parenchymal injury.

Bottom Line: Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus.We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome.We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, UCLA-Olive View Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA.

ABSTRACT
Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus. We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome. We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa. The importance of routine monitoring of kidney function and urinalysis among patients with chronic central venous catheterization is highlighted as kidney injury may herald or coincide with overtly infected chronic indwelling central venous catheters.

No MeSH data available.


Related in: MedlinePlus