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Antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding.

Kim M, Kim YU, Boo SJ, Kim SM, Kim HW - Kidney Res Clin Pract (2015)

Bottom Line: On the 45(th) hospital day, the patient suddenly lost consciousness.Brain computed tomography showed intracerebral hemorrhage.We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

ABSTRACT
A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45(th) hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

No MeSH data available.


Related in: MedlinePlus

Follow-up colonoscopy after embolization. Colonoscopy shows segmental ulcerations on terminal ileum, which is consistent with ischemic damage due to embolization.
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f0020: Follow-up colonoscopy after embolization. Colonoscopy shows segmental ulcerations on terminal ileum, which is consistent with ischemic damage due to embolization.

Mentions: Despite successful embolization, massive hematochezia occurred again after 2 days. Her hemoglobin level was 6.5 g/dL, and platelet count was 40,000/mm3. The patient received two units of packed RBCs and five units of platelet concentrate. Emergency colonoscopy showed multiple segmental ulcerations on the terminal ileum, which was consistent with ischemic damage due to embolization of the distal ileal artery (Fig. 4). The patient underwent hemodialysis because of intractable metabolic acidosis, hyperkalemia, and fluid overload. Anemia associated with schistocytes and transfusion-refractory consumptive thrombocytopenia was also present, consistent with microangiopathic hemolytic anemia (MAHA). Levels of hemostatic markers showed prothrombin time (international normalized ratio) 1.00; activated partial thromboplastin time 33 seconds; fibrinogen 399 mg/dL; and fibrin degradation product <5.0 µg/mL. We ruled out disseminated intravascular coagulation using the International Society on Thrombosis and Hemostasis disseminated intravascular coagulation scoring system.


Antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding.

Kim M, Kim YU, Boo SJ, Kim SM, Kim HW - Kidney Res Clin Pract (2015)

Follow-up colonoscopy after embolization. Colonoscopy shows segmental ulcerations on terminal ileum, which is consistent with ischemic damage due to embolization.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608877&req=5

f0020: Follow-up colonoscopy after embolization. Colonoscopy shows segmental ulcerations on terminal ileum, which is consistent with ischemic damage due to embolization.
Mentions: Despite successful embolization, massive hematochezia occurred again after 2 days. Her hemoglobin level was 6.5 g/dL, and platelet count was 40,000/mm3. The patient received two units of packed RBCs and five units of platelet concentrate. Emergency colonoscopy showed multiple segmental ulcerations on the terminal ileum, which was consistent with ischemic damage due to embolization of the distal ileal artery (Fig. 4). The patient underwent hemodialysis because of intractable metabolic acidosis, hyperkalemia, and fluid overload. Anemia associated with schistocytes and transfusion-refractory consumptive thrombocytopenia was also present, consistent with microangiopathic hemolytic anemia (MAHA). Levels of hemostatic markers showed prothrombin time (international normalized ratio) 1.00; activated partial thromboplastin time 33 seconds; fibrinogen 399 mg/dL; and fibrin degradation product <5.0 µg/mL. We ruled out disseminated intravascular coagulation using the International Society on Thrombosis and Hemostasis disseminated intravascular coagulation scoring system.

Bottom Line: On the 45(th) hospital day, the patient suddenly lost consciousness.Brain computed tomography showed intracerebral hemorrhage.We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

ABSTRACT
A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45(th) hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.

No MeSH data available.


Related in: MedlinePlus