A case of acute renal failure with multiple origins of the renal injury
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CASE REPORT
A case of acute renal failure with multiple origins of the renal injury David Micarelli1 · Emanuela Cristi2 · Anna Rita Taddei3 · Francesca Romana Della Rovere1 · Caterina Mercanti4 · Sandro Feriozzi1 Received: 23 April 2020 / Accepted: 28 June 2020 © Japanese Society of Nephrology 2020
Abstract Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). Patients with AKI must be evaluated promptly to determine cause. Different disorders can BE associated with AKI, and biopsy is the most accurate instrument for diagnosis of different types of diseases. We report a case of 69-year-old woman. In history, type II diabetes mellitus and arterial hypertension admitted to our hospital for the evaluation of leg pain, asthenia, diarrhea, and malaise. She was in the treatment with metformin and ARB. Laboratory data revealed renal failure: serum creatinine (Scr 16.5 mg/dl, BUN 280 mg/dl) hyperkalemia and severe anemia (Hb 7.8 g/dl). Renal ultrasound displayed preserved kidneys size. An X-ray of backbone showed fracture. She underwent hemodialysis in urgency regimen. After some days, urine output began to improve up to 1200 cc/24 h. we find proteinuria in nephrotic range. Renal function remained compromised (sCr 8.5 mg/dl, BUN 150 mg/dl). For the evaluation of renal disease, the patient underwent a kidney biopsy. Histological examination findings showed overlapping changes composed of three concurrent pathologic findings: cast nephropathy, diabetes, and light chain deposition disease. After the renal biopsy, therapy with bortezomib, thalidomide, and steroid were administered. At the same time, plasma exchange was carried out. Clinical response occurred with partial recovery of renal function (Scr 3.5 mg/dl eGFR), and dialysis treatment was stopped. Keywords Multiple myeloma · Light chain deposition disease · Plasma exchange · Diabetic nephropathy · Acute renal failure
Introduction * David Micarelli [email protected] Emanuela Cristi [email protected] Anna Rita Taddei [email protected] Francesca Romana Della Rovere [email protected] Caterina Mercanti [email protected] Sandro Feriozzi [email protected] 1
Nephrology and Dialysis Unit, Belcolle Hospital, Via Sammartinese, Snc, 01100 Viterbo, Italy
2
Pathology Unit, Belcolle Hospital, Viterbo, Italy
3
Center of Large Equipments, Section of Electron Microscopy, University of Tuscia, Viterbo, Italy
4
Hematology Unit, Belcolle Hospital, Viterbo, Italy
Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). Multiple etiologies can cause AKI; therefore, it may be incorrect to treat AKI as a single disease. The KDIGO guidelines specified that patients with AKI must be evaluated promptly to determine the cause [1]. To assess and evaluate acute renal failure due to parenchymal damage, it is crucial to exclude pre-renal disease (assess and optimize volume status) and post-renal (exclude obstructions of the urinary tract)
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