Adolescent ; Bone Diseases ; etiology ; Chronic Kidney Disease-Mineral and Bone Disorder ; complications ; pathology ; Facial Bones ; Female ; Humans ; Hyperparathyroidism, Secondary ; complications ; Kidney Failure, Chronic ; complications ; pathology ; Syndrome

Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy.
Female ; Humans ; Kidney Failure, Chronic/*complications ; Middle Aged ; *Renal Dialysis ; Rupture, Spontaneous ; Spleen/*pathology ; Splenic Diseases/*complications/*pathology

We present a case of medullary sclerosis of the appendicular skeleton in a patient with chronic renal insufficiency for whom MR imaging findings were char-acteristic. T1- and T2-weighted MR images showed multiple vertical lines (medullary streaks) of low signal intensity in the metaphyses and diaphyses of the distal femur and proximal tibia.
Adult ; Case Report ; Femur/pathology ; Human ; Kidney Failure, Chronic/complications ; *Magnetic Resonance Imaging ; Male ; Osteosclerosis/*pathology ; Tibia/pathology

A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.
Colonic Diseases/chemically induced/complications/*pathology ; Colonoscopy ; Female ; Humans ; Kidney Failure, Chronic/complications/*diagnosis ; Middle Aged ; Necrosis ; Polystyrenes/*adverse effects

A retrospective study of 223 patients with IgA nephropathy (IgAN) was performed to clarify the prognostic factors and the renal survival rates of the disease. One hundred twenty-two patients were followed-up for more than 6 months after their renal biopsy (mean follow-up duration: 43.0 months), and 20 of them (16.4%) had progressed to end-stage renal disease (ESRD). Using univariate analysis, 8 risk factors (2 clinical and 6 histopathological findings) for developing ESRD were identified: renal insufficiency at initial presentation (serum creatinine > or = 1.5 mg/dl); heavy proteinuria(> or = 3.5 gm/day); moderate to severe histopathologic findings such as class IV/V lesions by W.H.O. classification, mesangial hypercellularity, glomerular sclerosis, interstitial infiltration, interstitial fibrosis, and tubular atrophy. In multivariate regression analysis, class IV/V lesions and renal insufficiency at initial presentation were the independent prognostic factors of IgAN. The renal survival rates were 100% at 1 year, 97.0% at 3 years, and 78.9% at 5 years. In conclusion, it seems that about 20% of IgAN patients have a risk to progress to ESRD within 5 years, and a careful follow-up is recommended especially in patients who have either renal insufficiency at the time of presentation or severe renal pathology (class IV/V lesions).
Adolescent ; Adult ; Female ; Glomerulonephritis, IGA/*complications/pathology ; Human ; Kidney Failure, Chronic/*epidemiology/*etiology/pathology ; Male ; Prognosis ; Retrospective Studies ; Risk Factors

AIMTo investigate the changes of the spermatozoa ultrastructures before and after renal transplantation in uremic patients.

METHODSThe sperm of five uremic patients before and after transplantation and four healthy volunteers were collected and examined by scanning electron microscopy.

RESULTSAbnormal spermatozoa were found in patients pre-transplantation; abnormalities included deletion of the acrosome, absence of the postacrosomal and postnuclear ring, dumbbell-like changes of the head, tail curling, and absence of the mitochondrial sheath in the mid-segment. After renal transplantation, most of the spermatozoa became normal.

CONCLUSIONThere are many abnormalities with regard to the appearance and structure of the head, acrosome, mitochondria and tail of the spermatozoa in uremic patients. The majority of the spermatozoa returned to normal after renal transplantation, but a few still presented some abnormalities possibly relating to the administration of immunosuppressants.

Acrosome ; pathology ; Adult ; Case-Control Studies ; Humans ; Kidney Failure, Chronic ; complications ; Kidney Transplantation ; Male ; Microscopy, Electron ; Renal Dialysis ; Sperm Head ; pathology ; Sperm Tail ; pathology ; Spermatozoa ; pathology ; ultrastructure

Adolescent ; Age Factors ; Biopsy ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Kidney ; diagnostic imaging ; pathology ; physiopathology ; Kidney Failure, Chronic ; etiology ; pathology ; Male ; Multicystic Dysplastic Kidney ; complications ; Nephritis ; complications ; Nephrotic Syndrome ; complications ; Radiography

OBJECTIVEIdiopathic collapsing glomerulopathy (ICG) is a clinically and pathologically distinct variant of focal segmental glomerulosclerosis, which is characterized by proteinuria (often nephrotic range) and rapid progression to end-stage renal failure. The typical pathological changes are global/segmental glomerular collapse, hypertrophy and hyperplasia of podocytes and severe tubulointerstitial lesions. Most ICG patients who have been reported in previous published papers are adults. ICG in children is rare. The study aimed to analyze and investigate clinical manifestations, renal histopathological findings, treatment and outcomes of ICG in children.

METHODSData of two cases of ICG, a 7-year-old boy and a 12-year-old girl, were analyzed. Both of them were Chinese and Han. Clinical characteristics, results of laboratory tests, renal histopathological findings, treatment, outcomes and prognosis of the two children with ICG were retrospectively analyzed. Results were compared with published data.

RESULTSThese two children presented typical clinical features of nephrotic syndrome. The quantity of 24 hr urine protein was 7.6 g/d (0.47 g/kg x d for boy) and 10.67 g/d (0.35 g/kg x d for girl). Both of them had hypertension (blood pressure ranged from 130/90 to 150/110 mmHg) and hypercholesterolemia (15.4 mmol/L for the boy and 11.3 mmol/L for the girl). The serum albumin was 12 g/L for girl and 23 g/L for boy. The creatinine clearance rate gradually decreased from normal range to 30 ml/min for the girl. The histopathological changes in renal biopsy of them were focal segmental or global glomerular collapse, hypertrophy and hyperplasia of podocytes and severe tubulointerstitial lesions. These two cases were steroid-resistant and were treated with pulse intravenous methylprednisolone and pulse intravenous cyclphosphamade in one case, who rapidly progressed to end-stage renal failure and died half a year later. Another one was treated with cyclosporine. He showed continuous hypertention and heavy proteinuria for eight months.

CONCLUSIONICG in the 2 children was a severe disease which presented steroid-resistant nephrotic syndrome and rapidly progressive renal failure. The pathological characteristics was global/segmental glomerular collapse, hypertrophy and hyperplasia of podocytes and severe tubulointerstitial lesions. In children with ICG treatment was difficult and the prognosis was poor.

Child ; Disease Progression ; Female ; Glomerulosclerosis, Focal Segmental ; complications ; diagnosis ; pathology ; therapy ; Glucosinolates ; Humans ; Kidney ; pathology ; Kidney Failure, Chronic ; etiology ; Kidney Glomerulus ; pathology ; Male ; Nephrotic Syndrome ; etiology ; Proteinuria ; etiology ; Treatment Outcome

A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like eggs were noted. Serum IgG antibody levels showed strong reactivity with P. westermani excretory-secretory antigens by ELISA. Intestinal paragonimiasis was thus diagnosed according to the morphology of the eggs and serologic finding. After treatment with praziquantel, hematochezia resolved. The present case illustrates the extreme manifestations encountered in severe intestinal paragonimiasis.
Aged, 80 and over ; Animals ; Anthelmintics/therapeutic use ; Antibodies, Helminth/blood ; Antigens, Helminth/immunology ; Colonic Diseases/complications/drug therapy/*pathology ; Colonoscopy ; Enzyme-Linked Immunosorbent Assay ; Female ; Gastrointestinal Hemorrhage/complications/drug therapy/*pathology ; Humans ; Intestinal Diseases, Parasitic/complications/drug therapy/parasitology/*pathology ; Kidney Failure, Chronic/complications ; Paragonimiasis/complications/drug therapy/parasitology/*pathology ; Paragonimus westermani/*immunology ; Praziquantel/therapeutic use ; Taiwan ; Ulcer/complications/drug therapy/*pathology

Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis.
Aspirin/therapeutic use ; Colon/pathology ; Colonic Diseases/complications/*diagnosis/drug therapy ; Colonoscopy ; Drug Therapy, Combination ; Gastrointestinal Hemorrhage ; Humans ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Peritoneal Dialysis ; Recurrence ; Ticlopidine/therapeutic use ; Ulcer/complications/*diagnosis/drug therapy