We reviewed a case diagnosed with with chlorodifluoromethane poisoning (Freon-22) admitted to the Department of Nephrology, Xiangya Changde Hospitalin August, 2020, focusing on the clinical manifestations, laboratory examination, and course of treatment of patients, as well as discussing the clinical characteristics, treatment and prognosis of chlorodifluoromethane poisoning cases. The patient is a 29 years old male engaged in air conditioning maintenance work, with an acute onset. On the day of onset, the patient refilled chlorodifluoromethane poisoning refrigerant for a client's air conditioner and rested in a small car after work where he was found two hours later. At that time, the patient was experiencing impaired consciousness, vomiting and incontinence. After regaining consciousness, he presented with convulsions, dizziness, numbness of limbs and muscle aches, accompanied by a decrease in limb strength. The initial hospital examination indicated that impaired liver and kidney functionality, significantly elevated creatine kinase levels, and a little exudation in the sitting lung as shown by Chest CT, and no significant abnormalities found in the electroencephalogram (EEG) or electromyogram (EMG). Subsequent investigations revealed that the connecting pipe of the steel cylinder in the car was cracked due to high temperature, which led to the leakage of chlorodifluoromethane poisoning. After active treatment with hyperbaric oxygen, hormone, nerve nutrition and liver protection, the patient's condition improved and he was discharged from the hospital. After two-year follow-up, the patient still has mild numbness in both lower limbs. At present, there are few reports of Freon poisoning, and the clinical presentations can vary greatly, with severe cases even leading to death from poisoning. This paper summarizes and reports the clinical manifestations of a patient with chlorodifluoromethane poisoning, and reviews the related literature, with the aim to improve the clinician's understanding of the disease and make a timely and effective treatment plan.

OBJECTIVES: To evaluate the value of thrombospond in Type I domain-containing 7A (THSD7A) and M-type phospholipase A2 receptor (PLA2R) in primary membranous nephropathy (PMN) and to explore the relationship between their antibody levels and prognosis. METHODS: Renal tissues in 128 patients with membranous nephropathy in the Second Xiangya Hospital of Central South University were collected from February 2015 to August 2017, including 108 patients with primary membranous nephropathy (PMN group) and 20 patients with secondary membranous nephropathy (SMN) (SMN group). Indirect immunofluorescence method was used to detect the expression of PLA2R antigen in kidney tissues,and the glomerular expression of THSD7A antigen was examined by immunohistochemistry and indirect immunofluorescence. The serum levels of anti-PLA2R antibodies and THSD7A antibodies were also detected by ELISA. According to the results of PMN examination,the patients were also divided into a PLA2R-related membranous nephropathy group and a THSD7A-related membranous nephropathy group. RESULTS: The positive rate of PLA2R in the renal tissues in the PMN group was higher than that in the SMN group (78% in the PMN group, 35% in the SMN group, <0.01),while the positive rate of anti-PLA2R antibody in the PMN group was also higher than that in the SMN group (50% in the PMN group, 25% in the SMN group, <0.05).The serum level of anti-PLA2R antibody was positively correlated with 24 h urine protein (=0.254, <0.05) and negatively correlated with serum albumin (=-0.236, <0.05). The expression of THSD7A was positive in glomeruli in 7 cases of the PMN group (6%) by immuno-histochemistry, and which was positive in 1case of the SMN group (5%).The serum levels of anti-THSD7A antibody in the PMN group were higher than those in the SMN group [(0.49±0.26) pg/mL in the PMN group,(0.34±0.27) pg/mL in the SMN group, <0.05]. There was no difference in the clinical characteristics between the PLA2R-related membranous nephropathy group and the THSD7A-related membranous nephropathy group. CONCLUSIONS PLA2R and THSD7A are the target antigen of PMN, and the associated autoantibodies are helpful for the differential diagnosis of PMN. The anti-PLA2R antibody levels can reflect the severity of the disease and evaluate the effect of treatment. The incidence of THSD7A membranous nephropathy is low, and monitoring the serum anti-THSD7A antibody levels can assess patients' condition and predict disease outcome.
Autoantibodies ; Glomerulonephritis, Membranous ; Humans ; Immunohistochemistry ; Receptors, Phospholipase A2 ; Thrombospondins

In this paper, 2 cases of collagen Type Ⅲ glomerulopathy were analyzed. The clinical manifestations mainly included nephrotic syndrome, proteinuria, hypertension and renal dysfunction. One patient showed that the complement factor H-related protein 5 (CFHR5) gene was likely a disease-causing mutation. The pathological examination of renal tissues showed hyperplasia of mesangial matrix, sub-endothelial insertion, and double-track formation. Immunohistochemistry of Type III collagen was positive. Electron microscopy revealed that massive collagen fibers (40-70 nm in diameter) deposited in the mesangial matrix and basement membrane. As for the follow-up results, the normal renal function had kept steady and the proteinuria was moderate in 1 case treated with angiotensin Ⅱ receptor blocker. Due to other system disease, another case developed into acute kidney injury and then received hemodialysis. The clinical manifestations of collagen Type Ⅲ glomerulopathy was atypical, the light microscope pathological features were various, and the disease was mainly diagnosed by electron microscopy and immunohistochemistry.
Collagen Type III ; genetics ; Glomerular Mesangium ; Humans ; Kidney Diseases ; Kidney Glomerulus ; Proteinuria