Research
Staphylococcus Associated Glomerulonephritis with IgA Mesangial Deposition
The case is that of 52 year Caucasian male with motor vehicle accident, status post open reduction and internal fixation of the left hip. He sustained wound infection with osteomyelitis due to multidrug resistant pseudomonas infection. Extensive debridement of the wound was carried out but the hardware was left in place. He underwent treatment with polymyxin antibiotic for a month then the course was complicated by renal failure which resolved with polymyxin dose adjustment. However, the hard ware was removed after 2 months of treatment. At that time wound culture revealed MRSA infection. He received 4 weeks of Vancomycin and 6 week course of polymyxin after the hardware was removal. He was readmitted to the hospital with increasing pain and persistent drainage from the wound. Imagings were consistent with erosion of the femoral head with joint space loss, and septic arthritis with evidence of osteomyelitis and the presence of sinus tract to the skin surface. Wash out of the wound with debridement was carried out and another course of Vancomycin was instituted.
Acute Kidney Injury and Massive Proteinuria Secondary to Epstein – Barr virus aAssociated Nephrotic Syndrome
The case is that of 69 year old female who went on vacation and fell on her knees. She noticed progressive swelling of both legs over 2 weeks duration. During this period she gained 44 pounds in weight. She presented with sudden onset of edema of the lower extremity and weigh gain. She had 16 g/day of proteinuria. Past medical history is significant of hypertension of unknown duration. She had never seen a doctor in the last year. Her laboratory data showed 30 grams protein in 24 hrs urine, and her serum creatinine was 1.7 mg/dl. The baseline serum creatinine was not known.
Polyarteritis Nodosa Renal Crisis with Malignant Hypertension
A case of 28 years female with no significant past medical history presented with malignant hypertension. She was found to have Polyarteritis nodosa involving the kidney on angiography. She was treated successfully with steroids and cytotoxic drugs and made uneventful recovery. Her kidney function remained stable and her BP was controlled on Po medications. Even though she was negative for hepatitis B infection, the association was strongly confirmed in about 10% of patients. PAN should be suspected in any patients with multisystem involvement with hypertension and minimal findings in urinalysis. Polyneuropathy and high ESR are also red flags for PAN.
