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Immunologic Mechanisms in Renal Disease
Published in Robin S. Goldstein, Mechanisms of Injury in Renal Disease and Toxicity, 2020
Brian D. Schreiber, Gerald C. Groggel
The discussion to this point has focused on immunologic injury within the glomerulus. However, tubulointerstitial nephritis can also result from immunologic injury (Wilson, 1989). Antibodies can bind to intrinsic tubular and interstitial antigens and produce immune deposits and injury (Wilson, 1991). T-Cell-mediated injury may also occur in the interstitium (Wilson, 1989).
Methylmalonic acidemia
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Some patients have hepatomegaly. Liver function tests are normal. Renal functional impairment has been reported [1] and we have observed chronic renal tubular acidosis [48]. Hyperuricemia is usually present, a consequence of competition for its renal tubular excretion. Urate nephropathy and renal failure have been reported [49]. Tubulointerstitial nephritis has been reported in four biopsied patients of 15 reported with renal disease [50]. End-stage renal disease requiring dialysis and/or transplantation has been observed, as another late complication [35, 51, 52].
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Since stasis allows bacterial invasion through the urinary tract, urinary stasis is frequently implicated in acute pyelonephritis, and it may arise from such underlying disorders as ureteral or urethral strictures, renal calculi ("kidney stones" formed through the process of nephrolithiasis), tumors, prostatic hypertrophy, or neurogenic bladder. Symptoms of acute pyelonephritis include fever and chills, vomiting, and bladder irritation from infected urine, causing urgency and frequency of urination (also called miction or micturition). A more descriptive term for acute pyelonephritis, although one that is less frequently used, is acute infective tubulointerstitial nephritis because it describes the infective nature of the disease and the involvement of the tubules and their interstitial spaces. The term pyelonephritis should only be applied to diseases with documented urinary tract infection (UTI).
Acute kidney injury in patients with cancer receiving anti-PD-1/PD-L1 antibodies: incidence, risk factors, and prognosis
Published in Renal Failure, 2023
Qianqian Lou, Jianguang Gong, Binxian Ye, Rizhen Yu, Shuangshan Bu, Yiwen Li, Bin Zhu, Lina Shao
In conclusion, this study demonstrated that the incidence of AKI among patients with cancer treated with anti-PD-1/PD-L1 antibodies was 6.5%. The median time from the initial anti-PD-1/PD-L1 antibody treatment to AKI development was 99.85 days. Head and neck cancer and the combined use of NSAIDs, diuretics, lower hemoglobin levels, and combination regimens with chemotherapeutic drugs were independent risk factors for AKI. Complete or partial recovery was achieved in one-third of the 92 patients with AKI within 90 days in our cohort. Kidney biopsies were performed on two patients with AKI and pathology confirmed diagnosis of acute tubulointerstitial nephritis. In clinical practice, the occurrence of AKI among patients with cancer treated with anti-PD-1/PD-L1 antibodies requires increased attention, and it is necessary to monitor renal function and identify AKI early during anti-PD-1/PD-L1 antibody treatment. Further studies are necessary to accurately determine the predictors and biomarkers of AKI to provide a reference for future clinical studies.
Non-diabetic urine glucose in idiopathic membranous nephropathy
Published in Renal Failure, 2022
Lingling Liu, Ke Zuo, Weibo Le, Manman Lu, Zhihong Liu, Weiwei Xu
Another interesting phenomenon in our research was that urine glucose usually occurred when the patient had massive proteinuria, and if proteinuria was controlled, the urine glucose and scr would gradually become normal. Previous research has shown that there was a strong relationship between tubulointerstitial nephritis and the severity of proteinuria in experimental nephrosis [23]. Albumin overload could indeed induce renal tubular injury [24]. A recent research with single cell sequence also showed that proximal tubular cells had higher TNF signaling pathway, IL-17 signaling pathway, NOD like receptor, and apoptosis expression in massive proteinuria patients than nonmassive proteinuria patients [19]. Thus, it would be of importance to discriminate the tubular injury when patients had massive proteinuria. Some previous researches tried to find out the relationship between the time average proteinuria and the long-term renal outcome [25]. This procedure was complicate. However, our research showed that the occurring of urine glucose was corelated to proteinuria and was a risk factor of renal function deterioration. Moreover, urine glucose was easily to detect in clinical practice.
Clinicopathological characteristics and predictors of poor outcome in anti-glomerular basement membrane disease – a fifteen year single center experience
Published in Renal Failure, 2021
Zafirah Zahir, Asif Sadiq Wani, Narayan Prasad, Manoj Jain
A number of cases of atypical anti-GBM have been published since its first recognition by Wilson and Dixon [1, 25,26]. We report four cases of atypical anti-GBM in our study with linear staining along GBM on immunofluorescence. Other causes of linear staining on immunofluorescence were ruled out before making a diagnosis of atypical anti-GBM. One of the cases had MPGN pattern on light microscopy without any glomerular crescent formation and presented as nephritic-nephrotic syndrome. Two other cases were of anti-GBM along with IgA nephropathy. The fourth case showed a tubulointerstitial nephritis picture on light microscopy and had low complements. None of them had oliguria, ANA or associated ANCA antibodies. Lung involvement was present only in a single case. Two of the cases had anti-GBM just higher than normal limit, one had mildly elevated levels and fourth case had moderately high anti-GBM titers. The hepatitis and HIV serology were negative in all the cases. All the four patients did not require intensive triple therapy and three of them went in remission. These cases need to be recognized and diagnosed accurately because of the difference in treatment and course of the disease in them. Lesser degree of pulmonary involvement, mild renal insufficiency and better survival of these atypical anti-GBM cases have also been described previously [24]. However, further studies are required to recognize and prognosticate such cases.