Skip to main content
SpringerLink
Log in

A case of acute renal failure with multiple origins of the renal injury

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. KDIGO. AKI definition. Kidney Int Suppl. 2012;2:19–36. https://doi.org/10.1038/kisup.2011.32.

    Article  Google Scholar 

  2. Luciano RL, Moeckel GW. Update on the native kidney biopsy: core curriculum 2019. Am J Kidney Dis. 2019;73(3):404–15. https://doi.org/10.1053/j.ajkd.2018.10.011.

    Article  PubMed  Google Scholar 

  3. Leung N, Gertz M, Kyle RA, et al. Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases. Clin J Am Soc Nephrol. 2012;7:1964–8.

    Article  CAS  Google Scholar 

  4. Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23(15):3412–20. https://doi.org/10.1200/JCO.2005.04.242.

    Article  PubMed  Google Scholar 

  5. Cohen Tervaert TW, Mooyaart AL, Amann K, Cohen AH, Cook HT, Drachenberg CB, et al. Pathologic classification of diabetic nephropathy. J Am Soc Nephrol. 2010;21:556–63. https://doi.org/10.1681/ASN.2010010010.

    Article  Google Scholar 

  6. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. 2000;50:7–33.

    Article  CAS  Google Scholar 

  7. Clyne DH, Pesce AJ, Thompson RE. Nephrotoxicity of Bence Jones proteins in the rat: importance of protein isoelectric point. Kidney Int. 1979;16:345–52.

    Article  CAS  Google Scholar 

  8. Leung N, Bridoux F, Batuman V, et al. The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol. 2019;15(1):45–59. https://doi.org/10.1038/s41581-018-0077-4.

    Article  PubMed  Google Scholar 

  9. Seth S, Rajkumar SV, D’Agati V, et al. Heterogeneity of monoclonal immunoglobulin associated renal diseases. J Am Soc Nephrol. 2018;29:1810–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology and Dialysis Unit, Belcolle Hospital, Via Sammartinese, Snc, 01100, Viterbo, Italy

    David Micarelli, Francesca Romana Della Rovere & Sandro Feriozzi

  2. Pathology Unit, Belcolle Hospital, Viterbo, Italy

    Emanuela Cristi

  3. Center of Large Equipments, Section of Electron Microscopy, University of Tuscia, Viterbo, Italy

    Anna Rita Taddei

  4. Hematology Unit, Belcolle Hospital, Viterbo, Italy

    Caterina Mercanti

Authors
  1. David Micarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuela Cristi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Rita Taddei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Romana Della Rovere
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caterina Mercanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sandro Feriozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DM and SF wrote the paper, treated and followed the patient and revisited the case. EC reviewed samples and reported pathology results. ART was the electron microscopist who read TEM. FRDR e CM were the physicians of the patient and completed data and helped in writing the draft. All authors read and signed the final paper.

Corresponding author

Correspondence to David Micarelli.

Ethics declarations

Conflict of interest

The authors have no disclosures to declare.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Micarelli, D., Cristi, E., Taddei, A.R. et al. A case of acute renal failure with multiple origins of the renal injury. CEN Case Rep 9, 437–441 (2020). https://doi.org/10.1007/s13730-020-00505-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-020-00505-6

Keywords

Search

Navigation