Atypical presentation of acute post-infectious glomerulonephritis in patients with sickle cell disease: report of two cases
Autor: | Denise Maria Avancini Costa Malheiros, Bernardo Vergara Reichert, Rafaela B. Pinheiro, Cristiane Bitencourt Dias, Precil Diego Miranda de Menezes Neves, Viktoria Woronik, Leonardo de Abreu Testagrossa, Luis Yu, Lectícia Barbosa Jorge, Lívia Barreira Cavalcante, Ramaiane A. Bridi |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Nephrology
Male medicine.medical_specialty Thrombotic microangiopathy Adolescent Nephrotic syndrome Case Report Anemia Sickle Cell Kidney lcsh:RC870-923 Gastroenterology chemistry.chemical_compound Glomerulonephritis Internal medicine medicine Humans Child Hematuria Creatinine Proteinuria medicine.diagnostic_test business.industry Sickle cell anaemia Acute post-infectious glomerulonephritis Glomerulosclerosis medicine.disease lcsh:Diseases of the genitourinary system. Urology chemistry Female Renal biopsy medicine.symptom business Glomerular Filtration Rate |
Zdroj: | BMC Nephrology, Vol 21, Iss 1, Pp 1-6 (2020) BMC Nephrology |
ISSN: | 1471-2369 |
Popis: | Background Sickle cell disease (SCD) is a highly prevalent genetic disease worldwide. In the natural evolution of SCD, glomerular lesions can develop, presenting histopathological patterns of segmental or focal membranoproliferative glomerulosclerosis, with or without thrombotic microangiopathy. We report two cases of acute post-infectious glomerulonephritis (APIGN), with atypical presentations, in patients with SCD. Case presentation Case 1: An 18-year-old female with SCD presented with a 21-day history of progressive oedema, accompanied by dyspnoea, productive cough, fever, and chest pain. Blood tests showed the following: haemoglobin 6.1 g/dl; leucocytes 18,820 cells/mm3; and creatinine 0.49 mg/dl. A urine sample evidenced leucocyturia and haematuria. The 24-h proteinuria was 8.99 g, serum albumin level was 1.2 g/dl, low serum C3 levels and high levels of anti-streptolysin O. Renal biopsy was consistent with APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving to reversal of the renal alterations. Case 2: A 12-year-old male with SCD presented with a 20-day history of a non-productive cough and progressive oedema, together with hypertension. The serum creatinine concentration was 0.48 mg/dl. A urine sample evidenced leukocyturia and haematuria. The 24-h proteinuria was 12.5 g, and the serum albumin level was 2.6 g/dl. The levels of C3 and C4 were normal. Renal biopsy revealed APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving reversal of the renal alterations. Conclusions The presentation of the two cases reported here are not typical of SCD-related kidney injury. Analysis of the renal biopsy specimens elucidated the diagnosis, affecting the prognosis, because that of APIGN is highly favourable, unlike that of nephrotic syndrome associated with SCD glomerulopathy. |
Databáze: | OpenAIRE |
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