Ocular manifestations in renal diseases.

The eyes and kidneys are the targets for end-organ damage in multiple pathologies. Both these organs develop during the same embryonic stage around the fourth to sixth week of gestation, thus sharing a strong correlation between both eye and kidney diseases. Both the eyes and kidneys can be the target of the systemic disease process; however, the eyes can also be affected as a consequence of renal disease or its treatment. Risk factors such as diabetes, hypertension, and smoking are commonly shared between kidney and eye diseases. Ocular manifestations can be predictive of renal disease, and/or patients with renal disease are at higher risk for developing ocular manifestations. Various congenital anomalies of the eyes and kidneys can also present as an oculorenal syndrome. This article summarizes the ocular pathology, which can be seen in renal diseases.

Successful treatment of COVID-19-associated collapsing glomerulopathy: 22 months of follow-up.

The term COVAN (COVID-19-associated nephropathy) has been used to describe collapsing focal segmental glomerulosclerosis (FSGS) in individuals who have been infected with the SARS-CoV-2. This helps differentiate it from the majority of cases of acute kidney injury in COVID-19 patients, which are typically caused by acute tubular injury. The exact pathophysiology is unclear but is proposed to involve pro-inflammatory cytokines such as type 1 interferons, which are thought to increase expression of the APOL1 gene in glomerular epithelial cells. This triggers a cascade of inflammatory events that cause damage to the epithelia and underlying podocytes. The treatment of COVAN is centered on general supportive measures including dietary sodium restriction, optimization of hyperlipidemia and hypertension, RAAS blockade, and diuresis for edema. There is limited data to support the use of glucocorticoids in COVAN; however, the mechanism of podocytopathy is similar to that in HIVAN (HIV-associated nephropathy), with high disease burden in those with APOL1 gene mutation. Based on previous experience, treatment of HIVAN with glucocorticoids is beneficial and safe in selected patients. Here we present a case of COVAN which was successfully treated with glucocorticoids, and at 22-month follow-up patient remained in full remission (proteinuria < 1,000 mg/g) with stable kidney function.

Hydralazine-Induced Vasculitis.

Hydralazine is a commonly prescribed medication which is used in the treatment of hypertension. While it is generally considered to be a safe and effective treatment, in rare cases it can cause a serious side effect known as hydralazine-induced vasculitis. Here we discuss this rare presentation in the form of a case report in a 67-year-old female with a past medical history of chronic obstructive pulmonary disease (COPD), congestive heart failure, hypertension, hyperlipidemia, left renal artery stenosis status post stenting who presented in the nephrology office for evaluation of recent worsening kidney function, and on further evaluation was found to have hematuria and proteinuria in the urine analysis. On further workup, she was noted to have severely elevated myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers with renal biopsy revealed very focal crescentic glomerulonephritis, an increased number of occlusive red blood cell cast with acute tubular necrosis. Mild interstitial fibrosis of <20% was seen and a diagnosis of drug-induced vasculitis from hydralazine was made.

BK Polyomavirus-Induced Nephropathy in Native Kidney.

BK polyomavirus has been well-studied as an opportunistic infection in immunocompromised kidney transplant patients. In the majority of the population, BK polyomavirus establishes a lifelong infection in renal tubular and uroepithelial cells; however, in an immunocompromised state, the virus can reactivate and can lead to BK polyomavirus-associated nephropathy (BKN). In this case, the patient was a 46-year-old male with a past medical history of HIV, compliant with antiretroviral therapy (ART), and B-cell lymphoma treated with chemotherapy. The patient presented with worsening kidney function of unknown etiology. This prompted further assessment with a kidney biopsy. Kidney biopsy findings were consistent with BKN. In the literature, BKN has been studied in renal transplant patients; however, it rarely involves native kidneys.

Successful treatment of a unique case of congophilic fibrillary glomerulonephritis: A case report.

INTRODUCTION: Amyloidosis and fibrillary glomerulonephritis (FGN) share similar electron microscopic signatures including random arrangement of fibrils. However, distinction between the 2 can often be made using Congo Red staining. PATIENT CONCERNS: Here we describe a unique case of FGN, which stained positive for Congo Red, as well as DnaJ heat shock protein family (Hsp40) member B9 which is more specific for FGN. The patient presented with acute kidney injury and severe proteinuria. DIAGNOSIS: Congophilic FGN. INTERVENTIONS: Six-month course of mycophenolate mofetil and prednisone. OUTCOMES: complete resolution of acute kidney injury and proteinuria TAKE HOME LESSONS:: To our knowledge, this is the first reported case of successful treatment of this rare condition using mycophenolate mofetil and prednisone.