Recovery from rapidly progressive glomerulonephritis. Improvement after plasmapheresis and immunosuppression.

Two patients with rapidly advancing renal insufficiency underwent biopsy and were found to have crescentic glomerulonephritis. Patient 1 demonstrated findings compatible with Goodpasture's syndrome. Crescents were present in 100% of his glomeruli. Patient 2 had findings of immune complex-mediated glomerulonephritis and crescents in greater than 90% of his glomeruli. Both patients were treated with high-dose prednisone, cyclophosphamide, and plasmapheresis. Patient 2 additionally required hemodialysis for a brief period. Renal function improved in both patients and has not deteriorated after follow-up of 14 and 18 months, respectively. Repeated renal biopsies were performed in each patient. Our findings suggest that clinical improvement and histologic healing are possible in rapidly progressive glomerulonephritis despite the initial presence of crescents in every glomerulus.

Treatment of alkalosis with ammonium chloride: a case report.

Coma due to ammonium chloride used in the treatment of severe metabolic alkalosis is reported in a patient with normal hepatic and renal function. All symptoms resolved following discontinuance. Ammonium chloride should be abandoned as a treatment for metabolic alkalosis.

Crescentic glomerulonephritis complicating idiopathic membranous glomerulonephropathy.

We describe the course of a patient with multiple rectal abscesses and progressive renal dysfunction. A renal biopsy demonstrated a membranous glomerulopathy associated with extensive crescent formation. No underlying cause for the glomerulonephritis could be identified and, specifically, the anti-GBM antibody present in other similar cases was not found. There appears to be a subset of patients with membranous glomerulopathy in whom crescents develop with rapid loss of renal function. Anti-GBM antibody is not necessary in the pathogenesis of this lesion.

Renal artery thrombosis in a young woman taking oral contraceptives.

PIP: Retrospective studies indicate that oral contraceptive use is associated with an increased risk of venous thromboembolic disease, but the evidence linking oral contraceptive use with the development of arterial thrombosis is limited. In view of this paucity of evidence, the case report of a young women taking oral contraceptives and treated at the Naval Regional Medical Center in San Diego for sudden renal artery thrombosis without any predisposing cause, is of some significance. The 22 year old patient had no physical evidence or history indicative of trauma or systemic disease; however, she reported taking Orthonovum 1/50 for the 6 months preceeding the event and smoking a pack of cigarettes/day. These factors, in combination, may have predisposed her to arterial thrombosis. Included is a photograph of the patient's angiograph showing the occlusion.^ieng