Epidemiologic data of adult native biopsy-proven renal diseases in Croatia.

PURPOSE: There is a paucity of epidemiological data on biopsy-proven renal disease in Croatia. The purpose of this report is a review of clinical and histological data, over a period of 15 years, from the single biggest adult native renal biopsy center in Croatia. METHODS: This report includes data from 922 adult native renal biopsies in patients referred from the whole country and performed in our center from 1996 till February 2012. Data on age, gender, serum creatinine, urine sediment, 24-h proteinuria, clinical syndrome and histological diagnosis were collected and analyzed retrospectively. In all patients, light, immunofluorescence and electron microscopic analysis was performed. RESULTS: The median age of the patients was 48 years (interquartile range 36-59 years), and the majority of patients were men (57.8 %). The most common indication for renal biopsy was nephrotic syndrome (40.3 %) followed by asymptomatic urinary abnormalities (31.7 %). The most common biopsy-proven renal disease in total was IgA glomerulonephritis (19.3 %), followed by focal segmental glomerulosclerosis (FSGS) (15.8 %) and membranous glomerulonephritis (9.2 %). In men, similar results were found, while in women, the most common were hereditary nephritis (13.4 %), FSGS (12.9 %) and connective tissue disease-related glomerular disorders (11.6 %). CONCLUSION: The presented data are an important contribution to the better understanding of the epidemiology of biopsy-proven renal disease in Croatia and Europe throughout comparison with other registry data. This data should be the basis for the formation of Croatian Registry of Renal Biopsies.

[Fibrillary glomerulonephritis and immunotactoid glomerulopathy: case reports]. / Fibrilarni glomerulonefritis i imunotaktoidna glomerulopatija: prikaz bolesnika.

Fibrillary glomerulonephritis and immunotactoid glomerulopathy belong to the rare renal disorders characterized by formation of the organized glomerular deposits. Pathogenesis of these disorders is still not fully clarified but they could appear as a primary condition or be regarded as a part of the various systemic mainly lymphoproliferative disorders. Clinical presentation includes proteinuria, hematuria, arterial hypertension and progressive renal insufficiency during several years. In this work we presented a male patient with fibrillary glomerulonephritis and a female patient with immunotactoid glomerulopathy as a part of a non-Hodgkin lymphoma. The aim of this presentation is to show the features of the fibrillary glomerulonephritis and immunotactoid glomerulopathy as well as emphasize the significance of the electron microscopy in the identification of these uncommon entities.

Thrombotic microangiopathy associated with alpha-interferon therapy for chronic myeloid leukaemia.

The association of interferon (IFN) therapy with haemolytic uraemic syndrome in patients with chronic myeloid leukaemia (CML) has been reported infrequently. The pathogenesis of the renal lesion in such cases remains unclear. We report the case of a patient with chronic myeloid leukaemia who developed nephrotic syndrome and renal failure while being treated with hydroxyurea and IFN-alpha. Renal biopsy showed features of chronic thrombotic microangiopathy. The discontinuation of IFN-alpha, and a prompt institution of plasmapheresis and steroids resulted in improvement of the nephrotic syndrome and renal function. These findings suggest that long-term IFN-alpha therapy can induce thrombotic microangiopathy and haemolytic uraemic syndrome in patients with chronic myeloid leukaemia.

[Diagnostic and treatment of renovascular hypertension in the patient with horseshoe kidney]. / Dijagnosticki postupak i lijecenje renovaskularne hipertenzije u bolesnika s potkovastim bubregom.

A patient with renovascular hypertension and horseshoe kidney is presented. Diagnostic work-up consisted of ultrasonography, color-Doppler of renal arteries, dynamic scintigraphy with captopril test, separate renin, intravenous urography and computed tomography. Renal angiography revealed several aberrant renal arteries with significant fibromuscular dysplasia of the proximal artery of the right kidney. Contrast magnetic resonance of the kidneys with gadolinium was also performed. Following diagnostic procedure, a 5 mm balloon dilatation of the right proximal renal artery was performed. Immediate renal angiography showed no stenosis of the right proximal artery. The patient's blood pressure normalized after the invasive procedure. The diagnosis and treatment in the patient with renovascular hypertension due to fibromuscular dysplasia and horseshoe kidney are described. As renovascular hypertension is a rare diagnosis, this case report may help physicans recognize patients with this type of arterial hypertension.

Acute interstitial nephritis due to mesalazine.

A case of mesalazine-induced acute interstitial nephritis (AIN) in a 41-year-old patient with ulcerative colitis (UC) is reported here. Clinical symptoms such as fever and arthralgia, and laboratory findings such as eosinophilia and renal failure suggested AIN, which was confirmed by biopsy. With withdrawal of mesalazine and intravenous methylprednisolone the patient's renal function was recovered. It is observed that early discontinuation of mesalazine is associated with amelioration of interstitial nephritis in most patients, so the recommendation is that patients receiving mesalazine should undergo routine monitoring of renal function. Delayed diagnosis may lead to permanent renal function impairment.