RESUMO
We report the case of a 69-year-old man who presented with acute kidney injury in the setting of community-acquired Clostridium difficile-associated diarrhea and biopsy-proven acute oxalate nephropathy. We discuss potential mechanisms, including increased colonic permeability to oxalate. We conclude that C difficile-associated diarrhea is a potential cause of acute oxalate nephropathy.
Assuntos
Oxalato de Cálcio/metabolismo , Clostridioides difficile , Colo/metabolismo , Diarreia , Hidratação/métodos , Necrose Tubular Aguda , Metronidazol/administração & dosagem , Doença Aguda , Idoso , Anti-Infecciosos/administração & dosagem , Biópsia , Clostridioides difficile/efeitos dos fármacos , Clostridioides difficile/isolamento & purificação , Diarreia/complicações , Diarreia/microbiologia , Diarreia/fisiopatologia , Humanos , Rim/patologia , Testes de Função Renal , Necrose Tubular Aguda/diagnóstico , Necrose Tubular Aguda/etiologia , Necrose Tubular Aguda/fisiopatologia , Necrose Tubular Aguda/terapia , Masculino , Permeabilidade , Probióticos/administração & dosagem , Resultado do TratamentoRESUMO
We report the case of a 60- year- old man who presented with newly diagnosed multiple myeloma complicated by biopsy-proven acute cast nephropathy, requiring hemodialysis, plasmapheresis and chemotherapy. After remaining dialysis dependent for 5 weeks, a high cut-off (HCO) dialyzer, intended to use for the removal of plasma substances with a molecular weight of up to 45 kDa such as free light chains, was introduced to his outpatient 4-hour hemodialysis regimen with an increase in treatment frequency to 4 sessions per week. Following 6 weeks of dialysis with the HCO dialyzer, serum levels of free κ light chains declined by more than 75%. Concurrently, he recovered kidney function and discontinued dialysis. He subsequently received a successful autologous stem-cell transplant. We discuss the potential merit of using the HCO dialyzer late in the course of the care of patients with myeloma cast nephropathy who are dialysis dependent.