Takotsubo Syndrome Development Immediately Following Hemodialysis Initiation: A Case Report.

We herein report a case of Takotsubo syndrome in an 80-year-old woman with end-stage renal disease who hesitated to initiate hemodialysis for pulmonary edema. On hospital day 2, the patient experienced cardiac arrest. Coronary angiography after spontaneous return of circulation showed no substantial stenosis. Takotsubo syndrome was diagnosed based on echocardiography findings. On hospital day 3, she developed ventricular fibrillation but was spontaneously resuscitated. Patients with chronic kidney disease and those who postpone dialysis initiation may be at an increased risk of developing Takotsubo syndrome. Early and careful monitoring and adequate shared decision-making are essential for seamless initiation of dialysis.

Peritoneal Dialysis-associated Peritonitis Due to Streptococcus oralis Three Weeks after Peritoneal Dialysis Initiation.

A 60-year-old man with end-stage renal disease due to nephrosclerosis had a peritoneal dialysis catheter (PD) embedded with stepwise initiation of peritoneal dialysis using Moncrief and Popovich's technique three months ago. PD was initiated three weeks after creating an exit site. He presented with abdominal pain and fever a day before admission and was diagnosed with PD-associated peritonitis caused by Streptococcus oralis. Medical consultation after admission revealed a history of wisdom tooth extraction following PD catheter placement, resulting in delayed wound healing. Transient bacteremia can occur after tooth extraction, leading to PD-associated peritonitis. Contemplating the oral milieu in patients undergoing PD is pertinent.

Hemodialysis Patient with Streptococcal Toxic Shock Syndrome and Penile Necrosis.

A 72-year-old man on hemodialysis due to diabetic nephropathy presented with a fever and penile pain. Although his physical examination was unremarkable, his general condition deteriorated. Penile necrosis was observed by evening on the same day of presentation, and the patient died the next morning. Blood cultures revealed the presence of Group G Streptococcus, leading to a diagnosis of streptococcal toxic shock syndrome (STSS). Autopsy suggested penile necrosis due to septic shock. STSS in hemodialysis patients with vascular calcification, even in the absence of calciphylaxis, can lead to severe organ damage due to ischemia.

Clinicopathological analysis of ANCA-associated glomerulonephritis focusing on plasma cell infiltrate.

BACKGROUND: When we encounter glomerulonephritis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides demonstrating many plasma cell infiltrations, histological overlapping of immunoglobulin G4-related disease (IgG4-RD) often comes into the differential diagnosis. No previous study has focused on the degree of plasma cells in the kidney infiltrate in ANCA-associated glomerulonephritis (ANCA-GN), and the significance of massive plasma cell infiltrate has not been investigated. METHODS: To clarify the plasma cell ratio in renal biopsy specimens of ANCA-GN and the histological characteristic of "plasma cell-rich" ANCA-GN, 20 cases of ANCA-GN were reviewed and clinicopathologically analyzed. RESULTS: Plasma cell ratio was widely distributed between 1.4 and 81%, and the median ratio was 10%. Three patients were categorized in "plasma cell-rich" ANCA-GN, defined as over 45% plasma cell ratio. They tended to include many active glomerular lesions compared to chronic lesions and to display severe tubulointerstitial inflammation. It is suggested that plasma cell-rich ANCA-GN may be acute onset of the disease, and the target of early inflammation may also be in the tubulointerstitial region. Two of the three plasma cell-rich ANCA-GN cases demonstrated numerous IgG4+ cells, but no bird's-eye pattern fibrosis or obliterative phlebitis. CONCLUSIONS: Plasma cell-rich ANCA-GN is not rare and demonstrates distinct clinicopathological characteristics. This study also reminds us that the presence of the significant number of plasma cells in ANCA-GN, as such, is not a histological diagnostic basis for overlap ANCA-GN and IgG4-related disease.

Rapid weight loss with dietary salt restriction in hospitalized patients with chronic kidney disease.

Dietary salt restriction is essential for managing fluid retention in patients with chronic kidney disease (CKD). In this retrospective cohort study, we investigated weight loss from the perspective of fluid status in CKD patients during a 7-day hospitalization period while consuming a low-salt diet (5 g/day). Among 311 patients, the median weight loss (interquartile range, maximum) was 0.7 (0.0-1.4, 4.7) kg on Day 4 and 1.0 (0.3-1.7, 5.9) kg on Day 7. Patients were classified into quartiles based on pre-hospital urinary salt excretion (quartile [Q] 1, 1.2-5.7; Q2, 5.8-8.4; Q3, 8.5-11.3; Q4, 11.4-29.2 g/day). Weight loss was significantly greater in Q3 and Q4 than in Q1. The body mass index (BMI) and urinary salt excretion in the first 24 hours after admission were independently associated with rapid weight loss on Day 4 by multivariate logistic regression analysis. In conclusion, CKD patients with a high salt intake or high BMI exhibit rapid weight loss within a few days of consuming a low-salt diet. Dietary salt restriction is effective for reducing proteinuria in these patients, but long-term observation is needed to confirm the sustained effects.