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A 21-year-old euthyroid gentleman born to nonconsanguineous parents was diagnosed with bipolar affective disorder. He presented 4 years later with hypokalemic quadriparesis. On evaluation, he was found to have features of both proximal and distal renal tubular acidosis. Ophthalmologic examination by slit lamp confirmed the presence of the Kayser-Fleischer ring. The diagnosis of Wilson's disease was established with serum ceruloplasmin levels and 24-h urinary copper levels.Here is a rare clinical presentation of Wilson's disease in the form of hypokalemic muscle paralysis due to proximal renal tubular acidosis with distal tubule involvement. The diagnosis was delayed due to the initial presentation with psychiatric symptoms.
RESUMEN
Introduction: The incidence of acute interstitial nephritis (AIN) has been increasing in recent years. The causes and outcomes of AIN have been changing with time and vary widely based on geographical region. Methods: A retrospective observational study was conducted in a tertiary care center. All (n = 6234) native kidney biopsies were reviewed from January 2016 to December 2021. All biopsy-proven AIN cases were included in the study. AIN associated with systemic diseases (such as SLE, Sjogren's, sarcoidosis, plasma cell dyscrasias), proliferative glomerulonephritis, and allograft biopsies were excluded. Results: Among 6234 biopsies analyzed, there were 156 biopsy-proven AIN cases. The majority were in the 6th decade of life (24.4%) and males (80.8%). 50% of the patients had a history of drug intake, the most common being tenofovir (12.3%) followed by alternate forms of medications (10.3%). The majority (96.2%) presented with acute kidney injury (AKI). At the end of six months, 79.5% recovered completely, 19.2% progressed to chronic kidney disease. The presence of nephrotic range proteinuria at presentation was associated with progression to chronic kidney disease. Conclusion: AIN is an important cause of AKI, especially in the elderly population. Drugs are the most common cause, especially HAART follwed by alternate forms of medication. The presence of nephrotic range proteinuria was associated with increased risk of progression to chronic kidney disease.
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INTRODUCTION: Infection-related glomerulonephritis (IRGN) is an immunologically mediated renal injury due to non-renal infections. With time there has been a change with respect to its incidence, etiological agents, clinical features, and outcomes. MATERIALS AND METHODS: A retrospective observational study was conducted from May 1, 2018 to May 31, 2021. OBJECTIVES: 1. To study the clinical profile of patients with renal biopsy-proven IRGN. 2. To study the outcomes of IRGN at the end of 3 months. All patients were followed up for a minimum period of 3 months. Outcomes at the end of 3 months were categorized as any one of the following: (1) normalization of renal function tests and proteinuria < 500 mg/day, (2) persistent renal dysfunction without requirement of renal replacement therapy, (3) requirement of renal replacement therapy. RESULTS: A total of 114 patients were included in the study. The incidence of IRGN was 4.6%. The majority were males and in the fifth decade of life. Focus of infection was identified in 59.6% of cases. Acute glomerulonephritis (35.1%) and nephrotic syndrome (35.1%) were the most common syndromic presentations. 68.4% of patients had complete recovery at the end of 3 months. 15.7% of patients progressed to chronic kidney disease, and 15.7% of patients required renal replacement therapy. Elderly patients' requirement of renal replacement therapy and higher creatinine at presentation were significantly associated with poor outcomes (p < 0.05). CONCLUSION: This study emphasizes the need for early identification of the source of infection and treatment with appropriate antibiotics. Strategies to identify occult sources of infection should be employed. Elderly age and requirement of renal replacement therapy were associated with poor outcomes.
