Renal biopsy findings and clinical indicators of patients with hematuria without overt proteinuria.

BACKGROUND: Whether to perform a renal biopsy for isolated hematuria remains a matter of controversy. We performed renal biopsy in hematuria without overt proteinuria patients and reported the proportion of glomerulonephritis, pathological activities, and statistical analysis of indicators associated with glomerulonephritis. METHODS: Among 203 patients who underwent renal biopsy in Okubo Hospital, Japan, between January 2008 and October 2013, we identified 56 patients who fulfilled the criteria: (1) urine dipstick examination shows equal to or greater than ± blood on three or more visits, (2) proteinuria <0.3 g/day (g/g Cr), (3) eGFR ≧60 ml/min/1.73 m(2), and (4) no current medication for renal disease. We investigated biopsy findings and compared the clinical indicators in the IgA nephropathy (IgAN) and non-IgAN group. RESULTS: The pathological diagnosis was IgAN in 35 cases (62 %), thin basement membrane disease (TBMD) in 7 (13 %), minor glomerular abnormality (MGA) in 6 (11 %), glomerular basement membrane (GBM) abnormality in 5 (9 %), and others in 3 (5 %). The histological grade of IgAN was I in 90 % and II in 10; 31 % of patients had some crescentic lesions. Comparisons between the IgAN and non-IgAN group revealed significant differences in age of onset (26 ± 13 vs. 34 ± 17 years, p = 0.04), serum IgA (340 ± 114 vs. 220 ± 101 mg/dl, p < 0.01), proteinuria (0.08 [0-0.25] vs. 0 [0-0.23] g/day [g/gCr], p < 0.01), and the presence of poikilocytes (40 vs. 10 %, p = 0.02). CONCLUSIONS: The proportion of IgAN in hematuria without overt proteinuria was high and the pathological activities were variable. Patients with hematuria without overt proteinuria should continue their medical follow-up and the best timing of biopsy may be controversial for these patients who have multiple risk factors of IgAN.

Simultaneous nephrotic syndrome and hepatitis in secondary syphilis: case report and review of the literature.

A 66-year-old man presented with a penile ulcer, an acute clinical onset of nephrotic syndrome and hepatitis. Secondary syphilis was diagnosed on the basis of the history of rash and the result of strongly positive serological test for syphilis. A renal biopsy demonstrated membranous glomerulonephritis with subepithelial electron-dense deposits. After treatment with amoxicillin for 2 weeks, he achieved clinical recovery. It is important to recognize syphilis as a reversible cause of nephrotic syndrome and acute hepatitis because antibiotic therapy can result in complete remission.

[Three adult cases of severe acute glomerulonephritis with acute renal failure requiring hemodialysis].

Acute poststreptococcal glomerulonephritis (APSGN) typically recovers within 2 weeks with conservative therapy, but severe cases are known to develop acute renal failure and or nephrotic syndrome. We experienced 3 adult cases of APSGN with acute renal failure. All 3 cases required hemodialysis, 2 cases received double filtration plasmapheresis, and 2 cases received steroid therapy. In all cases, renal biopsy specimens showed endocapillary proliferative glomerulonephritis. One case had 25% cellular crescents and the others showed wide subendothelial deposits. There were no tubulointerstitial lesions. These 3 cases of severe APSGN with acute renal failure showed the benefits of combination therapy, hemodialysis, double filtration plasmapheresis and steroid therapy. Further clinical study is required to determine which therapy, double filtration plasmapheresis or steroid therapy, is useful.