A 24-Year-Old Female Transplant Recipient with Type 2 Membranoproliferative Glomerulonephritis and Disseminated Shingles: A Cautionary Tale of Deferring to Primary Care.
PRIMARY care; TRANSPLANTATION of organs tissues etc; GLOMERULONEPHRITIS; KIDNEY failure; KIDNEY transplants; MEDICAL errors; SHINGLES (Disease)
In this report, the case of a 24-year-old Caucasian female with type 2 membranoproliferative glomerulonephritis status-post living donor kidney transplant managed on triple regimen immunosuppressive therapy who developed shingles is discussed. With its onset, she promptly reached out to her nephrologist who deferred her to primary care. Prior to seeing her primary provider, she developed disseminated herpes zoster. She consulted emergency services where she was given inadequate care and again deferred to primary care. One day later, the dissemination included her entire torso, face, oral cavity, and all extremities. Fortunately, the patient had the insight to again reach out to her nephrologist who arranged for her to be admitted for appropriate care 6 days after her initial inquiry that carried 6 days of zoster progression. This case demonstrates how it is pertinent that specialists recognize potentially lethal complications associated with the conditions they follow. Although convenient to defer to primary care, if specialists were to take on the responsibility of providing a broader scope of care for their unique subsets of patients, it would likely result in a reduction in the 80% of serious medical errors that occur as a result of miscommunication, or lack thereof, between care providers. [ABSTRACT FROM AUTHOR]
Burdorf BT
Case Reports in Nephrology
2021
2021-07-27
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Chronic lymphocytic leukemia-associated membranous glomerulopathy: remission with fludarabine.
Antineoplastic Agents/*therapeutic use; B-Cell/*complications; Biopsy; Chronic; Female; Glomerulonephritis; Humans; Kidney/pathology; Leukemia; Lymphocytic; Membranous/diagnosis/*drug therapy/etiology; Vidarabine/*analogs & derivatives/therapeutic use
In some individuals, chronic lymphocytic leukemia (CLL) may be associated with glomerular disease from membranous nephropathy with resultant nephrotic syndrome. CLL is characterized by abnormal immunoregulation with a malignant clonal proliferation of lymphocytes. The association between the abnormal clone and nephrotic syndrome is suggested in some cases by the remission of proteinuria with a reduction in abnormal lymphocyte number after treatment with antineoplastic agents. For the first time, we describe a patient with CLL and associated membranous glomerulopathy whose nephrotic syndrome remitted after treatment with fludarabine, a new purine analogue used in the treatment of refractory CLL.
Butty H; Asfoura J; Cortese F; Doyle M; Rutecki G
American journal of kidney diseases : the official journal of the National Kidney Foundation
1999
1999-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0272-6386(99)70329-x" target="_blank" rel="noreferrer noopener">10.1016/s0272-6386(99)70329-x</a>
Waldenstrom's Macroglobulinemia And Nephrotic Syndrome With Membranous Nephropathy
antibody; glomerulonephritis; macroglobulinemia; membranous nephropathy; nephrotic syndrome; pathology; Urology & Nephrology; Waldenstrom's
Renal complications of Waldenstrom's macroglobulinemia (WM) are rarely observed. Nephrotic syndrome in association with WM has most often been secondary to amyloidosis. This article reports a case of WM with nephrotic syndrome as a result of membranous nephropathy with immunoglobulin M (IgM) deposition. A 44-year-old male diagnosed with WM 4 years previously, presented with heavy proteinuria (7.8 g/24 h). Kidney biopsy revealed expanded mesangium, thickened capillary loops and epimembranous spikes, with no significant interstitial inflammation or thickened tubular basement membranes. Immunofluorescence examination demonstrated strong granular staining of IgM and l light chains, with weaker C3 and C1q staining. Electron microscopy showed many subepithelial dense deposits, and fewer large subendothelial dense deposits. Treatment was directed at the patient's WM with maintenance rituximab and fludarabine. Subsequently, decreases were seen in both the patient's serum IgM and serum viscosity. With therapy for WM and the addition of an angiotensin receptor blocker, the patient's proteinuria also improved, from 7.8 g to 4.8 g/24 h. The patient continued to follow up with his hematologist and in 2009 creatinine was 1 mg/dl (76.26 mu mol/l), with a 24 h urine protein excretion of 0.159 g.
Lee B; Smith R S; Tanphaichitr N; Novak R; Robertson S; Haller N A
Scandinavian Journal of Urology and Nephrology
2011
2011-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3109/00365599.2011.568954" target="_blank" rel="noreferrer noopener">10.3109/00365599.2011.568954</a>