Search

Background Solar retinopathy is a disease that causes photochemical toxicity in the retinal fovea tissues, leading to an acute decrease of vision. Case presentation This case report is an interventional case of an asymptomatic 17-year-old Caucasian female with a history of suddenly decreased vision due to solar retinopathy. The patient was managed with a custom-made needle injection of triamcinolone acetonide in the suprachoroidal space. Four months post suprachoroidal injection showed an anatomical and functional improvement in the ellipsoid zone layer through optical coherence tomography signal reappearance. In addition, the best-corrected visual acuity had improved from 0.1 to 1.0 on the Snellen chart with the disappearance of the scotoma. However, there was a mild increase in intraocular pressure after this procedure, controlled with topical hypertensive eye drops. Conclusion Suprachoroidal triamcinolone acetonide injection using a custom-made needle showed both functional and anatomical improvement of macular changes post-solar retinopathy, with acceptable safety outcomes in a young female.

The results of the analysis of case histories of 100 deceased patients (55 women and 45 men), whose cause of death was the syndrome of multiple organ failure due to COVID-19, are presented. The case histories of patients who had no previous renal dysfunction were selected for the analysis. The average age of the patients was 76 years. At the terminal stage of the disease, microhematuria was detected in 27 patients, hypercreatininemia was noted in 17 patients, while the creatinine content in the blood did not exceed 437 mol / L in any of 100 patients. Oliguria was observed in 9 patients, polyuria in 43 patients. A possible cause of kidney damage is the damaging effect of SARS-CoV-2 on the proximal convoluted tubules of the nephron. At the same time, in no patient with a severe course of COVID-19, kidney damage did not determine the severity of the condition and was not the cause of death.

Гематурия — это наличие пяти или более эритроцитов в трех последовательных анализах мочи, полученных с интервалом в одну неделю. На уровне первичной медицинской помощи врач должен уметь распо­знать и подтвердить наличие гематурии, предположить ее возможные причины, провести отбор пациентов, которые потенциально могут иметь тяжелое заболевание мочевой системы. Алгоритм оказания первичной медицинской помощи при гематурии у детей зависит от ее клинического варианта: макрогематурия, симптоматическая микрогематурия, асимптоматическая микрогематурия с протеинурией, асимптоматическая изолированная микрогематурия. Детям с макрогематурией показано следующее обследование: общий анализ мочи, общий анализ крови, креатинин сыворотки, соотношение кальций/креатинин в разовой моче, УЗИ почек и мочевого пузыря. Если в результате уточнения жалоб, анамнеза, объективного и дополнительного обследования причина макрогематурии не установлена, ребенка следует направить к детскому нефрологу. Оценка детей с симптоматической микрогематурией направлена на выявление общих (лихорадка, недомогание, боль в животе и др.), неспецифических (сыпь, артрит, желтуха, респираторные, желудочно-кишечные симптомы и др.) и специфических для мочевой системы (дизурия, поллакиурия, недержание мочи, энурез, отеки, артериальная гипертензия) симптомов. Наличие гематурии в сочетании с протеинурией у детей чаще всего предполагает гломерулярное происхождение гематурии. Бессимптомные пациенты, у которых сохраняются гематурия и протеинурия в течение 2–3 недель, должны быть направлены к детскому нефрологу для дальнейшего обследования. Бессимптомная изолированная микрогематурия является наиболее распространенным вариантом гематурии у детей, обычно кратковременным и, как правило, не связанным с тяжелым почечным заболеванием. Наиболее распространенными причинами персистирующей более шести месяцев асимптоматической микрогематурии являются IgA-нефропатия, болезнь тонких базальных мембран, менее частыми — наследственный нефрит (синдром Альпорта), гиперкальциурия, инфекция мочевых путей. На этапе дообследования и дальнейшего наблюдения детей с асимптоматической изолированной микрогематурией оптимальным лекарственным средством является фитониринговый препарат Канефрон® Н.

Cellular crescents are defined as two or more layers of proliferating cells in Bowman's space and are a hallmark of inflammatory active glomerulonephritis and a histologic marker of severe glomerular injury. In general, the percentage of glomeruli that exhibit crescents correlates with the severity of kidney failure and other clinical manifestations of nephritic syndrome. In general, a predominance of active crescents is associated with rapidly progressive glomerulonephritis and a poor outcome. The duration and potential reversibility of the underlying disease correspond with the relative predominance of cellular or fibrous components in the crescents, the initial location of the immunologic insult inside the glomerulus, and the sort of involved cells and inflammatory mediators. However, the presence of active crescents may not have the same degree of significance in the different types of glomerulopathies. The pathophysiology of parietal cell proliferation may have dissimilar origins, underscoring the fact that the resultant crescents are a non-specific morphological pattern of glomerular injury with different implications in clinical prognosis in the scope of glomerular diseases.

Gastrointestinal (GI) symptoms of SARS-CoV-2/COVID-19 in the form of anorexia, nausea, vomiting, abdominal pain and diarrhea are usually preceded by respiratory manifestations and are associated with a poor prognosis. Hematochezia is an uncommon clinical presentation of COVID-19, and we hypothesize that older patients with significant comorbidities (obesity and cardiovascular) and prolonged hospitalization are susceptible to ischemic injury to the bowel. We reviewed the clinical course, key laboratory data including acute-phase reactants, and drug/medication history in 2 elderly male patients admitted for COVID-19 respiratory failure. Both patients had a complicated clinical course and suffered from hematochezia, acute blood loss, and anemia which led to hemodynamic instability requiring blood transfusion around day 40 of their hospitalization. Colonoscopic impressions were correlated with the histopathological findings in the colonic biopsies that included changes compatible with ischemia and nonspecific acute inflammation, edema, and increased eosinophils in the lamina propria. Both patients were hemodynamically stable, on prophylactic anticoagulants, multiple antibiotics, and antifungal agents due to respiratory infections at the time of lower GI bleeding. Hematochezia resolved spontaneously with supportive care. Both patients eventually recovered and were discharged. Elderly patients with significant comorbid conditions are uniquely at risk for ischemic injury to the bowel. This case report highlights hematochezia as an uncommon GI manifestation of spectrum of COVID-19 complications. The causes of bleeding in these COVID-19 associated cases are likely multifactorial and can be attributed to concomitant etiologies based on their age, multiple comorbid conditions, prolonged hospitalization compounded by lung injury, and hypoxia precipitated by the virus. We hypothesize that rather than a direct viral cytopathic effect, ischemia and hypoperfusion may be unleashed due to the cytokine storm orchestrated by the virus that leads to abnormal coagulation profile. Additional factors that may contribute to ischemic injury are prophylactic use of anticoagulants and polypharmacy. There were no other causes to explain the brisk lower GI bleeding. Presentation of hematochezia was followed by hemodynamic instability that may further increase the mortality and morbidity of COVID-19 patients, and prompt consultation and management by gastroenterology is therefore warranted.

Objective To study the differences between solar retinopathy (SR) and the maculopathy produced by laser pointer (LPM) using multimodal imaging. Method A retrospective series is presented of 20 eyes of 12 patients with injuries associated with light, 7 with SR-compatible injuries, and 5 with LPM. At diagnosis, a complete opht-halmological examination was performed, including visual acuity (VA), retinography, andspectral domain optical coherence tomography (OCT). The patients were followed-up for a mean period of 20 months. Results LPM is common in paediatrics (mean age 15.60 ± 1.5 years), and SR affects patients of all ages (mean age 47.56 ± 1.51 years). VA at diagnosis in LPM is greater, and recovery is more complete than in solar retinopathy. In conventional retinography, SR is shown as a single lesion in the macular area (100% of cases), while LPM usually presents as multifocallesions (86% of cases). Infrared reflectance makes this difference clearer. The main sign in OCT is the disruption of the ellipsoid layer and interdigitation zone. This sign is maintained over time, and its size is greater in the SR than in the LPM. Hyper-reflective columns and hyper-reflective reaction of the retinal pigment epithelium are associated with the acutephase. Conclusions LPM and SR show significant differences in the type of patient affected, as well as in the signs in multimodal imaging, as well as in functional impairment and their evolution.

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.В обзорной статье представлены данные по вопросам: а) определения понятия микрогематурия и методов ее выявления; б) оценки распространенности и причин бессимптомной микрогематурии; в) диагностических подходов при первичном (случайном) выявлении микрогематурии; г) последующего мониторинга пациентов с бессимптомной гематурией; д) целесообразности скрининга на микрогематурию. В анализ включены российские и зарубежные рекомендации профессиональных сообществ, результаты когортных и обсервационных исследований, ранее выполненные обзоры. Микрогематурией следует считать выявление 3 и более эритроцитов при микроскопическом исследовании. В мире отсутствует единый для всех пациентов алгоритм обследования. Основной принцип индивидуальная диагностическая тактика с учетом анамнеза, возраста, сопутствующих заболеваний и факторов риска. Целью комплексного обследования является исключение жизнеугрожающих состояний (злокачественного новообразования и/или гломерулярного поражения почек). В части случаев после проведения исследований причина микрогематурии остается неясной и требуется мониторинг. Рутинный скрининг населения с целью выявления микрогематурии в настоящее время не считается обоснованным.

Background Coexistence of fibrillary glomerulonephritis (FGN) and immunoglobulin A (IgA) nephropathy (IgAN) in the same kidney biopsy (FGN–IgAN) is rare, and the clinicopathologic characteristics and outcome of this dual glomerulopathy are unknown. Methods In this study, 20 patients with FGN–IgAN were studied and their characteristics were compared with 40 FGN and 40 IgAN control patients. Results Concurrent IgAN was present in 1.8% of 847 consecutive FGN cases and was the second most common concurrent glomerulopathy after diabetic nephropathy. FGN–IgAN patients were overwhelmingly White (94%) and contrary to FGN patients were predominantly (60%) males. Compared with IgAN patients, FGN–IgAN patients were older, had higher proteinuria, a higher incidence of renal insufficiency, and a lower incidence of microhematuria and gross hematuria at diagnosis. Six (30%) patients had malignancy, autoimmune disease or hepatitis C infection, but none had a secondary cause of IgAN or clinical features of Henoch–Schonlein purpura. Histologically, all cases exhibited smudgy glomerular staining for immunoglobulin G and DnaJ homolog subfamily B member 9 (DNAJB9) with corresponding fibrillary deposits and granular mesangial staining for IgA with corresponding mesangial granular electron-dense deposits. On follow-up (median 27 months), 10 of 18 (56%) FGN–IgAN patients progressed to end-stage kidney disease (ESKD), including 5 who subsequently died. Serum creatinine at diagnosis was a poor predictor of renal survival. The proportion of patients reaching ESKD or died was higher in FGN–IgAN than in IgAN. The median Kaplan–Meier ESKD-free survival time was 44 months for FGN–IgAN, which was shorter than IgAN (unable to compute, P = 0.013) and FGN (107 months, P = 0.048). Conclusions FGN–IgAN is very rare, with clinical presentation and demographics closer to FGN than IgAN. Prognosis is guarded with a median renal survival of 3.6 years. The diagnosis of this dual glomerulopathy requires careful evaluation of immunofluorescence findings, and electron microscopy or DNAJB9 immunohistochemistry.

To study the characteristics of photoreceptors on adaptive optics (AO) in patients of solar retinopathy and its correlation to changes in spectral domain optical coherence tomography (SDOCT) and visual acuity. This is a cross-sectional observational study of six eyes of five patients with clinically diagnosed solar retinopathy. Five age-matched controls were included for comparison. A flood-illuminated adaptive optics retinal camera (AO; rtx1, Imagine Eyes, Orsay, France) was used to image the photoreceptors and a spectral domain optical coherence tomography (SDOCT; Spectralis™ Heidelberg Engineering, Germany) was used to study the retinal layers in these patients. The corrected distance visual acuity (CDVA) was assessed using Snellen’s chart. Defects on the SDOCT were smaller (0.25 to 0.75°) at the fovea compared with AO (more than 1°). The cone mosaic was preserved beyond 1°. The cone count from the foveal center at 0.75, 1, 2, and 3° was decreased in all patients of solar retinopathy (mean value 5352) compared with age-matched controls (mean value 15693). A corresponding increase in spacing (mean value 19.13) compared with controls (mean value 9.34) was also observed. The CDVA ranged from 20/30 to 20/80. There was no statistically significant relationship between cone density, at any of the eccentricities measured, with CDVA or OCT defect (p > 0.05, for all). Adaptive optics is a sensitive and accurate tool to analyze photoreceptor damage in solar maculopathy. It can be used as an adjunct for better understanding of the pathology and to observe or predict changes in these patients.

Absztrakt: A solaris retinopathia a fotoreceptorok és a retina pigmentepitheliumának ultraibolya (UV) fény okozta fotokémiai és termikus károsodása. A behatás következtében a leggyakoribb panaszok között a visuscsökkenés, a homályos látás és a pozitív scotomák szerepelnek. A diagnózis alkotásában az optikai koherencia tomográfia (OCT), a mikroperimetria és a fluoreszcein angiográfia (FLAG) nyújt segítséget. A szerzők egy 18 éves férfi esetét mutatják be, aki prolongált napfény-expozíció után jelentkezett a Semmelweis Egyetem Szemészeti Klinikáján, mindkét szemet érintő centralis scotoma miatt. Az OCT-felvételeken a retina egyes rétegeiben folytonossághiányt és reflexiófokozódást figyeltünk meg, míg mikroperimetriás vizsgálattal a laesióknak megfelelően érzékenységcsökkenés volt tapasztalható. A féléves követés során a jobb retina folytonossághiánya csökkent, míg a bal oldal teljes restitúciót mutatott. A mikroperimetriás lelet az OCT-n látottakkal korrelált. A beteg szubjektív panasza a jobb szemén minimálisra csökkent, mindennapi életét nem korlátozza, a bal szemére megszűnt. A solaris retinopathiának jelenleg specifikus terápiája nincs. A panaszok és az eltérések kedvező esetben 3–6 hónap alatt normalizálódnak, ez felhívja a figyelmet a megfelelő tájékoztatás és a prevenció szerepére. Orv Hetil. 2020; 161(16): 632–636.

To identify patterns of care for women referred for asymptomatic microhematuria in a single, hospital-based health care system and estimate the cost of unindicated evaluation.We conducted a retrospective study of 100 women with a diagnosis of asymptomatic microhematuria referred to a tertiary female pelvic medicine and reconstructive surgery practice. Our analysis focused on referral patterns by obstetrician-gynecologists and primary care physicians. Data analyzed included whether asymptomatic microhematuria was documented using urine microscopy (vs urine dipstick) and whether the urine microscopy correctly identified asymptomatic microhematuria with three red blood cells (RBCs).Forty-six patients were referred who met the American Urological Association's guidelines for asymptomatic microhematuria with a workup estimated at $8,298 per patient. Fifty-four were referred to a female pelvic medicine and reconstructive surgery specialist despite clearly not meeting the American Urological Association's definition of asymptomatic microhematuria. Of these, 33 patients were referred based on dipstick-positive results only, 11 were referred based on microscopic urinalysis demonstrating fewer than three RBCs per high-power field (HPF), and the remaining 10 patients were referred with urine microscopy demonstrating at least 3 RBC/HPF but in the setting of a clearly benign cause, such as infection or menstruation. The total estimated cost of the unnecessary asymptomatic microhematuria workup in patients who did not meet American Urological Association criteria for referral was $1,213 per patient.Fewer than half of the referrals for asymptomatic microhematuria were appropriate, leading to wasted and entirely preventable health care expenditures. This study highlights the need for education of health care providers making these referrals.

Although urine analysis is a simple and inexpensive method for the initial evaluation of renal colic patients presenting in emergency departments, it is regarded as unreliable for an exact diagnosis of urinary system stones. The aim of the present study is to assess the association between clinical demographics, and stone size and location, with the combined utility of urinalysis and unenhanced multidetector computed tomography (MDCT) in the emergency department. After gaining local Ethics Committee approval, a retrospective study was conducted with data from 186 patients who presented at our emergency service with flank pain and documented urolithiasis. Stone location and size was determined by MDCT, and the presence of microhematuria confirmed by urinalysis. The presence of hydronephrosis and clinical complaints were also recorded. A total of 186 patients were included in the present study, in which an absence of microhematuria was recorded in 24.7% patients. Urine density was found to be elevated in the microhematuria group (p=0.001). Upper urinary tract stones and hydronephrosis were found to be associated with the presence of microhematuria. Although statistically insignificant, an increased trend of microhematuria was observed with stones over 5 mm in size. Urinary stone size and location are directly associated with the incidence of microhematuria. Absence of microhematuria does not preclude MDCT imaging, however, especially in cases where stones are suspected in patients with renal colic. [Med-Science 2019; 8(2.000): 407-11]

We report on the development of nephrotic proteinuria and microhematuria, with histological features of renal thrombotic microangiopathy (TMA), following the first dose of BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) and COVID-19 diagnosis. A 35-year-old previously healthy man was admitted at our hospital due to the onset of foamy urine. Previously, 40 days earlier, he had received the first injection of the vaccine, and 33 days earlier, the RT-PCR for SARS-CoV-2 tested positive. Laboratory tests showed nephrotic proteinuria (7.9 gr/day), microhematuria, serum creatinine 0.91 mg/dL. Kidney biopsy revealed ultrastructural evidence of severe endothelial cell injury suggestive of a starting phase of TMA. After high-dose steroid treatment administration, complete remission of proteinuria was achieved in a few weeks. The association of COVID-19 with renal TMA has been previously described only in patients with acute renal injury. Besides, the correlation with COVID-19 vaccine has not been reported so far. The close temporal proximity (7 days) between the two events opens the question whether the histological findings should be ascribed to COVID-19 itself or to vaccine injection.

Purpose To describe a case series of scleritis associated with IgA vasculitis (IgAV) at a tertiary referral center. Observations Three men with scleritis associated with IgAV were identified: one with anterior scleritis alone, one with anterior scleritis and peripheral ulcerative keratitis (sclerokeratitis), and one with anterior and posterior scleritis. Visual acuity was preserved except from the patient who developed posterior scleritis. Ocular pain was the main symptom at presentation. All patients had a previous history of palpable purpura, but only one was aware of his underlying IgAV. Laboratory results revealed microhematuria and proteinuria with normal urinary β2 microglobulin levels and negative serum ANCAs. Skin or kidney biopsy demonstrated leukocytoclastic vasculitis or glomerulonephritis with dominant IgA immune deposits. Conclusions and Importance Although uncommon, IgAV should be included in the differential diagnosis of anterior scleritis alone or associated with peripheral ulcerative keratitis or posterior scleritis, even in systemically asymptomatic patients. Urinalysis should not be underestimated in assessment of scleritis to detect early stages of glomerular disease. Scleritis may be the first manifestation whose study may lead to the diagnosis of IgAV. Multidisciplinary approach is necessary to prevent irreversible organ damage such as renal failure.

The co-occurrence of IgA nephropathy (IgAN) and positive anti-neutrophil cytoplasmic autoantibodies (ANCA) serology is uncommon. In the present case series and literature review, we aimed to clarify the impact of ANCA on pathogenesis, clinical and histopathology presentation, and outcome in IgAN patients. We report four patients with an overlap lesion of IgAN-ANCA positive. Also, we performed a narrative review of all biopsy-proven published case series. Only 1.2% patients had ANCA in our 330-biopsy-proven IgAN cohort. We compared our data with previous reports-6 case series and 3 small retrospective studies-a total of 103 patients. All patients but one had eGFR below 15 mL/min at diagnosis. Besides rapidly decreasing eGFR, all presented with proteinuria around 1.5 g/day and dysmorphic microhematuria, suggesting glomerular inflammation. Systemic symptoms suggestive for ANCA vasculitis were seen in half of our patients, but only one patient had hemorrhagic alveolitis. Patients from our cohort responded to the intensive immunosuppressive regimens used in ANCA-positive vasculitis with renal involvement. However, in the follow-up, one patient had a relapse followed by septic shock related to immunosuppression and one patient started hemodialysis. In the review, we found that IgAN-ANCA -positive patients are characterized by vasculitis-like lesions and clinically by a rapidly progressive decline in kidney function, which was reversed by an aggressive induction immunosuppressive protocol used in ANCA vasculitis. Checking ANCA serology seems useful in patients with rapidly progressive IgAN for therapeutic and prognostic reasons.

Background Overweight and obesity are associated with diabetes, hypertension and chronic kidney disease (CKD). However, there is scarce information from lower income countries about undiagnosed obesity-associated conditions. This information is necessary for healthcare planning and for assessment of Global Burden of Disease. Methods We assessed the prevalence of obesity-associated conditions in 656 overweight (n = 360) and obese (n = 296) adults from inner-city Portoviejo (Ecuador), in descriptive field research, based on an opportunistic and selective sampling strategy. Results Of 316 men and 340 women, 73% met criteria for prehypertension (27%) or hypertension (46%), 50% met criteria for prediabetes (30%) or diabetes (20%), 11% had an estimated glomerular filtration rate (eGFR) 2 consistent with chronic kidney disease (CKD) and 5.5% had pathological albuminuria for a total CKD prevalence of 16%. Age-related prevalence data were generated. In all participants, serum total cholesterol and triglycerides were >200 and >150 mg/dl, respectively. Hyperuricemia and microhematuria (p 0.000). Diabetes and pathological albuminuria prevalence were higher in obese than in overweight participants (15 vs 12%, p 0.018; and 8 vs 4%, p 0.0199, respectively). Discussion In conclusion, undiagnosed hypertension, diabetes and CKD were more common than expected in overweight and obese persons from Ecuador. Detection rates exceeded official estimates of prevalene of these conditions. Screening the overweight/obese for these conditions, especially at the age ranges at higher risk, may be cost-effective to identify a high number of persons who may benefit from early inexpensive intervention.

An adult male with alcoholic cirrhosis presented with acute blood loss anemia, hypotension and a painful bruise over his body’s left side. He denied any trauma or falls. Computed tomography of the chest showed left chest wall hematoma. Emergent angiography with successful embolization of the left intercostal artery was performed.

A 45-year-old male with hypertension and alcohol use disorder presented to the hospital after being found intoxicated, with bright red blood in the toilet and around his mouth. He was found to be tachycardiac and required intubation due to his inebriated state to establish a secure airway. Initial workup revealed a hemoglobin decrease from 16.7 g/dL to 8.7 g/dL, as well as lactic acidosis. He quickly underwent an upper endoscopy to evaluate his source of hematemesis. An actively bleeding lesion was found in the proximal stomach consistent with prolapse gastropathy syndrome. This case highlights a unique presentation of hematemesis that requires endoscopic evaluation for both diagnosis and treatment.

Wilkie's syndrome is a very rare vascular alteration caused by congenital or acquired reduction of space between the superior mesenteric artery (SMA) and aorta. In acquired form, it is caused by perivascular adipose tissue reduction due to rapid weight loss and, if symptomatic, causes postprandial vomiting and weight loss. The left renal vein (LRV) when it has a retro-aortic course can be compressed in aorto-vertebral space (AVS); if the stenosis is severe it can cause venous congestion symptoms with left flank pain, microhematuria, and thrombosis, this vascular alteration is known as a pseudo-nutcracker syndrome. The combination of Wilkie's and pseudo-nutcracker's syndrome (PNCS) is very rare and has not yet been described in the literature. We describe a case of a 62-year-old woman who presented symptoms and alterations typical of two syndromes.

Background World Health Organization (WHO) guidelines for measuring global progress in schistosomiasis control classify individuals with Schistosoma spp. infections based on the concentration of excreted eggs. We assessed the associations between WHO infection intensity categories and morbidity prevalence for selected S. haematobium and S. mansoni morbidities in school-age children. Methodology A total of 22,488 children aged 6–15 years from monitoring and evaluation cohorts in Burkina Faso, Mali, Niger, Uganda, Tanzania, and Zambia from 2003–2008 were analyzed using Bayesian logistic regression. Models were utilized to evaluate associations between intensity categories and the prevalence of any urinary bladder lesion, any upper urinary tract lesion, microhematuria, and pain while urinating (for S. haematobium) and irregular hepatic ultrasound image pattern (C-F), enlarged portal vein, laboratory-confirmed diarrhea, and self-reported diarrhea (for S. mansoni) across participants with infection and morbidity data. Principal findings S. haematobium infection intensity categories possessed consistent morbidity prevalence across surveys for multiple morbidities and participants with light infections had elevated morbidity levels, compared to negative participants. Conversely, S. mansoni infection intensity categories lacked association with prevalence of the morbidity measures assessed. Conclusions/significance Current status infection intensity categories for S. haematobium were associated with morbidity levels in school-age children, suggesting urogenital schistosomiasis morbidity can be predicted by an individual’s intensity category. Conversely, S. mansoni infection intensity categories were not consistently indicative of childhood morbidity at baseline or during the first two years of a preventive chemotherapy control program., Author summary Infections with Schistosoma parasites are commonly classified by the presence and concentration of excreted Schistosoma eggs. Guidelines put forward by the World Health Organization (WHO) include classifications of S. haematobium infections assessed by urine filtration into light and heavy infections and S. mansoni infections assessed by Kato-Katz thick smears into light, moderate, and heavy infections. Past evidence has demonstrated an association between intensity of infection with morbidity for severe morbidities, but this was before recognition of the effect of light-intensity infections on morbidity and was done in treatment naïve populations. In these analyses, we assessed the associations between the WHO classifications for infection intensity and a wide array of S. haematobium and S. mansoni morbidity indicators in school-age children ascertained in monitoring and evaluation cohorts before and after initiation of deworming. Our analyses found a high correlation with S. haematobium intensity categories and morbidity indicators, especially microhematuria, but weaker correlation between S. mansoni intensity categories and morbidity indicators. The results indicate that, on the aggregate, the intensity categories represent a person’s S. haematobium-related morbidity but are poor at representing a person’s S. mansoni-related morbidity.

Photic retinopathy may lead to permanent foveal structural injury, leading to irreversible visual acuity loss. This prospective observational study evaluated 51 eyes of 30 patients with photic retinopathy. Optical coherence tomography (OCT) imaging was performed for all the eyes at baseline and final follow-up. All the eyes showed a focal outer retinal defect on spectral-domain OCT (SD-OCT) at the junction of the inner and outer photoreceptor segments. SD-OCT was used to measure central macular thickness, maximum horizontal dimension of the defect, maximum defect thickness, and the photic retinopathy index (PRI) through the foveal raster scan. Although PRI improved significantly at the final follow-up from baseline with a 17% improvement in PRI after a period of 6 months in photic retinopathy eyes, visual acuity declined for 14% of the patients and was stable for 84%. There was mild correlation of visual acuity with baseline PRI. Baseline PRI was significantly higher in eyes with poorer presenting visual acuity (VA). In total, 33.3% of the eyes showed partial ellipsoid zone recovery at 6 months. The area under curve of the receiver operator characteristic curve for partial ellipsoid zone recovery with the mean baseline PRI as the independent variable was poor at 0.612. OCT-based ultrastructural features in photic retinopathy seem to have poor correlation with presenting or final visual acuity. To the best of our knowledge, this is the largest study on longitudinal OCT evaluation of photic retinopathy eyes in literature.

Asymptomatic microhematuria (AMH) is defined as 3 or more red blood cells per field in urinary sediment microscopy in the absence of an obvious cause. The most common causes of AMH in adults are urinary tract infection, benign prostatic hyperplasia and kidney stones, however the possibility of malignancy should always be considered. For initial assessment, rule out benign causes and microscopy urinalysis is essential. The use of imaging studies for diagnosis is necessary, being the CT Urography the most recommended and for patients with a risk factor for malignancy, cystoscopy should always be performed. The follow-up varies according to whether the AMH is persistent or not and the risk factors for malignancy. La microhematuria asintomática (MHA) se define como 3 o más eritrocitos por campo en microscopía del sedimento urinario en ausencia de causa obvia. Las causas más comunes de MHA en adultos son infección del tracto urinario, hiperplasia prostática benigna y cálculos urinarios, sin embargo siempre se debe tener en cuenta la posibilidad de malignidad. Para la valoración inicial es esencial el uroanálisis con microscopía, y descartar primero causas benignas. Es necesario emplear estudios de imagen para el diagnóstico, siendo la Urografía por TAC el más recomendado y en pacientes con algún factor de riesgo para malignidad se debe realizar siempre la cistoscopia. El seguimiento varía de acuerdo a sí la MHA es persistente o no y de los factores de riesgo para malignidad

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronavirus family, which comprises enveloped positive sense ribonucleic acid (RNA) viruses responsible for pandemic outbreaks including Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV), and most recently coronavirus disease 2019 (COVID-19). A 30-year-old previously healthy male diagnosed 11 days earlier with COVID-19 presented with right-sided weakness and dysarthria. The patient was found to have an acute left carotid thrombus with embolic multifocal infarcts throughout the left cerebral hemisphere. He was treated acutely with intravenous heparin however developed gastrointestinal bleeding, prompting discontinuation of anticoagulation. Follow up CT angiography 12 days following his stroke demonstrated complete resolution of the thrombus. Since discharge, the patient has been managed with antiplatelet therapy alone with complete neurologic recovery. Large vessel strokes amongst young patients have been a growing concern during the SARS-CoV-2 outbreak. The use of acute therapeutic and prophylactic anticoagulation is based on risk assessment. Albeit, the utility of anticoagulation in COVID-19 patients remains undetermined. Prevention of stroke recurrence is a clinical priority for providers treating large vessel stroke patients. More research is required to establish the effectiveness of anticoagulation and antiplatelet therapy for stroke prevention in patients diagnosed with COVID-19.

Background Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is known for its benefits as a definitive treatment for severe endometriosis. Undiagnosed endometriosis is common in patients with symptomatic fibroids or chronic pelvic pain. There are minimal studies that outline the safety and feasibility of nerve-sparing modified radical hysterectomy for other complex pelvic pathology in addition to endometriosis. Objectives The aim of this study is to evaluate the incidence of hospital readmission, intraoperative and postoperative complications, and long-term pain relief after laparoscopic nerve-sparing modified radical hysterectomy for severe endometriosis and complex benign pelvic pathology. Study design We performed a retrospective observational study of patients who underwent laparoscopic nerve-sparing modified radical hysterectomy with and without robotic-assistance with a high-volume minimally invasive endoscopic surgeon between November 2017 and December 2019. Results A total of 112 patients met the inclusion criteria. There were no cases of vaginal cuff dehiscence, venous thromboembolism, genitourinary system injury, gastrointestinal tract injury, vessel injury, nerve injury, sepsis, or death. Three patients required postoperative hospital admission for the management of umbilical cellulitis, acute blood loss anemia, and possible Addison’s crisis. Other postoperative complications included allergic reaction to adhesives (1.8%) and urinary retention (0.9%). All patients reported significant pain relief at the time of their postoperative visits. Three patients reported return of pain symptoms within the first seven months after surgery, with one requiring an additional surgery for persistent pain. Conclusions Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is a safe and feasible alternative that provides long-term symptom relief in patients undergoing hysterectomy for a variety of indications.

Minimally invasive options are safe and reliable alternatives for the treatment of nutcracker syndrome (NCS). After continued efforts, our team successfully devised a new and effective therapeutic method: 3D-printed extravascular stenting of the left renal vein. From December 2017 to May 2019, 28 patients (25 men and 3 women) from different parts of China between 18 and 37 years old (mean, 23.6 years) diagnosed with NCS were admitted for laparoscopic 3D-printed extravascular stenting treatment. The post-operative follow-up duration was 6–24 months (median, 16.3 months). Technical success of the operation was achieved in all patients. After treatment, the NCS symptoms all patients resolved or improved during the follow-up period, without relapse. Most symptoms, including macro-/microhematuria, proteinuria, and flank/abdominal pain, tended to resolve within 3–6 months after the surgery; other symptoms, such as left-sided varicocele, also showed varying degrees of improvement at different times post-operatively. Perioperative complications were noted in two patients, including transient and mild lymphatic leakage, without any adverse effects. All extravascular stents were visualized on computed tomography and Doppler ultrasound scans, and no migration or any side effects occurred during the entire follow-up period. Compared to endovascular stenting or polytetrafluoroethylene artificial vessel procedures, 3D-printed polyetheretherketone extravascular stenting has more advantages in terms of stent design and rigidity and approach rationality while successfully preventing stent migration and thrombosis. Therefore, this method may serve as an accurate and effective treatment for NCS patients.

Purpose The American Urological Association guideline for asymptomatic microhematuria recommends in patients with a negative initial workup, repeat workup should be considered for those with persistent/recurrent microhematuria. However, there is little data on the yield of repeat evaluation. Our hypothesis was that repeat workup yields a low detection rate of urologic malignancy. Materials and Methods We retrospectively reviewed all patients at our institution who underwent microhematuria workup with cystoscopy and upper tract imaging from May 2010 to June 2016. Microhematuria was defined as ≥3 RBCs/HPF on a properly collected specimen in the absence of a benign cause. Demographics, age, smoking history, history of radiation, and findings on repeat cystoscopy and imaging were collected. Our primary endpoint was a new diagnosis of urologic malignancy. Results Our initial cohort included 1,332 patients, of whom 21 were diagnosed with urothelial carcinoma and 7 with suspicious renal masses on initial workup. A total of 637 patients with negative initial workup had persistent/recurrent microhematuria. Repeat cystoscopy was performed in 161 (25%) patients at a median of 39 months, and repeat upper tract imaging was performed in 317 (50%) patients at a median of 39 months. Overall, repeat cystoscopy revealed new bladder cancer in 2 (1.2%) patients and repeat imaging revealed new suspicious renal mass in 4 (1.3%) patients. Conclusions We observed a low number of newly diagnosed malignancies among patients with persistent/recurrent asymptomatic microhematuria who had a prior negative workup. Additional research is required to determine the utility of a repeat AMH workup.

Background: Genetically determined prelingual hearing loss (HL) may occur in an isolated or syndromic form. Objective: The aim of the study was to unravel the genetic cause of medical problems in a 21-year-old woman, whose phenotypic presentation extended beyond Stickler syndrome and included enlarged vestibular aqueduct (EVA) and persistent microhematuria. Methods and Results: After sequencing of clinical exome, a known de novo COL2A1 pathogenic variant (c.1833+1G>A, p.?) causative for Stickler syndrome and one paternally inherited pathogenic change in COL4A5 (c.1871G>A, p.Gly624Asp) causative for X-linked Alport syndrome were found. No pathogenic variants, including those within the SLC26A4 5′ region (Caucasian EVA haplotype), explaining the development of EVA, were identified. Conclusions: The study reveals a multilocus genomic variation in one individual and provides a molecular diagnosis of two HL syndromes that co-occur in the proband independent of each other. For the third entity, EVA, no etiological factor was identified. Our data emphasize the relevance of detailed clinical phenotyping for accurate genotype interpretation. Focus on broadening the phenotypic spectrum of known genetic syndromes may actually obscure patients with multiple molecular diagnoses.

Hyperplastic polyps are the second most common type of gastric polyp in the United States with equal incidence in both genders, usually found incidentally during endoscopic examinations. It is a well-known fact that they are associated with iron-deficiency anemia due to chronic blood loss. We present a case of a 69-year-old man with a relatively small hyperplastic gastric polyp with acute upper gastrointestinal bleeding, presenting with melena and acute blood loss anemia requiring admission to intensive care unit and urgent endoscopic intervention with hot snare removal of the polyp and cautery of surrounding area with excellent hemostasis. The pathology revealed focal intestinal metaplasia and low-grade dysplasia with no evidence of malignancy. He was subsequently discharged with outpatient follow-up with gastroenterology.

Crystalglobulinemia is an extremely rare complication of monoclonal gammopathy. We report a 49-year-old female who presented with acute kidney injury, microhematuria, and non-nephrotic range proteinuria. Eight weeks prior to presentation, she developed a lower urinary tract infection and acute kidney injury, but her creatinine failed to resolve after resolution of her symptoms with antibiotics. Kidney biopsy revealed a membranoproliferative pattern of injury, and numerous crystals were noted in the glomerular capillaries on electron microscopy. On immunofluorescence, positive staining for immunoglobulin G and kappa was demonstrated in the capillary lumen along the capillary walls. Based on the biopsy, a diagnosis of crystalglobulinemia was made. On serum protein electrophoresis, there was presence of a monoclonal band, which was too small to quantify. Urine immunofixation was negative. Patient was treated with cyclophosphamide, bortezomib, and dexamethasone regime and made a remarkable renal recovery.

Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121–13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

Microscopic hematuria is a common feature of patients with Alport syndrome, a familial nephropathy due to mutations in COL4A3, COL4A4 or COL4A5. These genes encode for α3, α4, and α5 type IV collagen polypeptide chains (collagen IV α345), crucial for the structural component of the glomerular basement membrane. Even patients with mild phenotype, namely isolated microhematuria (X-linked females with thin basement membrane on electron microscopy or heterozygous carriers of COL4A3 or COL4A4 mutations), can potentially progress to proteinuria and to end-stage renal disease. Recent pedigree analyses provided evidence for digenic inheritance of Alport syndrome by concomitant mutations in COL4A3/COL4A4 or COL4A4/COL4A5. We describe a Caucasian family with concomitant COL4A3 and COL4A5 mutations, consisting of a novel c.4484A>G COL4A3 (p.Gln1495Arg) mutation and a previously reported c.1871G>A COL4A5 (p.Gly624Asp) mutation. Our segregation analysis raises the possibility that Alport syndrome resembles also digenic inheritance by COL4A3/COL4A5.

INTRODUCTION AND OBJECTIVE:The current AUA guidelines for asymptomatic microhematuria (AMH) recommends in patients with negative initial workup, annual urinalyses (UAs) should be obtained and repea...

C3 glomerulopathy (C3G) is a clinical spectrum that presents with a variety of symptoms, ranging from a mild disease with asymptomatic microhematuria and/or proteinuria to severe disease with nephritic or nephrotic syndrome and renal impairment. Herein, we aim to document the clinical and laboratory findings, response to immunosuppressive and supportive treatment and prognosis of the children with C3G. We retrospectively reviewed the medical records of patients diagnosed with membranoproliferative glomerulonephritis (MPGN). Kidney biopsy materials were reexamined for the diagnosis of C3G. The inclusion criteria for C3G are the dominant C3 staining with or without scanty immunoglobulins (Ig) deposition on immuno- fluorescence (IF) and MPGN patterns on light microscope. Twelve of 69 patients with MPGN were included in the study based on the definition criteria of C3G. Ten of them had only C3 staining and the rest of the patients had both C3 staining and a small amount of IgG/M staining on IF microscopy. One patient was on remission with only ACEI. The rest of the patients used immunosuppressive treatment and two of them needed eculizumab therapy. One of them did not respond to the treatment of eculizumab and progressed to end-stage renal failure. C3G is a disease characterized by a heterogeneous clinical presentation and outcome. Because of this broad spectrum of disease, treatment may vary widely. We think that complement-targeting therapy with eculizumab should be an alternative option for refractory cases, especially in the early stage of disease, if they did not respond to immunosuppressive treatment.

Introduction The aim of this study was to identify factors associated with absent hematuria in patients with symptomatic urinary stones. Methods This retrospective study analyzed the clinical and imaging findings of emergency department patients who underwent computed tomography (CT) for suspected ureteral colic over the past 2 years. All patients also underwent a microscopic urinalysis, and the presence of 4 or more red blood cells/high-power field was defined as microhematuria. Results A total of 798 patients were included in this study. Of these patients, 750 (94.0%) presented with hematuria, while 48 (6.0%) urine samples did not have evidence of hematuria. The group with an absence of hematuria was more likely to have a lower stone location (located in an area from the distal ureter to the bladder) and perinephric stranding on CT than the hematuria group (75.0% vs. 54.3%, p = 0.005; 47.9% vs. 30.5%, p = 0.012, respectively). The degree of hematuria at each stone location was significantly different (p = 0.001). In multivariate analysis, perinephric stranding (odds ratios (OR) 1.87 [95% confidence interval (CI) 1.01–3.46], p = 0.047), a lower stone location (OR 2.72 [95% CI 1.37–5.36], p = 0.004), and elevated serum blood urea nitrogen (BUN) levels (OR 1.06 [95% CI 1.01–1.12], p = 0.026) were associated with absent hematuria. Conclusions In this large cohort of patients with renal colic, 6% had no microhematuria. Although some CT findings and elevated BUN were independently associated with hematuria absence, there was no difference in the demographics, time of presentation and degree and location of pain between the groups.

We herein report the case of a 36-year-old woman with Kartagener syndrome (KS), which is an autosomal recessive disorder defined by a triad of bronchiectasis, sinusitis, and situs inversus, with complications of asymptomatic microhematuria and proteinuria. She was finally diagnosed with biopsy-proven immunoglobulin (Ig) A nephropathy. KS constitutes a subgroup of primary ciliary dyskinesia (PCD) characterized by structural and/or functional ciliary abnormalities resulting in sinopulmonary involvement with varying severity. Our case does not allow us to corroborate the clinical impact of KS and/or PCD as a pathogenic basis for the IgA nephropathy, and each disease might develop independently. However, systematic studies on this topic are quite lacking, so we strongly recommend the accumulation of more cases similar to our own, which would allow us to clarify the nature of this disease state more precisely.

Introduction In 2012 the American Urological Association released asymptomatic microhematuria guidelines that resulted in criticisms of overtreatment and improper risk stratification, particularly in women. Specifically, concerns have been raised regarding overtreatment in low risk female patients. Evaluating trade-offs between cost and effectiveness can provide valuable insight into the applicability of these guidelines in different patient populations. Methods We used a decision analysis model to estimate the cost-effectiveness of a microhematuria evaluation according to the 2012 guidelines, using varying strategies according to whether confirmatory urinalysis was obtained and stratifying by sex. Where applicable, model parameter values were from prospective observational trials. Costs were estimated based on U.S. databases. Results Up-front evaluation costs 20% more than confirmatory evaluation ($792.76 vs $662.65). When considering costs per quality adjusted life-year, up-front evaluation costs $125,105 per quality adjusted life-year gained in the overall population. When stratified by sex, up-front evaluation costs $94,777 per quality adjusted life-year gained in male patients and $390,954 per quality adjusted life-year gained in female patients. At a cost-effectiveness threshold of $100,000 per quality adjusted life-year, up-front evaluation is cost-effective in male but not in female patients or the overall population compared to a delayed evaluation. Conclusions Up-front microhematuria evaluation may be economically justifiable in men but not in women or in the overall population. Sex specific risk stratification and confirmatory urinalyses may have a role in populations with a lower risk of urinary tract malignancy.

We present a 77-year-old Caucasian woman who presented with nephrotic-range proteinuria, microhematuria, renal impairment, and extremely elevated blood pressure. She had a long history of well-controlled type 2 diabetes. Renal biopsy revealed fibrillary deposits in the mesangium and glomerular basement membrane consistent with fibrillary glomerulopathy (FGN), with crescentic changes and thrombotic microangiopathy (TMA). We could not identify any radiological, clinical, or laboratory evidence of autoimmune disorders, lymphoproliferative disorders, and malignancy. It was decided not to offer her any immunosuppressive therapy, as she was frail with substantial renal damage on the biopsy. Five months after presentation, she gradually progressed to requiring renal replacement therapy and is currently on maintenance hemodialysis. Crescentic changes in FGN, though rare, have been previously described, but the concurrent presence of TMA has never been previously reported.

Purpose. To report the clinical course of solar retinopathy after steroid therapy. Case Presentation. A 45-year-old male gazed at the sun and noticed bilateral central scotoma and decreased vision after the episode. After 7 weeks from onset, ophthalmic examinations were firstly performed. Decimal best corrected visual acuity (BCVA) was decreased to 0.8 and 0.7 in the right and left eyes. Funduscopy showed a tiny, yellowish spot in the fovea bilaterally. Corresponding to the lesion, optical coherence tomography (OCT) images showed an elevated and blurred ellipsoid zone and loss of the interdigitation zone. A posterior sub-Tenon triamcinolone injection in the right eye and oral prednisolone therapy were performed as a medication. BCVA was improved to 1.2 and 1.0 in the right and left eyes at 9 weeks after medication. OCT images showed ellipsoid zone was gradually improved bilaterally, which became nearly normal at 4 weeks in the right eye and at 21 weeks in the left eye. The loss of the interdigitation zone remained at 12 weeks in the right eye and at 21 weeks at the left eye. Conclusions. We described a case with solar retinopathy who exhibited anatomical recovery of the photoreceptor outer layers by steroid therapy, started after 7 weeks from onset.

Introduction: Acute tubulointerstitial nephritis (ATIN) is a rare entity in the pediatric age. It is defined by the infiltration of the renal parenchyma by mononuclear and/or polynuclear cells with secondary involvement of the tubules, without glomerular injury. It can be triggered by infections or immunological diseases, drugs like NSAIDs or be of idiopathic origin. Objective: To raise awareness among pediatricians about the prescription of NSAIDs, especially to patients of less than a year old, since they can provoke renal damage. Case Report: A ten month old child, with no nephrological antecedents of interest, was transferred to our hospital due to acute renal failure stage 3 KDIGO 2012. The three previous days received treatment with amoxicillin and ibuprofen for acute otitis media. Physical examination revealed mild eyelid edema with normal blood pressure. In the urine analysis, there were non-nephrotic proteinuria with tubular component, microhematuria and leukocyturia. Renal ultrasound showed no abnormalities. ATIN was suspected and so the antibiotic was changed to intravenous cefotaxime and ibuprofen was discontinued, opting for conservative management of acute renal damage. There was an increase in the number of creatinine up to 4.14 mg/dL and eosinophilia, with the immunological study being negative. Treatment with methylprednisolone was initiated, achieving normalization of renal function. Discussion: NTIA can be produced by any medication through an idiosyncratic immune reaction. Among the responsible drugs, there are ones commonly used in the pediatric age, such as NSAIDs. Therefore, the pediatricians should pay special attention during prescriptions and have a high diagnostic suspicion of this disease.

Background: Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a newly described and rare entity that can develop in native and very rarely in transplanted kidneys. We present a patient who developed de novo PGNMID in the kidney allograft along with a review of the literature. Case Presentation: A 38-year old female with type 1 diabetes who underwent successful simultaneous pancreas-kidney (SPK) transplantation 6 years earlier presented with rising serum creatinine, nephrotic range proteinuria and microhematuria. She underwent extensive work up and kidney allograft biopsy revealed mesangial expansion and hypercelluarity on light microscopy, mesangial staining for IgG3, kappa light chains, C1q and C3 on immunofluorescence and abundant mesangial electron dense deposits without substructures on electron microscopy. Serum and urine immunofixation electrophoresis were negative. A diagnosis of de novo PGNMID was made. Patient’s proteinuria improved and serum creatinine stabilized with conservative therapy. Conclusions: PGNMID can rarely develop in kidney allograft as recurrent or de novo disease and may be mislabeled as transplant glomerulopathy if careful immunofluorescence and electron microscopy are not performed on biopsy specimens. Further studies are needed to better understand the pathogenesis of this disease entity and to develop optimal therapeutic approaches.

We describe a case of 62-year-old gentleman presenting with abdominal pain associated with loss of weight, nocturia, oedema of feet, constipation, altered sleep rhythm and dyspepsia. On evaluation he had hepatomegaly with raised alkaline phosphatase and raised GGT levels with normal transaminases and bilirubin. On imaging he had diffuse enlargement of liver with heterogeneous contrast uptake in liver. His viral marker and autoimmune markers were negative. Liver biopsy depicted deposition of amorphous eosinophilic substance within the sinusoids which revealed apple green birefringence on polarizing microscopy after Congo red staining; Congophilia persisted even after treating with KMnO4. Abdominal fat pad was negative for amyloid deposit. Cardiac evaluation was unremarkable and renal evaluation showed Subnephrotic proteinuria and microhematuria. Serum and urine immunofixation electrophoresis showed positive kappa, lambda and gamma globulin. Immunoperoxidase staining for serum amyloid associated protein for secondary amyloidosis was negative from liver biopsy. Here we report a case of primary hepatic amyloidosis that presented with features of hepatic vein obstruction. The association of Budd-Chiari's syndrome, with amyloidosis may be related to the increased risk of thrombosis observed in the latter disease also due to loss of anticoagulants due to significant proteinuria. Patient could not be treated either with chemotherapy or with surgery. We lost him for progressive liver failure.Asian Journal of Medical Sciences Vol.8(2) 2017 97-100

Gastrointestinal (GI) hemorrhage is a common complaint of patients presented to the emergency department, and most episodes of GI bleeding resolve spontaneously. In select cases, however, patients require aggressive resuscitation and rapid implementation of definitive care. Much of the literature discussing management of acute GI bleeding focuses on determining the source of bleeding, however, we attempt to take a more pragmatic approach and focus on resuscitating patients while simultaneously obtaining evidence to localize bleeding. This chapter will explain the key aspects of resuscitation specific to an unstable patient with GI hemorrhage and hemorrhagic shock. We present the evidence supporting adequate intravenous access, transfusion of blood products, and pharmacotherapy. Definitive interventions including endoscopy and interventional radiology will be discussed, but as these techniques are often performed after hospital admission, we will focus on temporizing measures to improve survival while definitive therapy is arranged. Detailed procedures regarding insertion of a balloon tamponade device (commonly referred to as a Minnesota tube or a Sengstaken–Blakemore tube) will be discussed.

Diffuse alveolar hemorrhage is a life-threatening condition characterized by acute hypoxic respiratory failure, hemoptysis, and acute blood loss anemia. Most common etiologies are related to systemic vasculitis due to ongoing vessel inflammation. Diagnosis, however, can be challenging due to variety of non-specific symptoms. We present a challenging case of a 65-year-old male with newly diagnosed acute myeloid leukemia undergoing induction chemotherapy who developed diffuse alveolar hemorrhage.

Asymptomatic microscopic hematuria (AMH) is incidentally found during routine health screenings. In the clinical evaluation of persistent AMH imaging modalities, CT urography, MR urography, and retrograde pyelography are of diagnostic importance. In case of pathologic findings (e.g., contrast-filling defects), endoscopic evaluation is mostly performed. To our knowledge, we report the first case of a patient with persistent AMH caused by biopsy-proven renal papillary hyperplasia.

Improving diagnostic methods for the appointment of effective treatment of animals with urocystitis is an extremely important problem in veterinary medicine. Microscopy of urine sediment is a necessary and important part of general clinical research. With this research method, it is possible to clarify the localization of the inflammatory process in the urinary tract, establish the degree of mucosal damage, differentiate urinary tract diseases from kidney diseases, and conduct differential diagnosis of neoplasms. Urine sediment in dogs suffering from urocystitis revealed postrenal microhematuria (in the field of view of the microscope 5-20 red blood cells), pyuria due to neutrophils (in the field of view 20-100), bacteriuria and the appearance of a significant number of transitional and superficial epithelial cells (in the field of view 3-5 cells), which were placed, both singly and in the form of layers. The admission of a large amount of transitional epithelial cells epithelium into the urine of the male dogs indicated the development of an inflammatory process of bacterial origin in the bladder and distal urethra, sometimes with prostate damage. In 50% of the dogs with urocystitis, crystalluria and spermatorea were noted. Of the unorganized sediments in the urine of experimental animals, crystals of ammonium biurate (acidic uric acid ammonium) were most often found, less often crystals of phosphoric acid calx, and even less often struvite crystals.

Background Microhematuria is common in immunoglobulin A nephropathy (IgAN). However, current prognostication is based on proteinuria and mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, tubulointerstitial fibrosis and crescent (MEST-C) scores. Methods In this retrospective study, we evaluated whether MEST-C score components are associated with the presence of microhematuria at biopsy and whether the degree of microhematuria during follow-up is associated with change in estimated glomerular filtration rate (eGFR), after adjusting for clinical and histological parameters. We identified 125 patients with biopsy-proven IgAN and MEST-C scoring who were not on immunosuppressive therapy at biopsy. Microhematuria was defined as ≥3 red blood cells (RBCs)/high-power field (hpf). Results Of the 125 patients, 97 had microhematuria at baseline and were more likely to have M1, E1 and C ≥ 1 lesions (P Conclusion Degree of microhematuria during follow-up is an independent predictor of eGFR decline after adjusting for clinical and histological parameters. Therefore, monitoring the degree of microhematuria as well as proteinuria is important when evaluating patients with IgAN. Additional studies using improvement in microhematuria as a primary surrogate outcome are needed.

Three major consequences of complement deficiencies are: 1) inadequate opsonization, 2) ineffective pathogen cell membrane lysis, and 3) co-morbid immune complex related disorders Partial C4 deficiency predisposes to systemic lupus erythematosus (SLE), while complete C4 deficiency is rare

Background This systematic review and meta-analysis aims to investigate the prevalence of microhematuria in patients presenting with suspected acute renal colic and/or confirmed urolithiasis at the emergency department. Methods A comprehensive literature search was conducted to find relevant data on prevalence of microhematuria in patients with suspected acute renal colic and/or confirmed urolithiasis. Data from each study regarding study design, patient characteristics and prevalence of microhematuria were retrieved. A random effect-model was used for the pooled analyses. Results Forty-nine articles including 15′860 patients were selected through the literature search. The pooled microhematuria prevalence was 77% (95%CI: 73–80%) and 84% (95%CI: 80–87%) for suspected acute renal colic and confirmed urolithiasis, respectively. This proportion was much higher when the dipstick was used as diagnostic test (80 and 90% for acute renal colic and urolithiasis, respectively) compared to the microscopic urinalysis (74 and 78% for acute renal colic and urolithiasis, respectively). Conclusions This meta-analysis revealed a high prevalence of microhematuria in patients with acute renal colic (77%), including those with confirmed urolithiasis (84%). Intending this prevalence as sensitivity, we reached moderate values, which make microhematuria alone a poor diagnostic test for acute renal colic or urolithiasis. Microhematuria could possibly still important to assess the risk in patients with renal colic.