A 58-year-old man with type 1 autoimmune pancreatitis was referred to nephrologists for severe proteinuria. Laboratory data revealed a high serum IgG4 level, hypoalbuminemia, and massive proteinuria, which were compatible with nephrotic syndrome. The renal pathological findings confirmed the diagnosis of secondary membranous nephropathy concurrent with IgG4-related tubulointerstitial nephritis. Despite the improvement of interstitial markers, the proteinuria was refractory to prednisolone, requiring cyclosporine to achieve complete remission. Membranous nephropathy is a rare manifestation of IgG4-related kidney disease. This case shows that the therapeutic response to prednisolone significantly differs between glomerular lesions and interstitial lesions of IgG4-related kidney disease.
A 73-year-old woman with atrial fibrillation treated with rivaroxaban was hospitalized for nephrotic syndrome. After discontinuation of rivaroxaban to lower the risk of hemorrhagic events, a renal biopsy was performed. Rivaroxaban was scheduled to resume a week after the biopsy to prevent renal hemorrhaging. However, she developed acute brachial arterial embolic occlusion and mural thrombosis in the abdominal aorta before resuming rivaroxaban. If immune-mediated renal diseases are suspected in anticoagulated patients at a risk of thrombotic events, physicians should consider initiating glucocorticoid therapy without a renal biopsy in order to avoid hemorrhagic and thrombotic events.
Keywords: uremic pericarditis, cardiac tamponade, low pressure cardiac tamponade, non ultrafiltration for fluid removal 〈Abstract〉 Dialysis therapy has been reported to be an effective treatment for uremic pericarditis, but the necessity of ultrafiltration for fluid removal has not been investigated. We report a case of uremic pericarditis that was successfully treated without ultrafiltration being performed for fluid removal. A 67 year old Japanese male on hemodialysis was diagnosed with asymptomatic uremic pericarditis. Excessive fluid removal may cause circulatory disruption due to low pressure cardiac tamponade. We should consider treating uremic pericarditis without ultrafiltration to prevent unnecessary fluid removal.
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