Gustavo Lenci Marques

Acute kidney injury in patients infected by H1N1 - clinical histological correlation in a series of cases

INTRODUCTION Influenza A (H1N1) virus was first reported on April 2009 and, since then, several studies have reported the characteristics concerning the clinical presentation and pulmonary involvement. However, accurate information about the acute kidney injury (AKI) and kidney histopathological findings in these patients remain scarce. OBJECTIVE To describe the kidney histopathological findings of 6 patients with H1N1 who developed AKI and underwent kidney biopsy, correlating them with clinical features. METHODS We studied six patients admitted to Hospital de Clínicas UFPR with a PCR-confirmed diagnosis of H1N1who developed ARF and underwent kidney biopsy. We reviewed their medical file and the microscopy findings of the biopsy. RESULTS Clinical and/or laboratory evidence of AKI was present in all cases, and only one did not present oliguria. Kidney tissues revealed glomerular lesions in two patients: one patient, with systemic lupus erythematosus, showed changes consistent with lupus nephritis class III A-C according to the ISN/RPS 2003 and focal thrombotic microangiopathy; the other one had intercapillary nodular glomerulosclerosis, but without clinical or laboratory evidence of diabetes. Vacuolar degenerative tubular changes were present in all cases, with focus of oxalosis in two cases. Mild to moderate atherosclerosis was found in two patients. CONCLUSION In this study, varying degrees of vacuolar degenerative tubular changes were present in all patients, but there were no signs of acute tubular necrosis. It seems that in the present study a prerenal cause of acute renal failure was the main involved mechanim to explain the cause of renal failure in these patients.

Nutcraker syndrome as a cause of recurrent hematuria in a young woman: a case report

INTRODUCTION The nutcracker syndrome is defined by the compression of the left renal vein between the aorta and superior mesenteric arteries, accompanied by a classic, but less specific, symptomatology. CASE REPORT We reported a case of a 37-year-old woman who had been investigated because of intermittent gross hematuria of unknown origin. Computed tomographic angiography revealed compression of the left renal vein as it ran between the superior mesenteric artery and the abdominal aorta, associated with significant dilation of the left ovarian vein. DISCUSSION The nutcracker syndrome, caused by compression of the left renal vein by the aorta and superior mesenteric arteries, is probably more prevalent in women, and it is caused by specific situations, such as renal ptosis and paucity of retroperitoneal fat. Hematuria, a typical symptom, is due to rupture of the thin-walled septum separating the veins of the urinary collecting system. Imaging tests may help with the diagnosis. The best treatment is still elusive, but there are several surgical approaches, such as intravascular stenting, and also a conservative management. Diagnosis is usually delayed, and the syndrome should be included in the differential of hematuria of unknown origin.

Seborrheic Keratoses as the First Sign of Bladder Carcinoma: Case Report of Leser-Trélat Sign in a Rare Association with Urinary Tract Cancer

Introduction. Skin disorders can be the first manifestation of occult diseases. The recognition of typical paraneoplastic dermatoses may anticipate the cancer diagnosis and improve its prognosis. Although rarely observed, the sudden appearance and/or rapid increase in number and size of seborrheic keratoses can be associated with malignant neoplasms, known as the sign of Leser-Trélat. The aim of this report is to unveil a case of a patient whose recently erupted seborrheic keratoses led to investigation and consequent diagnosis of bladder cancer. Case Presentation. A 67-year-old man was admitted to the intensive care unit due to an exacerbation of chronic obstructive pulmonary disease (COPD). On physical examination, multiple seborrheic keratoses on the back of the hands, elbows, and trunk were observed; the patient had a 4-month history of these lesions yet was asymptomatic. The possibility of Leser-Trélat syndrome justified the investigation for neoplasia, and a bladder carcinoma was detected by CT-scan. The patient denied previous hematuria or any other related symptoms. Many of the lesions regressed during oncologic treatment. Conclusion. Despite the critics on the validity of the sign of Leser-Trélat, our patient fulfills the description of the disease, though urinary malignancy is a rare association. That corroborates the need of further investigation when there is a possibility of paraneoplastic manifestation.

The Giant Caecum with No Apparent Reason: Ogilvie's Syndrome

Acute colonic pseudobstruction (Ogilvie’s syndrome) is a severe, life threatening condition characterized by acute colonic distension without evidence, or mechanical obstructive factor. Prompt detection results in an early colonoscopy treatment, which results in better prognosis. We report the case of a 57 year old female patient, with a previously diagnosed follicular lymphoma which presented with severe abdominal distention, impairing adequate thoracic expansion. The abdominal CT performed showed a significant dilatation of the cecum (13.27cm), with no mechanical obstruction. A decompressive colonoscopy was performed, with immediate clinical response.