Moonahm Yum

Radiation nephritis following total-body irradiation and cyclophosphamide in preparation for bone marrow transplantation

Two children prepared for bone marrow transplantation with total-body irradiation and cyclophosphamide developed hypertension, microscopic hematuria, proteinuria, diminished renal function, and anemia six months after transplantation. Light microscopy of the kidneys revealed mesangial expansion, glomerular capillary wall thickening, and lumenal thrombosis. Electron microscopy demonstrated widening of the subendothelial space due to the deposition of amorphous fluffy material. In one patient, immunofluorescence microscopy revealed glomerular capillary wall deposition of fibrin and immunoglobulins. The clinical and histologic findings support the diagnosis of radiation nephritis. Patients prepared for bone marrow transplantation with total-body irradiation and cyclophosphamide should be followed closely after transplantation for the development of hypertension, proteinuria, and renal insufficiency.

Primary glomerulonephritis complicating diabetic nephropathy: report of seven cases and review of the literature

Glomerulonephritis has been recognized as a rare complication of diabetes mellitus. The clinical, pathologic, and laboratory findings for 18 diabetic patients were reviewed. Eight of these patients (44 per cent) were found to have primary glomerulonephritis in addition to diabetic nephropathy. Although this series may not represent the true incidence of complicating glomerulonephritis in diabetes, it is probable that the incidence of this condition has been underestimated. An additional 26 previously reported cases are reviewed.

Leiomyosarcoma arising in atypical fibromuscular hyperplasia (phyllodes tumor) of the prostate with distant metastasis

An extremely rare neoplasm of the prostate, commonly known as phyllodes type of atypical prostatic hyperplasia, is described in a 57‐year‐old man. Over a 2‐year period, the atypical smooth muscle component has transformed into leiomyosarcoma, and eventually metastasized to the bones and the lungs. Such an evolution has never been documented for this tumor.

Acute tubulointerstitial nephritis attributable to indinavir therapy.

Indinavir sulfate has been reported to cause asymptomatic crystalluria and nephrolithiasis in patients with human immunodeficiency virus (HIV) infection. Patients taking indinavir may present with asymptomatic crystalluria, nephrolithiasis with frank renal colic and obstruction, flank pain in the absence of nephrolithiasis, and dysuria or urgency. Asymptomatic crystalluria has been described as benign. Discontinuation of the drug has not been recommended in the absence of nephrolithiasis. We report two HIV-positive patients receiving indinavir who developed acute interstitial nephritis with foreign body giant cell reaction on renal biopsies. Both patients had asymptomatic crystalluria, although crystals were associated with clumps of white blood cells (WBCs) on urinalysis in one patient. Both cases show that the inflammatory response was significant enough to lead to tubular injury and acute renal impairment. Our findings suggest that asymptomatic crystalluria attributable to indinavir may illicit an inflammatory response with acute renal insufficiency, warranting monitoring of renal function, especially in patients with crystalluria.

A malignant peripheral nerve sheath tumor in association with a paratesticular ganglioneuroma

A malignant peripheral nerve sheath (PNS) tumor and a benign ganglioneuroma were present as a composite tumor in the paratesticular area of a 15‐year‐old boy. The pathologic diagnosis was made by characteristic histologic and ultrastructural features and was supported by the demonstration of neuron‐specific enolase (NSE)‐positive ganglion cells and S‐100‐protein—positive spindle cells consistent with schwannian cells. The patient has remained disease‐free for 3 years since the orchiectomy and the retroperitoneal lymph node dissection, which was followed by combination chemotherapy.

Basement membrane nephropathy: A new classification for alport's syndrome and asymptomatic hematuria based on ultrastructural findings

Renal biopsy specimens from 19 patients with asymptomatic hematuria, normal glomeruli on light microscopic examination, and negative immunofluorescence were studied to characterize the ultrastructural changes of the glomerular basement membrane. Three groups of patients were identified. Four patients (group 1) had type I basement membrane nephropathy, characterized by marked thickening and lamellation of the basement membrane in a pattern resembling that of Alports syndrome. Seven patients (group 2) had type II basement membrane nephropathy, which was characterized by extensive attenuation of the basement membrane with only occasional small areas of lamellation or fragmentation. Eight patients (group 3) had moderate variability in basement membrane thickness with no other structural alterations. The authors propose that this pathologic classification be used in patients with asymptomatic hematuria as a basis for long-term clinical investigations, in hopes of distinguishing the natural history of each group.

Toxicity of sodium pentafluorostannite, a new anticariogenic agent. I. Comparison of the acute toxicity of sodium pentafluorostannite, sodium fluoride, and stannous chloride in mice and/or rats☆☆☆

The toxicity of sodium pentafluorostannite (NaSn2F5) in mice and rats has been investigated. LD50 values in mice were 18.9, 80.9, and 592.9 mg/kg in fed mice dosed iv, ip, and po, respectively. Signs of toxicity in mice included ataxia, muscle weakness, central nervous system depression, and occasionally tremors. LD50 values in female rats were 12.9, 65.0, and 218.7 mg/kg in fed rats dosed iv and ip and in fasted rats dosed po, respectively. LD50 values in male rats were 12.9, 75.4, 573.1, and 223.1 mg/kg in fed rats dosed iv, ip, and po and in fasted rats dosed po, respectively. Signs, accompanying toxic doses of NaSn2F5, sodium fluoride (NaF), or stannous chloride (SnCl2·2H2O) in the rat were similar and included ataxia, muscle weakness, and CNS depression. Sodium pentafluorostannite was found to be more toxic than either NaF, based on F, or SnCl2·2H2O, based on Sn. Rats given either Sn compound developed pathologic changes in the kidneys grossly visible 4 days following administration. The data suggest that both F and Sn play a role in the acute toxicity of NaSn2F5 in rats.

Juxtaglomerular cells in renal angiomyolipoma Ultrastructural observation

We have studied a case of renal angiomyolipoma by electron microscopy and found juxtaglomerular cells with typical rhomboid and spherical granules, in addition to smooth muscle cells, fat cells, and abnormal blood vessels. To our knowledge, this is the first ultrastructural demonstration of juxtaglomerular cells in renal angiomyolipoma.

Toxicity of sodium pentafluorostannite. A new anticariogenic agent. III. 30-Day toxicity study in rats

Abstract For 30 days, groups of 12–19 Wistar rats (divided according to sex) were dosed daily by gavage with distilled water or with 20, 100, or 175 mg/kg sodium pentafluorostannite. On Days 14 and 29, blood was collected from five rats in each group to determine hemoglobin concentration and packed cell volume. On Days 15 and 30, rats were sacrificed, blood collected, and serum urea nitrogen (BUN), direct and total bilirubin, SGOT activity, inorganic phosphorus, calcium and glucose concentrations were determined. A necropsy was performed on each rat, its organs weighed, and sections prepared for microscopic examination. After 15 and 30 days, growth was depressed in a dose-related manner. Serum glucose concentration was also lowered. Microscopic findings in organs were generally unremarkable except for degenerative changes of the proximal tubular epithelium of the kidneys in 15–20% of the animals in the 175-mg/kg groups. Animals that died spontaneously displayed signs suggestive of cardiac failure, including congestion of the liver, spleen, lungs and/or kidneys. In addition, most had moderate to severe renal tubular necrosis.

Case Report A beneficial effect of splenectomy in sickle cell anemia and chronic renal failure

Abstract A 25-year-old black male with known sickle cell disease developed progressive chronic renal failure. Eight months after the initiation of chronic hemodialysis, he developed a rapidly-increasing transfusion requirement. The requirement was one unit of blood per week in order to maintain a hematocrit of 16%. His spleen was found, at that time, to be enlarged both on physical examination and radioisotopic scan, A radiochromium study disclosed a red blood cell half-life of 17 days. No evidence of splenic sequestration could be demonstrated isotopically. Splenectomy produced a marked decrease in the patient’s transfusion need. Presently, this patient needs one unit of blood every 10 to 12 weeks to maintain a hematocrit of 18%.