Renal Arcuate Vein Microthrombi-Associated AKI

Abstract

Backgrounds and objectives This report describes six patients with AKI stages 2-3 (median admission creatinine level, 2.75 mg/dl [range, 1.58-5.44 mg/dl]), hematuria (five with hemoproteinuria), and unremarkable imaging with an unusual and unexplained histologic diagnosis on renal biopsy.Design, setting, participants, & measurements The patients were young adults who presented to two neighboring United Kingdom nephrology centers over a 40-month period (between July 2010 and November 2013). Four were male, and the median age was 22.5 years (range, 18-27 years). Their principal symptoms were flank pain or lower back pain. All had consumed alcohol in the days leading up to admission.Results Renal biopsy demonstrated microthrombi in the renal arcuate veins with a corresponding stereotypical, localized inflammatory infiltrate at the corticomedullary junction. All patients recovered to baseline renal function with supportive care (median, 17 days; range, 6-60 days), and none required RRT. To date, additional investigations have not revealed an underlying cause for these histopathologic changes. Investigations have included screening for thrombophilic tendencies, renal vein Doppler ultrasonographic studies, and testing for recreational drugs and alcohol (including liquid chromatography-mass spectrometry of urine) to look for socalled designer drugs. Inquiries to the United Kingdom National Poisons Information Centre have identified no other cases with similar presentation or histologic findings.Conclusions Increased awareness and additional study of future cases may lead to a greater understanding of the underlying pathophysiologic mechanisms that caused AKI in these patients.

An Unusual Case of Acute Kidney Injury with Edematous Kidneys and Venous Micro Thrombi: A Case Report

“…In case series of 6 patients, all of them reported to have consumed alcohol and notably 4 out of 6 patients were either using NSAID or Acetaminophen for pain. Hematuria and proteinuria along with negative immunology screen was reported [11]. The other striking features are the presence of flank pain as a presenting complaint and demographically young patients [11][12][13].…”

“…Hematuria and proteinuria along with negative immunology screen was reported [11]. The other striking features are the presence of flank pain as a presenting complaint and demographically young patients [11][12][13]. Most often patients have had successful renal recovery with conservative management however there have been reports where temporary dialysis has been necessary [11,14].…”

Renal arcuate vein thrombosis–induced acute kidney injury: a rare multiple-Hit–mediated disease

“…An interesting study by Redfern et al . recently reported six young adults with AKI and thrombosis in the renal arcuate veins demonstrated by kidney biopsy [ 8 ]. However, in this study, the specific causality and the underlying pathophysiologic mechanisms remained elusive.…”

“…Importantly, a recent study by Redfern et al . reported thrombosis in the renal arcuate veins (RAVT) demonstrated by kidney biopsy in young adult patients with AKI [ 8 ]. However, the precise incidence and underlying pathophysiologic mechanisms of RAVT leading to AKI in these patients remain elusive.…”

Biological Effects of XyloCore, a Glucose Sparing PD Solution, on Mesothelial Cells: Focus on Mesothelial-Mesenchymal Transition, Inflammation and Angiogenesis

“…Glucose-based solutions continue to be the most used in PD, although new, more biocompatible, less acidic solutions with lower GDP content have been developed over the years [ 54 ]. Although cell culture and animal studies have shown that the newer PD solutions achieve better biocompatibility than acidic glucose-based ones, this does not translate into clinical superiority [ 55 , 56 , 57 , 58 , 59 ]. Again, when one looks at the effect on biomarkers of angiogenesis and inflammation, VEGF and IL- 6 levels, there is no evidence of benefit [ 27 , 60 , 61 ].…”