The Tale of a Forgotten Stent

NKF 2017 Spring Clinical Meetings Abstracts Gustavo Borda, Ashfaq Balla. Metrowest Medical Center, Framingham, MA, USA P-ANCA POSITIVE IMMUNE COMPLEX 59 GLOMERULONEPHRITIS Sevelamer Induced Diffuse Crystal Colitis: A Case Report of ASSOCIATED WITH LEVAMISOLE USE: Kelly Beers, Arun Kottarathara, Wilfred a Rarely Reported Side Effect Lieberthal and Rajeev Rohatgi. Northport VA Medical Center, Samir Brahmbhatt, Michael Cruise, James Simon. Cleveland Northport, NY, USA Clinic Foundation, Cleveland, OH, Levamisole (Lv), an anti-helminthic drug USA with immunomodulatory formerlyCase used to of treat cancer. However, inAttributed 2000 Lv was to 61 effects, An was Unusual Hyponatremia withdrawn from the market due to adverse effects. It remains in use in Trimethoprim-Sulfamethoxazole Therapy veterinary medicine. Recently, Lv has been found as an adulterant in AdamWeBsiso, Sheffield, cocaine Roberto Collazococaine. present a Michael case of Lv contaminated associated with Maldonado. Methodist Dallas p-ANCA glomerulonephritis (GN). Medical Center, Dallas, TX, A 45 year old male presented to a university medical center with a leg USA rash, dark urine and a recent history of cocaine and NSAID use. 62 ulcer, Enteroccous Species Causing Bacterial-Endocarditis AssoHe was found to have acute kidney injury (AKI) with serum creatinine ciated in an At Population (SCr) 6.4 Glomerulonephritis mg/dL. Labs were significant for Risk low C3 and positive pANCA andBueno, MPO. Skin biopsyRizg, showed leukocytoclastic Emma Keyrillos Mario Cisneros, vasculitis Juan Chique consistent with Ryan Lv-associated vasculitis. Kidney biopsy wasRaafat F Figueroa, Kunjal, Andreea Poenariu, inconclusive. patient wasoftreated with oral prednisone Makaray. The University Florida College of which Medicineimproved the ulcer/rash and renal function (SCr to 2.8 mg/dL). He was Jacksonville, Jacksonville, FL, USA lost to follow up and then presented months later to the VA with vomiting, and dyspnea. He had AKI with ainSCr 13.9 mg/dL 65 nausea, Recurrent Thrombotic Microangiopathy a of Renal Alloand required hemodialysis. As before, his lab tests were significant for graft: A Clinical Conundrum p-ANCA positivity and a low C3, and he admitted to recent cocaine Olivia Campa, Jose A.crescentic Morfin.GNUniversity ofcomplex California use. Kidney biopsy revealed with immune Davis, Sacramento, CA, USA deposition, a finding consistent with Lv exposure during cocaine use. treated andBartter mycophenolate 500mg BID. After 3 68 HeAwas Rare Casewith of steroids Neonatal Syndrome months the patient was no with a SCr of 3.3 1 longer dialysis dependent 2 1 Tushar Chaturvedi , Rupesh Raina . Akron Nephrology mg/dL. 2 Clinic Akron Associates, Akron, OH, USA; Cleveland Cocaine adulterated by Lv is associated with leukocytoclastic General, OH, USA GN with immune complex vasculitis andAkron, p-ANCA crescentic Though idiopathic p-ANCA associated GNwith is 71 deposition. An Unusual Case of Negative Anion Gap crescentic in a Patient treated with steroids and cyclophosphomide, we show that this drugHypercalcemia induced form of p-ANCA induced GN can be successfully treated by Avantika Chenna, Pradeep Reddy Thodima, Rasib Raja. cocaine abstinence, mycophenolate and prednisone. Further studies are needed to Einstein, evaluate if Philadelphia, this regimen or PA, otherUSA regimens adequately prevent Albert recurrence of GN, in the absence of recurrent cocaine use. 74 Atypical Presentation of Metastatic Esthesioneuroblastoma with Ectopic ACTH Syndrome After 7 Years 50 Vamsi Chilluru, Jay Hawkins. University of Nebraska Medical Center, Omaha, NE, USA Vikrampal Bhatti, THE TALE OF A FORGOTTEN STENT: 86Abhilash Prosthetic Valve Endocarditis from Mycobacterium Koratala, University of Florida, Gainesville, FL, USA. AChimaera 27-year-oldInfection white female with a history of recurrent Interstitial Causing Granulomatous nephrolithiasis Nephritis presented with right flank and suprapubic pain for 4 days.She right ureteral J stent placed 24 months Jonathan had Da aCosta, Ahmeddouble Abdalrhim, Ivan Porter, Peter prior to presentation for right sided urolithiasis. The stent not Fitzpatrick, Cherise Cortese, Nabeel Aslam. Mayowas Clinic, exchanged or removed during this period. Physical examination Jacksonville, FL, USA was remarkable only for right costo-vertebral angle tenderness. 87Urinalysis Health or Beauty: A Case of an Unusual Causeper ofhpf. Severe revealed about 1600 WBCs and 400 RBCs Hypercalcemia Urine culture grew more than 100,000 col/ml Klebsiella Gulshan Dangol, Sashi Ariyaratne, Hilmer pneumoniae. Computed tomography (CT) scan of theNegrete. abdomenSt. Elizabeth Hospital, Youngstown, OH, USA showed right Youngstown pelvi-ureteral junction nephrolithiasis with rightDense ureteral stent andAa Report large bladder stoneCases (Figures 88encrusted Recurrent Disease: of Two with 1 and 2). Cystoscopy showed a large, free floating ~6 cm Varying Presentations, Pathologic Findings and Patient spherical stone within the bladder. She subsequently underwent Outcomes cystolithalopaxy, laser lithotripsy, right percutaneous Dilini Daswatta, Sharon Graves, Carla Ellis. Emory nephrolithotomy and removal of bladder and uretero-pelvic University, USAcarbonate apatite and junction. StoneAtlanta, analysis GA, revealed 90magnesium Crystalglobulin-Induced Nephropathy and Keratopathy ammonium phosphate hexahydrate. Ureteral have become mainstay of treatment Matthewstents D’Costa, SandhyatheManohar, Joe Grande,of Samih ureteral UretericMayo stent encrustation is a common late Nasr, obstruction. Marie C. Hogan. Clinic, Rochester, MN, USA complication often associated with stent indwelling time of more 91 Vitamin C Induced Oxalate Nephropathy than 12 weeks, alkaline urine, urinary tract infections and poor Matthew The D’Costa, Lorenstones Herrera Hernandez, Sandra compliance. most common associated with Herrmann.are Mayo Clinic, Rochester, USA encrustation calcium oxalate, (69.1%)MN, and carbapatite Management of encrusted stents challenging. 92(15.5%) A Case of Severe Hyponatremia and remains Acute Kidney Injury Patient maintenance a computerized to Eddyeducation DeJesus,andNasr, Rabih. ofBronx Lebanonregistry Hospital prevent ‘forgotten may play a key role in prevention. Center, Bronx, stents’ NY, USA 103 Acute Glomerulonephritis Post Administration of Pegfilgrastim Hatem Elabd, Naheed Ansari, Belinda Jim. Jacobi Medical Center, New York, NY, USA

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Am J Kidney Dis. 2017;69(4):A1-A105

108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome A CASE OF DOUBLE WHAMMY: IgA NEPHROPATHY WITH Thomas Frohwein, Kim, Isaiarasi Gnanasekaran. ANCA VASCULITIS: RohanSusan Bhojwani, Mehak Idrees2, Arash Lincoln Medical and Mental Health Center, 1 1 Rashidi , Cleveland Clinic-Fairview Hospital, Fairview Park,Bronx, OH, NY, 2 USA USA; Yale-Griffin hospital, Derby, CT, USA progressive and crescentic IgA nephropathy (IgAN) is (RVT) 110A rapidly Diagnosis and Treatment of Renal Vein Thrombosis uncommon, it has a of highLupus risk of progression end-stage renal in the but Setting Nephritis toand Antiphospholipid disease and variable response to immunosuppression. The importance Syndrome (APS) of a positive anti-neutrophil Pablo Garcia, Felix cytoplasmic Renneberg,antibody Maanit(ANCA) Kohli,serology Steve in Bibu, this group of patients is not fully understood but may have prognostic Navya Kuchipudi, Anne Van Hoven, Shaunak Dwivedi. significance. Saint Peter’s University Hospital, New Brunswick, NJ, USA A 71 year old male was referred to our nephrology clinic for elevated 111 Scleroderma Renal Crisis (SRC)was in 1.7mg/dl the Setting of year Systemic creatinine. On presentation, his creatinine and one SineOn Scleroderma (ssSSc)heinhad Pregnancy ago itSclerosis was 1.1mg/dl. his initial evaluation, no medical complaints. did not Shaylika have any urological symptoms including Pablo He Garcia, Chauhan, Maanit Kohli,flank Navya pain,Kuchipudi, change in his bladder habits, or any change in his physicalUniversity Shaunak Dwivedi. Saint Peter’s characteristics his urine. He was a NJ, nonsmoker, Hospital,ofNew Brunswick, USA occasional alcohol drinker, single and retired. Physical exam revealed blood pressure of 121 Red Eyes and Renal Insufficiency in A Middle Age 152/78 mm Hg. He did not have any other significant findings. On Gentleman investigation, his creatinine had risen to 1.9mg/dl. His BUN was Maryam Heidi Mae Urinalysis Timbol, showed Jefferyhematuria Turner. Yale 31mg/dl, eGFRGondal, was 35ml/min/1.73m2. University, CT, USAbeing 1.4. C3 and (149/hpf) with spotNew urineHaven, protein /creatinine C4,ANA, dsDNA, HBV and HIV serologies, 125 Atypical Case of HCV, Behcet’s Disease , anti-glomerular Leading to IGA basement membrane (GBM) antibodies were negative but he had Nephropathy positive P-ANCA titer. Renal biopsy wasPapanagnou, done and it showed Sanjeev Gupta, Anastasios Yorg Al-Azzi. mesangial proliferation, endocapillary proliferation, and focal cellular Westchester Medical Center, Westchester, NY, USA crescents, with findings of IgA deposits. Our patient was started on 126 Toxicity Presenting Status Epilepticus pulseCefepime steroids, then cyclophosphamide but as he did not tolerate steroids in a Patient with End Stage Renal Disease and developed pancytopenia because of cyclophosphamide. Eventually, 1 1 , Jayaprakash Dasari , Aziz Bakhous1, Raed Mohit Gupta he was switched to Rituximab. His recent Cr level is 2.4mg/dl. 1 1 1 , to Donald Patrick Gallegos , Rupesh It isAzzem important identify Dumford this pattern ,of overlapping diseases since its 1 1 aggressive regress with early onsetAkron, of Rainamanifestations . Clevelandmay Clinic Akron General, OH, USA immunosuppression treatment. 129 Tenofovir Causing Hospitalization Due to Severe Symptomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 52 Westchester Medical Center, Valhalla, NY, USA GRANULOMATOUS AS A RARE Antibodies PRESENTATION 130 The SignificancePROSTATITIS of Anti-Phospholipase in a OF GRANULOMATOSIS WITH POLYANGIITIS. Anum Bilal1, Patient with Membranous Nephropathy Rafia Chaudhry1, Richard Blinkhorn1, Loay Salman1,Elvira Mohit 1,2Gupta, Jayaprakash Dasari, Rupesh Gosmanova .1 Albany Medical College, Albany, NY. 2Raina, Albany Pallavi Stratton VA Medical Center, Albany, NY.General, Akron, OH, USA Reddy. Cleveland Clinic Akron with polyangiitis (GPA) is an ANCA-associated 132Granulomatosis A Mystery Case of Blood Leak Alarm Going On vasculitis that rarely involves the prostate. We report a case of Seifeldin prostatitis Hakim, Rhyan Sadichhya Sami granulomatous (GP) as Maditz, initial presentation of Lohani, GPA. Oakland University Hospital, A Zarouk. 21-year old man presented with aWilliam six monthBeaumont history of prostatitis unresponsive to multiple courses of antibiotics, urinary retention, 50 Royal Oak, MI, USA lbs. weight loss, unilateral hearing loss, and recurrent sinusitis. Renal 133 Previously Undiagnosed ANCA Associated Vasculitis Prestudies showed serum creatinine of 1.1 mg/dL, CRP 99.3mg/dL, urine senting One Month After Kidney Transplantation protein-to-creatinine ratio of 0.36g/g, microscopic nonglomerular AymannoHallab, Karthik S. Yaqub. hematuria, cellular casts, andKannegolla, sterile pyuria.Mohammad Prostate biopsy was performed andUniversity revealed granulomatous prostatitis, fungal and AFB IN, Indiana School of Medicine, Indianapolis, smears negative. HIV antibody and Quantiferon TB assay were USA negative. Serologic investigation was negative except for high titer P149 Case Report of a Dialysis Dependent Immunotactoid ANCA antibodies. Computed tomography of the chest revealed 2 Glomerulopathy with Favorable Response Rituximab cavitary lesions and subsequent lung biopsy showedto necrotizing 1 2 granulomas. did Bhojwani not reveal glomerular pathology.3,The , Rohan , Glen Markowitz Aaron Mehak Renal Idreesbiopsy 4 1 2 diagnosis of renal-sparing (GP, upper lower respiratory tract Dommu . Griffin GPA Hospital, Derby,andCT, USA; Fairview involvement) made. Oral prednisone (60mg daily) and four New University, Hospital,was Cleveland, OH, USA; 3Columbia weekly intravenous rituximab doses were administered with York, NY, USA; 4Nephrology Associates, Bridgeport, CT, improvement. USA GP accounts for only 3.3% of inflammatory lesions of the prostate, 150 De both Novo Atypical Uremic Syndrome Fourteen and has infectious andHemolytic inflammatory etiologies. Until 2015, only 40 cases of GP secondary GPA have been reported. Our case is even Months After RenaltoTransplant more intriguing due to the renal sparing aspect. Olusola Isikalu, Jennifer Thompson, Maria Aurora Posadas Salas. Medical University of South Carolina, Charleston, SC, USA 151 “Lone” Lupus Nephritis: A Seronegative, Histopathological Diagnosis Jamal Janjua, Pratima Kamada, Aiman Riaz. Gundersen Health System, La Crosse, WI, USA

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