Cardiorenal Syndromes: Advances in Determining Diagnosis, Prognosis and Therapy

The term cardiorenal syndrome (CRS) implies acute or chronic injury to the heart and kidneys that often involves a temporal sequence of disease initiation and progression. The classification of CRS is divided into five sub types each of which has complicated and poorly understood pathogenetic factors, yet holding promise for research and clinical opportunities to improve patient outcomes. Types 1 and 2 involve acute and chronic cardiovascular disease (CVD) scenarios leading to acute kidney injury (AKI) or accelerated chronic kidney disease (CKD). 

 

Cardiorenal Syndromes

Types 3 and 4, describe AKI and CKD, respectively, leading primarily to heart failure, although, it is possible that acute coronary syndromes, stroke, and arrhythmias could be CVD outcomes in these forms of CRS. Finally, CRS type 5 describes a systemic insult to both heart and the kidneys, such as sepsis, where both organs are injured simultaneously in persons with previously normal heart and kidney function at baseline. Read more>>>>>>>>>>>>>

Coexistent Membranous Nephropathy with Doubly ANCA-Associated Crescentic Glomerulonephritis

Membranous nephropathy (MN) is the most common cause of primary nephrotic syndrome in nondiabetic, Caucasian adults, accounting for more than one third of cases. Most of patients with MN have preserved renal function at the time of presentation. Renal failure usually develops gradually in patients with MN and only rarely is complicated by acute kidney injury.

Pauci-immune necrotizing and crescentic glomerulonephritis (PNCGN) typically present with rapidly progressive glomerulonephritis (RPGN). Coexistent MN and PNCGN is a rare occurrence. We report a case of both MPO- and PR3-ANCA associated NCGN with membranous nephropathy that presented as rapidly progressiveglomerulonephritis.

Case Presentation: 

A 46-year-old Caucasian woman presented to emergency department with nausea, vomiting and weight loss. Medical history was remarkable for gastroesophageal reflux disease (GERD), fibromyalgia and depression. She noticed poor appetite and 40-pound weight loss over 2 months. Patient denied any recent history of upper respiratory tract infection, or skin infection. She was taking 4,800 mg of ibuprofen per day and no other medications. Read more.....................