![]() IgA nephropathy or postinfectious glomerulonephritis) and pulmonary-renal syndrome (granulomatosis with polyangitis, microscopic polyangitis, Goodpasture's syndrome) due to simultaneous involvement of lungs. As the presenting symptom was cola-colored urine, pigment-induced nephropathy was therefore the first differential, followed by glomerulonephritis (e.g. On the basis of his history and clinical examination, the following differential diagnoses were established. Here, we briefly review the literature on renal involvement in PNH, treatment options for PNH and pigment-induced nephropathy followed by a question-and-answer session at the clinicopathological conference held on March 4, 2011, at Sindh Institute of Urology and Transplantation in Karachi, Pakistan. The permanent catheter was removed and maintenance dialysis was stopped. His subsequent outpatient visits showed improved renal function. He required dialysis for 1 week then started producing urine. Our patient was dialyzed initially and discharged with a permanent catheter in place with advice to continue dialysis three times a week. This could be due to ATN or AKI superimposed on CKD due to hemosiderin deposits in the renal tubular epithelial cells. This case shows AKI as one of the complications of PNH which may have a clinical course like acute tubular necrosis (ATN). We report a case of acute kidney injury (AKI) due to PNH. ![]() Doctor visits, hospitalization, and dialysis are all out-of-pocket expenses, therefore prevention, early detection, and timely intervention are the only cost-effective strategies. In a third-world country like Pakistan, increased burden due to CKD can be very hard on families. The ultimate outcome of CKD in many patients is the need for renal replacement therapy, which necessitates ever-growing dialysis and transplantation programs, thereby imposing a significant economic burden on the healthcare system. ![]() Early diagnosis and treatment is crucial to prevent disease progression and irreversible chronic kidney disease (CKD). Past history of similar attacks unless first presentation.Ĭonfirmed by: reversibility following bronchodilator treatment, and symptomatic response to treatment.Renal involvement in paroxysmal nocturnal hemoglobinuria (PNH) is not usually apparent but in cases with clinical involvement varies from reversible acute dysfunction to chronic irreversible damage. Other specific triggers to breathlessness. Spirometry: reduced FEV, reduced FEV1/FVC ratio, <12% reversibility, hypoxia ± increased arterial PCO (rarely, reduced α 1-antitrypsin levels). Reduced peak flow rate.Ĭonfirmed by: CXR: radiolucent lungs. Pursed lip breathing, use of accessory muscles, reduced breath sounds, wheezes. Suggested by: smoking history, cough and sputum. ![]() Abnormal ECG reflecting underlying heart disease Impaired left ventricular (LV) function on echocardiogram. Suggested by: dyspnoea, displaced apex beat, third heart sound, bilateral basal fine crackles.Ĭonfirmed by: CXR appearances. Pulmonary oedema due to congestive (chronic) left ventricular failure Differential diagnosis for orthopnea and paroxysmal nocturnal dyspnoea (PND)Ĭommon and important causes of orthopnoea and paroxysmal nocturnal dyspnoea (PND) for doctors and medical students Diagnosis ![]()
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