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Renal Biopsy showing Cortical Necrosis with medium vessel
thrombotic occlusion
Conclusions: Irreversible Kidney Injury is an extremely rare
complication of Dengue fever as most of the patients of AKI
recover with supportive treatment. In our case a young patient
with a short clinical history of Dengue Fever presented with AKI.
Renal Biopsy showed Renal Cortical Necrosis with medium sized
vessels showing near complete occlusion of vascular lamina by
thrombi suggesting Thrombotic Microangiopathy. Hence, delay in
recovery of AKI in Dengue patients presenting without Hemor-
rhage or shock should prompt the clinician to evaluate further
regarding the underlying pathological mechanisms of Acute Kid-
ney Injury.
SAT-434
RENAL TUBERCULOSIS: A CASE REPORT
FROM UNIVERSITY TEACHING HOSPITAL
OF KIGALI (CHUK)
MUNEZERO, L*
1
, Belson, R
2
1
Ministry of Health Clinical biology Kigali Rwanda,
2
CHUK Clinical biology
Kigali Rwanda
Introduction: Urogenital tuberculosis constitutes a current public
health problem especially in endemic areas. Renal tuberculosis is among
rare form of extra pulmonary tuberculosis (EPTB) and the clinical
presentation of this form of the disease may be misleading. The pseu-
dotumoral type of renal tuberculosis is extremely uncommon and dif-
ferential diagnosis may include even malignant tumors like renal cell
carcinoma. Diagnosis require renal biopsy which is a specialized pro-
cedure. Prompt treatment of the underlying TB focus can prevent
progression to end-stage renal disease. Treatment of renal TB includes
surgery followed by anti- tuberculosis treatment. We report a case of
renal TB, presented as kidney tumor. On histology TB was suspected
and confirmed by Auramine stain at University Teaching Hospital of
Kigali (CHUK).
Methods: We report a 49 years old male, consulted with left kidney
mass who underwent left nephrectomy. Histological findings were
suggestive of renal tuberculosis, confirmed by auramaine stain.
Results: This is a 49 years old male presented with left kidney mass
invading vena cava, left nephrectomy was performed and vena cava
thrombus was sampled. The nephrectomy specimen was weighing
1792g and measuring (17x14x11) cm. The kidney outer surface was
multinodulated, cystic and firm with intact capsule. The renal pa-
renchyma was almost entirely involved by multiple small cysts like
lesions, firm and grey. The hilum was also involved by cystic lesions.
The so called vena cava thrombus were two fragments of (2x1.7x1)
cm, firm and grey. Histology showed extensive caseous necrosis
creating pseudocyst cavities, numerous Langhans-type multinucleated
giant cells. Fragments of tissue labeled ‘thrombus from vena cava’
showed granulomatous inflammation with frequent Langhans-type
multinucleated giant cells. Auramine stain was positive for acid fast
bacilli (AFB).
Figure legend
Photomicrographs of Renal tuberculosis: A: Pseudoyst (H&E, X40). B:
Necrosis (H&E, X100). C: Multinucleated giant cells (H&E, X100). D:
Chronic inflammatory cells (H&E, X100).
Dour text here
Cour text here
Bour text here
Aour text here
Conclusions: Renal tuberculosis is very rare and pseudotumoral pre-
sentation of urogenital tuberculosis is extremely rare. Renal tubercu-
losis should be suspected when atypical renal masses are seen in
patients from tuberculosis endemic areas.
SAT-435
HEpPTITIS C3GLOMERULOPATHIES:
CASE PRESENTATION AND THE DILEMMA
OF THE THERAPEUTIQUE CARE
AJIMI, K
1
, Zellama, D*
1
1
K. Ajimi- S. Mrabet- N. Thabet- - Abdessaied N*- Sahtout W- Zellama D-
Guedri Y- Azzabi A- Fradi A- Ben Aicha N- Achour A. Pathology Department.
Farhat Hached Hospital. Sousse. Tunisia sousse Tunisia
Introduction: Isolated C3 glomerulonephritis (CNG3) are rare glomer-
ulopathies defined by the presence of glomerular deposits visible in OM
and containing C3 complement deposits, without immunoglobulin IF
deposits. These deposits are usually secondary to an impairment of the
alternative complement pathway. We report the case of an infection with
hepatitis B virus associated with membranous proliferative glomerulo-
nephritis with C3 deposits. It's a rare entity that poses a real problem since
there is no well-established consensus faced to the therapeutic emergency.
Methods: It is a descreptive and an analystique presentation of case of
c3 glomerulonephritis due to B hepatitis that was repported in August
2019 in the nephrologie departement of sahloul hospital
Results: We present the case of 52 years old aged man, hypertensive
and followed for chronic renal failure for 4 years, poorly observing
therapeutic, his causal nephropathy was not yet identified. He was
referred by his GP for rapid worsening of his renal function with
creatinine numbers ranging from 172 micro moles in May to 342 in
early August to 476 at the end of August and 625 in early September
2019 with high blood pressure figures. Two-cross proteinuria and he-
maturia with proteinuria at 3 grams / 24 hours were noticed. Faced with
this rapid worsening of renal function, the patient received a renal
biopsy puncture that showed a membrano-proliferative glomerulone-
phritis with isolated c3 depositis. An etiological assessment was carried
out with a viral serology which was in favor of active hepatitis B with
positive HBs antigen with 3150 viral load. The C hepatitis and HIV
serologies were negative. In addition, the C3 complement fraction was
consumed and anti-DNA, anti-nuclear, anti-neutrophil cytoplasmic
were negative. It was probably a membranous proliferative glomeru-
lonephritis with C3 deposits secondary to infection with the B hepatitis
virus. The patient was initially treated with Entecavir, then with
corticosteroid therapy containing solumedrol bolis 500 mg for three
days followed by full dose steroids. The evolution was marked by a
dependence on dialysis, then, after a short delay in starting intensive
coticotherapy, the patient developped a fulminant B hepatitis with a
pleuro-pericarditis which led to the death of the patient. The first
description of chronic hepatitis B associated with renal impairment
dates back to 1971, by demonstration on kidney biopsies of Hbs antigen
/ anti Hbs immune complexes. For our case, the identification of Hbs
antigen on the renal biopsy fragment is ongoing. The exact mechanism
through which some patients with chronic HBV infection develop
glomerulonephritis is not well known. Several treatments have been
tested in GN-HBV, including interferon, lamivudine and entecavir with
or without addition of corticosteroids with reduction of proteinuria and
improvement of renal function. However no codified support has not
yet been established.
Conclusions: This is a rare association of HBV infection and GNC3 that
has not well responded to treatment. The search for renal HBV DNA is
ongoing. The response to treatment had not been observed because of
the appearance of fatal secondary complications of high dose of corti-
costeroid therapy. The dilemma is to find the best approach to treat and
save these patients witch vital and a renal prognosis are threatened
ISN WCN 2020, ABU DHABI, UAE
S182 Kidney International Reports (2020) 5, S1–S392