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The Korean Journal of Pathology 1997;31(3): 263-268.
Acute Renal Failure Associated with Gross Hematuria in a Patient with Focal Glomerulonephritis.
Hee Jung Kim, Hyeon Joo Jeong, Dae Suk Han
1Department of Pathology, Yonsei University College of Medicine, Seoul 120-752, Korea.
2Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea.
A 58-year-old female with an episode of gross hematuria two months before and fever and chill for the past three days presented oliguric acute renal failure. She has taken NSAID intermittently for 18 years due to rheumatoid arthritis, and herb medicine for one week two months ago when gross hematuria developed. Physical examination revealed mild tenderness on costovertebral angles. Her blood pressure was 170/100 mmHg, the urinalysis showed >300 mg protein with many RBCs and 10-20 WBCs and the serum creatinine was 5.8 mg/dl. A renal biopsy performed on the 4th hospital day showed that it was overwhelmed by severe tubular lesions which reveal intratubular obstruction by massive erythrocyte casts and tubular necrosis. The glomeruli showed focal minimal crescents with many red blood cells entrapped in the crescents and in the capillaries. Immune deposits were not present. A renal failure resolved spontaneously and the patient was discharged three weeks later with creatinine of 2.4 mg/dl. In this patient, acute renal failure was considered to be due to a tubular lesion related to the glomerular bleeding from focal glomerulonephritis revealing minimal crescents.
Key Words: acute renal failure; glomerulonephritis; gross hematuria
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