title: [An elderly patient with purpura nephritis that appeared after extracorporeal shock wave lithotripsy].
abstract: We report a 63-year-old male patient with purpura nephritis, which appeared 7 days after extracorporeal shock wave lithotripsy (ESWL). He was referred to our clinic because of a petechial rash on both lower extremities, pretibial edema and massive proteinuria. Urinalysis showed proteinuria and hematuria and some hyaline casts. A 24-hour urine sample contained 5.0 g of protein. Renal function on admission was decreased: serum creatinine was 1.5 mg/dl and creatinine clearance, 21 ml/min. Immunoserological tests demonstrated an increase in serum IgA (424.3 mg/dl). A skin biopsy revealed leukocytoclastic vasculitis. A renal biopsy showed endocapillary proliferation in a diffuse, but segmental fashion. However, no crescent formation was seen. Immunofluorescence microscopy disclosed mesangial staining for IgA and C3. Electron microscopy demonstrated severe injury to endothelial and epithelial cells: detachment of endothelial and epithelial cells, foot process effacement and macrophage infiltration. Electron-dense deposits were observed in the subendothelial and paramesangial areas. Because renal function was deteriorating rapidly, methylprednisolone pulse therapy and immunosuppressive treatment were implemented. Treatment was effective and the patient's renal function and proteinuria improved remarkably. The electron microscopic findings in this case of purpura nephritis seemed to be more severe than usual, suggesting that ESWL may aggravate glomerular damage.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nishino
authors.forename: H
authors.initials: H
authors.lastname: Uyama
authors.forename: T
authors.initials: T
authors.lastname: Kimura
authors.forename: M
authors.initials: M
authors.lastname: Iwano
authors.forename: H
authors.initials: H
authors.lastname: Shiiki
authors.forename: K
authors.initials: K
authors.lastname: Dohi
authors.forename: M
authors.initials: M
authors.lastname: Yoshii
authors.forename: Y
authors.initials: Y
authors.lastname: Hirao
authors.forename: T
authors.initials: T
authors.lastname: Fukumoto
mesh_terms: D004334:Drug Administration Schedule; D005921:Glomerulonephritis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D014545:Urinary Calculi / Q000628:therapy
chemical_list: D011239:Prednisolone; D008775:Methylprednisolone