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clinical studies have pointed out the lipid-induced renal damage, and statins
may have pleiotropic effects on renoprotection. We reported a girl with
X-linked Alport syndrome whose late steroid-responsive nephrotic syndrome (NS)
was resolved by atorvastatin. She had been in a nephrotic condition despite of
prednisone therapy 60 mg/day for 8 weeks. Renal biopsy dispicted extreme foamy
appearance of tubular epithelial cells with detachment led to luminal
obliteration. Atorvastatin was started on the ninth week of prednisone therapy
due to severe hypercholesterolemia. Partial remission of NS was dramatically
achieved with unchanged dosage of prednisone at the end of the twelfth week.
Our case provides a pathology-based evidence to support the use of statins in
profoundly hyperlipidemic patients with NS. In patients with NS and profound
hyperlipidemia, early initiation of statin therapy is required in combination
with immunosuppressive therapy.
Background: The prevalence of asymptomatic renal scarring, such as a focal segmental glomerulosclerosis (FSGS), was suggested to be high in women who develop preeclampsia. FSGS is a risk factor for endstage renal disease. Objective: To document preeclamptic women with proteinuria that developed eight weeks prior to hypertension with confirmed FSGS postpartum. Case: A 20-year-old nulliparous Japanese woman with a negative dipstick test result at gestational week (GW) 18 exhibited proteinuria 1+ on dipstick test at GW 22. Proteinuria determined from the random urine protein to creatinine ratio (P/Cr, g/g) was increased from 3.7 at GW 26 to 4.6 and 8.9 at GW 28 and 30, respectively. She developed hypertension (142/66 mmHg) at GW 30. Due to increased edema, emergency cesarean section was performed at GW 33. She gave birth to an otherwise healthy female small-for-gestational-age infant, weighing 1290 g. Postpartum course was uneventful except for persisting proteinuria: P/Cr of 9.8 just before delivery decreased to 3.6 and 1.7 on postpartum weeks 9 and 17, respectively. Renal biopsy on postpartum week 13 revealed FSGS in this patient. Conclusion: Hidden FSGS may have manifested as preeclampsia in this patient. This case highlighted the need to determine the prevalence of asymptomatic FSGS among women who later develop preeclampsia.
Idiopathic hypereosinophilic syndrome (IHES) is a disorder characterized
by increased eosinophil count (eosinophilia) along with organ dysfunction
secondary to organ infiltration of eosinophils and release of inflammatory markers [1-4], with no obvious cause for eosinophilia. The onset of symptoms
is insidious in most of the cases and eosinophilia is detected incidentally.
However, in others, the initial manifestations are severe and life-threatening
due to the rapid evolution of cardiac or neurologic complications . Renal
involvement is rarely reported  in IHES. Herein we reported a case
of IHES with predominant renal involvement as nephrotic syndrome with focal
necrotizing IgA nephropathy.