English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

glomeruli with cellular crescents associated with segCase report mental capillary wall necrosis in seven (Fig. 1), and acute interstitial nephritis. Granular mesangial and A previously healthy 56-year-old woman was referred endomembranous deposits of IgM and C3 were for evaluation of fatigue, skin lesions and renal failure. observed by immunofluorescence microscopy (Fig. 2). She had noticed for several months progressive astheA diagnosis of necrotizing glomerulonephritis associnia, nocturnal sweats, intermittent fever (38°C), anorexia and a 3 kg weight loss. Two weeks before admission, red spots appeared on the legs. At that time, erythrocyte sedimentation rate reached 60 mm/h, while serum creatinine had risen to 154 mmol/l from 88 mmol/l 1 month earlier. On admission, cardiopulmonary auscultation was normal. Blood pressure was 120/80 mmHg. Noticeable findings were palpable purpura on the legs and mild spleen enlargement. Serum C-reactive protein (CRP); (5 mg/l ) and plasma fibrinogen (212 mg/dl ) were normal. Serum creatinine was elevated (181 mmol/l ). Additional tests included: haemoglobin 8.2 g/dl with microcytosis (71.6 m3), iron 17 mg/dl, TIBC 224 mg/dl, ferritin 269 mg/ml, white cell count 3.69×109/l (neutrophils 56%), platelets 150×109/l, total protein serum level 90 g/l (albumin 32 g/l, gamma-globulins 42 g/l Fig. 1. Segmental glomerular tuft thrombonecrosis. Masson’s trich( IgM 0.41 g/l, IgG 3.59 g/l, without evidence of monorome (×250). clonal component)). Urinalysis disclosed 80–90 red blood cells/hpf with red cell casts; proteinuria was 1.8 g/24 h. Several autoantibodies were detected: antinuclear antibodies (ANA) at a titre of 1/320 (nucleolar and speckled patterns), anticardiolipin antibodies 61 U.GPL (normal < 10), perinuclear ANCA at a titre of 1/2560 without reactivity, by ELISA, for myeloperoxidase, elastase, cathepsin or lactoferrin extracts. C3 serum level was 0.6 g/l (normal 0.7–1.3). A mixed type III cryoglobulin ( IgM–IgG) was detected (0.7 mg/ml, normal <0.08). Serological tests for hepatitis B and C viruses were negative. Bone marrow biopsy, chest and abdominal computerized tomographies were normal except for splenic enlargement. Kidney biopsy showed six obsolescent glomeruli, 14

ANCA-positive rapidly progressive glomerulonephritis: there may be more to the diagnosis than you think!