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Abstract
Malakoplakia is an uncommon chronic granulomatous inflammatory disease which is associated with immunocompromised conditions such as malignancy, autoimmune disease, chronic alcohol intake, poorly controlled diabetes and long-term steroid use. Malakoplakia can occur at various sites, most commonly in the genitourinary tract including urinary bladder and the ureter. Renal parenchymal involvement is relatively uncommon, accounting for 15% of all malakoplakia. A few cases of renal malakoplakia have been reported in Korea, and only one case was accompanied by acute kidney injury. Here we report an 80-year-old female patient with renal parenchymal malakoplakia and acute interstitial nephritis presented as acute kidney injury with literature review.
Figures and Tables
Fig. 1
Abdomino-pelvic CT on admission. It demonstrates multifocal attenuation differences at both kidneys (A) and normal-sized kidneys without hydronephrosis (B).
Fig. 2
Renal biopsy specimen they show (A) localized moderate fibrosis with dense histiocytic infiltrates, (B) mild lymphoplasma cell and eosinophilic infiltrates, (C) foam cells surrounding the interstitium and tubules (H&E, ×200), and (D) histiocytes with round concentric layered intracytoplasmic Michaelis-Gutmann bodies (Periodic acid-Schiff, ×200).
Table 1
Summary of reported cases of renal malakoplakia in Korea
BUN, blood urea nitrogen; Cr, serum creatinine level; WBC, white blood cell count; RA, rheumatoid arthritis; HTN, hypertension; DM, diabetes mellitus; NM, not mentioned; E.coli, Escherichia coli; CVA, cerebrovascular accident; CLD, chronic liver disease; TMP/SMX, trimethoprim/sulfamethoxazole; CP, chronic pancreatitis; IgAN, IgA nephropathy; Tx, treatment; OA, osteoarthritis; WNL, within normal limits; MG, Myasthenia gravis; PD, Parkinson' s disease.
References
1. Jung SJ, Kang HC, Choi JJ. Malakoplakia of the kidney extending to the descending colon in a patient with secondary adrenal insufficiency: a case report. Korean J Fam Med. 2011; 32:367–372.
2. Yoon SY, Lee HJ, An JH, Kim SJ, Kim SW, Woo JH, et al. Renal parenchymal malakoplakia presenting with abscesses and hepatic extension misdiagnosed as a malignant tumor: a case report. Korean J Med. 2012; 82:764–768.
3. Jo YI, Yoo TS, Heo WM, Yoo JK, Jo HS, Yoo KH, et al. A case of renal malakoplakia with renal insufficiency. Korean J Med. 1996; 51:843–849.
4. Keitel E, Pegas KL, do Nascimento Bittar AE, dos Santos AF, da Cas Porto F, Cambruzzi E. Diffuse parenchymal form of malakoplakia in renal transplant recipient: a case report. Clin Nephrol. 2014; 81:435–439.
5. Diwakar R, Else J, Wong V, Carne A, Banerjee D, MacPhee I. Enlarged kidneys and acute renal failure: why is a renal biopsy necessary for diagnosis and treatment? Nephrol Dial Transplant. 2008; 23:401–403.
6. Cho MH, Chae IY, Kim KB, Rhew HY, Hur B, Huh MH. A case of Malakoplakia with duplex kidney. Korean J Urol. 1989; 30:250–255.
7. Hong JH, Kim HJ, Kim CS, Ahn TJ, Ahn TY, Kim KH. Malacoplakia in genitourinary tract: 2 cases. Ulsan Univ Med J. 1992; 1:212–216.
8. Jung SS, Joo YS, Jin JY, Jung DR, Moon HB, Kim KH, et al. A case of renal parenchymal malakoplakia associated with E: coli empyema. Korean J Infect Dis. 1993; 25:277–281.
9. Kim SE, Noh TW, Kown KW, Jeong HJ, Kim YS, Kim SI, et al. Malakoplakia in a renal allograft: a case report. J Korean Soc Transplant. 2001; 15:256–258.
10. Jeong YH, Kim DJ, Kim JH, Lee HJ, Jang GD, Kim EK, et al. Bilateral renal parenchymal malacoplakia presenting as fever and acute renal failure. Korean J Nephrol. 2001; 20:530–534.
11. Sung DE, Yu E, Kim CS, Ro JY. Renal malakoplakia with secondary hepatic extension: a case report. Korean J Pathol. 2003; 37:199–203.
12. Tam VK, Kung WH, Li R, Chan KW. Renal parenchymal malacoplakia: a rare cause of ARF with a review of recent literature. Am J Kidney Dis. 2003; 41:E13–E17.
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