Renal involvement in paroxysmal nocturnal hemoglobinuria

S. Hussain, A. Qureshi, J. Kazi

Research output: Contribution to journalReview article

Abstract

Renal involvement in paroxysmal nocturnal hemoglobinuria (PNH) is not usually apparent but in cases with clinical involvement varies from reversible acute dysfunction to chronic irreversible damage. Early diagnosis and treatment is crucial to prevent disease progression and irreversible chronic kidney disease (CKD). The ultimate outcome of CKD in many patients is the need for renal replacement therapy, which necessitates ever-growing dialysis and transplantation programs, thereby imposing a significant economic burden on the healthcare system. In a third-world country like Pakistan, increased burden due to CKD can be very hard on families. Doctor visits, hospitalization, and dialysis are all out-of-pocket expenses, therefore prevention, early detection, and timely intervention are the only cost-effective strategies. We report a case of acute kidney injury (AKI) due to PNH. This case shows AKI as one of the complications of PNH which may have a clinical course like acute tubular necrosis (ATN). This could be due to ATN or AKI superimposed on CKD due to hemosiderin deposits in the renal tubular epithelial cells. Our patient was dialyzed initially and discharged with a permanent catheter in place with advice to continue dialysis three times a week. He required dialysis for 1 week then started producing urine. His subsequent outpatient visits showed improved renal function. The permanent catheter was removed and maintenance dialysis was stopped. Here, we briefly review the literature on renal involvement in PNH, treatment options for PNH and pigment-induced nephropathy followed by a question-and-answer session at the clinicopathological conference held on March 4, 2011, at Sindh Institute of Urology and Transplantation in Karachi, Pakistan.

Original languageEnglish
Pages (from-to)28-35
Number of pages8
JournalNephron - Clinical Practice
Volume123
Issue number1-2
DOIs
Publication statusPublished - 2013

Fingerprint

Paroxysmal Hemoglobinuria
Dialysis
Chronic Renal Insufficiency
Kidney
Acute Kidney Injury
Pakistan
Necrosis
Catheters
Transplantation
Hemosiderin
Renal Replacement Therapy
Urology
Health Expenditures
Developing Countries
Disease Progression
Early Diagnosis
Hospitalization
Outpatients
Epithelial Cells
Maintenance

Keywords

  • Acute kidney injury
  • Chronic kidney disease
  • Hemodialysis
  • Paroxysmal nocturnal hemoglobinuria

ASJC Scopus subject areas

  • Nephrology

Cite this

Renal involvement in paroxysmal nocturnal hemoglobinuria. / Hussain, S.; Qureshi, A.; Kazi, J.

In: Nephron - Clinical Practice, Vol. 123, No. 1-2, 2013, p. 28-35.

Research output: Contribution to journalReview article

Hussain, S. ; Qureshi, A. ; Kazi, J. / Renal involvement in paroxysmal nocturnal hemoglobinuria. In: Nephron - Clinical Practice. 2013 ; Vol. 123, No. 1-2. pp. 28-35.
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