@article{matsui2014case,
  title = {A Case of Henoch-Schönlein Purpura with Acute Kidney Injury Accompanied by Severe Gross Hematuria and Erythrocytes-Casts Occlusion in Distal Tubules},
  author = {Satoshi Matsui and Hiroko Tsuji and Kazuhiro Nagao and Shinji Ono},
  year = 2014,
  url = {https://ibimapublishing.com/articles/IJCRM/2014/917068/},
  journal = {International Journal of Case Reports in Medicine},
  volume = 2014 (2014),
  pages = 6,
  doi = 10.5171/2014.917068,
  abstract = {A 77-year-old man came to our hospital with purpura on lower extremities, severe gross hematuria, and acute kidney injury (AKI). On presentation, he was generally edematous and had no oliguria. Any signs of volume depletion were not detected. After the diagnosis of Henoch-Schönlein purpura (HSP) was confirmed, we initiated hydration and daily oral administration of prednisolone (PSL) (0.6 mg/kg). AKI improved gradually, but hematuria and fecal occult blood (FOB) did not disappear and sustained for four weeks. Therefore, we added mizoribine (MZR) (1 mg/kg/day) to oral PSL. Three weeks after MZR was administered, both of hematuria and positive FOB resolved. Renal biopsy specimen, after AKI improved, showed some erythrocytes-casts occlusion in distal tubules, not severe mesangial cell proliferation, crescents, IgA depositions, or vasculitis. These pathological pictures suggest that one of the causes of renal manifestations might be erythrocytes-casts occlusion in distal tubules, which is similar to the pathological findings of warfarin-related nephropathy. In our case, massive gross hematuria was observed and supposed to make numerous erythrocytes-casts in tubules, and it might lead to acute tubular injury and AKI. Following his clinical improvement, we tapered oral prednisolone to a dose of 0.4 mg/kg/day and discharged him. This case shows that we should consider occlusive erythrocytes-casts as one of the causes of AKI when we treat HSP patients with severe gross hematuria.},
  keywords = {AKI, Henoch-Schönlein purpura, erythrocytes-casts occlusion.},
  note = Article ID: 917068
}