Hassan Maha, Perez Melissa, Girdler Michael, Dhillon Amarbir, Karkal Prashant
Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Cureus. 2025 Jul 6;17(7):e87373. doi: 10.7759/cureus.87373. eCollection 2025 Jul.
Acute kidney injury (AKI) is a critical condition characterized by a sudden decline in kidney function, often posing diagnostic and therapeutic challenges due to its multifactorial nature. This case is significant, as it exemplifies the complexity of AKI in the context of coexisting sepsis, potential antibiotic nephrotoxicity, and immune-mediated processes. While AKI related to sepsis and renal toxic antibiotics is well-documented, the rapid onset and the involvement of antineutrophil cytoplasmic antibody (ANCA)-negative pauci-immune glomerulonephritis add a unique dimension to this case, contributing novel insights to the medical literature. ANCA-negative pauci-immune glomerulonephritis is characterized by a rapidly progressive glomerulonephritis that lacks the detection of antineutrophil cytoplasmic antibodies. We report the case of a 68-year-old Hispanic male with a history of asthma and pulmonary emphysema, presenting with acute respiratory symptoms, including shortness of breath, chills, and a productive cough, accompanied by gastrointestinal symptoms. The patient was admitted to the hospital with pneumonia complicated by sepsis. Initial treatment included antibiotics known for potential renal toxicity. Within 48 hours, the patient experienced a rapid deterioration in renal function, marked by a significant increase in serum creatinine levels. A renal biopsy revealed acute tubular injury with no immune complex deposition and an elevated myeloperoxidase level, suggestive of an immune-mediated process. The patient responded positively to immunosuppressive therapy, consisting of rituximab and corticosteroids, resulting in improved renal function. This case underscores the importance of considering a broad differential diagnosis in AKI, particularly in patients with complex clinical presentations. The involvement of ANCA-negative pauci-immune glomerulonephritis highlights the need for awareness of immune-mediated renal injuries in similar clinical scenarios. This case has implications for both nephrology and broader medical practice, as it emphasizes the necessity of integrating clinical, laboratory, and histopathological data to guide effective treatment strategies. The findings advance our understanding of the potential interplay between sepsis, drug-induced nephrotoxicity, and immune-mediated processes in AKI, offering valuable insights for future diagnostic and therapeutic approaches.
急性肾损伤（AKI）是一种危急病症，其特征是肾功能突然下降，由于其多因素性质，常常带来诊断和治疗挑战。该病例具有重要意义，因为它体现了在合并脓毒症、潜在抗生素肾毒性和免疫介导过程的背景下AKI的复杂性。虽然与脓毒症和肾毒性抗生素相关的AKI已有充分记录，但抗中性粒细胞胞浆抗体（ANCA）阴性的寡免疫性肾小球肾炎的快速发作以及累及情况为该病例增添了独特维度，为医学文献提供了新的见解。ANCA阴性的寡免疫性肾小球肾炎的特征是快速进展性肾小球肾炎，且未检测到抗中性粒细胞胞浆抗体。我们报告了一例68岁的西班牙裔男性病例，他有哮喘和肺气肿病史，出现急性呼吸道症状，包括呼吸急促、寒战和咳痰，伴有胃肠道症状。该患者因肺炎并发脓毒症入院。初始治疗包括已知有潜在肾毒性的抗生素。在48小时内，患者肾功能迅速恶化，表现为血清肌酐水平显著升高。肾活检显示急性肾小管损伤，无免疫复合物沉积，髓过氧化物酶水平升高，提示存在免疫介导过程。患者对由利妥昔单抗和皮质类固醇组成的免疫抑制治疗反应良好，肾功能得到改善。该病例强调了在AKI中考虑广泛鉴别诊断的重要性，特别是在临床表现复杂的患者中。ANCA阴性的寡免疫性肾小球肾炎的累及突出了在类似临床情况下认识免疫介导性肾损伤的必要性。该病例对肾脏病学和更广泛的医学实践都有影响，因为它强调了整合临床、实验室和组织病理学数据以指导有效治疗策略的必要性。这些发现增进了我们对脓毒症、药物性肾毒性和免疫介导过程在AKI中潜在相互作用的理解，为未来的诊断和治疗方法提供了有价值的见解。
