Chronic Kidney Disease from Polyvinylpyrrolidone Deposition in Persons with Intravenous Drug Use

BACKGROUND AND OBJECTIVES

Persons with intravenous drug use have a higher risk of developing CKD compared with the general population. In Norway, deposits of polyvinylpyrrolidone have been observed in kidney biopsies taken from persons with opioid addiction and intravenous drug use since 2009. Polyvinylpyrrolidone is an excipient commonly used in pharmaceuticals, and the polyvinylpyrrolidone deposits observed in these patients were caused by intravenous injection of a specific oral methadone syrup containing very high molecular weight polyvinylpyrrolidone. Here, we present the clinicopathologic findings from 28 patients with CKD associated with polyvinylpyrrolidone deposition in the kidney.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The 28 patients and their kidney biopsies were included when polyvinylpyrrolidone deposition was recognized, either retrospectively or at the time of diagnostic evaluation. Biopsies were taken between 2009 and 2016. We collected laboratory parameters and clinical data from digital patient charts. For each kidney biopsy, the glomerular volume, extent of polyvinylpyrrolidone deposition, and tubulointerstitial area with tubular atrophy were assessed quantitatively.

RESULTS

All patients (mean age: 37 years) had CKD (mean eGFR: 33 ml/min per 1.73 m²) and normal urine protein or non-nephrotic-range proteinuria. Biopsies showed moderate to severe tubular atrophy (mean extent: 65%) and interstitial infiltrates of vacuolated macrophages containing polyvinylpyrrolidone (mean share of biopsy area: 1.5%). Underperfused and ischemic glomeruli were common findings. In 22 samples, ultrastructural investigation revealed polyvinylpyrrolidone-containing vacuoles in the mesangial or endothelial cells of glomeruli. At the last follow-up, most patients had stable or improved eGFR. Two patients had developed kidney failure and underwent hemodialysis.

CONCLUSIONS

Intravenous injection of a specific oral methadone syrup caused polyvinylpyrrolidone deposition in the kidney in persons with opioid addiction and intravenous drug use. Kidney biopsy findings suggested an association between polyvinylpyrrolidone deposition and tubular atrophy.

Non-Contact Optical Detection of Foreign Materials Adhered to Color Filter and Thin-Film Transistor

This paper describes the non-contact optical detection of debris material that adheres to the substrates of color filters (CFs) and thin-film transistors (TFTs) by area charge-coupled devices (CCDs) and laser sensors. One of the optical detections is a side-view illumination by an area CCD that emits a coherency light to detect debris on the CF. In contrast to the height of the debris material, the image is acquired by transforming the geometric shape from a square to a circle. As a result, the side-view illumination from the area CCD identified the height of the debris adhered to the black matrix (BM) as well as the red, green, and blue of a CF with 95, 97, 98, and 99% accuracy compared to the golden sample. The uncertainty analysis was at 5% for the BM, 3% for the red, 2% for the green, and 1% for the blue. The other optical detection, a laser optical interception with a horizontal alignment, inspected the material foreign to the TFT. At the same time, laser sensors intercepted the debris on the TFT at a voltage of 3.5 V, which the five sets of laser optics make scanning the sample. Consequently, the scanning rate reached over 98% accuracy, and the uncertainty analysis was within 5%. Thus, both non-contact optical methods can detect debris at a 50 μm height or lower. The experiment presents a successful design for the efficient prevention of a valuable component malfunction.

Ultrasonographic diagnosis of a hair foreign body in the urinary bladder of a dog

A 13-year-old male neutered mixed-breed dog with a history of gallbladder mucocele and urolithiasis was evaluated by ultrasound. Two hyperechoic, linear foreign bodies with no distal acoustic shadowing were detected in the urinary bladder and urethra. Following the ultrasound examination, the patient underwent cystoscopy, and two single hairs were found and successfully retrieved. Considering that urinary bladder foreign bodies may be a source for urinary tract infection and can act as a nidus for urocystolith formation, removal is recommended. This is the first published report describing ultrasonographic diagnosis of a hair foreign body in the canine urinary bladder and urethra.

Apparent foreign-body-like structure detected in the left atrium after catheter ablation for persistent atrial fibrillation

BACKGROUND

A foreign body left in left atrium after catheter ablation of atrial fibrillation is a very rare complication. Nevertheless, there are no reports so far about a large newly emerged structure only giving the impression of being a foreign body left in the heart after catheter ablation.

CASE REPORT

This report presents a case of a patient after catheter ablation for persistent atrial fibrillation. Because of atrial tachycardia during follow-up, patient was indicated for reablation. Imaging methods including intracardiac echocardiography showed a straw-like foreign body with the character of a transseptal sheath in left atrium. A cardiac surgery was performed with extraction of the foreign body. We found a fibrous chord-like material in the left atrium, microscopy showed myocardial tissue with continuous transition to fibrinous elastic vessel. No signs of foreign material were found.

CONCLUSION

We have found a newly emerged body giving the impression of being of foreign origin in left atrium after catheter ablation of atrial fibrillation. Microscopy of the extracted material showed myocardial tissue with continuous transition to fibrinous elastic vessel and a fibrinous tissue with focal dystrophic calcification. Its origin remains unknown.

Postoperative granulomatous peritonitis mimicking abdominal tuberculosis

Granulomatous peritonitis represents a rare postoperative complication that should be considered as important differential diagnosis in all patients who present to the hospital with abdominal pain, abdominal tenderness, and fever after abdominal surgery. Clinical distinction from abdominal tuberculosis remains a diagnostic challenge and requires thorough histopathological and microbiological examination.

Role of Sonography for Evaluation of Gastrointestinal Foreign Bodies

Foreign body ingestion is frequently encountered in children. The locations of the foreign bodies and the period during which they have been present in the thorax and abdomen are important for determining the method and timing of treatment. Although plain radiography and computed tomography are primarily used for assessment of foreign bodies, sonography without radiation is also useful for diagnosis of foreign bodies. This report describes 5 cases of foreign bodies in the digestive tract and the usefulness of sonography for real-time evaluation of foreign bodies with high spatial resolution. Physicians can use sonography along with radiography and computed tomography in cases involving foreign bodies.