Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can be triggered by environmental factors. We report a novel case of a 22-year-old female that was exposed to volatile organic solvents (VOCs) while diluting oil-based paint colors prior to presenting with nephrotic syndrome and acute kidney injury, later confirmed as class IV lupus nephritis (LN). Multidisciplinary management resulted in significant clinical improvement, with a return to normal renal function and stabilization of SLE markers. This case highlights possible association between VOCs exposure and LN.

Although COVID-19 mRNA vaccines have demonstrated excellent safety profiles, rare autoimmune complications - including new-onset systemic lupus erythematosus (SLE) and lupus nephritis (LN) - have been reported. We describe a case of new-onset class IV LN with neuropsychiatric lupus (NPSLE) occurring shortly after COVID-19 vaccination in a previously healthy adult. This case highlights a rare presentation of new-onset SLE manifesting with both severe renal and neuropsychiatric involvement following COVID-19 mRNA vaccination. While causality cannot be established, the temporal association and absence of alternative triggers suggest vaccine-induced immune dysregulation as a potential precipitating factor. Awareness of such atypical presentations may facilitate earlier diagnosis and management, although these events remain exceedingly uncommon relative to the overwhelming benefits of vaccination.

We report the case of a 53-year-old man who presented with Fanconi syndrome as the initial clinical manifestation. Laboratory findings included hypokalemia, hypophosphatemia, mild metabolic acidosis, and renal glucosuria. Kidney biopsy revealed crystalline light-chain proximal tubulopathy (LCPT) with κ-restricted light-chain deposition in proximal tubular epithelial cells. Bone marrow examination demonstrated multiple myeloma with plasma cells containing Auer rod-like intracytoplasmic inclusions, an extremely rare morphological finding. The coexistence of crystalline κ-restricted LCPT and Auer rod-like inclusions in plasma cells is exceedingly rare and remains poorly characterized. This case underscores the diagnostic value of kidney biopsy in unexplained Fanconi syndrome and suggests that abnormal physicochemical properties of monoclonal κ light chains may contribute to intracellular crystal formation in both renal tubular epithelial cells and plasma cells.

Patients undergoing Mohs micrographic surgery (MMS) on perioperative diuretics represent a medically complex population, yet the impact of diuretic use on postoperative outcomes remains underexplored. Despite use in patients with cardiometabolic comorbidities, limited research has evaluated how perioperative diuretic exposure influences postoperative outcomes following MMS. This study investigates the association between perioperative diuretic use and postoperative outcomes following MMS. Utilizing the TriNetX database, MMS patients were matched on a 1 : 1 basis according to perioperative diuretic use. Outcome variables were evaluated over a 30- and 90-day follow-up period. Among 37,781 matched patients, diuretic use was associated with higher odds of surgical site infection at both 30 days (OR 1.29, 95% CI 1.03 - 1.62, p = 0.03) and 90 days (OR 1.36, 95% CI 1.12 - 1.65, p < 0.001), as well as substantially increased odds of rash or cellulitis at 30 days (OR 1.95, 95% CI 1.68 - 2.26, p < 0.001) and 90 days (OR 1.92, 95% CI 1.74 - 2.13, p < 0.001). Perioperative diuretic use was linked to increased odds of infection, rash or cellulitis, postoperative pain, opioid use, emergency department visits, sepsis, and short-term mortality, with time-to-event analysis identifying loop and osmotic diuretics as the primary drivers of risk.

Anemia is one of the most common complications affecting individuals with chronic kidney disease (CKD). It is driven primarily by relative erythropoietin (EPO) deficiency, chronic inflammation, and altered iron metabolism. Emerging therapies, known as hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), offer a novel oral treatment approach by stabilizing intracellular HIF levels to mimic tissue hypoxia and stimulate endogenous EPO production. This comprehensive narrative review synthesizes literature indexed in PubMed, MEDLINE, Scopus, and Web of Science to evaluate the efficacy of HIF stabilizers in the anemia of CKD compared to current guideline-directed therapies worldwide. Phase 3 clinical trials consistently demonstrate that HIF-PHIs are non-inferior to conventional erythropoiesis-stimulating agents (ESAs) and superior to placebo in increasing and maintaining hemoglobin levels in both dialysis-dependent and non-dialysis-dependent CKD patients. Additionally, HIF-PHIs improve iron mobilization and utilization by decreasing hepcidin levels. However, trials have raised safety concerns regarding cardiovascular outcomes, including major adverse cardiovascular events, and an increased incidence of thromboembolic events, particularly in non-dialysis-dependent populations. These safety signals have led to divergent global regulatory pathways, with the United States Food and Drug Administration largely restricting approvals to dialysis-dependent patients, while agencies in Europe and Japan have granted broader authorizations. As a growing body of literature accumulates, HIF-PHIs offer a promising oral alternative to ESAs that addresses both relative EPO deficiency and iron sequestration. While they have the potential to become a new standard of care, therapy initiation requires individualized risk-benefit assessments, and continued post-marketing surveillance is necessary to fully elucidate long-term cardiovascular and thromboembolic risks.