Immunoglobulin A-dominant infection-related glomerulonephritis (IgA-DIRGN) is a rare variant of acute postinfectious glomerulonephritis, typically seen in elderly individuals with comorbid conditions. IgA-DIRGN is characterized by diffuse endocapillary proliferation and the formation of mesangial deposits of IgA and C3, leading to inflammation and subsequently resulting in acute kidney injury, proteinuria, hematuria, and hypocomplementemia. In this report, we describe an immunocompromised 68-year-old man who developed acute kidney injury, nephrotic-range proteinuria, and microscopic hematuria following a splenic Mycobacterium avium abscess. Kidney biopsy showed endocapillary proliferative glomerulonephritis with IgA and C3-dominant granular deposits, consistent with IgA-DIRGN. Progression of kidney dysfunction during antimycobacterial therapy prompted the use of glucocorticoids 1 month after the initial presentation and eventually a splenectomy 1 month later, followed by renal recovery. To our knowledge, this is the first case to report the association between a nontuberculous mycobacterial infection and IgA-DIRGN, emphasizing the importance of source control and illustrating the usefulness of steroids in this patient.

Cryoglobulinemia is an immune complex-mediated disorder that can be associated with autoimmune diseases, lymphoproliferative disorders, and chronic infections. Renal involvement can be a prominent manifestation and may occasionally be the initial clue to an underlying systemic condition. Here, we describe a 33-year-old woman who presented with pedal edema, intermittent arthralgia, hematuria, and impaired renal function. Kidney biopsy demonstrated characteristic intraluminal pseudothrombi with dominant immunoglobulin M deposition, consistent with cryoglobulinemic glomerulonephritis. Subsequently, serologic testing confirmed mixed cryoglobulinemia. Further evaluation revealed strong positivity for anti-Sjögren syndrome-related antigen-A and anti-Sjögren syndrome-related antigen-B antibodies, and a labial salivary gland biopsy fulfilled the 2016 American College of Rheumatology European Alliance of Associations for Rheumatology criteria for Sjögren syndrome, despite the absence of sicca symptoms. Treatment with corticosteroids and rituximab led to significant improvement in renal function. The clinical course was complicated by secondary thrombotic microangiopathy, which responded to plasma exchange. This report highlights the diagnostic value of kidney biopsy in uncovering occult systemic autoimmune disease and emphasizes that Sjögren syndrome may initially present with isolated renal manifestations. Early recognition is essential for the timely initiation of appropriate immunomodulatory therapy.

Perivascular epithelioid cell tumor (PEComa) of the urinary bladder is an exceptionally rare mesenchymal neoplasm and may be difficult to diagnose preoperatively. We report a rare case of a hypervascular bladder PEComa with TFE3 expression in an adolescent female that was clinically misdiagnosed as paraganglioma. A 16-year-old girl presented with intermittent gross hematuria. Imaging revealed a hypervascular submucosal bladder mass with marked homogeneous enhancement on computed tomography urography (CTU) and mild-to-moderate uptake on somatostatin receptor imaging, leading to suspicion of paraganglioma and preoperative α-adrenergic blockade. Histopathologic examination after transurethral resection showed epithelioid tumor cells with a low proliferative index. Immunohistochemistry demonstrated nuclear TFE3 positivity and strong cathepsin K expression, while melanocytic and neuroendocrine markers were negative, supporting a diagnosis of PEComa showing TFE3 immunoreactivity. The patient remains disease-free at six months of follow-up. This case highlights an important diagnostic pitfall of hypervascular bladder tumors mimicking paraganglioma, particularly in adolescent patients.

Urothelial carcinoma is a malignant neoplasm of the urinary tract arising from the transitional epithelium. Its clinical manifestations often overlap with non-neoplastic conditions, such as urinary tract infections, thereby presenting a diagnostic challenge for clinicians. Differentiating from others condition is important, as the treatment and prognoses vary significantly. This case report presented a 4-year-old female local dog, weighing 11.55 kg in BVC Animal Hospital with a primary complaint of hematuria. Clinical, hematological, and serum biochemical evaluations revealed no significant abnormalities. Ultrasonographic (USG) examination identified a hypoechoic mass measuring 0.31×0.85 cm located within the lumen and thickening of urinary bladder wall. Cytological assessment was performed via urine catheterization. The cytological specimen demonstrated a population of cells with anisocytosis, anisokaryosis, and a high nucleus-to-cytoplasm ratio, raising suspicion of a malignant tumor. Consequently, biopsy was performed via cystotomy to establish a definitive diagnosis. Prior to release the histopathological results, post-cystotomy the dog was treated with cefadroxil as antibiotics at 20 mg/kg BW b.i.d for 14 days, carprofen as anti-inflammatory at 2 mg/kg BW s.i.d. for 5 days, and tramadol as analgesics at 2 mg/kg BW b.i.d. for 5 days. Histopathological examination showed a non-encapsulated tumor with well-defined demarcation in the mucosa. The tumor consists of a dense population of epithelial tumor cells without evidence of invasion, confirmed the diagnosis of non-invasive, non-papillary urothelial carcinoma (in situ). The patient was managed palliatively with the administration of piroxicam at 0.3 mg/kg BW s.i.d as monotherapy. Until day 190, the dog showing a stable disease. To the best of the authors' knowledge, this is the first documented case of canine urothelial carcinoma in Indonesi.

Nail-patella syndrome (NPS) (previously referred to as Fong's disease), encompasses the classic clinical tetrad of changes in the nails, knees, and elbows, and the presence of iliac horns. Nail changes are the most constant feature of NPS. Nails may be absent, hypoplastic, or dystrophic; ridged longitudinally or horizontally; pitted; discolored; separated into two halves by a longitudinal cleft or ridge of skin; and thin or (less often) thickened. The patellae may be small, irregularly shaped, or absent. Elbow abnormalities may include limitation of extension, pronation, and supination; cubitus valgus; and antecubital pterygia. Iliac horns are bilateral, conical, bony processes that project posteriorly and laterally from the central part of the iliac bones of the pelvis. Renal involvement, first manifest as proteinuria with or without hematuria, occurs in 30%-50% of affected individuals; end-stage renal disease occurs up to 15% of affected individuals. Primary open-angle glaucoma and ocular hypertension occur at increased frequency and at a younger age than in the general population.