{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:10:40Z","timestamp":1778217040360,"version":"3.51.4"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    This report presents the case of a 60-year-old woman who was admitted with symptoms of fatigue and poor appetite. Laboratory investigations revealed severe acute kidney injury (AKI), indicated by a serum creatinine level of 2,065 \u03bcmol\/L, necessitating the initiation of emergency hemodialysis. The patient also exhibited hemolytic anemia (hemoglobin, 69 g\/L), thrombocytopenia (platelet nadir, 45 \u00d7 10\n                    <jats:sup>9<\/jats:sup>\n                    \/L), venous thrombosis, a positive direct antiglobulin test (DAT), and a low absolute reticulocyte count. Conventional flow cytometry (red blood cells and neutrophils CD55\/CD59) did not detect a paroxysmal nocturnal hemoglobinuria (PNH) clone. Renal biopsy revealed hemoglobin cast nephropathy and intrarenal venous thrombosis. Subsequent bone marrow evaluation, high-sensitivity flow cytometry (FLAER method), and supportive PIGA sequencing findings established the diagnosis of PNH. Treatment with eculizumab led to hematologic remission and progressive renal recovery. This case underscores the importance of considering PNH in patients with severe AKI and hemolysis, even when initial conventional flow cytometry is negative.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1778834","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:34:58Z","timestamp":1778214898000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Paroxysmal nocturnal hemoglobinuria with a positive Coombs test presenting as acute kidney injury: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Luyao","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, The First People\u2019s Hospital of Yongkang, Jinhua","place":["Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianxi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First People\u2019s Hospital of Yongkang, Jinhua","place":["Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linlin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First People\u2019s Hospital of Yongkang, Jinhua","place":["Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miaojun","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First People\u2019s Hospital of Yongkang, Jinhua","place":["Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Affiliated Hospital and Yuying Children\u2019s Hospital of Wenzhou Medical University, Wenzhou","place":["Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/ejh.12543","article-title":"Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.","volume":"95","author":"Devalet","year":"2015","journal-title":"Eur J Haematol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1080\/10245332.2018.1444563","article-title":"Renal involvement in paroxysmal nocturnal hemoglobinuria: an update on clinical features, pathophysiology and treatment.","volume":"23","author":"Kokoris","year":"2018","journal-title":"Hematology."},{"key":"B3","doi-asserted-by":"publisher","first-page":"17028","DOI":"10.1038\/nrdp.2017.28","article-title":"Paroxysmal nocturnal haemoglobinuria.","volume":"3","author":"Hill","year":"2017","journal-title":"Nat Rev Dis 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