{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:34:36Z","timestamp":1787841276757,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disorder of hematopoietic stem cells characterized by complement-mediated intravascular hemolysis. Renal involvement, though often subclinical, can occasionally present as acute kidney injury (AKI). We report a case of a 24-year-old female who presented with AKI without any clinical or laboratory evidence of hemolysis. Kidney biopsy revealed acute tubular necrosis with hemosiderin deposition, suggestive of chronic hemolysis. The patient recovered with supportive care, and a diagnosis of PNH was not confirmed until 6 years later, following evaluation for anemia. Flow cytometry at that time revealed CD55 and CD59 deficiency, confirming PNH. This case highlights the diagnostic challenge of PNH when it presents atypically and emphasizes the importance of recognizing renal hemosiderosis as a potential early clue. In patients with unexplained AKI and biopsy evidence of hemosiderin deposition, PNH should be considered even in the absence of overt hemolysis or classical symptoms.<\/jats:p>","DOI":"10.4103\/ijpm.ijpm_381_25","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:00:10Z","timestamp":1768831210000},"page":"144-146","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Acute kidney injury as a harbinger of paroxysmal nocturnal hemoglobinuria in an unsuspected case"],"prefix":"10.4103","volume":"69","author":[{"given":"V. M.","family":"Mimna","sequence":"first","affiliation":[{"name":"Department of Pathology, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India"},{"name":"Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bheemanathi H.","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. S.","family":"Priyamvada","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhee","family":"Kar","sequence":"additional","affiliation":[{"name":"Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"R1-20260403","first-page":"21","article-title":"Management of paroxysmal nocturnal hemoglobinuria in the era of complement inhibitory therapy","author":"Parker","year":"2011","journal-title":"Hematology Am Soc Hematol Educ Program 2011"},{"key":"R2-20260403","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJM199511093331904","article-title":"Natural history of paroxysmal nocturnal hemoglobinuria","volume":"333","author":"Hillmen","year":"1995","journal-title":"N Engl J Med"},{"key":"R3-20260403","doi-asserted-by":"crossref","first-page":"3408","DOI":"10.1093\/ndt\/gfr391","article-title":"Acute renal failure associated to paroxysmal nocturnal haemoglobinuria leads to intratubular haemosiderin accumulation and CD163 expression","volume":"26","author":"Ballar\u00edn","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"R4-20260403","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.1097\/MPH.0000000000001847","article-title":"Pediatric paroxysmal nocturnal hemoglobinuria presenting as acute kidney injury","volume":"43","author":"Henderson","year":"2021","journal-title":"J Pediatr Hematol Oncol"},{"key":"R5-20260403","doi-asserted-by":"crossref","first-page":"E17","DOI":"10.1053\/ajkd.2001.21361","article-title":"Reversible renal failure in paroxysmal nocturnal hemoglobinuria","volume":"37","author":"Chow","year":"2001","journal-title":"Am J Kidney Dis"},{"key":"R6-20260403","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1182\/blood.V57.1.83.83","article-title":"The kidneys in paroxysmal nocturnal hemoglobinuria","volume":"57","author":"Clark","year":"1981","journal-title":"Blood"},{"key":"R7-20260403","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/MAJ.0b013e3181f515b9","article-title":"Reversible acute kidney injury caused by paroxysmal nocturnal hemoglobinuria","volume":"341","author":"Qi","year":"2011","journal-title":"Am J Med Sci"},{"key":"R8-20260403","first-page":"136","article-title":"Clinical course and flow cytometric analysis of paroxysmal nocturnal hemoglobinuria in Japanese patients","volume":"79","author":"Nishimura","year":"2004","journal-title":"Int J Hematol"},{"key":"R9-20260403","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1084\/jem.131.3.443","article-title":"Evaluation of the renal toxicity of heme proteins and their derivatives: a role in the genesis of acute tubule necrosis","volume":"131","author":"Braun","year":"1970","journal-title":"J Exp Med"},{"issue":"(3 Pt 2)","key":"R10-20260403","first-page":"F446","article-title":"Pathogenetic mechanisms in experimental hemoglobinuric acute renal failure","volume":"256","author":"Zager","year":"1989","journal-title":"Am J Physiol"}],"container-title":["Indian Journal of Pathology and Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijpm.ijpm_381_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:47:27Z","timestamp":1787838447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijpm.ijpm_381_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijpm.ijpm_381_25","relation":{},"ISSN":["0377-4929","0974-5130"],"issn-type":[{"value":"0377-4929","type":"print"},{"value":"0974-5130","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-04-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}