RESUMEN
Calcification of coronary vessels progresses rapidly in hemodialysis (HD) patients and comprises a strong predictor of cardiovascular events. The aim of this prospective study was to evaluate the coronary artery calcification (CAC) in patients with end stage renal disease undergoing regular HD and to determine the effect of renal transplantation (RT) in the progression of CAC, using the Agatston technique for calcium scoring. The study included 20 patients with end-stage renal disease undergoing a regular HD treatment (16 males, 4 females) 54.1 ± 9.5 years old who had just received a renal transplant and 16 more HD patients (11 males, 5 females) 54.4 ± 13.8 years old as control group. The baseline evaluation showed a very high prevalence of CAC in both groups, which was positively correlated with age (p < 0.001) and CRP (p = 0.03). The second (follow-up) evaluation showed a significant slower progression of calcification after RT. In both groups, high calcium score values in the follow-up evaluation had a strong positive correlation with baseline calcium score (p < 0.001).
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Trasplante de Riñón , Diálisis Renal , Calcificación Vascular/epidemiología , Adulto , Anciano , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/prevención & control , Progresión de la Enfermedad , Femenino , Humanos , Fallo Renal Crónico/patología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Calcificación Vascular/patología , Calcificación Vascular/prevención & controlRESUMEN
Malignant lymphomas can affect kidneys in several ways. They may precipitate acute renal failure by causing ureteral or renal vascular obstruction, or by direct renal parenchymal infiltration. Furthermore, they may insult renal function via paraneoplastic mechanisms such as hypercalcemia. Lymphomas only rarely can cause glomerulonephritis (GN). We report a case of a 72-year-old male who presented with mild renal function impairment, proteinuria, and microscopic hematuria, suggesting active glomerulonephritis, and pancytopenia of immune origin. A bone marrow biopsy led to a diagnosis of splenic marginal zone lymphoma. Although a kidney biopsy was not performed, glomerulonephritis was attributed to the lymphoma and splenic marginal zone lymphoma-related glomerulonephritis was the final diagnosis. The course of splenic marginal zone lymphoma is extremely indolent. The first manifestation in some patients can be immune cytopenia or other autoimmune phenomena. These patients may respond well to corticosteroids. Therefore, our patient was started on prednisolone resulting in a good hematologic response. Renal function also improved and proteinuria and hematuria disappeared, suggesting a lymphoma-related origin of the GN. Two years after full steroids withdrawal, the patient remained stable with a good renal function and daily protein excretion less than 300 mg. Lymphomas rarely are the cause of secondary glomerulonephritis; however, with a lack of an apparent cause, the clinician should be aware of them, particularly in the elderly with autoimmune manifestations.
Asunto(s)
Glomerulonefritis/diagnóstico , Linfoma/diagnóstico , Neoplasias del Bazo/diagnóstico , Anciano , Biopsia , Diagnóstico Diferencial , Glomerulonefritis/tratamiento farmacológico , Humanos , Linfoma/tratamiento farmacológico , Masculino , Neoplasias del Bazo/tratamiento farmacológico , Esteroides/administración & dosificaciónRESUMEN
Paraquat is a pesticide widely used in agriculture. Numerous cases of paraquat intoxication have been reported either accidentally or intentionally as a suicidal attempt. The most severe cases of paraquat poisoning refer to oral ingestion. Complications include respiratory, hepatic, and renal failure, and are usually fatal. Dermal exposure is less frequent and rarely fatal. This article reports a case of an 81-year-old man with minimal skin burn after accidental paraquat exposure. The patient developed acute renal and respiratory failure and, despite aggressive treatment with hemodialysis, hemoperfusion, and mechanical ventilation, died two days later.