RESUMO
We present a 24-year-old man who developed primary cytomegalovirus peritonitis without gut perforation, but with concomitant colitis 6 weeks after liver transplant from a deceased donor for end-stage liver disease because of primary sclerosing cholangitis. The patient was treated only medically, with no need for surgery, and is well at 12 months. This case represents the need for suspicious for cytomegalovirus peritonitis in the appropriate setting in post liver transplant even in the absence of perforation.
Assuntos
Colangite Esclerosante/complicações , Colite/virologia , Infecções por Citomegalovirus/virologia , Citomegalovirus/isolamento & purificação , Doença Hepática Terminal/cirurgia , Transplante de Fígado/efeitos adversos , Peritonite/virologia , Administração Intravenosa , Aloenxertos , Antivirais/administração & dosagem , Colangite Esclerosante/diagnóstico , Colite/diagnóstico , Colite/tratamento farmacológico , Citomegalovirus/efeitos dos fármacos , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/etiologia , Ganciclovir/administração & dosagem , Humanos , Masculino , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury in hospitalized patients. The prevalence of CIN is reported to range from 0% to 50%, depending not only on patient condition and the procedure used but also the definition of CIN applied. We aimed to determine the best diagnostic indicator of CIN in patients with normal serum creatinine. This study included 206 patients with normal serum creatinine who underwent coronary angiography/angioplasty. Serum creatinine level and glomerular filtration rate (GFR) were measured before and on the second and fifth days after contrast administration. The incidence of CIN based on a 25% increase in serum creatinine was calculated and compared with the incidence based on a 25% decrease in GFR or an increase of at least 0.5 mg/dL in serum creatinine. Of 206 patients, 127 were male (61.7%) and 79 were female (38.3%); the mean age was 59.56±10.3 years. The prevalence of CIN was 30% based on a 25% increase in serum creatinine, 23% based on a 25% decrease in GFR (P<0.012) and 3.8% based on a serum creatinine increase of at least 0.5 mg/dL (P<0.0001). The serum creatinine levels remained within the normal range in the majority of patients with CIN based on the different definitions. In patients with normal serum creatinine, the absolute increase in serum creatinine may describe the prevalence of CIN more accurately than the relative increase in serum creatinine or relative decrease in GFR.