[Acute Renal Failure, Lactic Acidosis, and Metformin: Two Case Reports and Literature Review].

Lactic acidosis is a potential adverse event related to metformin therapy. Although metformin-associated lactic acidosis (MALA) is a rare condition (about 10 cases / 100,000 patients / year), new cases continue to be reported, with a mortality of 40-50%. We describe two clinical cases characterized by severe metabolic acidosis, hyperlactacidemia, and acute renal injury. The first also with NSTEMI, successfully treated.

[Infected hepatic cyst in ADPKD patient in peritoneal dialysis].

Renal and hepatic cysts infections are among the most important infectious complications of ADPKD and often require hospitalization. Liver cysts are even more complex than renal cysts and their diagnosis and treatment are quite controversial. We report the case of a 58-year-old patient with ADPKD undergoing peritoneal dialysis treatment. He presented fever and severe asthenia and was diagnosed with a hepatic cyst infection. Given the presence of the peritoneal catheter, and in order to facilitate the targeted treatment of the infection, we administered antibiotics (ceftazidime and teicoplanin) in the bags used for peritoneal dialysis exchanges for 4 weeks, obtaining the complete disappearance of symptoms and laboratory and ultrasound alterations. Intraperitoneal antibiotics administration in the treatment of infected hepatic cysts represents an effective and safe therapeutic alternative, never described in literature so far.