Acute renal infarction secondary to membranous glomerulopathy

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Acute renal infarction often presents with abdominal  pain,  nausea,  vomiting,  and  fever.With other more common illnesses presenting with the same symptoms, <br />it is often misdiagnosed leading to delayed treatment.We present a case of a young female diagnosed to have Membranous Glomerulopathy who presented with sudden onset  flank  pain  in  whom was initially treated as urinary tract infection. <br /><strong>CASE:</strong> A  19-year-old  female  diagnosed  with  membranous glomerulopathy presented at the Emergency Room (ER) with severe,  right  sided,  flank  pain  of  acute  onset,  associated with nausea and vomiting. No fever, dysuria, hematuria, or history of trauma. Her vital signs were within normal range. Abdominal  examination  revealed  a  distended  but  soft non-tender  abdomen  with  positive  shifting  dullness and fluid wave test. Right sided costovertebral angle tenderness was  elicited.Initial diagnostics showed leukocytosis with neutrophilic  predominance,  serum  creatinine  of  0.77mg/dL,  and  proteinuria  of  >600mg/dL.Abdominal  ultrasound showed  non-specific  findings,  thus  contrast-enhanced  computed  tomography  scan  (CT-Scan)  of  the  abdomen was  done which revealed areas of non-enhancement in the upper to middle portions of the right kidney which may relate to areas of ischemia and/or infarction, likely due to thrombosis involving the more distal portion of the right renal artery and massive ascites. Result was confirmed by computed tomography angiography (CTA) of the kidneys showing right renal artery thrombosis. Evaluations for other causes  of  renal  artery  thrombosis  aside  from  patient's concurrent  membranous  glomerulopathy  were  done  and were negative. Anti-coagulation therapy was initiated using low molecular weight heparin (LMWH) and was thereafter maintained on warfarin.<br /><strong>CONCLUSION:</strong> A  high  index  of  clinical  suspicion  is  needed to  diagnose  acute  renal  infarction  because  of  its  non-specific symptoms which can mimic other conditions. Early diagnosis and prompt initiation of anti-coagulation therapy is  important  to  avoid  irreversible  kidney  damage.  Acute renal infarction should be considered as a cause of acute onset flank pain in patients with risk factors and normal initial screening test.</p>

Pediatric endocrinology transition clinic profile at the University of Santo Tomas Hospital Outpatient Department - Clinical Division (USTH OPD-CD)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To  determine the prevalence of depression in Filipino adult patients with type 2 diabetes mellitus (DM) and the risk factors associated in its development.<br /><strong>METHODS:</strong>This is a prospective cross-sectional  study. Adult  patients (age 19 and above) with type 2 DM being seen at the outpatient department of the Makati Medical Center from  January  to  March  2015  were included,  taking  into  account  the  following:  age,  gender,  marital  status,  body  mass index, waist circumference, blood pressure, duration of  diabetes,  presence  of  other  co-morbid  illnesses,  pill  burden,  insulin  use,  educational  attainment,  employment  status,  family  income, and glycemic status. They  were  then screened for depression using the standardized PHQ-9 questionnaire. Bivariate analyses through Chi-square Test (for categorical variables) and Analysis of Variance (for interval/ratio variables) were used to determine which among the risk factors are significant for the development of depression.Significant  risk  factors  were  treated  for  multivariate  and univariate analyses through ordinal logistic regression.<br /><strong>RESULTS:</strong> A  total  of  110  adult  patients  with  type  2  DM  were  enrolled  in  this  study.  There  were  no  drop-outs.  Sixty-nine  percent  of  the  patients  had  none  to  minimal  depression,  24% had mild depression, and 7% had moderate depression. None  of  the  patients  had  depression  that  warranted  anti-depressants  or  psychotherapy.After step-wise analysis, increased  BMI,  elevated  diastolic  blood  pressure  and  uncontrolled blood sugar were found to be associated with higher  PHQ-9  scores  while  unemployment  was  associated  with decreased PHQ-9 score.<br /><strong>CONCLUSION:</strong>The  prevalence  of  depression  among  Filipino  type  2  diabetic  patients  is  higher  than  in  non-diabetic patients. Being obese, having an elevated diastolic blood pressure, and the presence of uncontrolled blood sugar were significant predictors and were associated with an increased likelihood  of  developing  major  depressive  disorder.  Being unemployed appears to have the opposite effect.</p>