Cutaneous manifestations in renal failure patients: a case series.

Cutaneous involvement in renal disease is due to a host of factors ranging from metabolic disturbances to immunosuppressive drugs. Herein we report a series of six cases of renal failure with varied cutaneous manifestations ranging from infections to neoplasms due to prolonged immunosuppression. Our first case had cutaneous cryptococcosis where skin lesions gave a clue to the diagnosis of altered sensorium and underlying meningitis. The second case initially presented with florid warts and was treated successfully but later presented with an explosive recurrence of skin lesions due to malignant transformation. Our third case had basal cell carcinoma over the presternal region that was successfully treated with liquid nitrogen cryotherapy. Our fourth case had diabetic nephropathy that presented with septicemia and purpura fulminans. The last case had cutaneous manifestations of drug therapy because of heparin infusion. To conclude, cutaneous manifestations in patients with renal failure are varied and a high degree of suspicion is needed for early diagnosis and aggressive treatment to effectively combat mortality and morbidity.

Acute renal failure and hypercalcemia.

Hypercalcemia can result from excessive bone resorption, renal calcium retention, excessive intestinal calcium absorption, or a combination of these conditions. Hypercalcemia may also provoke acute renal failure (ARF) or hypertension, or aggravate the tubular necrosis that is frequently found in cases of ARF. The association of ARF and hypercalcemia was studied retrospectively in eight patients based in the data in their charts. Data are expressed as median and percentile (25th; 75th). Our results show that ARF associated with hypercalcemia was related with comorbidity in all cases (cancer, multiple myeloma, hyperparathyroidism, sarcoidosis, vitamin D intoxication, and leprosy). Maximum median serum creatinine levels were 3.3 mg/dL (2.7, 3.8 mg/dL) before treatment and 1.1 mg/dL (0.9, 1.3 mg/dL) after treatment. Maximum total median serum calcium was 15.9 mg/dL (13.5, 19.8 mg/dL) before treatment and 9.1 mg/dL (8.4, 9.7 mg/dL) after treatment. Maximum median ionized serum calcium was 2.1 mmol/L (1.8, 2.2 mmol/L) before treatment and 1.1 mmol/L (1.0, 1.2 mmol/L) after treatment. Different kinds of treatment induced a rapid fall in serum calcium concentration. All patients were treated with hydration and diuretics, and three patients also received calcitonin. Serum creatinine concentration always fell simultaneously with the decrease in serum calcium in all cases. All patients progressed with nonoliguric renal failure. In conclusion, in ARF, patients are frequently hypocalcemic. Usually, the presence of hypercalcemia associated with ARF is indicative of the presence of comorbidity, as observed in all eight patients studied here. There was an improvement of renal function in all cases as serum calcium levels decreased.

Relato de caso: nefrite intersticial aguda causada por uso intermitente de rifampicina: dois casos / Relate the cases: acute intersticial nephritis caused by intermiten use of rifampin two cases

A rifampicina (RFP) é um antibiótico largamente utilizado no tratamento de doenças infecciosas. O uso intermitente da droga ocasiona vários efeitos colaterais, entre eles insuficiência renal aguda (IRA). Säo relatados dois casos de pacientes portadores de hanseníase que após o uso intermitente de RFP evoluíram para IRA, anemia hemolítica e hepatotoxidade. Säo revistos os principais mecanismos causadores da IRA, sua evoluçäo e tratamento (au)

Fatal proliferative glomerulonephritis in lepromatous leprosy.

A patient of lepromatous leprosy with recurrent erythema nodosum leprosum developing acute renal failure proving fatal within 8 weeks is reported. The renal lesion demonstrated acute proliferative glomerulonephritis. Its pathogenesis in relation to ENL is discussed.

Fatal proliferative glomerulonephritis in lepromatous leprosy

A patient of lepromatous leprosy with recurrent erythema nodosum leprosum developing acute renal failure proving fatal within 8 weeks is reported. The renal lesion demonstrated acute proliferative glomerulonephritis. Its pathogenesis in relation to ENL is discussed.