RESUMEN
Kidney failure is common in haematologic malignancies. However, the nephrotoxic effect of lysozyme is seldom recognized. We present a 78-year-old male with chronic myelomonocytic leukaemia who developed progressive kidney failure due to increased production of lysozyme.
Asunto(s)
Leucemia Mielomonocítica Crónica/enzimología , Muramidasa/metabolismo , Insuficiencia Renal/enzimología , Anciano , Progresión de la Enfermedad , Humanos , Leucemia Mielomonocítica Crónica/complicaciones , Hígado/enzimología , Masculino , Insuficiencia Renal/etiologíaRESUMEN
In the last few years, gamma hydroxybutyric acid (GHB) has been used increasingly as a party drug; this has led to a marked increase in the number of requests for professional help with the treatment of GHB addiction. Pharmaceutical GHB (sodium oxybate, the sodium-salt of GHB), registered for cataplexia in narcolepsy patients, is used off-label to treat the withdrawal symptoms associated with GHB addiction. Pharmaceutical GHB has a high sodium load. In this report we present the cases of two patients who developed symptomatic hypernatremia following treatment with pharmaceutical GHB and who thereafter needed intensive care for the severe withdrawal symptoms that they experienced.
Asunto(s)
Hipernatremia/inducido químicamente , Oxibato de Sodio/efectos adversos , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Adulto , Femenino , Humanos , Masculino , Oxibato de Sodio/uso terapéuticoAsunto(s)
Acenocumarol/efectos adversos , Lesión Renal Aguda/patología , Anticoagulantes/efectos adversos , Embolia por Colesterol/patología , Embolia Pulmonar/tratamiento farmacológico , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/diagnóstico , Anciano , Aneurisma de la Aorta Abdominal/complicaciones , Embolia por Colesterol/inducido químicamente , Embolia por Colesterol/diagnóstico , Humanos , Riñón/patología , Masculino , Embolia Pulmonar/complicacionesAsunto(s)
Calcifilaxia/diagnóstico por imagen , Fallo Renal Crónico/terapia , Dermatosis de la Pierna/diagnóstico por imagen , Diálisis Renal , Anciano , Calcifilaxia/complicaciones , Humanos , Fallo Renal Crónico/complicaciones , Dermatosis de la Pierna/complicaciones , Masculino , Muslo , Tomografía Computarizada por Rayos XAsunto(s)
Pericarditis/etiología , Neumonía Neumocócica/complicaciones , Streptococcus pneumoniae/aislamiento & purificación , Enfermedad Aguda , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Pericarditis/diagnóstico , Pericarditis/microbiología , Neumonía Neumocócica/diagnóstico , Neumonía Neumocócica/microbiología , Radiografía TorácicaRESUMEN
BACKGROUND: Dysregulation of complement activation is the most common cause of the atypical haemolytic uraemic syndrome (aHUS). Many patients with aHUS develop end-stage renal disease and consider kidney transplantation. However, the recurrence rate after transplantation ranges from 45-90% in patients with known abnormalities in circulating complement proteins. It was recently proposed that patients with aHUS should be treated prophylactically with plasma exchange or eculizumab to prevent recurrence after transplantation. METHODS: A case series describing the successful outcome of kidney transplantation without prophylactic therapy in four adult patients with aHUS and a high risk of disease recurrence. Patients received a living donor kidney and immunosuppression consisting of basiliximab induction, low-dose tacrolimus, prednisone and mycophenolate mofetil. Patients received a statin, and were targeted to a low blood pressure preferably using blockers of the renin-angiotensin system. RESULTS: After a follow-up of 16-21 months, none of the patients developed recurrent aHUS. Also, no rejection was observed. CONCLUSIONS: Kidney transplantation in adult patients with aHUS can be successful without prophylactic eculizumab, using a protocol that minimises cold ischaemia time, reduces the risk of rejection and provides endothelial protection. Our data suggest that in patients with aHUS, controlled trials are needed to demonstrate the optimal strategy.
Asunto(s)
Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/etiología , Trasplante de Riñón/métodos , Adulto , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Síndrome Hemolítico Urémico Atípico , Basiliximab , Isquemia Fría , Quimioterapia Combinada , Femenino , Síndrome Hemolítico-Urémico/genética , Humanos , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Prednisona/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Prevención Secundaria , Tacrolimus/uso terapéutico , Adulto JovenRESUMEN
Reactivation of tuberculosis is a severe side effect of anti-TNF treatment. Especially extrapulmonary forms of tuberculosis may occur, which are difficult to diagnose. The diagnosis may be obtained by a thorough search for Mycobacterium tuberculosis. We describe two patients who developed tuberculous peritonitis after infliximab therapy that was prescribed for treatment of rheumatoid arthritis. These cases illustrate that tuberculous peritonitis has a nonspecific clinical manifestation and that Mycobacteria can be difficult to find in ascites fluid. For this reason, tuberculostatic therapy has to be started in case of clinical suspicion. Before starting infliximab therapy, the patient must be thoroughly screened for the presence of (latent) tuberculosis.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Antirreumáticos/efectos adversos , Peritonitis Tuberculosa/etiología , Anciano , Artritis Reumatoide/tratamiento farmacológico , Femenino , Humanos , Infliximab , Persona de Mediana Edad , Peritonitis Tuberculosa/diagnósticoRESUMEN
A glomerular filtration rate (GFR) <60 ml/min/1.73 m2 is associated with an increased risk of cardiovascular disease and renal insufficiency. The formula of the 'Modification of diet in renal disease' (MDRD) study is derived from plasma-creatinine concentrations and estimates GFR based on age, sex and race. Many clinical laboratories have started to report estimated GFR using this formula, which may lead to earlier recognition of chronic kidney disease. Clinicians should understand for which patients the MDRD formula may be appropriate and be aware of its limitations.
Asunto(s)
Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Enfermedades Renales/diagnóstico , Pruebas de Función Renal/métodos , Femenino , Humanos , Enfermedades Renales/sangre , Masculino , Valor Predictivo de las Pruebas , Factores de RiesgoAsunto(s)
Baclofeno/uso terapéutico , Hipo/tratamiento farmacológico , Relajantes Musculares Centrales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Hipo/etiología , Humanos , Masculino , Persona de Mediana Edad , Úlcera Gástrica/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVES: To examine the relationship between sodium intake and urinary albumin excretion, being an established risk marker for later cardiovascular morbidity and mortality. DESIGN: Cross-sectional cohort study using linear regression analysis. Setting. University hospital outpatient clinic. SUBJECTS: A cohort drawn from the general population, consisting of 7850 subjects 28-75 years of age, all inhabitants of the city of Groningen, the Netherlands. The cohort is enriched for the presence of subjects with elevated urinary albumin concentration. RESULTS: The results show a positive relationship between dietary sodium intake and urinary albumin excretion. The association was independent of other cardiovascular risk factors (such as sex, age, blood pressure, body mass index (BMI), waist-to-hip ratio, serum cholesterol, plasma glucose and smoking) and other food constituents (calcium, potassium and protein). The relationship between sodium intake and urinary albumin excretion was steeper in subjects with a higher BMI compared with a lower BMI. CONCLUSIONS: Sodium intake is positively related to urinary albumin excretion. This relation is more pronounced in subjects with a higher BMI. These results suggest that high sodium intake may unfavourably influences cardiovascular prognosis especially in overweight and obese subjects.
Asunto(s)
Albuminuria/etiología , Obesidad/metabolismo , Sodio en la Dieta/administración & dosificación , Adulto , Anciano , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/orina , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Sodio/orinaRESUMEN
OBJECTIVES: Creatinine clearance (CCR) is a commonly used tool to measure glomerular filtration rate (GFR) in clinical practice. This tool requires collection of 24-h urine, which is quite bothersome. Several different formulae have been used to estimate GFR using plasma creatinine and other easy formulae to obtain biometrical data. We examined 10 formulae and compared them with actually measured CCR in a large sample of the general population. DESIGN: Cross-sectional cohort study. SETTING: University hospital outpatient clinic, a population based study. SUBJECTS: A total of 8592 inhabitants of the city of Groningen, 28-75 years of age. The cohort is enriched for microalbuminuria. RESULTS: In general, the formulae did not give an accurate estimation of CCR, particularly not in male and in obese subjects. Six formulae, including the Cockcroft-Gault gave a fairly good estimation of CCR in the overall population and in subgroups of specific gender, body mass index and age. All formulae however, gave an underestimation of the measured CCR in higher ranges of CCR and an overestimation in the lower ranges. Moreover, the age-related decline of CCR is hard to approximate with a formula. CONCLUSIONS: We conclude that formulae to estimate CCR in the general population, although giving a fairly good estimate of mean CCR, do not offer reliable data on CCR in the upper and lower ranges and do not adequately estimate the age-related decline in CCR.
Asunto(s)
Algoritmos , Creatinina/sangre , Creatinina/orina , Tasa de Filtración Glomerular , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Valores de Referencia , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Obesity is a risk marker for progressive renal function loss in patients with known renal disease. There is, however, increasing evidence that obesity may also damage the kidney in otherwise healthy subjects. There appears to be an intriguing parallel between the renal effects of obesity and those of diabetes. First, an increased renal blood flow and glomerular filtration rate has been described in obesity and, second, microalbuminuria is found to be related to obesity. These two events are known to predict future loss of renal function in diabetes. The mechanism responsible for the renal damage in obesity has not been established but there is evidence suggesting that this might be related to both hormonal changes as well as low-grade inflammation.
Asunto(s)
Glomeruloesclerosis Focal y Segmentaria/etiología , Obesidad/complicaciones , Adulto , Anciano , Albuminuria/etiología , Nefropatías Diabéticas/fisiopatología , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatologíaRESUMEN
Three patients, men aged 21, 57 and 53 years, presented with variable non-specific symptoms such as general malaise, weight loss, elevated temperature, abdominal pain, cough, pulmonary crepitations and elevated liver enzymes. Diffuse fine nodular infiltration was seen on chest radiography in the last two cases. The first patient refused to be tentatively treated with tuberculostatics and died. Mycobacterium tuberculosis complex grew on Löwenstein medium a week later. The two other patients received tuberculostatic treatment. The second patient recovered, while the third patient suffered a cerebrovascular accident on top of emaciation and respiratory insufficiency and died. In the Netherlands, currently more than one hundred patients with tuberculosis disease die each year. The disease is mostly seen in people from the high-risk groups for tuberculosis such as asylum seekers and immigrants. Even after extensive diagnostic procedures it can be difficult to obtain rapid bacteriological confirmation. When miliary tuberculosis is suspected it is important to carry out the complete range of tests (Ziehl Neelsen microscopy, PCR, Löwenstein cultivation) and to start therapy immediately and not to await the results of the diagnostic tests. However, in many cases this may still be too late, with an estimated mortality of 20%.
Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Miliar/diagnóstico , Adulto , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/crecimiento & desarrollo , Países Bajos/epidemiología , Radiografía Torácica , Factores de Riesgo , Negativa del Paciente al Tratamiento , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/mortalidadRESUMEN
A 34-year-old man from Nigeria who had resided permanently in the Netherlands for five years had experienced fever, upper abdominal pain and weight loss for several months. He did not give the impression of being ill. A CT scan gave cause to suspect pancreatitis. An HIV test gave a positive result. Puncture of the accumulated fluid around the pancreas led to the diagnosis 'tuberculosis' (infection by Mycobacterium tuberculosis). Once the patient had made a good recovery with antituberculosis therapy, antiretroviral therapy was initiated, whereupon the number of CD4+ cells in the blood increased. Extrapulmonal tuberculosis is not unusual in HIV seropositive patients from countries with a high prevalence of tuberculosis. However, in such patients isolated tuberculosis of the pancreas is unusual and has not previously been described in the Netherlands. The diagnosis can be established following a CT guided puncture; tuberculosis is instantly suspected if the Ziehl-Neelsen stains are positive and the diagnosis can then be confirmed by a polymerase chain reaction (PCR) analysis and by culturing. Anti-retroviral therapy is withheld until response to anti-tuberculosis treatment is satisfactory.