RESUMEN
Acute renal failure developed in a 28-year-old man after status epilepticus. Myoglobinuria was contributed to by convulsions, trauma and coma during status epilepticus, the three mechanisms responsible for this condition.
Asunto(s)
Lesión Renal Aguda/etiología , Mioglobinuria/etiología , Estado Epiléptico/complicaciones , Adulto , Humanos , MasculinoRESUMEN
Success in renal transplantation is now largely dependent on safe and effective immunosuppression. Nonspecific immunosuppression by chemical agents continues to be the mainstay of clinical immunosuppression. Azathioprine and prednisolone have remained the two main drugs used in combination in standard immunosuppressive therapy in renal transplantation for many years. Although cyclophosphamide (CP) was tried in the early years of transplantation, enthusiasm for its use was dampened by the advent of newer agents. We have analyzed our experience with 29 recipients of living-related donor (LRD) renal allotransplantation on cyclophosphamide therapy. Cyclophosphamide is a safe and effective alternative to azathioprine in clinical renal allotransplantation. Due to its easy availability and the fact that it is a cheaper alternative to azathioprine and cyclosporine, it is more significant for developing countries.
Asunto(s)
Ciclofosfamida/uso terapéutico , Trasplante de Riñón , Adulto , Azatioprina/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Prednisolona/uso terapéutico , Estudios RetrospectivosRESUMEN
Tuberculosis is an important infection encountered after renal transplantation in third-world countries. Over an 8-year period, 36 cases of tuberculosis were encountered in 305 renal transplant recipients (11.8%) with grafts functioning for more than 3 months followed up at our center. The infection was limited to the thoracic cavity in 41.7% and a single extrapulmonary site in 11.1%, and it was disseminated in 27.8% cases. In 19.4% of cases, the disease appeared as pyrexia of unknown etiology and the diagnosis was confirmed by a good therapeutic response to antitubercular therapy. Tuberculosis was diagnosed within 1 year of transplantation in 58.3% of cases. There was no significant difference in the incidence of tuberculosis in patients on different immunosuppressive regimens. The Mantoux test was positive in 33.3% patients. A total of 23 patients were treated with isoniazid and rifampicin, with the addition of a third drug for the first 2 months. Treatment was continued for 9 months in 11 cases with isolated pleuropulmonary disease and for 12-15 months in the other 12 patients. The other 13 were on cyclosporine and were given isoniazid, pyrazinamide, and ethambutol for 18 months. Two patients died of fulminant disease and five more died from unrelated causes. No recurrence of disease has been noted in any of the patients after a mean follow-up of 14.6 months. We conclude that the incidence of tuberculosis in renal allograft recipients in third world countries is much higher than that seen in the western world. Most of the cases are encountered in the first posttransplant year. Tuberculosis must be considered seriously in all patients who have prolonged fever of undetermined etiology. Treatment with isoniazid and rifampicin for 9 months is adequate for patients with localized pleuropulmonary disease. In patients on cyclosporine to whom rifampicin cannot be given because of economic considerations, treatment with isoniazid, pyrazinamide, and ethambutol should be given for 18 months.
Asunto(s)
Trasplante de Riñón/efectos adversos , Tuberculosis/etiología , Adulto , Antituberculosos/uso terapéutico , Etambutol/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Incidencia , India , Isoniazida/uso terapéutico , Masculino , Pirazinamida/uso terapéutico , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiologíaRESUMEN
Acute renal failure developed in a 25-year-old man following status asthmaticus. He was found to have myoglobinuria. Vigorous contraction of the respiratory muscles and hypoxia were considered to be responsible for the development of myoglobinuria. Associated dehydration, in the presence of myoglobinuria, also contributed to the development of acute renal failure.
Asunto(s)
Lesión Renal Aguda/etiología , Asma/complicaciones , Mioglobinuria/etiología , Adulto , Deshidratación/complicaciones , Humanos , Hipoxia/complicaciones , Masculino , Contracción MuscularRESUMEN
Acute renal failure of obstetric origin is common among North Indian patients and comprised 72 (22.1%) of 325 patients undergoing dialysis over an 11-year period. Of these, 46 gravidas had developed renal failure following abortion, and 29 cases were due to complications of late pregnancy. The most striking feature of this study was a high incidence of irreversible renal lesions of bilateral diffuse cortical necrosis in early (18.6%) as well as late pregnancy (37.8%). Overall incidence of diffuse cortical necrosis was 25%. In the remainder, acute tubular necrosis was seen in 52 (72.2%), patchy cortical necrosis in 1 (1.4%), and tubular necrosis along with glomerular involvement in 1 patient (1.4%). Pathogenetic factors which contributed to the development of renal failure, either singly or in combination, were loss of blood failure, either singly or in combination, were loss of blood (79.1%), septicemia (31.9%), hypotension due th hemorrhagic and septicemic shock (51.4%), eclamptic toxemia (11.1%), and disseminated intravascular coagulation in 12.5% patients. Infrequent occurrence of disseminated intravascular coagulation in the septic anc eclamptic patients who developed diffuse cortical necrosis was an interesting finding, as was the fact that coagulopathy was more frequently observed in acute tubular necrosis. Late referral, frequent sepsis, and high incidence of bilateral diffuse cortical necrosis contributed significantly to a high mortality (55.3%).
Asunto(s)
Aborto Inducido/efectos adversos , Aborto Espontáneo/complicaciones , Lesión Renal Aguda/etiología , Complicaciones del Embarazo , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/patología , Eclampsia/complicaciones , Femenino , Humanos , Riñón/patología , Necrosis Tubular Aguda/etiología , Necrosis Tubular Aguda/patología , Hemorragia Posparto/complicaciones , Embarazo , Complicaciones del Embarazo/mortalidad , Complicaciones del Embarazo/patología , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales/complicaciones , Sepsis/complicacionesRESUMEN
RRT has crossed the threshold of clinical applications, and its value as an effective modality for management of ESRD is fully established. However, RRT has emphasized the wide gap between developed and developing countries. Most of the developed nations are able to provide sufficient funds, directly or indirectly, for RRT and have organized cadaver donor networks. However, providing RRT is particulary difficult in the developing countries where national incomes are not sufficient to cover even the basic requirements of their citizens. Although some developing countries are making active efforts to establish cadaver donor transplant programs, these are virtually nonexistent in the majority at this time. The abject poverty in the developing world and the increasing success rate of transplantation following the discovery of cyclosporine have led to the commercialization and sale of kidneys for transplantation, an unethical practice which must be curbed. There is a near unanimity of opinion that renal transplantation is far cheaper than prolonged dialysis, and the benefit to the recipient is enormous in terms of the years of life saved and the quality of life. Until such time as cadaveric donor programs become a reality in the developing countries, short periods of dialysis followed by transplants with living-related donor kidneys appear to be the most cost-effective treatments of ESRD.
Asunto(s)
Salud Global , Fallo Renal Crónico/terapia , Predicción , Humanos , Trasplante de Riñón/estadística & datos numéricos , Trasplante de Riñón/tendencias , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/estadística & datos numéricos , Diálisis Peritoneal Ambulatoria Continua/tendencias , Diálisis Renal/estadística & datos numéricos , Diálisis Renal/tendencias , Donantes de Tejidos/estadística & datos numéricosRESUMEN
Significant depletion of C3 was observed following administration of lethal and sublethal doses of Russell's viper and Echis carinatus venom to rhesus monkeys. A sequential study carried out over a period of 3 weeks following sublethal envenomation showed a steady rise in the C3 level from 48 hours onwards. By the 20th day the C3 values had attained the pre-envenomation levels. The extent of depletion of C3 was similar in both Russell's viper and E. carinatus envenomation. Because of the close immunological similarity of monkey and man, the rise in C3 which corresponded with recovery of the animals in this experimental model could serve as a useful parameter of recovery in clinical cases of snake poisoning.
Asunto(s)
Complemento C3/metabolismo , Venenos de Serpiente/farmacología , Animales , Relación Dosis-Respuesta a Droga , Haplorrinos , Macaca mulatta , Masculino , Factores de TiempoRESUMEN
Coagulation studies were carried out in a group of non-human primates (rhesus monkeys) following envenomation with lethal and sublethal doses of Russell's viper venom. The envenomated animals showed significant fibrinogenopenia in association with or without disseminated intravascular coagulation. The findings offer a rational explanation for the bleeding manifestations seen in clinical cases of Russell's viper bite.
Asunto(s)
Afibrinogenemia/inducido químicamente , Trastornos de la Coagulación Sanguínea/inducido químicamente , Venenos de Víboras/toxicidad , Animales , Recuento de Células Sanguíneas , Plaquetas , Coagulación Intravascular Diseminada/inducido químicamente , Haplorrinos , Tiempo de ProtrombinaRESUMEN
Hemostatic abnormalities following lethal and sublethal doses of Echis carinatus venom were studied in a subhuman primate model. The observations suggest the occurrence of disseminated intravascular coagulation of varying magnitude within a few hours of envenomation. A procoagulant effect of the venom of Echis carinatus is likely to be the major cause of the disturbance in the hemostatic mechanism.
Asunto(s)
Trastornos de la Coagulación Sanguínea/etiología , Coagulación Intravascular Diseminada/etiología , Venenos de Víboras/farmacología , Animales , Modelos Animales de Enfermedad , Hemorragia , Hemostasis , Macaca mulatta , Factores de TiempoRESUMEN
Eight patients with acute renal failure following snakebite were studied. Intravascular hemolysis and disseminated intravascular coagulation contributed to the development of acute renal failure in 6 patients. Direct nephrotoxicity causing acute renal failure is postulated in 2 patients, 1 of whom also revealed evidence of mild, disseminated intravascular coagulation. Three patients had histopathological lesions of acute symmetrical cortical necrosis and 3 had acute tubular necrosis. In 1 patient with acute tubular necrosis, in whom direct nephrotoxicity seemed to be responsible for renal failure, the striking histological feature was a uniform debasement and disappearance of tubular epithelium. In 2 patients with a clinical course of acute tubular necrosis, histological lesions could not be documented. All the 5 patients with acute tubular necrosis regained full recovery of renal function, 3 of them with the help of dialysis and 2 with conservative management. None of the 3 patients with acute cortical necrosis survived in spite of intermittent dialysis therapy.
Asunto(s)
Lesión Renal Aguda/etiología , Mordeduras de Serpientes/complicaciones , Lesión Renal Aguda/sangre , Lesión Renal Aguda/patología , Lesión Renal Aguda/terapia , Adolescente , Adulto , Biopsia , Pruebas de Coagulación Sanguínea , Niño , Coagulación Intravascular Diseminada/etiología , Epistaxis/etiología , Femenino , Fibrinólisis , Hematuria/etiología , Hemorragia/etiología , Humanos , Ictericia/etiología , Riñón/patología , Masculino , Persona de Mediana Edad , Oliguria/etiología , Diálisis Renal , Mordeduras de Serpientes/sangre , Mordeduras de Serpientes/patología , Mordeduras de Serpientes/terapiaRESUMEN
Fatal acute tubular necrosis occurred in 1 patient in whom intravesical formalin was used to control massive persistent hemorrhage from radiation cystitis. A suggestion is made to monitor blood formic acid levels and institute prompt dialysis whenever these exceed 80 mg. per 100 ml. to avert such a catastrophe. Intravenous sodium bicarbonate appears to be indicated prophylactically in combating the associated metabolic acidosis due to absorbed formic acid.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Formaldehído/efectos adversos , Hemorragia/tratamiento farmacológico , Necrosis Tubular Aguda/inducido químicamente , Enfermedades de la Vejiga Urinaria/tratamiento farmacológico , Adulto , Cistitis/complicaciones , Formaldehído/metabolismo , Formaldehído/uso terapéutico , Hemorragia/etiología , Humanos , Inyecciones , Masculino , Traumatismos por Radiación , Vejiga Urinaria , Enfermedades de la Vejiga Urinaria/etiologíaRESUMEN
Erythrocyte superoxide dismutase (SOD: EC 1.15.1.1), catalase (EC 1.15.1.6), glucose-6-phosphate dehydrogenase (G-6-PD: EC 1.1.1.49), reduced glutathione (GSH) and malonyldialdehyde (MDA) were studied in 27 patients with chronic and 11 patients with acute renal failure. A comparison with 15 age- and sex-matched healthy subjects showed that patients with both acute and chronic renal failure had significantly low G-6-PD (p less than 0.05) values whereas SOD, catalase and MDA showed significantly elevated levels (p less than 0.05). After adequate dialysis or renal transplantation the SOD, G-6-PD, catalase and MDA values returned to normal. The findings suggest that the erythrocyte SOD, catalase, and G-6-PD can undergo an adaptive alteration which however appears reversible.
Asunto(s)
Catalasa/sangre , Glucosafosfato Deshidrogenasa/sangre , Glutatión/sangre , Malonatos/sangre , Malondialdehído/sangre , Superóxido Dismutasa/sangre , Uremia/sangre , Lesión Renal Aguda/sangre , Eritrocitos/metabolismo , Humanos , Fallo Renal Crónico/sangre , Trasplante de Riñón , Diálisis Renal , Uremia/terapiaRESUMEN
Acute renal failure due to intravascular hemolysis is a common clinical problem in North Indian patients. It constituted 21.5 percent of 325 patients dialyzed for acute renal failure over an 11-year period at Chandigarh. Thirty patients had developed acute intravascular hemolysis in association with erythrocyte glucose-6 phosphate dehydrogenase (G-6PD) deficiency, 17 due to copper sulphate intoxication and 8 due to envenomation by snakes. Less frequent causes were insect stings, incompatible blood transfusion, intake of anti-leprosy drug--dapsone in non-G-6PD-deficient patients, and mercuric chloride toxicity in two patients each; naphthalene poisoning in one; and uncertain causes in six patients. Renal histology was available in 55 patients. Acute tubular necrosis was seen in 54 and bilateral diffuse cortical necrosis in one patient. Fifty patients (71.43 percent) survived and 20(28.6 percent) diet. G-6PD erythrocyte deficiency, which is present in 4.5 percent of the North Indian population, was the most frequent cause of acute renal failure in this group.
Asunto(s)
Lesión Renal Aguda/etiología , Anemia Hemolítica/complicaciones , Lesión Renal Aguda/patología , Adolescente , Adulto , Anemia Hemolítica/inducido químicamente , Anemia Hemolítica/etiología , Niño , Preescolar , Cobre/envenenamiento , Dapsona/efectos adversos , Etnicidad , Femenino , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Humanos , India , Lactante , Túbulos Renales/patología , Masculino , Persona de Mediana Edad , Mordeduras de Serpientes/complicaciones , Sulfatos/envenenamientoRESUMEN
Forty-nine out of 662 patients (7.4%) dialysed for acute renal failure were found to have bilateral renal cortical necrosis. Amongst 6061 autopsies carried out in our centre during the same period, the incidence of cortical necrosis was 0.7%. Obstetric causes were responsible for the renal lesion in 35 (71%) and non-obstetrical causes in 14 patients. In the obstetric group, cortical necrosis was observed in association with spontaneous or induced abortion in 39% and as a complication of late pregnancy in 33%. The non-obstetric causes included snake bite in 26 (12%), acute gastro-enteritis in 5 (10%), haemolytic uremic syndrome in 2 (4%) and G6PD deficiency with intravascular haemolysis in one patient (2%). Thirty-nine (80%) patients were anuric or severely oliguric throughout their illness but a steady rise in urinary output following a protracted phase of oligo-anuria was observed in ten patients. Forty-two (86%) patients died and seven survived. None of the survivors, however, achieved a normal renal function (Ccr 8 ml to 28 ml/min). The diagnosis of renal lesion was confirmed during life in 8 and after death in 41 patients. Morphological lesions were consistent with bilateral diffuse cortical necrosis in 39 (80%) and patchy lesions in 10 patients. Factors responsible for the high incidence of cortical necrosis amongst Indian patients have been high-lighted.
Asunto(s)
Necrosis de la Corteza Renal/etiología , Aborto Espontáneo/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Coagulación Intravascular Diseminada/complicaciones , Femenino , Estudios de Seguimiento , Gastroenteritis/complicaciones , Hemorragia/complicaciones , Humanos , India , Lactante , Infecciones/complicaciones , Necrosis de la Corteza Renal/patología , Masculino , Embarazo , Complicaciones del Embarazo/patología , Mordeduras de Serpientes/complicacionesRESUMEN
Renal functional status in Mycobacterium leprae infected mice can be best studied by examining the enzymatic status of brush border membrane vesicles from proximal convoluted tubule. The role of vaccination in modulation of the renal status brought by the disease has been studied using this technique. The characteristic marker enzymes of renal brush border membrane--namely alkaline phosphatase, leucine aminopeptidase and gamma-glutamyl transpeptidase decreased significantly (p less than 0.01) in due course in M. leprae infection over a period of 9 months. The combined vaccine (BCG + M. leprae) may have a protective effect on renal abnormalities only in the initial stages of infection as indicated by a significant rise in enzymatic levels. However, no significant (p greater than 0.05) protective effect of vaccine was found in a more advanced disease state after 9 months in infected mice.
Asunto(s)
Vacuna BCG/administración & dosificación , Vacunas Bacterianas/administración & dosificación , Corteza Renal/enzimología , Lepra/enzimología , Animales , Lepra/prevención & control , Ratones , Microvellosidades/enzimología , Mycobacterium leprae/inmunologíaRESUMEN
Brush border membrane vesicles prepared from kidneys of Mycobacterium leprae infected (non-vaccinated) and vaccinated-infected Swiss albino mice were used to assess the effect of Convit's combined vaccine (BCG + M. leprae) on amino acid transport activity across the tubular basement membrane. The protective effect of Convit's vaccine was more pronounced with respect to the uptake of L-alanine than L-aspartate. Uptake of L-lysine showed no significant difference in the different groups. Footpad counts followed characteristic growth curves in the non-vaccinated infected group but showed a lag in the development of peak levels in the vaccinated group. Further Convit's vaccine appeared to have a protective effect on renal impairment in the mouse model of leprosy in the initial stages of infection only, as indicated by the transient reversal of amino acid uptake and a diminution in the footpad counts induced by M. leprae infection. No significant (P > 0.05) protective effect of the vaccine was found in the advanced disease state.
Asunto(s)
Aminoácidos/metabolismo , Vacunas Bacterianas/farmacología , Corteza Renal/metabolismo , Lepra/metabolismo , Animales , Inmunización , Corteza Renal/ultraestructura , Lepra/inmunología , Ratones , Microvellosidades/metabolismo , Mycobacterium leprae/inmunologíaRESUMEN
Renal involvement is known to occur in leprosy. In the present study the possible role of reactive oxygen species (ROS) in causation of renal damage in mice infected with Mycobacterium leprae has been investigated. At least six animals from each group (control and infected) were killed at 0 day, 3, 6 and 9 months postinfection. The results showed a significant increase in the chemiluminescence (CL) response of peritoneal macrophages which was maximum between 3 and 6 months. No significant increase was observed in CL response of blood neutrophils. A significant increase in lipid peroxidation was observed at 3 and 6 months as evident by an increase in malondialdehyde levels. The increased ROS production might be the cause of lipid peroxidation. The renal damage is alos evident by decrease in the activity of renal brush border membrane enzymes, namely, alkaline phosphatase, leucine aminopeptidase and r-glutamyl transpeptidase. Thus ROS might play a role during early stages of M. leprae infection but in the later stages other immunological mechanisms may overpower the effect of ROS.
Asunto(s)
Enfermedades Renales/etiología , Lepra/complicaciones , Especies Reactivas de Oxígeno/metabolismo , Fosfatasa Alcalina/metabolismo , Animales , Riñón/enzimología , Riñón/ultraestructura , Enfermedades Renales/fisiopatología , Lepra/fisiopatología , Leucil Aminopeptidasa/metabolismo , Mediciones Luminiscentes , Macrófagos Peritoneales/metabolismo , Malondialdehído/metabolismo , Ratones , Microvellosidades/enzimología , gamma-Glutamiltransferasa/metabolismoRESUMEN
The incidence and significance of class specific antinuclear antibodies (ANA), specially with relevance to clinical manifestations of arthritis, renal disease and serositis was studied in 40 patients of systemic lupus erythematosus by the indirect immunofluorescent method. Clinical activity was scored by Morimoto's scoring system. A significant correlation was obtained between IgD ANA and clinical activity of the disease and IgG ANA exhibiting lupus pattern of immunofluorescence and serositis.
Asunto(s)
Anticuerpos Antinucleares/análisis , Lupus Eritematoso Sistémico/inmunología , Especificidad de Anticuerpos , Técnica del Anticuerpo Fluorescente , Humanos , Inmunoglobulina D/análisis , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Lupus Eritematoso Sistémico/diagnóstico , Nefritis Lúpica/inmunologíaRESUMEN
Gastrointestinal complications are responsible for substantial morbidity and mortality among renal allograft recipients in developing countries. During a 10 year period, 166 (62.6%) of 265 allograft recipients developed gastrointestinal complications. This figure reflects the high incidence of infectious complications, especially acute diarrheas. Also notable was the incidence of esophageal candidiasis (7.2%), ischemic colitis (2.6%), and gastrointestinal and peritoneal tuberculosis (3.0%). Almost one quarter of the complications developed in the first 6 months after transplantation. Mortality was the highest with acute ischemic colitis (100%), pancreatitis (60%), and upper gastrointestinal hemorrhage (40%). Improvements in standards of living and sanitary conditions, pre transplant evaluation and assessment of risk factors, prophylaxis with anti ulcer drugs, early diagnosis, and appropriate treatment are needed to decrease the frequency and severity of gastrointestinal complications in renal allograft recipients.
Asunto(s)
Enfermedades Gastrointestinales/etiología , Trasplante de Riñón/efectos adversos , Adolescente , Adulto , Colitis/etiología , Países en Desarrollo , Diarrea/etiología , Esofagitis/etiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , India/epidemiología , Isquemia/etiología , Masculino , Persona de Mediana Edad , Pancreatitis/etiologíaRESUMEN
The role of surgery in the management of postabortum renal failure complicated with extensive uterine sepsis, perforation or peritonitis is controversial. This study compares the course and final outcome of 14 patients (66.6%) conservatively managed with appropriate antibiotics, fluid or blood replacement and dialysis, with seven patients (33.3%) for whom hysterectomy or laparotomy was undertaken in addition. Whereas all 14 patients treated conservatively died as the result of uncontrolled septicemia, three of the seven surgical patients recovered completely. Extensive necrosis with perforation of the uterine wall was confirmed either at laparotomy or at autopsy in all 21 women. To reduce mortality, the authors recommend early surgical intervention for patients suffering from postabortum renal failure complicated with uterine sepsis or perforation.