Glucose-6-phosphate dehydrogenase deficiency presenting with rhabdomyolysis in a patient with coronavirus disease 2019 pneumonia: a case report.

BACKGROUND: Glucose-6-phosphate dehydrogenase deficiency is a rarely recognized predisposing factor for rhabdomyolysis. Rhabdomyolysis with coronavirus disease 2019 has been increasingly seen during the pandemic. We report the uncommon occurrence of coronavirus disease 2019 pneumonia, severe rhabdomyolysis, and acute renal failure in the setting of glucose-6-phosphate dehydrogenase deficiency. CASE PRESENTATION: A 19-year-old African American male presented with myalgias, diaphoresis, and dark urine. Testing for severe acute respiratory syndrome coronavirus 2 was positive. He had severe rhabdomyolysis with creatine kinase levels up to 346,695 U/L. He was oliguric and eventually required hemodialysis. Progressive hypoxemia, methemoglobinemia, and hemolytic anemia occurred following one dose of rasburicase for hyperuricemia. Glucose-6-phosphate dehydrogenase deficiency was diagnosed. Full recovery followed a single volume exchange transfusion and simple packed red blood cell transfusions. CONCLUSIONS: Glucose-6-phosphate dehydrogenase deficiency may predispose individuals to rhabdomyolysis due to severe acute respiratory syndrome coronavirus 2, presumably due to altered host responses to viral oxidative stress. Early screening for glucose-6-phosphate dehydrogenase deficiency can be useful for management of patients with rhabdomyolysis.

Relationship between obesity and pulse pressure in children: results of the National Health and Nutrition Survey (NHANES) 1988-1994.

BACKGROUND: Obesity is a known cardiometabolic risk factor in children. In adults, pulse pressure (PP) is a known predictor and a risk factor of cardiovascular (CV) diseases. In this study, we examined the association between measures of obesity and PP in children. METHODS: A retrospective analysis of 4667 children ages 6-17 years from the National Health and Nutrition Survey (1988-1994) was performed. We defined wide PP as 4th quartile PP and high waist circumference (WC) as >75th percentile based on age and gender. RESULTS: There were 51% boys, 74% whites, 16% blacks, 10% Hispanics, 12% obese, 26% with high WC, 26% with wide PP, and 9% with high blood pressure (BP). Prevalence of wide PP was high among obese children. A significantly higher mean PP was observed in boys, Blacks, obese, those with high WC and high BP. The adjusted odds ratio (OR) for wide PP was higher in boys, Blacks, and those with high WC. CONCLUSION: There was a statistically significant independent association observed between wide PP and high WC, but not with obesity based on BMI. Further exploration of wide PP as a CV risk factor in childhood and its relationship to CV outcomes appears warranted.

Comparing body composition assessment tests in long-term hemodialysis patients.

BACKGROUND: Protein-energy wasting is common in chronic kidney disease and is associated with decreases in body muscle and fat stores and poor outcomes. The accuracy and reliability of field methods to measure body composition is unknown in this population. STUDY DESIGN: Cross-sectional observational study. SETTING & PARTICIPANTS: 118 maintenance hemodialysis patients were seen at the General Clinical Research Center at Harbor-UCLA Medical Center, Torrance, CA. INDEX TESTS: Triceps skinfold, near-infrared interactance, and bioelectrical impedance analysis using the Segal, Kushner, and Lukaski equations. REFERENCE TEST: Dual-energy x-ray absorptiometry (DEXA). RESULTS: Participants (42% women, 52% with diabetes, 40% African Americans, and 38% Hispanics) were aged 49.4 +/- 11.5 (mean +/- SD) years, and had undergone dialysis therapy for 41.1 +/- 32.9 months. Body mass index was 27.0 +/- 6.0 kg/m(2). Using DEXA as the reference test, the bioelectrical impedance analysis-Kushner equation, triceps skinfold, and near-infrared interactance were most accurate of the index tests in estimating total-body fat percentage, whereas bioelectrical impedance analysis-Segal equation and bioelectrical impedance analysis-Lukaski equation overestimated total body fat percentage. Bland-Altman analyses and difference plots showed that bioelectrical impedance analysis-Kushner and near-infrared interactance were most similar to the reference test. Bioelectrical impedance analysis-Kushner, triceps skinfold, and near-infrared interactance had the smallest mean differences from DEXA, especially in women (1.6%, 0.7%, and 1.2%, respectively). Similar results were observed in African American participants (n = 47). LIMITATIONS: Measurements were performed 1 day after a hemodialysis treatment, leading to more fluid retention, which may have affected the reference and index tests differently. CONCLUSIONS: Using DEXA as the reference test, both near-infrared interactance and bioelectrical impedance analysis-Kushner method yield more consistent estimates of total body fat percentage in maintenance hemodialysis patients compared with the other index tests. Near-infrared interactance is not affected by skin color. Field methods with portable devices may provide adequate precision.

Role of gamma melanocyte-stimulating hormone-renal melanocortin 3 receptor system in blood pressure regulation in salt-resistant and salt-sensitive rats.

Melanocortin 3 receptor (MC3-R) has high affinity and specificity to gamma melanocyte-stimulating hormone (gammaMSH), a natriuretic peptide involved in regulation of blood pressure (BP) and sodium excretion. Recent studies showing increased MC3-R expression and elevated plasma gammaMSH in normal rats fed a high-salt diet support the role of this system in sodium homeostasis. We hypothesized that dysregulation of MC3-R response to dietary salt may contribute to salt retention and BP elevation in salt-sensitive hypertension. We examined renal MC3-R expression, plasma gammaMSH concentration, and response to MC3-R agonist and antagonist in Dahl salt-sensitive (DSS) and Dahl salt-resistant (DSR) rats fed high-salt (8%) or low-salt (0.07%) diets for 3 weeks. Consumption of high-salt diet significantly increased BP in the DSS but not the DSR group. High-salt diet led to a 5-fold increase in plasma gammaMSH and a 2-fold increase in renal MC3-R in DSR rats. Plasma gammaMSH and renal MC3-R abundance in DSS rats were maximally elevated on low-salt diet and remained unchanged on high-salt diet. Administration of MC3-R agonist melanotan II significantly lowered BP and raised fractional Na excretion in the DSR but not the DSS rats consuming high-salt diet. In contrast, MC3-R antagonist SHU9119 significantly raised BP and lowered fractional Na excretion in both groups. Thus, the data suggest that gammaMSH-renal MC3-R pathway is activated and appears to be biologically functional in the DSS rats.

Adequacy of urinary tract infection management among minority underserved children.

Urinary tract infection (UTI) is one of the common bacterial infections in children and may lead to substantial morbidity. This study examines (1) the frequency of the performance of follow-up urine cultures and imaging studies for children diagnosed with UTI and (2) the relationship of the demographic and insurance status of patients with the management and follow-up of UTI. We conducted a retrospective chart review of children with first-time documented UTI at six different county medical center satellite outpatient clinics and hospital-based pediatric outpatient walk-in clinics, serving an indigent minority community, from January 1998 to December 2000. We identified 144 children with confirmed UTI. Of 144 subjects in our study, 44% had follow-up urine cultures and 43% of these children showed continued infection after a full course of antibiotics. Renal ultrasonography and voiding cystourethrogram were performed in 53% and 39% of children, respectively. Of those patients who did not receive follow-up imaging, 67% had no documentation for follow-up appointments. However, in 29% of cases attempts had been made to contact patients who were scheduled for follow-up, but they did not return for the studies. These data suggest there is a significant failure rate for the follow-up of pediatric UTI. There is need for educational intervention among pediatricians who provide medical care to ethnically diverse underserved, often uninsured, minority children. This intervention should reinforce compliance with the standard recommendations for appropriate UTI follow-up studies and imaging and provide realistic strategies for achieving recommended outcomes in these high-risk populations.