Long-term follow-up of acute renal failure caused by angiotensin converting enzyme inhibitors.

Angiotensin converting enzyme (ACE) inhibitors are useful in the treatment of hypertension and heart failure. However, acute renal failure (ARF) may occur in patients who are taking these drugs in situations associated with decreased glomerular filtration pressure, such as dehydration caused by acute diarrhea or diuretic therapy. Sixty-four patients who were admitted to the intensive care unit for ARF associated with ACE inhibitor therapy were followed for more than 5 years. In this historical retrospective study, we documented that 45 patients were treated for hypertension (group I) and 19 were treated for heart failure (group II). Their mean age was 71.2+/-11.6 years. Patients with ARF presented with overt dehydration in 91% and 84% of the cases in groups I and II, respectively. Hypovolemia was caused by diuretics or gastrointestinal fluid loss. Bilateral artery-renal stenosis or stenosis in a solitary kidney was documented in 22% and 10% of patients in groups I and II, respectively. The probability of survival was 91% and 49% at 1 year and 64% and 18% at 5 years, for groups I and II, respectively. Acute renal failure required hemodialysis in seven patients, but none of them became dialysis dependent. In the subgroup of patients with preexisting chronic renal failure, all the patients except for one who belonged to group II died within 2 years. In both groups, after resolution of ARF, plasma creatinine concentration returned to baseline level and the course of renal function was not significantly worsened. In conclusion, ARF associated with ACE inhibitors is likely to occur in many patients without renal artery stenosis after unexpected dehydration, especially in older patients with congestive heart failure. In both groups of patients, in the absence of preexisting chronic uremia, recovery of renal function occurred without sequelae, even after an episode of acute tubular necrosis requiring dialysis.

[Recombinant human erythropoietin (epoetin) and autologous blood transfusion in chronic hemodialysis. Apropos of 2 cases]. / Erythropoïétine recombinante humaine (époétine) et transfusion autologue programmée chez I'hémodialysé chronique. A propos de deux observations.

Recombinant human erythropoietin (epoetin) is sometimes used in order to enhance autologous blood predonation before scheduled hemorrhagic surgery. This procedure reduces and some times better avoids homologous blood transfusions with their disadvantages. In certain circumstances, it will be of particular importance and, despite of its cost, has to be discussed for several surgical operations in some patients. Among them, pre-dialysis and dialysis patients can benefit of autologous blood transfusion if their anemic state and the response to epoetin and iron supplementation allow a sufficient and well-tolerated preoperative collection. As such observations are rare, we report two successful cases of autologous transfusion strategy with epoetin therapy in chronic hemodialyzed patients undergoing orthopedic surgery.

[Entomophthoramycosis: a case report of a Congolese child with rapid regression using ketoconazole]. / Basidiobolomycose: une observation chez un enfant congolais avec régression rapide sous kétoconazole.

We report the second Congolese case of subcutaneous entomophthoramycasis, a rare tropical disease expressed as cellulitis. Despite characteristic clinical features, the diagnosis for this twelve-year old child was confirmed four years after the beginning of the disease. Dramatic clinical improvement was observed within the first month of treatment with ketoconazole.

Disseminated African histoplasmosis in a Congolese patient with AIDS.

We report the first Congolese case of African histoplasmosis in a patient with AIDS which represents the third case to be described in the literature. This contrasts with the now frequent occurrence of Histoplasma capsulatum histoplasmosis in HIV-infected subjects in North America; the difference is likely to be due to differences in exposure to the fungus rather than to differences in behaviour of the fungus or in the epidemiology of HIV.

[Therapeutic trial with ivermectin in loiasis with medium and high microfilaremia]. / Essai thérapeutique de l'ivermectine au cours de la loase à moyenne et forte microfilarémie.

Treatment with ivermectin at the dosage of 200 microgram/kg in 28 Congolese loiasis patients led to an important decrease of the microfilaremia on day 7, with a reduction of about 90% of the initial parasite load. However, no negativation was observed and, moreover, the parasitemia did not change from day 7 to day 14. Tolerance was quite good, but weak to moderate reactions, linked to the lysis of the microfilariae, were observed in one third of the patients with a microfilaremia greater or equal to 2,500/mm3.