RESUMEN
We report a case of a 40-year-old woman who developed profound polyuria (>25 L urine output) immediately after initiation of venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Investigations into the cause determined the polyuria was due to marked natriuresis (>85 g of sodium excreted in 1 day). This natriuresis persisted despite low cardiac filling pressures and high-negative ECMO venous pressures, suggesting clinical hypovolemia due to pressure natriuresis from locally high pressures at the renal artery due to arterial ECMO inflow. As ECMO flows were decreased, polyuria and natriuresis resolved. To our knowledge, this is the first description of VA-ECMO-associated salt wasting.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Adulto , Presión Sanguínea , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Humanos , Natriuresis , Poliuria/etiologíaRESUMEN
OBJECTIVE: Our objective is to describe how polydipsia and intake of nonsteroidal anti-inflammatory drugs (NSAIDs) after fasting while breastfeeding may result in acute symptomatic hyponatremia. CASE REPORT: We present the case of a 24-year-old woman at 4 weeks postpartum who engaged in a 20-hour fast from both eating and drinking, during which she continued to breastfeed her newborn child. After ending her fast, she noted decreased milk supply. Attributing her decreased milk supply to dehydration, she then consumed 4 L of water with little salt and also took NSAIDs for a headache, which continued to worsen. Upon presentation to the emergency department, she was found to have a sodium level of 124 mEq/L (normal, 135-145 mEq/L) and a urine specific gravity of 1.015 (normal, 1.005 - 1.030). Thyroid function and cortisol level test results were normal. She was diagnosed with acute symptomatic hypovolemic hyponatremia. After 1 L of normal saline her sodium rapidly corrected to normal and her symptoms resolved. At 2 months of follow-up she was asymptomatic and had no further episodes of hyponatremia. DISCUSSION: Due to the patient's gender and small body size, 4 L of water was sufficient to lower her serum sodium rapidly from normal to 124 mEq/L. She was unable to excrete this water due to a combination of hypovolemia-mediated arginine vasopressin and NSAID use. CONCLUSION: Clinicians should be cognizant that reproductive-age women are uniquely susceptible to hyponatremia and dangerous sequelae therein. They should counsel fasting individuals, particularly lactating women, to consume solute as well as fluid after fasting.
Asunto(s)
Neumonía Viral , Tromboembolia , Betacoronavirus , COVID-19 , Infecciones por Coronavirus , Humanos , Italia , Pandemias , SARS-CoV-2RESUMEN
Membranous Nephropathy (MN) is a rare autoimmune cause of kidney failure. Here we report a genome-wide association study (GWAS) for primary MN in 3,782 cases and 9,038 controls of East Asian and European ancestries. We discover two previously unreported loci, NFKB1 (rs230540, OR = 1.25, P = 3.4 × 10-12) and IRF4 (rs9405192, OR = 1.29, P = 1.4 × 10-14), fine-map the PLA2R1 locus (rs17831251, OR = 2.25, P = 4.7 × 10-103) and report ancestry-specific effects of three classical HLA alleles: DRB1*1501 in East Asians (OR = 3.81, P = 2.0 × 10-49), DQA1*0501 in Europeans (OR = 2.88, P = 5.7 × 10-93), and DRB1*0301 in both ethnicities (OR = 3.50, P = 9.2 × 10-23 and OR = 3.39, P = 5.2 × 10-82, respectively). GWAS loci explain 32% of disease risk in East Asians and 25% in Europeans, and correctly re-classify 20-37% of the cases in validation cohorts that are antibody-negative by the serum anti-PLA2R ELISA diagnostic test. Our findings highlight an unusual genetic architecture of MN, with four loci and their interactions accounting for nearly one-third of the disease risk.
Asunto(s)
Estudio de Asociación del Genoma Completo , Glomerulonefritis Membranosa/diagnóstico , Glomerulonefritis Membranosa/genética , Alelos , Secuencia de Aminoácidos , Pueblo Asiatico/genética , Estudios de Casos y Controles , Glomerulonefritis Membranosa/inmunología , Humanos , Factores Reguladores del Interferón/genética , Modelos Moleculares , Subunidad p50 de NF-kappa B/genética , Polimorfismo de Nucleótido Simple , Receptores de Fosfolipasa A2/genética , Población Blanca/genéticaRESUMEN
OBJECTIVE: To evaluate whether introduction of a densitometry workflow, data-storage, and reporting software system would result in streamlined workflow with fewer expenses and quicker result turnaround time. METHODS: BoneStation was implemented March 30, 2009, in a large, urban, tertiary referral center performing more than 6000 bone mineral density studies annually at 3 different geographic sites. The times of scan acquisition, report preparation, and final signature in the online medical record were recorded, and the delays from scan to report and from scan to final signature in the online medical record were calculated for each patient during 2 representative weeks before (n = 274) and 2 weeks after (n = 235) implementation of BoneStation. RESULTS: Use of BoneStation reduced time from scan to report from 2.11 +/- 0.16 days to 0.46 +/- 0.05 days (P<.001). BoneStation saved our practice $8.94 per scan, while costing only $3 per scan, resulting in net savings. Considering that the total reimbursement from Medicare in 2010 for dual-energy x-ray absorptiometry is projected to be $55.44, this constitutes cost savings of 10.7% of the total reimbursement. CONCLUSION: The introduction of a specialized electronic medical system for data storage and reporting reduced costs and improved result turnaround time in a densitometry practice.
