RESUMO
We report a case of a 68 year old male who presented with an acute onset of anuric renal failure. Investigations revealed a histologically confirmed "double-positive" anti-GBM disease with initially undetectably high antibody values. An induction therapy with plasma exchange, cyclophosphamide and initially high dose steroids and further maintenance therapy for three months was initiated. The patient remained dialysis-dependent despite partial recovering of renal function. Without pulmonary involvement there were no clues for Goodpasture's disease. Renal prognosis is unfavourable.
Assuntos
Injúria Renal Aguda/diagnóstico , Doença Antimembrana Basal Glomerular/diagnóstico , Anuria/etiologia , Idoso , Algoritmos , Autoanticorpos/sangue , Tosse/etiologia , Diagnóstico Diferencial , Membrana Basal Glomerular/imunologia , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnósticoRESUMO
Background. Methemoglobin (MetHb) most commonly results from exposure to an oxidizing chemical but may also arise from genetic, dietary, or even idiopathic etiologies. P-chloroaniline (PCA) was one of the first substances described in the context of acquired methemoglobinemia. Case Report. We report the case of a cyanotic chemistry worker who presented to our emergency department (ED) after working with PCA. His peripheral oxygen saturation (SpO2) measured by pulse oximetry was at 81% and remained on that level despite oxygen administration (100% oxygenation via nonrebreather mask). His MetHb level was measured at 42.8% in arterial blood gas analysis. After treatment with intravenous methylene blue cyanosis resolved and the patient was discharged after 36 hours of observation. Conclusion. Acquired methemoglobinemia is a treatable condition, which may cause significant morbidity and mortality. The knowledge about the most common causes, fast diagnostic, and proper treatment is crucial.
RESUMO
The prevalence of CKD increases with old age. The increase of risk factors for the development of CKD such as hypertension, diabetes and adipositas is essentially responsible for this. For the treating physician it is therefore important to diagnose CKD early to slow its progression. Physiological aging of the kidney is responsible for the development of functional impairments in the elderly. Electrolyte disorders and hemodynamically caused perfusion deficits are more frequent in old age and are often caused by medication. If kidney replacement therapy in end stage renal disease in the elderly is initiated or not should not depend on age but should consider patient preference, comorbidities and quality of life, which together are ideally assessed early.
La prévalence des affections rénales chroniques augmente avec l'âge. La raison en est principalement une fréquence accrue de facteurs de risque favorisant le développement des affections rénales comme l'hypertension, le diabète et l'adiposité. Pour le médecin praticien il est dès lors important de diagnostiquer précocement les affections rénales afin de ralentir leur progression. Le vieillissement physiologique du rein est responsable d'anomalies fonctionnelles chez la personne âgée. Des troubles électrolytiques et hémodynamiques causés par des déficits de perfusion sont plus fréquents chez la personne âgée et sont souvent d'origine médicamenteuse. Le recours ou non à une thérapie de remplacement rénal ne devrait pas dépendre de l'âge mais devrait prendre en compte la préférence du malade, l'existence de co-morbidités et la qualité de vie, des facteurs qui idéalement devraient être évalués ensembles précocement.
