Lethal Strongyloides stercoralis superinfection in an immunocompromised patient.

In this article, we describe the case of a 49-year-old male gypsy on hemodialysis that was referred to our center due to high fever, breathlessness, and productive cough with bloody sputum. Forty-five days before hospitalization, he was treated for vasculitis with prednisolone and intravenous cyclophosphamide. Soon after admission he was resuscitated and intubated after a cardiac arrest. A large worm load of Strongyloides stercoralis larvae was identified in the sputum. The patient was treated with thiopental 25 mg/kgBW/12 h through a Levine tube and died 24 h later.

Comparison of immunosuppressive therapeutic regimens in patients with nephrotic syndrome due to idiopathic membranous nephropathy.

In this prospective randomized trial, we compared the effects of cyclosporine- and cyclophosphamide-based treatment regimens in patients with idiopathic membranous nephropathy. Twenty-eight patients were randomized to receive treatment with one of the three therapeutic regimens: cyclosporine with methylprednisolone, cyclophosphamide with methylprednisolone or lisinopril (control). Renal function and nephrotic syndrome parameters were determined at baseline and during a 9-month treatment period. At the end of the study period, renal function improved significantly in the cyclophosphamide and deteriorated significantly in the cyclosporine group. Serum albumin levels increased significantly in the cyclosporine and cyclophosphamide group. Total cholesterol levels and proteinuria were significantly reduced in all groups. In the comparison between the groups, serum albumin levels were significantly lower in the control group and there were no differences in the rest of the studied parameters at the end of the study. Six patients from the cyclosporine group (1/10 complete and 5/10 partial), all cyclophosphamide-treated (4/8 complete and 4/8 partial) and all 10 lisinopril-treated patients (10/10 partial) were on remission at the end of the study. In conclusion, cyclosporine-based regimens are not inferior to cyclophosphamide-based regimens. Cyclophosphamide is associated with more complete remissions after 9 months of treatment. Lisinopril is associated with a significant proteinuria reduction and without inducing any complete remissions.

Quantitative evaluation of proteinuria by estimation of the protein/creatinine ratio in a random urine sample.

The aim of this study was to evaluate the severity of proteinuria using the protein/creatinine ratio in a random urine sample. In 45 patients (male 28, female 17; mean age 50.68 +/- 18.26 years) with proteinuria of various causes, we measured the 24-hour protein excretion per 1.73 m(2) of body surface and, during the same day, the protein/creatinine ratio in three different urine samples (8 am, 12 pm, 4 pm). The 24 h proteinuria was defined as mild (<1 g), moderate (1-3.4 g), and severe (>3.4 g) in 7, 27, and 11 patients, respectively. The sensitivity for protein/creatinine ratio compared to the 24 h proteinuria as a method of reference was 86-100% in the mild, 78-100% in the moderate, and 73-82% in the severe proteinuria, whereas the specificity was 84-100%, 78-83%, and 100% respectively. The patients with better renal function had significantly higher proteinuria levels. There was a similarity in the 24 h proteinuria and the protein/creatinine ratio measurements in all renal function and level-of-proteinuria groups. The protein/creatinine ratio of the morning and midday samples had a very good association with the 24 h sample, whereas it was not associated significantly with the evening sample (4 pm). In conclusion, the degree of 24 h proteinuria levels can be evaluated by calculating the protein/creatinine ratio in a random urine sample collected at any time from morning until midday. Protein/creatinine ratio is independent of the severity of proteinuria or renal function, and it can replace in clinical practice the cumbersome 24 h urine collections.

Comparison of the influence of angiotensin-converting enzyme inhibitor lisinopril and angiotensin II receptor antagonist losartan in patients with idiopathic membranous nephropathy and nephrotic syndrome.

OBJECTIVE: In this prospective study, the effects of an angiotensin-converting enzyme inhibitor [lisinopril (LIS)] and an angiotensin II receptor antagonist [losartan (LOS)] were compared in nephrotic patients with idiopathic membranous nephropathy. MATERIAL AND METHODS: Twenty-seven patients (13 males, mean age +/- SD 51.3 +/- 15.4 years) were treated with LIS (13 patients, six males, mean age 52.1 +/- 15.3 years) or LOS (14 patients, seven males, mean age 50.5 +/- 15.5 years) for 12 months. At baseline and after the treatment period, serum albumin, total cholesterol, estimated glomerular filtration rate (GFR), 24 h proteinuria and mean arterial pressure were determined. RESULTS: Proteinuria (g/24 h) was significantly reduced in both groups (LIS from 4.82 +/- 1.26 to 1.75 +/- 0.64, p < 0.0001; LOS from 4.55 +/- 1.09 to 2.54 +/- 1.94, p = 0.002) (all results +/- SD). Serum albumin levels (g/dl) increased significantly in both groups (LIS 2.27 +/- 0.41 to 3.17 +/- 0.63, p < 0.0001; LOS 2.93 +/- 0.40 to 3.55 +/- 0.44, p < 0.0001). GFR (ml/min x 1.73 m(2)) did not change significantly in either group (LIS 55 +/- 17 to 56 +/- 17, p = 0.65; LOS 64 +/- 18 to 59 +/- 16, p = 0.13). Total cholesterol (mg/dl) was significantly reduced only in the lisinopril group (LIS 347 +/- 81 to 266 +/- 64, p < 0.0001; LOS 306 +/- 58 to 263 +/- 77, p = 0.138). Mean arterial pressure (mmHg) was reduced in both groups (LIS 107 +/- 12 to 95 +/- 6, p < 0.0001; LOS 104 +/- 10 to 96 +/- 5, p = 0.003). In the comparison between the two groups, serum albumin levels were higher in the losartan group at baseline (p < 0.0001) and after 12 months (p = 0.029). There were no significant differences between the baseline and end-of-study values for the rest of the studied parameters. CONCLUSION: Treatment with lisinopril and losartan in nephrotic patients with idiopathic membranous nephropathy results in similar (and significant) effects on renal function, hypoalbuminaemia, proteinuria and blood pressure.