Neisseria mucosa Peritonitis in the Setting of a Migrated Intrauterine Device.

Peritonitis is a major complication in peritoneal dialysis (PD) patients, often requiring a switch to hemodialysis (HD). Common sources of bacterial peritonitis are touch contamination and PD catheter-related infection. Intra-abdominal pathology is a less common cause of peritonitis in PD patients, and rarely is Neisseria mucosa the causative organism.We present an uncommon case of N. mucosa peritonitis in a 30-year-old African American female patient treated with nocturnal intermittent PD. The infection occurred in the setting of a translocated intrauterine contraceptive device (IUCD) in the infrahepatic region because of transmural migration. Our patient underwent laparoscopic removal of the IUCD and received empiric intraperitoneal (IP) vancomycin and intravenous ceftriaxone. After the isolate was identified as N. mucosa, her regimen was changed to IP ceftriaxone for a total of 21 days. Cell count after completion of antibiotics showed resolution of the peritonitis. The PD catheter was salvaged and transition to HD was avoided.

Bath salt intoxication causing acute kidney injury requiring hemodialysis.

Traditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of "bath salts." They are beta-ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the "khat" plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. Serious adverse effects reported with intoxication included cardiac, psychiatric, and neurological signs and symptoms. Not much is known about the toxicology and metabolism of these compounds. They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of "bath salt" pills that improved with hemodialysis.

Ischemic heart disease in patients undergoing dialysis.

Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD) who are undergoing chronic dialysis. Diabetes and hypertension, the 2 leading causes of ESRD, contribute to the pathogenesis of ischemic heart disease (IHD) in these patients, as do other traditional risk factors (eg, dyslipidemias, smoking, and sedentary lifestyle). However, patients with ESRD are subject to several unique risk factors that contribute to the development and progression of IHD. Chronic volume overload and anemia, leading to left ventricular hypertrophy, and deranged calcium-phosphate metabolism with vascular and coronary calcification, contribute to the pathogenesis of IHD. Other risk factors that have been implicated include oxidative stress, homocysteine, and myocardial stunning while undergoing dialysis treatment. Additional risk factors include erythropoietin use for treating anemia, as well as use of calcium-based phosphate binders. The complex pathogenesis of IHD in such patients poses unique challenges to its management. Serological biomarkers and sophisticated imaging techniques are being developed to better delineate the pathological process and enhance disease detection. A combination of medical and surgical approaches is necessary to treat IHD. In this article, we discuss the pathogenesis and management of IHD.