Multiple brown tumors-Forgotten pathology in times of calcimimetics: A case report and literature review.

Multiple brown tumors represent a rare variant of osteitis fibrosa cystica. Brown tumors are associated with primary, secondary, or tertiary hyperparathyroidism. Brown tumors have been reported in patients with chronic kidney disease resulting in mineral and bone disorders. Chronic kidney disease resulting in mineral and bone disorder is a result of increased osteoclast activity and excessive production of parathormone due to parathyroid gland hyperactivity. Brown tumors are frequently overlooked in patients with end-stage renal disease since calcimimetics and vitamin D analogs were introduced as pharmacological therapy for secondary hyperparathyroidism. We present a case of a 79 year-old pre-dialysis woman, with multiple brown tumors secondary to a parathyroid adenoma despite being treated with cinacalcet for secondary hyperparathyroidism. In addition, we review the corresponding literature.

COVID-19 in chronic hemodialysis patients: A report of 9 cases in Madrid, Spain.

INTRODUCTION: In December 2019, a new respiratory disease, named COVID-19, caused by a novel coronavirus, emerged in Wuhan and since then spread rapidly throughout China and worldwide. Hemodialysis patients are an especially vulnerable subgroup of the general population. However, there are only a few reports on the course of COVID-19 in maintenance hemodialysis patients. CASE REPORT: We describe in depth the clinical, analytical, and radiological details of 9 hemodialysis patients from a single center in Madrid (Spain) diagnosed with COVID-19. Furthermore, we describe and discuss the therapeutic aspects and the patients' outcomes. DISCUSSION: We present one of the first case series of chronic hemodialysis patients with COVID-19. Between March 14 and April 8, 2020, out of 76 prevalent patients in our hemodialysis unit, 9 (11.8%) patients were diagnosed with COVID-19. The most common symptoms were fever (77.8%), asthenia (77.8%), cough (55.6%), and dyspnea (33.3%). A total of 3 patients developed severe pneumonia, whereas 4 patients developed mild pneumonia. In 2 patients, no pathologic changes were found on chest radiography. All patients presented lymphopenia. While 6 (66.7%) patients required hospitalization, none of them was admitted to intensive care unit. The most common treatments used were azithromycin (100%), hydroxychloroquine (66.7%), lopinavir/ritonavir (55.6%) and ß-interferon (22.2%). In general, we observed a mild to moderate severity of disease in our case series. One patient died, however due to a cause not related to COVID-19.

Clinical risk factors for the prediction of acute kidney injury post cardiac resynchronization therapy in an elderly population.

BACKGROUND: Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8-14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI. OBJECTIVES: To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality. METHODS: Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center. RESULTS: 60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI). CONCLUSIONS: AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.