Preliminary study on tubuloglomerular dysfunction and evidence of renal inflammation in patients with visceral leishmaniasis.

Visceral leishmaniasis (VL) is a re-emerging zoonosis of worldwide distribution. Monocyte chemotactic protein-1 (MCP-1) and malondialdehyde (MDA) are inflammation biomarkers that have never been investigated in VL. The aim of this study is to investigate the association between renal abnormalities and inflammation biomarkers in VL. This study is a preliminary prospective study with 16 VL adult patients evaluated before treatment compared with a group of 13 healthy volunteers and 5 VL patients evaluated after treatment. Urinary concentration and acidification tests were performed. MCP-1 and MDA were quantified in urine. Urinary concentration deficit was found in all VL patients before (100%) and four VL patients after (80%) treatment. Urinary acidification deficit was found in nine cases before (56.2%) and two cases after (40%) treatment. Urinary MCP-1 (374 ± 359 versus 42 ± 29 pg/mg creatinine, P = 0.002) as well as urinary MDA (5.4 ± 2.6 versus 2.0 ± 0.8 µmol/mL) showed significant differences between VL patients and controls. These data show that VL patients present urinary concentration and acidification deficit, which can persist even after specific treatment. Urinary MCP-1 and MDA are elevated in patients with VL, which suggests renal inflammation and incipient renal damage.

Acute kidney injury after snakebite accident treated in a Brazilian tertiary care centre.

AIM: Acute kidney injury (AKI) is one of the main causes of morbidity and mortality in cases of envenomation by venomous snakes. The present study was carried out to investigate the clinical and laboratory manifestations in accidents with venomous snakes and the risk factors associated with AKI in these accidents. METHODS: A retrospective study was carried out with patients victims of snakebite admitted to a reference centre. AKI was defined according to the RIFLE and AKIN criteria. RESULTS: A total of 276 patients were included, of which 230 (83.7%) were males. AKI was observed in 42 cases (15.2%). The mean genus involved in the accidents was Bothrops (82.2%). Mean age of patients with AKI was higher than in patients without AKI (43 ± 20 vs. 34 ± 21 years, P = 0.015). The time elapsed between the accident and medical care was higher in the AKI group (25 ± 28 vs. 14 ± 16h, P = 0.034), as well as the time elapsed between the accident and the administration of antivenom (30.7 ± 27 vs. 15 ± 16 h, P = 0.01). Haemodialysis was required in 30% of cases and complete renal function recovery was observed in 54.8% of cases at hospital discharge. There were four deaths, none of which had AKI. Factors associated with AKI were haemorrhagic abnormalities (P = 0.036, OR = 6.718, 95% CI: 1.067-25.661) and longer length of hospital stay (P = 0.004, OR = 1.69, 95% CI 1.165-2.088). CONCLUSION: Acute kidney injury is an important complication of snakebite accidents, showing low mortality, but high morbidity, which can lead to partial renal function recovery.

Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease).

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1 ± 15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p=0.001) and acute kidney injury (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during the hospital stay (12.6% vs. 11.3%, p=0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.

Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease)

OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p = 0.001), epistaxis (5.7% vs. 0.8%, p = 0.033), hematemesis (13% vs. 4.6%, p = 0.006), myalgia (91.5% vs. 84.5%, p = 0.038), hematuria (54.8% vs. 37.6%, p = 0.011), metabolic acidosis (18% vs. 9.2%, p = 0.016) and hypoalbuminemia (17.8% vs. 7.5%, p = 0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p = 0.001) and acute kidney injury (OR: 6.6, p = 0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p = 1.000) or during the hospital stay (12.6% vs. 11.3%, p = 0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality. .

Tumor cardiaco en un paciente de mediana edad con enfermedad coronaria - una rara asociación / Cardiac tumor in a middle aged patient with coronary disease - a rare association

Se describe una rara asociación de tumor cardíaco y enfermedad coronaria. Un varón de 42 años de edad fue admitido con queja de disnea. El electrocardiograma mostró ritmo sinusal, bloqueo de rama derecha y repolarización anormal de la pared ventricular anterior. El ecocardiograma mostró una estructura con ecogenicidad aumentada dentro de la aurícula izquierda, compatible con tumor cardíaco. El paciente fue enviado a cirugía; se estabilizó y fue dado de alta en el cuarto día post-operatorio sin complicaciones y sin síntomas.

We describe a rare association between cardiac tumor and coronary disease. A 42 years old male was admitted with complaints of dyspnea. The physical examination was unremarkable. The electrocardiogram showed sinus rhythm, with right bundle block and ventricular anterior wall repolarization abnormality. The echocardiogram showed a structure with increased echogenicity inside the left atrium, compatible with cardiac tumor. A surgery was then indicated to remove the tumor. The patient became stable and was discharged in the fourth post-operative day with no symptom and no complication.

Hyponatremia, acute kidney injury, and mortality in HIV-related toxoplasmic encephalitis.

BACKGROUND: There are no reports on hyponatremia and acute kidney injury (AKI) involved in the course of HIV-related toxoplasmic encephalitis (TE). The main objective of this study was to describe the occurrence of hyponatremia and its relationship with AKI and mortality in HIV-related toxoplasmic encephalitis (TE). METHODS: This was a retrospective cohort study on patients with HIV-related TE. AKI was considered only when the RIFLE (risk, injury, failure, loss, end-stage) criterion was met, after the patient was admitted. RESULTS: A total of 92 patients were included, with a mean age of 36±9 years. Hyponatremia at admission was observed in 43 patients (46.7%), with AKI developing in 25 (27.1%) patients during their hospitalization. Sulfadiazine was the treatment of choice in 81% of the cases. Death occurred in 13 cases (14.1%). Low serum sodium level correlated directly with AKI and mortality. Male gender (OR 7.89, 95% CI 1.22-50.90, p = 0.03) and hyponatremia at admission (OR 4.73, 95% CI 1.22-18.30, p = 0.02) were predictors for AKI. Independent risk factors for death were AKI (OR 8.3, 95% CI 1.4-48.2, p < 0.0001) and hyponatremia (OR 9.9, 95% CI 1.2-96.3, p < 0.0001). CONCLUSION: AKI and hyponatremia are frequent in TE. Hyponatremia on admission is highly associated with AKI and mortality.

Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country.

Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD). The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on hemodialysis (HD) in Brazil. Their mean age was 47 ± 39 years. The main risk factors for cardiovascular diseases were arterial hypertension (89.4%), dyslipidemia (78.3%), low high-density lipoprotein levels (84.2%) and low physical activity (64.1%). Family history of coronary insufficiency and high low-density lipoprotein levels were significantly associated with coronary artery disease (P = 0.005 and P = 0.029, respectively). Sedentary life style, diabetes mellitus, secondary hyperparathyroidism and hyperglycemia also showed a significant association with the underlying vascular disease (P = 0.017, P = 0.039, P = 0.037 and P = 0.030, respectively). Hypercalcemia, hypertension and black race were factors significantly associated with left ventricular systolic dysfunction (P = 0.01, P = 0.0013 and P = 0.024, respectively). Our study shows that the most prevalent cardiovascular diseases in patients with ESRD were left ventricular hypertrophy, atherosclerotic disease, valvular disease and coronary artery disease. Hypertension and dyslipidemia were the common risk factors associated with cardiovascular diseases. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on HD in a single center in Brazil.

Acute kidney injury in children with visceral leishmaniasis.

BACKGROUND: There is no comprehensive study about renal function in children with visceral leishmaniasis (VL). The aim of this study was to investigate the incidence of acute kidney injury (AKI) in children with VL using pRIFLE classification and to determine the risk factors for AKI. METHODS: A retrospective cohort study was conducted with 146 patients younger than 14 years of age with VL diagnosis in one center located at the northeast of Brazil from December 2003 to 2010. AKI was evaluated by pediatric Risk, Injury, Failure, Loss, End-stage kidney disease (pRIFLE) criteria. RESULTS: The mean age was 5 ± 4.0 years (range, 5 months to 14 years), and 53.4% were males. AKI was observed in 67 patients (45.9%). The distribution according to the pRIFLE criteria was as follows: risk 45 (67.2%), injury 21 (31.3%), and failure 1 (1.5%). Patients in the AKI group were significantly younger (P < 0.001) and had jaundice (P = 0.028) and secondary infections (P = 0.001) more often than non-AKI patients. The AKI group had a significantly lower serum sodium (P = 0.03), potassium (P = 0.009), serum albumin (P = 0.001), and elevated serum globulins (P = 0.04), and a more prolonged prothrombin time (P = 0.001) at admission. Independent risk factors for AKI were: secondary infections (OR: 3.65, 95% CI: 1.426-9.358, P = 0.007), serum albumin decrement (OR: 1.672, 95% CI: 1.065-2.114, P = 0.019 per each 1 mg dL(-1) serum albumin decrement), and high serum globulin (OR: 1.35, 95% CI: 1.031-1.779, P = 0.029 per each 1 mg dL(-1) serum globulin increment). CONCLUSIONS: AKI is a frequent complication in children with VL. The risk factors for AKI were secondary infections, high serum globulin and low serum albumin.

Tophus gout and chronic kidney disease in a young female patient: report of familial juvenile hyperuricemic nephropathy in three generations of the same family.

A 20-year-old female was admitted with tophus gout and chronic kidney disease (CKD), progressing to dialysis need and death. The familial investigation evidenced several cases of hyperuricemia, gout and CKD, as well as several cases of early death due to CKD. After analyzing these cases, it was concluded that the diagnosis was familial juvenile hyperuricemic nephropathy. This is an autosomal dominant disorder caused by mutations in the uromodulin gene, characterized by early beginning hyperuricemia and gout, in men and women, associated with progressive CKD.

Different patterns in a cohort of patients with severe leptospirosis (Weil syndrome): effects of an educational program in an endemic area.

The aim of this study is to investigate the changes in clinical pattern and therapeutic measures in leptospirosis-associated acute kidney injury; a retrospective study with 318 patients in Brazil. Patients were divided according to the time of admission: 1985-1996 (group I) and 1997-2010 (group II). Patients were younger in group I (36 ± 13 versus 41 ± 16 years, P = 0.005) and the numbers of oliguria increased (21% versus 41% in group II, P = 0.014). Higher frequency of lung manifestations was observed in group II (P < 0.0001). Although increased severity, there was a significant reduction in mortality (20% in group I versus 12% in group II, P = 0.03). Mortality was associated with advanced age, low diastolic blood pressure, oliguria, arrhythmia, and peritoneal dialysis, besides a trend to better mortality with penicillin administration. Leptospirosis is occurring in an older population, with a higher number of oliguria and lung manifestations. However, mortality is decreasing and can be the result of changes in treatment.

Visceral leishmaniasis in children: a cohort of 120 patients in a metropolitan city of Brazil.

There are few studies regarding the clinical presentation of visceral leishmaniasis (VL) in children. The aim of this study was to investigate the clinical manifestations, major complications and causes of death in children with VL. A retrospective study was performed with pediatric patients (< or = 14 years old) with a diagnosis of VL in Fortaleza, state of Ceara, in Northeast Brazil. A total of 120 patients were included. The mean age was 5 +/- 3.9 years, and 53.4% were male. The main clinical manifestations at admission were: fever (94.2%), splenomegaly (94.2%), hepatomegaly (82.5%), anorexia (55%), malaise (47.5%), cough (41.6%), abdominal pain (27.5%), vomiting (25.5%), and diarrhea (16.6%). Acute kidney injury was found in 25% of the patients. The main complication during hospital stay was pulmonary infection, found in 27.5% (n = 33), leading to sepsis in 3 cases. Glucantime was the drug of choice in 90% (n = 108) of the cases, amphotericin B in 7.5% (n = 9) and AmBisome in 2.5% (n = 3). Death occurred in 4 cases (3.3%) due to sepsis (3 cases) and hemorrhagic complications (1 case). Visceral leishmaniasis is a frequent infection among children in our region. The main complications were pulmonary infection and acute kidney injury related to antiparasitic therapy, along with sepsis and hemorrhage.

Renal tubular dysfunction in patients with American cutaneous leishmaniasis.

Renal dysfunction seen in patients with American cutaneous leishmaniasis (ACL) has been attributed to the use of antimonials for treatment. To determine whether ACL itself causes tubular dysfunction, we measured renal function in 37 patients with ACL prior to their treatment and compared results to that in 10 healthy volunteers of similar mean age. None of the patients presented with glomerular dysfunction; however, 27 had a urinary concentrating defect. There was no statistical difference between groups in the pre- and post-desmopressin test of urine osmolality, but the post-test urine osmolality of the controls was significantly higher. Urinary AQP2 levels, determined by western blot of isolated exosomes, were found to be significantly lower in patients than in controls, whereas that of the cotransporter (NKCC2) was significantly higher. A urinary acidification defect (post-test pH greater than 5.50 following calcium chloride) was found in 15 patients. Pretest plasma bicarbonate was below normal in 12 patients as was the pretest plasma pH in 14. Expression of the Na/H exchanger (NHE3), H(+)-ATPase, and pendrin were all significantly higher in patients with ACL than in controls. A combined urinary concentration and acidification defect was found in 12 patients. Thus, the urinary concentrating defect of ACL may be caused by decreased AQP2, with increased NKCC2 compensatory. Pendrin upregulation may be related to the urinary acidification defect with increased NHE3 and H(+)-ATPase also compensatory. Hence, ACL can cause asymptomatic renal tubular dysfunction.

Predicting hospital mortality in critically ill cancer patients according to acute kidney injury severity.

BACKGROUND: Acute kidney injury (AKI) is a frequent complication in hospitalized patients, especially in those in intensive care units (ICU). The RIFLE classification might be a valid prognostic factor for critically ill cancer patients. The present study aims to evaluate the discriminatory capacity of RIFLE versus other general prognostic scores in predicting hospital mortality in critically ill cancer patients. METHODS: This is a single-center study conducted in a cancer-specialized ICU in Brazil. All of the 288 patients hospitalized from May 2006 to June 2008 were included. RIFLE classification, APACHE II, SOFA, and SAPS II scores were calculated and the area under receiver operating characteristic (AROC) curves and logistic multiple regression were performed using hospital mortality as the outcome. RESULTS: AKI, defined by RIFLE criteria, was observed in 156 (54.2%) patients. The distribution of patients with any degree of AKI was: risk, n = 96 (33.3%); injury, n = 30 (10.4%), and failure, n = 30 (10.4%). Mortality was 13.6% for non-AKI patients, 49% for RIFLE 'R' patients, 62.3% for RIFLE 'I' patients, and 86.8% for RIFLE 'F' patients (p = 0.0006). Logistic regression analysis showed that RIFLE criteria, APACHE II, SOFA, and SAPS II were independent factors for mortality in this population. The discrimination of RIFLE was good (AROC 0.801, 95% CI 0.748-0.854) but inferior compared to those of APACHE II (AROC 0.940, 95% CI 0.915-0.966), SOFA (AROC 0.910, 95% CI 0.876-0.943), and SAPS II (AROC 0.869, 95% CI 0.827-0.912). CONCLUSION: AKI is a frequent complication in ICU patients with cancer. RIFLE was inferior to commonly used prognostic scores for predicting mortality in this cohort of patients.

Renal dysfunction in leprosy: a historical cohort of 923 patients in Brazil.

We investigated the factors associated with renal dysfunction in leprosy patients from Brazil. We report on a historical cohort of leprosy patients followed in two hospitals in Fortaleza City in northeastern Brazil. The factors associated with renal dysfunction were investigated. A total of 923 patients were included, with a mean age of 41.5 ± 19.1 years, and 53.3% were male. Renal dysfunction was found in 35 cases (3.8%). Proteinuria was found in 4.8% of cases, haematuria in 6.8% and leukocyturia in 10.4%. Factors associated with renal dysfunction by multivariate analysis were: reaction episode (odds ratio [OR] = 3.9, P = 0.03), multibacillary classification (OR = 3.5, P = 0.02) and advanced age (OR = 1.04, P = 0.01). Four patients (0.4%) died. Leprosy is associated with renal dysfunction, especially in older patients and those presenting with reaction episode and multibacillary classification.

Predictors of oliguric acute kidney injury in leptospirosis. A retrospective study on 196 consecutive patients.

BACKGROUND: Acute kidney injury (AKI) occurs in 10 to 60% of patients with leptospirosis. The aim of this study is to investigate markers for oliguric AKI in leptospirosis. METHODS: A retrospective study was performed with 196 consecutive patients with leptospirosis-associated AKI. These patients were categorized into either oliguric or non-oliguric according to their urine output. Clinical and laboratory characteristics were compared between the two groups. RESULTS: Among these patients, 64 (32.6%) were oliguric and 132 (67.4%) nonoliguric. Markers for oliguria were age higher than 40 years (OR = 1.02, p = 0.04), hyponatremia (OR = 0.94, p = 0.03), elevated serum creatinine (OR = 1.11, p = 0.04), low arterial pH (OR = 1.0002, p = 0.01), high levels of AST (OR = 1.005, p = 0.01), crackles (OR = 3.83, p < 0.001) and direct bilirubin (OR = 1.03, p = 0.03). Elevated activated prothrombin time (OR = 0.97, p = 0.03) was a factor associated with nonoliguric AKI. Independent markers for oliguria were crackles (OR = 5.17, p = 0.0016) and direct bilirubin levels (OR = 1.051, p = 0.04). Mortality was significantly higher in oliguric than nonoliguric (27 vs. 8%, p < 0.001). Renal function at discharge was similar in oliguric and nonoliguric patients. CONCLUSION: Age higher than 40 years, hyponatremia, elevated serum creatinine, low arterial pH, high levels of AST, crackles and direct bilirubin levels would be useful to early identify patients with oliguric AKI in leptospirosis.

Quality of life assessment among haemodialysis patients in a single centre: a 2-year follow-up.

BACKGROUND: Prospective studies of the effects of long-standing haemodialysis (HD) on quality of life (QOL) show conflicting results. We investigated how QOL progresses over time in HD patients and what factors are associated with this evolution. METHODS: We included chronic HD patients over the age of 18 from a single unit, who had never had transplants and survived the first 3 months of treatment. Ninety-two patients were followed for 2 years, and the SF-36 questionnaire was administered at baseline and every 12 months. Comorbidity was assessed at baseline using the Khan index. We used repeated-measures analysis of variance to establish changes in QOL and stepwise linear regression to identify continuous variables that could explain variations of SF-36 sub-scales. Then, according to the rate of change of QOL, we stratified the sample to identify the association between categorical variables and the evolution of QOL. RESULTS: There was a higher (better) final score related to social functioning (63.8 vs. 75.0; P < 0.01), role-emotional (39.7 vs. 63.1; P < 0.01) and mental health (63.1 vs. 69.0; P < 0.01) in the all-sample analysis, and in two other domains in low-comorbidity patients: physical functioning (56.7 vs. 63.5; P = 0.01) and bodily pain (56.7 vs. 66.5; P < 0.01). Creatinine (r = 0.09; P = 0.04) and age (r = -0.03; P = 0.02) were correlated with the evolution of general health and bodily pain, respectively. There were more women who presented deteriorated physical function than men (50.0 vs. 21.2%; P < 0.01). CONCLUSIONS: There was improvement of QOL mental domains over time. However, the physical aspects improved only in low-comorbidity patients. More women than men worsened regarding physical functioning.

Metabolic acidosis in AIDS patients.

BACKGROUND AND AIMS: Metabolic acidosis (MA) is a frequent and serious complication in HIV-infected patients. The aim of the study is to compare patients with and without MA associated with HIV. METHODS: Patients were retrospectively studied involving all HIV-infected patients with blood gas analysis performed during hospital stay admitted to a single hospital between April 2004 and July 2006. Statistical analysis was performed using SPSS 10.0 for Windows. RESULTS: Included in the study were 159 HIV patients, 72 cases (45.3%) with MA and 87 cases (54.7%) without. The comparison of both groups showed a mean arterial pH of 7.24 +/- 0.08 vs. 7.44 +/- 0.05, HCO(3) 12 +/- 5.7 vs. 21 +/- 5.1 mEq/L, serum urea 81 +/- 68 mg/dL vs. 39 +/- 46 mg/dL and serum creatinine 2.7 +/- 2.6 mg/dL vs. 1.2 +/- 1.9 mg/dL in MA-HIV and non-MA-HIV, respectively (p <0.05). Antiretroviral therapy (ART) was being administered to 38 subjects (52.8%) in MA-HIV group and 45 (51.7%) in non-MA-HIV group (p = 0.57). There was no association between the use of ART and MA. Mortality was higher in patients with acidosis (52.7 vs. 17.2%, p <0.0001). CONCLUSIONS: In the present study, MA was associated with acute kidney injury and increased mortality. There was no association between the use of ART and MA.

Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil.

OBJECTIVE: To investigate the risk factors associated with oliguria and death in obstetric patients with acute kidney injury (AKI). METHODS: The study group included all obstetric patients with AKI, under dialytic treatment, in Hospital Geral César Cals, Fortaleza, Brazil, from January 2000 to December 2006. AKI were classified according to the RIFLE criteria. Univariate and multivariate analysis were performed to investigate the factors associated with oliguria and death. RESULTS: A total of 55 patients were included. Their average age was 26.2 +/- 6.7 years. The main etiologies of AKI were pregnancy-related hypertension (41.8%), HELLP syndrome (40%), puerperal sepsis (14.5%), abruption placentae (9.1%), hemolytic uremic syndrome (9.1%) and thrombotic thrombocytopenic purpura (5.5%). Oliguria was observed in 36 cases (65%). Death occurred in 17 cases (30.9%). Factors associated with oliguria were, diagnosis of HELLP syndrome, hyperbilirubinemia and death. Factors associated with death were, presence of puerperal sepsis, hyperbilirubinemia, hypotension, oliguria and low levels of HCO(3). CONCLUSION: AKI is a rare but potential fatal complication in obstetric patients. RIFLE criteria seem to have association with mortality. There are important factors associated with oliguria and death, which must be prompt recognized to the institution of adequate therapeutic measures.

Posterior reversible encephalopathy syndrome (PRES) induced by cyclosporine use in a patient with collapsing focal glomeruloesclerosis.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by abnormalities in cerebral white matter and neurologic symptoms. It can be caused by immunosuppressive drugs or autoimmune diseases. We describe a case of PRES in a patient with collapsing focal glomeruloesclerosis (collapsing FGS) with complete recovery after withdrawal of cyclosporine (CSA). CASE REPORT: A 27-year-old male presented a corticosteroid-resistant nephrotic syndrome secondary to collapsing FGS corticosteroid. Treatment with CSA was started after a nonresponding course of prednisone. Three weeks later, he developed an abrupt elevation of blood pressure (210/120 mmHg), with headaches, mental confusion, and generalized seizures. Magnetic resonance imaging (MRI) showed lesions suggestive of PRES. CSA was withdrawn, and a new MRI was normal after 2 months. CONCLUSIONS: PRES is a rare syndrome that must be suspected in every patient presenting neurologic symptoms in the course of immunosuppression. It can be induced by CSA and is totally reversible when the drug is rapidly withdrawn.