Mitomycin-associated renal failure. Case report and review.

Renal failure due to mitomycin chemotherapy is a poorly appreciated entity often associated with microangiopathic hemolytic anemia. We describe a 45-year-old man in whom renal failure and anemia developed, without evidence of hemolysis, five months after beginning chemotherapy with mitomycin, fluorouracil, and doxorubicin hydrochloride. A biopsy specimen taken from the patient's kidney showed fibrin thrombi in two of 18 glomeruli and in several small arteries. The patient's condition required institution of maintenance dialysis. Similar reports from the literature are reviewed.

Coccidioidal meningitis diagnosed by skin biopsy.

We present a patient with coccidioidal meningitis whose diagnosis was not confirmed until a skin biopsy was performed. Because he lived in an area where coccidioidomycosis is not endemic, his meningitis was at first attributed to tuberculosis or sarcoidosis. After a verrucous lesion from the face was biopsied and the diagnosis substantiated, the patient responded well to consolidation therapy consisting of intrathecal amphotericin B and oral ketoconazole.

Hyperthyroidism in end-stage renal disease.

We report the 2nd patient to have hyperthyroidism while on maintenance hemodialysis. This case is instructive because the diagnosis of hyperthyroidism in uremic patients is difficult due to similar signs and symptoms. This case report describes, for the first time, the unique interaction between hemodialysis and thyrotoxic heart disease. Paroxysmal atrial fibrillation and severe hypotension interfered with all hemodialyses. Only the correction of the hyperthyroid state and withdrawal of all beta-blocking agents allowed resumption of normal hemodialysis. The delayed gastric emptying and hypercalcemia ultimately resolved with return to the euthyroid state and did not recur during 10 months of follow-up.

Serum potassium concentrations in cyclosporine- and azathioprine-treated renal transplant patients.

Hyperkalemia was commonly observed in successful renal transplant patients treated with cyclosporine and prednisone. At 1, 3 and 6 months after transplantation, 13 of 50, 9 of 50, and 5 of 50 patients, respectively, had serum concentrations of potassium greater than 5 mEq/1. This contrasts with the finding of hyperkalemia in only 1 of 13 comparable patients treated with azathioprine and prednisone. Mean serum concentrations of potassium at these dates were significantly higher in cyclosporine-treated patients than azathioprine-treated patients. The 2 patient groups had similar mean serum concentrations of chloride, bicarbonate and creatinine, and mean creatinine clearances at 1 and 3 months. Exposure to diuretic agents and antihypertensive agents was similar in the 2 groups. Serum concentrations of electrolytes and renal function data in hyperkalemic and normokalemic transplant patients receiving cyclosporine were similar. These observations suggest an association between cyclosporine administration and hyperkalemia in renal transplant recipients.