Hypersensitivity to salicylazosulfapyridine: renal and hepatic toxic reactions.

Salicylazosulfapyridine has been used for a number of years as therapy for ulcerative colitis. Reported toxicities are usually minor. This case report represents an acute allergic reaction to the drug. Characterized by fever, rash, eosinophilia, nephritis, and hepatitis. Resolution occurred with discontinuation of salicylazosulfapyridine. Although similar reactions have been reported with the antimicrobial sulfonamides, none has been fully described with salicylazosulfapyridine, a combination of a sulfonamide and salicylate.

Clinical analgesic nephropathy.

Analgesic nephropathy is recognized worldwide, but the differences in incidence in various countries, or regions, remain unexplained. Analgesic compounds may cause both functional and structural renal damage. This damage may be related to depletion of glutathione and renal vasoconstriction (probably mediated through prostaglandin depletion) and to the fact that the concentrations of glutathione and prostaglandins and their metabolites in the kidneys are manyfold their concentrations in plasma. Most patients with analgesic nephropathy are middle-aged women with histories of peptic ulcer, anemia, psychiatric disorders, headaches, and arthralgias. Investigations often show pyuria, some bacteriuria, and impaired concentrating ability, as well as other abnormalities of tubular function; caliceal abnormalities on intravenous pyelography are also frequent. It is important to discover these patients; evidence exists that with cessation of drug ingestion, renal function may stabilize and, in some cases, may improve.

Analgesic nephropathy. An uncommon cause of end-stage renal disease.

The frequency of analgesic nephropathy as a cause of end-stage renal disease varies considerably, not only between countries but also between different areas in the same country. We questioned 277 hemodialysis patients in the Washington, DC, area regarding the consumption of analgesic preparations. Only eight (2.8%) of the patients consumed excessive quantities of analgesic compounds prior to institution of hemodialysis. In addition, three of the eight patients had other causes for their end-stage renal disease. We conclude that analgesic nephropathy is an unusual cause of end-stage renal disease in the greater Washington, DC, area.

Hemodialysis in the eighth and ninth decades of life.

In a review of 45 patients who started receiving hemodialysis (HD) after the age of 70 years (mean, 75 years), compared with a control of 70 HD patients (mean age, 42 years), the two-year survival for elderly patients was 42% and 58% for controls. In the elderly group, age did not correlate with survival. Nine elderly patients were over 80 years old and had a two-year survival of 41%. The elderly patients had a significantly lower mean predialysis blood pressure (BP) (142/73 +/- 3/1 mm Hg) than the controls (158/88 +/- 2/1 mm Hg) (P less than .001). Only 13% of the elderly patients received antihypertensive medication, compared with 41% of controls (P less than .01). The BP showed a significant negative correlation with age in both elderly ( r - .41, P less than .01) and control (r = .35, P less than .001) patients. Glomerulonephritis was less common in the elderly (9%) than control (31%) groups, and pyelonephritis was more common (29% vs 16%).

Extracorporeal treatment of salicylate or acetaminophen poisoning--is there a role?

Hemodialysis or sorbent hemoperfusion has been used in the management of clinical overdose of salicylates or acetaminophen. Hemodialysis offers considerable benefit in severe salicylate poisoning and is preferred to hemoperfusion or peritoneal dialysis, since it more rapidly corrects acid-base and electrolyte abnormalities than does hemoperfusion, and since it is clearly more efficient than is peritoneal dialysis for the removal of salicylates. Charcoal hemoperfusion in animal studies and hemodialysis in man have been shown to accelerate acetaminophen elimination from the body. Hemodialysis and hemoperfusion are of questionable benefit in clinical acetaminophen overdose. However, our clinical experience to date with charcoal hemoperfusion in "late" acetaminophen overdose has been associated with a less notable increase in liver enzyme concentrations in comparison with results of retrospective studies of series of patients treated or not treated with sulfhydryl donors.

How end-stage renal disease (ESRD)-Medicare developed.

Uremia is a chemical, toxic, potentially fatal condition. In a variable pattern, uremia ultimately kills almost every cell in the body. Uremia is produced by hundreds of diseases, both kidney and systemic (e.g., diabetes). These kinds of uremic conditions range from the acute and catastrophic to the slowly and moderately progressive. Humans and medicine have struggled at least since Hippocrates to understand, prevent and treat uremia and thereby prolong the useful lives of the young and the aging. Accelerated by the spectacle of premature uremic deaths from crush syndrome, shock, and forms of nephritis during major wars and disasters, medicine fused clinical and basic science with industrial technology and came up with two effective treatments. Dialysis in several modes and kidney transplantation became feasible but proved complex and expensive. How people, struggling to survive, were able to use a representative form of government to treat all kidney patients, forms a human story: A "people" story. Since it culminated within a single medical generation, it is possible to tell the story as a participant and eye-witness. This is how the medical, social and national organization of substitution therapy for uremia evolved. Since it is legislatively called end-stage renal disease, we titled the entitlement, "How ESRD-Medicare Developed."

Alport's syndrome representing as crescentic glomerulonephritis: a report of two siblings.

Hereditary nephritis is a disease presenting with hematuria, proteinuria, and systemic findings including ocular lesions and deafness. Renal failure frequently occurs in males who have the disease at a young age. We report the case of a female with hereditary nephritis who presented with the classic clinical and pathologic features of crescentic glomerulonephritis post-pregnancy. A sibling also had a comparable course. It is proposed that crescentic glomerulonephritis may be a heretofore unreported presentation of hereditary nephritis with terminal renal failure.

Pericardial effusion associated with minoxidil therapy in dialyzed patients.

Pericardial effusion, diagnosed clinically or by echocardiography, was found in 13 of 16 regularly dialyzed patients (81%) receiving minoxidil for refractory hypertension. In a comparable group of 125 patients not receiving minoxidil, 28 patients (23%) had evidence of pericardial effusion, the difference between the groups being highly significant (p less than 0.0005). In minoxidil treated patients, the effusions resolved spontaneously in 4 (3 remaining on treatment), required pericardiocentesis (3), or pericardiectomy (1), and persisted in 4 (3 remaining on treatment). It is suggested that minoxidil treated dialysis patients be regulary examined for the development of potentially threatening pericardial effusions.