-
Annals of Medicine and Surgery (2012) Nov 2023Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare co-occurrence with systemic sclerosis, in around 2.5-9% of patients. The clinical...
INTRODUCTION AND IMPORTANCE
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare co-occurrence with systemic sclerosis, in around 2.5-9% of patients. The clinical manifestations and prognosis of vasculitis in systemic sclerosis depend on organ involvement. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers get along with purpuric vasculitis in some cases reports. Reports had found that survival in those with pulmonary-renal syndrome is poor. However, high-dose corticosteroids and cyclophosphamide increase the survival percent in those patients.
CASE PRESENTATION
An 81-year-old female was admitted for newly diagnosed acute renal failure and highly elevated C-reactive protein levels. She was diagnosed with systemic sclerosis 8 years previously, with a 3-year history of interstitial lung disease, and a 2-year history of pulmonary hypertension. Treatment included home oxygen on demand, prednisone 5 mg/day, and azathioprine 75 mg daily. On physical examination, she had sclerodactyly, both extremities ulcers, severe livedo reticularis, and hyperpigmented papules on her hand and feet. Laboratory findings included a markedly positive MPO (p-ANCA), and anti-Scl-70. She was treated with pulse methylprednisolone without any improvement. After a day, she developed anuria and became comatose. Then, she developed cardiac arrest, leading to death.
CLINICAL DISCUSSION
The presence of ANCA in systemic sclerosis patients ranges from 2.5 to 9% of systemic sclerosis patients. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers. The treatment with high-dose corticosteroids and cyclophosphamide is benefit. Survival in those with pulmonary-renal syndrome is poor.
CONCLUSION
The presence of ANCA-associated vasculitis is rarely reported with scleroderma. It occurs most commonly in women with limited or Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) variants of scleroderma, as well as those with overlap features. Severe manifestations including pulmonary-renal syndrome and death may occur.
PubMed: 37915665
DOI: 10.1097/MS9.0000000000001347 -
Pediatric Transplantation Aug 2019Anuria from end-stage renal disease leads to a defunctionalized bladder and may pose technical challenges at the time of renal transplantation. Anuria's effect on...
INTRODUCTION
Anuria from end-stage renal disease leads to a defunctionalized bladder and may pose technical challenges at the time of renal transplantation. Anuria's effect on bladder function after renal transplantation is considered to be minimal in adults, although a paucity of evidence is available in children. The purpose of this study was to examine the effects of anuria prior to pediatric renal transplantation for ESRD due to medical renal disease on allograft outcome.
METHODS
We performed a retrospective review of pediatric patients who underwent renal transplantation for medical renal disease at our institution between 2005 and 2016. Demographics and clinical data were assessed. We also compared GFR at 1 year post-transplant for medical renal patients with history of anuria and those without.
RESULTS
Twenty-one patients fulfilled our inclusion criteria with median duration of anuria was 10 months. Preoperative VCUG was available in five patients and their bladder capacity was 29% of expected bladder capacity for age (range 8%-41%). Anticholinergic therapy was prescribed in six patients (28%) for a mean duration of 5 months (range 1-16 months). Comparison of GFR at 1 year post-transplant in anuria group and those without anuria showed no difference (69 vs 75 mL/min, P = 0.37). No correlation was observed between duration of anuria and post-transplant GFR.
CONCLUSION
The majority of children in our pretransplant anuria cohort did not develop bladder dysfunction after renal transplantation. No difference was observed between GFR at 1 year when comparing anuric to non-anuric transplant recipients of medical renal disease etiology.
Topics: Adolescent; Anuria; Child; Female; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Retrospective Studies; Transplantation, Homologous
PubMed: 31066481
DOI: 10.1111/petr.13453 -
Drug and Therapeutics Bulletin Jan 2018Hyperkalaemia is a potentially life-threatening condition, in which there is an abnormally high concentration of potassium ions in the blood. Cation-exchange resins... (Review)
Review
Hyperkalaemia is a potentially life-threatening condition, in which there is an abnormally high concentration of potassium ions in the blood. Cation-exchange resins (e.g. calcium or sodium polystyrene sulfonate) that bind potassium in the gastrointestinal tract to increase faecal elimination have been used as part of the management of hyperkalaemia but they have some serious adverse effects, including potentially fatal gastrointestinal necrosis. Patiromer (▼Veltassa - Vifor Fresenius) is a cation-exchange polymer that is licensed for the treatment of hyperkalaemia in adults and, unlike other exchange resins, its licence is not restricted to people with anuria, severe oliguria or those requiring or undergoing dialysis. Here, we review the evidence for the efficacy and safety of patiromer and consider its place in the management of hyperkalaemia.
Topics: Contraindications, Drug; Drug Interactions; Humans; Hyperkalemia; Polymers
PubMed: 29326277
DOI: 10.1136/dtb.2018.1.0575 -
Open Forum Infectious Diseases Aug 2020Human parvovirus B19 (B19V) causes glomerulopathy or microangiopathy, but not tubulopathy. We experienced an 11-year-old girl with spherocytosis who developed acute...
BACKGROUND
Human parvovirus B19 (B19V) causes glomerulopathy or microangiopathy, but not tubulopathy. We experienced an 11-year-old girl with spherocytosis who developed acute kidney injury on a primary infection of B19V. She presented with anuria, encephalopathy, thrombocytopenia, and coagulopathy, along with no apparent aplastic crisis.
METHODS
Continuous hemodiafiltration, immunoglobulin, and intensive therapies led to a cure.
RESULTS
A kidney biopsy resulted in a histopathological diagnosis of tubulointerstitial nephritis without immune deposits. The virus capsid protein was limitedly expressed in the tubular epithelial cells with infiltrating CD8-positive cells.
CONCLUSIONS
Viral and histopathological analyses first demonstrated B19-infected tubulointerstitial nephritis due to the aberrant viremia with hereditary spherocytosis.
PubMed: 32760751
DOI: 10.1093/ofid/ofaa288 -
Experimental and Clinical... Jun 2023This study was devised to investigate papal deaths due to acute kidney injury, a topic for which scarce data exist. (Review)
Review
OBJECTIVES
This study was devised to investigate papal deaths due to acute kidney injury, a topic for which scarce data exist.
MATERIALS AND METHODS
We studied all popes between John XXI, who died in 1277 of crush syndrome, and John Paul II, who died of anuria and urinary sepsis in 2005.
RESULTS
Between pontification years from 1277 to 2005, 21 of 78 popes (26.9%) died of acute kidney injury. Sepsis was identified as the leading cause of acute kidney injury and death in 20 of 21 popes (95.2%). Mean ± SE age at death of the 21 popes was 69.4 ± 2.26 years. Six popes (28.6%) died of stroke.
CONCLUSIONS
Sepsis-associated acute kidney injury, a syndrome with a complex pathogenesis and poor prognosis, which is far from being fully understood, contributed to a high number of papal deaths.
Topics: Humans; Aged; Acute Kidney Injury; Sepsis; Anuria
PubMed: 37496352
DOI: 10.6002/ect.IAHNCongress.20 -
Current Opinion in Nephrology and... Nov 2018To summarize the findings of recent trials and meta-analyses designed to determine whether bioimpedance spectroscopy adds value to the clinical assessment of fluid... (Review)
Review
PURPOSE OF REVIEW
To summarize the findings of recent trials and meta-analyses designed to determine whether bioimpedance spectroscopy adds value to the clinical assessment of fluid status in dialysis patients so as to achieve a normally hydrated weight and put these in a contemporary context.
RECENT FINDINGS
Eight trials (published 2010-2018) and two meta-analyses (2017) are reviewed. Both haemodialysis and peritoneal dialysis modalities are represented. Despite considerable heterogeneity in intervention, all are open-label randomized comparisons of a bioimpedance intervention with normal clinical practice in which clinicians were blinded to bioimpedance data. In a total of 1443 patients studied, no significant differences in mortality, cardiovascular or adverse events between groups were observed. Bioimpedance use was associated with a reduction in overhydration, especially when residual kidney function was not present and a greater reduction in blood pressure. A modest correlation in the change in fluid status and fall in systolic blood pressure was seen compared to baseline. A more rapid fall in urine volume was seen in the two studies with the greatest change in fluid status, with significantly higher risk of anuria in one. How bioimpedance was integrated with the complex process of decision making by clinicians was variable and not always explained.
SUMMARY
The usefulness of bioimpedance spectroscopy in guiding fluid management in dialysis patients is not yet clear. Bioimpedance can drive clinical decisions that lead to significant changes in fluid status but the best way to apply this in clinical practice requires further studies.
Topics: Electric Impedance; Fluid Therapy; Humans; Kidney Diseases; Meta-Analysis as Topic; Renal Dialysis; Spectrum Analysis
PubMed: 30063488
DOI: 10.1097/MNH.0000000000000445 -
Clinical, ultrasonographic, and postmortem findings in sheep and goats with urinary tract disorders.Veterinary World Jul 2021In sheep and goats, most urinary disorders are incidental findings at the postmortem examination and do not present clinically. As such, the diagnosis of renal diseases...
BACKGROUND AND AIM
In sheep and goats, most urinary disorders are incidental findings at the postmortem examination and do not present clinically. As such, the diagnosis of renal diseases in sheep and goats can be overlooked. Therefore, this study was carried out on sheep and goats to describe the clinical, ultrasonography(USG), and postmortem findings of various disorders affecting the urinary tract.
MATERIALS AND METHODS
A total of 58 animals (30 sheep and 28 goats) were examined, as well as were ten healthy control animals (five sheep and five goats) for a comparison. The animals were referred for various causes, including anorexia, frequent and painful urination, hematuria, decreased body weight, oliguria, and anuria.
RESULTS
The sheep and goats were categorized into ten groups of symptoms and disorders: Pelvic abscessation, pigmented urine, renal failure, pyelonephritis, cystitis, hydronephrosis, rupture of the urethra, rupture of the urinary bladder, rupture of the urinary bladder together with the urethra, and paralysis of the urinary bladder. Clinical presentation, USG, and postmortem examination results for each group were detailed. Many clinical presentations were nonspecific. USG examination of the urinary tract significantly facilitated the verification of the previously mentioned disorders.
CONCLUSION
USG demonstrated superior performance in the early and confirmatory diagnosis of urinary disorders in sheep and goats. Therefore, it is recommended that routine USG be the preferred imaging modality for examining sheep and goats with urinary disorders and for determining their prognosis.
PubMed: 34475712
DOI: 10.14202/vetworld.2021.1879-1887 -
Acta Physiologica (Oxford, England) Apr 2015Despite data showing that inhibitors of the renin-angiotensin system increase the risks of fetal morbidity and dysfunctionality later in life, their use during pregnancy... (Review)
Review
Despite data showing that inhibitors of the renin-angiotensin system increase the risks of fetal morbidity and dysfunctionality later in life, their use during pregnancy has increased. The fetopathy induced by angiotensin converting enzyme (ACE) inhibitors is characterized by anuria, hypotension and growth restriction, but can also be associated with pulmonary hypoplasia. In the kidney, this fetopathy includes atrophy of the medulla, reduced number of glomeruli, developmental lesions of tubules and vessels, tubulointerstitial inflammation and extracellular matrix accumulation. Although angiotensin II (Ang II) inhibition during nephrogenesis interferes with normal growth and development, this review will focus on effects of the heavily accumulated matrix component hyaluronan (HA). An important mechanism of HA accumulation during nephrogenesis is disruption of its normal reduction as a consequence of lack of Ang II activation of hyaluronidase. Hyaluronan has very large water-attracting properties and is pro-inflammatory when fragmented. The ensuing inflammation and interstitial oedema affect kidney function. Hyaluronan is colocalized with CD44 overexpression and infiltrating immune cells. These properties make HA a plausible contributor to the observed structural and functional kidney defects associated with the fetopathy. Available data support an involvement of HA in kidney dysfunction of the foetus and during adulthood due to the physico-chemical characteristics of HA. No clinical treatment for HA accumulation exists. Treatment with the HA-degrading enzyme hyaluronidase and an HA synthesis inhibitor has been tested successfully in experimental models in the kidney, heart and pancreas. Reduced HA accumulation to reduce interstitial oedema and inflammation may improve organ function, but this concept needs to be tested in a controlled study before causal relationships can be established.
Topics: Angiotensin-Converting Enzyme Inhibitors; Female; Fetal Diseases; Humans; Hyaluronic Acid; Kidney; Kidney Diseases; Pregnancy
PubMed: 25600777
DOI: 10.1111/apha.12456 -
Inflammopharmacology Feb 2022A novel coronavirus disease (COVID-19), caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was discovered in Wuhan, China, in December 2019, and... (Review)
Review
A novel coronavirus disease (COVID-19), caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was discovered in Wuhan, China, in December 2019, and the world has suffered from a pandemic. As of 22nd March 2020, at least 185 countries worldwide had been affected by COVID-19. SARS-CoV-2, leading to COVID-19 pneumonia, infects cells through ACE-2 receptors. The disease has different clinical signs and symptoms, including chills, high fever, dyspnea, and cough. Other symptoms including haemoptysis, myalgia, diarrhoea, expectoration, and fatigue may also occur. The rapid rise in confirmation cases is severe in preventing and controlling COVID-19. In this review, the article will explore and evaluate the insights into how COVID influences patients with other comorbid conditions such as cardiovascular disease, diabetes, Parkinson's, and how conditions Urolithiasis, anosmia, and anuria may develop after infection. The virus mutates and the variants are now prevalent in the present scenario where the world stands in eradicating the pandemic by looking into the development of vaccines by several countries and how the vaccination can temporarily help prevent COVID spread.
Topics: Humans; Pandemics; Renin-Angiotensin System; SARS-CoV-2; Vaccination; COVID-19 Drug Treatment
PubMed: 34981320
DOI: 10.1007/s10787-021-00904-w -
Nephrologie & Therapeutique Jun 2022The overall objective of the study was to determine the prevalence of acute renal failure due to bladder tumors by describing the clinical, paraclinical, therapeutic,...
OBJECTIVES
The overall objective of the study was to determine the prevalence of acute renal failure due to bladder tumors by describing the clinical, paraclinical, therapeutic, histological and clinical evolution parameters.
MATERIALS AND METHODS
Retrospective study over a period of 2 years dating from the first of September 2017 to the 31 of October 2019 on a number of patients with acute renal failure due to bladder tumors treated at the department of urology in the Ibn Roch teaching Hospital in Casablanca.
RESULTS
In a series of 597 cases of bladder tumors, the prevalence of acute renal failure was 17.8%. The mean age was 69.5 years [51-88], with a male predominance (97%). The main clinical signs were hematuria (87%), lower back pain (62%), oligo-anuria (31%) and acute urine retention (12%). The mean serum creatinine on admission was 1316μmol/L (extremes: 155-2477) and The mean serum urea was 2.4g/L (0.8-4). Renal ultrasound showed hydronephrosis in 96% of cases, which was bilateral in 69% of cases. Hemodialysis was indicated in 23.6% of the cases, due to hyperkalemia (14.1%), metabolic acidosis (6.6%) and acute pulmonary oedema in (2.8%). Percutaneous nephrostomy was performed in 77% of cases, bladder catheterization in 21% of cases and double J-stenting in 2% of cases. As to the treatment of bladder tumors, endoscopic trans-urethral bladder resection was the main treatment and was performed in (71%) of cases. Meanwhile, 21% of the patients benefited from a cystoprostatectomy and combined radio-chemotherapy was indicated in 9% of cases. The main histological finding was transitional cell carcinoma (98%). The evolution of renal function was favorable in 87% of cases.
CONCLUSION
Acute renal failure is a frequent and severe complication of bladder tumors that can be life-threatening and makes it difficult to treat bladder tumors requiring multidisciplinary management.
Topics: Acute Kidney Injury; Aged; Anuria; Female; Humans; Male; Retrospective Studies; Urinary Bladder Neoplasms; Urology
PubMed: 35181289
DOI: 10.1016/j.nephro.2021.10.005