RESUMEN
Cytomegalovirus remains the most common infection after kidney transplant. We report cytomegalovirus retinitis and anterior uveitis, which developed consecutively within 1 year in a kidney transplant recipient. A 25-year-old man presented 5 months after transplant with decreased visual acuity in his left eye. Fundus examination revealed bilateral areas of necrotizing retinitis with intraretinal hemorrhages. The confirmation of cytomegalovirus disease was based on clinical findings and positive polymerase chain reaction for cytomegalovirus in plasma and in aqueous humor. The patient was treated with intravenous ganciclovir for 21 days and then with valacyclovir for 3 months. The patient's symptoms improved, and fundus examination revealed resolution of retinitis with appearance of retinal scarring. One year later, the patient presented with cytomegalovirus anterior uveitis associated with increased intraocular pressure, which was treated with antiviral agents, antiglaucomatous eye drops, and trabeculectomy. Cytomegalovirus ocular involvement for our immunocompromised patient presented in 2 consecutive forms: bilateral retinitis and anterior uveitis. Early diagnosis and treatment of active cytomegalovirus retinitis and uveitis remain crucial to prevent their progression to irreversible visual impairment.
Asunto(s)
Retinitis por Citomegalovirus/virología , Trasplante de Riñón/efectos adversos , Uveítis Anterior/virología , Adulto , Antivirales/uso terapéutico , Retinitis por Citomegalovirus/diagnóstico , Retinitis por Citomegalovirus/tratamiento farmacológico , Retinitis por Citomegalovirus/inmunología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/virología , Resultado del Tratamiento , Uveítis Anterior/diagnóstico , Uveítis Anterior/tratamiento farmacológico , Uveítis Anterior/inmunologíaRESUMEN
We report a rare case of cytomegalovirus (CMV)-associated ischemic colitis and transverse myelitis (TM) occurring precociously after renal transplantation. A 57-year-old male was transplanted with a cadaveric kidney on 5 June 2009. The patient was CMV seropositive and the donor was seronegative. Transplantation was followed shortly by TM, which resulted in paraplegia. The results of magnetic resonance imaging of the spinal cord showed abnormalities. Twenty days after transplantation, he developed abdominal pain with melena and was diagnosed as having CMV-associated ischemic colitis confirmed by colonoscopy and biopsy. Serological data and identification of the viral genome by polymerase chain reaction were confirmatory for CMV. Treatment consisted of intravenous ganciclovir, followed by polyvalent immunoglobulin. The outcome was favorable. Symptomatic CMV infection is relatively common among the renal transplant population. Early colonoscopy is beneficial for making a quick diagnosis and therefore helps to institute a prompt management of CMV colitis. Myelitis is less common in transplant recipients and diagnosis, therefore, was more difficult.
Asunto(s)
Colitis Isquémica/etiología , Infecciones por Citomegalovirus/etiología , Trasplante de Riñón/efectos adversos , Mielitis Transversa/etiología , Dolor Abdominal/etiología , Antivirales/uso terapéutico , Biopsia , Colitis Isquémica/diagnóstico , Colitis Isquémica/tratamiento farmacológico , Colitis Isquémica/virología , Colonoscopía , Citomegalovirus/genética , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/virología , ADN Viral/análisis , Ganciclovir/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Melena/etiología , Persona de Mediana Edad , Mielitis Transversa/diagnóstico , Mielitis Transversa/tratamiento farmacológico , Mielitis Transversa/virología , Reacción en Cadena de la Polimerasa , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
Severe pre-eclampsia and acute tubular necrosis due to hemorrhagic shock are the major causes of postpartum acute renal failure. Cortical necrosis and haemolytic uraemic syndrome are less frequently. Post-infectious glomerulonephritis as a cause of postpartum acute glomerular disease and renal failure has been rarely reported. We report a patient with postpartum acute glomerulonephritis who presented nephritic syndrome, the diagnosis of which was confirmed by renal biopsy.
Asunto(s)
Lesión Renal Aguda/etiología , Glomerulonefritis/complicaciones , Preeclampsia/patología , Lesión Renal Aguda/diagnóstico , Adulto , Biopsia , Diagnóstico Diferencial , Femenino , Glomerulonefritis/diagnóstico , Humanos , Riñón/patología , Periodo Posparto , Preeclampsia/diagnóstico , EmbarazoRESUMEN
Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major peri-operative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity.
Asunto(s)
Estado de Salud , Trasplante de Riñón , Donadores Vivos , Nefrectomía , Adulto , Anciano , Enfermedades Cardiovasculares/epidemiología , Creatinina/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , TúnezRESUMEN
Gastrointestinal adverse effects are common with mycophenolate mofetil administration, especially diarrhea. We report a case of mycophenolate mofetil-related colitis in a kidney transplant recipient. Colonoscopy revealed an ulcerative diffuse colitis. The colonoscopic biopsy specimen showed mild crypt distortion, accompanied by cryptitis and focal graft-versus-host disease like changes. The patient's symptoms improved after we discontinued the mycophenolate mofetil. A repeat colonoscopy 2 months after we discontinued the mycophenolate mofetil showed reparative changes. Mycophenolate mofetil is an important drug in organ transplant immune-suppression regimens; however, with its widespread use, additional adverse effects continue to be recognized.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Colitis/inducido químicamente , Rechazo de Injerto/tratamiento farmacológico , Trasplante de Riñón , Ácido Micofenólico/análogos & derivados , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Colitis/patología , Diarrea/inducido químicamente , Diarrea/patología , Humanos , Masculino , Ácido Micofenólico/administración & dosificación , Ácido Micofenólico/efectos adversosRESUMEN
Brown tumors (BTs) are relatively uncommon but they are serious complications of renal osteodystrophy. The objective of this study was to analyze the clinical, biological, and radiological characteristics of 16 patients with BTs provoked by secondary hyperparathyroidism (sHPT) and its response to the decrease in parathyroid hormone levels after parathyroidectomy (PTX). The management of that uncommon condition was also reviewed. We conducted a retrospective study including 16 end-stage renal disease patients who underwent subtotal PTX between 1997 and 2007 for severe sHPT with BTs. Our study included 10 men and 6 women, whose average age was 34 years. All patients were on dialysis. Ten of them were on dialysis for more than 5 years. The median duration on dialysis was 84 months. Patients included suffered from swellings associated with functional limitations. BTs had multiple locations in 7 patients. Jaw was the most frequent location (62%). Radiography and tomodensitometry demonstrated a mixed radio lucent and radio-opaque lesions with an expansion of the cortical bone. Bone scan demonstrated an increased uptake of lesions. Chirurgical treatment was indicated in all cases because of severe refractory sHPT with functional limitations and/or disfiguring deformities. In all cases, BTs stopped its progression and even decreased in size. However, it was insufficient in four cases, which required a surgical resection. PTX remains an efficacious approach in resistant cases of sHPT with persistent BTs.
Asunto(s)
Huesos/patología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/complicaciones , Hiperparatiroidismo Secundario/complicaciones , Fallo Renal Crónico/complicaciones , Diálisis Renal/efectos adversos , Adolescente , Adulto , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/terapia , Femenino , Humanos , Hiperparatiroidismo Secundario/cirugía , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Paratiroidectomía , Estudios Retrospectivos , Adulto JovenAsunto(s)
Hipertensión/etiología , Enfermedades Renales Quísticas/cirugía , Procedimientos Quirúrgicos Urológicos , Antihipertensivos/uso terapéutico , Presión Sanguínea , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Enfermedades Renales Quísticas/complicaciones , Enfermedades Renales Quísticas/diagnóstico por imagen , Enfermedades Renales Quísticas/fisiopatología , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: To identify the indications for subtotal parathyroidectomy (PTX) in secondary hyperparathyroidism (SHPT) and report postoperative, early and late complications of PTX. PATIENTS AND METHODS: We conducted a retrospective study of subjects with chronic renal failure operated in Tunisian hospitals who received subtotal PTX over 10 years from January 1997 to December 2007. We analyzed the clinical, biological and radiological parameters pre- and postoperatively. RESULTS: We included 70 patients with average age of 39.4 years, 55.7% men and 44.3% in dialysis for 7.75 ± 4.8 years before PTX. The initial nephropathy was interstitial in 50% of cases. No cases of diabetic nephropathy have been reported. The clinical signs were bone pain (88.6%), muscle pain (85.6%), pruritus (81.4%). Radiological signs of osteitis fibrosa were observed in the majority of patients mainly resorption of extremities (92.9%), thinning of cortical (85.7%) and osteosclerosis (87.1%). The most common indication of PTX (85.7% of cases) was the persistence of serum PTH of more than 800 pg/ml associated with hypercalcemia and/or hyperphosphatemia refractory to medical treatment. A subtotal PTX (3/4 or 7/8) was performed after ultrasound and scintigraphy in the majority of cases. The histology of the parathyroid glands showed diffuse hyperplasia (51.4%), nodular hyperplasia (45.7%) and adenoma (2.8%). The postoperative evolution was marked by an improvement of the clinical and radiological criteria in 80% of cases. A PTH level of less than 15 pg/ml was rarely observed (10% of cases), and a PTH level of more than 300 pg/ml concerned 13% of patients. We noted a low morbidity and mortality (no cases laryngeal paralysis or cervical hematoma). CONCLUSION: Surgical treatment of SHPT in Tunisia is very effective in our experience. The biological results are comparable to treatment with calcimimetics, not available in Tunisia and whose price is higher. An early treatment of disorders of bone and mineral metabolism should reduce the incidence of SHPT.
Asunto(s)
Hiperparatiroidismo Secundario/etiología , Hiperparatiroidismo Secundario/cirugía , Fallo Renal Crónico/complicaciones , Paratiroidectomía , Diálisis Renal/efectos adversos , Adolescente , Adulto , Biomarcadores/sangre , Femenino , Humanos , Hiperparatiroidismo Secundario/sangre , Hiperparatiroidismo Secundario/diagnóstico , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Paratiroidectomía/métodos , Cuidados Posoperatorios , Cuidados Preoperatorios , Estudios Retrospectivos , Resultado del Tratamiento , TúnezRESUMEN
BACKGROUND: Hemolytic uremic syndrome consists of a triad of acquired hemolytic anemia, thrombocytopenia and renal failure. AIM: Our objectives were to determine epidemiology, clinical and laboratory characteristics of patients with atypical hemolytic uremic syndrome (aHUS) to determine the relationship between the complement protein deficit and aHUS in the Tunisian population. METHODS: We studied retrospectively four cases of atypical HUS in adults admitted in the Nephrology Department of Fattouma Bourguiba Universitary Hospital in Monastir between 2000 and 2008. RESULTS: Three patients had renal failure that required dialysis. One of them received kidney transplantation with no further recurrence of aHUS. Three patients had normal C3, C4, CFH, and FB levels, and in all patients anti-FH autoantibodies were absent. The kidney biopsy of one patient showed in addition to lupus glomerulonephritis histological findings consistent with TMA. A decrease in C3, C4 and CFH levels in this patient was found both before and after the cure. CONCLUSION: Nephrologists should be aware of autoimmune conditions and genetic abnormalities of the complement regulatory genes as possible pathogenic mechanisms in atypical HUS patients.
Asunto(s)
Síndrome Hemolítico-Urémico/diagnóstico , Adulto , Proteínas del Sistema Complemento/análisis , Femenino , Síndrome Hemolítico-Urémico/sangre , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , TúnezRESUMEN
A 59-year-old diabetic man was admitted for severe acute renal failure. Clinical signs were compatible with an acute tubular necrosis but no etiology was found. Kidney biopsy showed an osmotic nephrosis. Resumption of interrogatoire reveals consumption of Artemisia herba-alba accused in very few experimental studies to cause a lesion indicative of osmotic nephrosis.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/diagnóstico , Artemisia/efectos adversos , Nefropatías Diabéticas/inducido químicamente , Fitoterapia/efectos adversos , Extractos Vegetales/efectos adversos , Nefropatías Diabéticas/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Fungus ball is rarely associated with acute renal failure (ARF). We report the case of a 65-year-old diabetic patient who has been admitted for a right kidney infection. Urinary exam showed a leucocyturia with a negative urine culture. Ultrasonography showed pelvicaliceal dilation. Nephroscopy revealed a fungal material in ureter. Culture of this material was positive for Candida tropicalis. After endoscopic and antifongic therapy, the serum creatinin decreased from 336 micromol/L to 150 micromol/L, indicating the good evolution of his renal function.
Asunto(s)
Lesión Renal Aguda/etiología , Candida tropicalis , Candidiasis/complicaciones , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/microbiología , Anciano , Femenino , HumanosRESUMEN
Acute renal failure, as the initial manifestation of lymphoma, has been reported only in a few cases. In this work, we report the case of a 28-year-old women admitted for acute renal failure. Her physical examination detected bilateral kidney enlargement. Laboratory evaluation revealed a serum creatinine value 218 micromol/l. A 24-hour urine collection analysis allowed the detection of 1g of protein. No red cells were found after urinanalysis. Renal ultrasound showed massively enlarged kidneys. Renal biopsy of the kidney and pathologic examination showed diffuse infiltration of the interstitium with lymphocytes and atypical cells positive for CD20 markers. A diagnosis of diffuse large B-cell type non-Hodgkin lymphoma was made. However, investigations revealed the presence of two others sites of lymphoma: gastric and ophthalmic. The patient's renal function and kidney size as well as the other lymphoma locations were normalized after the initiation of chemotherapy.
Asunto(s)
Lesión Renal Aguda/etiología , Neoplasias del Ojo/diagnóstico , Neoplasias Renales/diagnóstico , Linfoma de Células B Grandes Difuso/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Antígenos CD20/sangre , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/sangre , Diagnóstico Diferencial , Neoplasias del Ojo/sangre , Neoplasias del Ojo/complicaciones , Neoplasias del Ojo/tratamiento farmacológico , Femenino , Humanos , Neoplasias Renales/sangre , Neoplasias Renales/complicaciones , Neoplasias Renales/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/sangre , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Neoplasias Primarias Múltiples/sangre , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Gástricas/sangre , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/tratamiento farmacológico , Resultado del TratamientoRESUMEN
A 50-year-old woman who was being treated with hemodialysis was admitted for severe neuropsychiatric symptoms. She tested positive for antibody to hepatitis C virus. Her medical history revealed ophthalmic herpes zoster four days before her admission for which she was started on oral acyclovir (800 mg three times daily). Four days later, she became disoriented and agitated. She had visual hallucinations and myoclonus. She was diagnosed as having acyclovir toxicity and was instituted on vigorous dialysis. The serum acyclovir levels normalized and the patient became asymptomatic with three dialysis sessions. Our case further reinforces that the dose of acyclovir should be reduced in patients with renal failure and that dialysis is a good form of treatment for over dosage.