RESUMEN
We present a case of a 64-year-old man, a kidney transplant recipient with acute pyelonephritis and acute graft deterioration. He was diagnosed with Actinobaculum schaalii infection in urine cultures. He was treated with antibiotics for 3 weeks and recovered well. The case describes an unusual pathogenic infection in a kidney transplant patient.
Asunto(s)
Actinomycetaceae/aislamiento & purificación , Infecciones por Actinomycetales/microbiología , Trasplante de Riñón/efectos adversos , Pielonefritis/microbiología , Infecciones Urinarias/microbiología , Infecciones por Actinomycetales/diagnóstico , Infecciones por Actinomycetales/tratamiento farmacológico , Antibacterianos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Pielonefritis/diagnóstico , Pielonefritis/tratamiento farmacológico , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Orina/microbiologíaRESUMEN
A retrospective analysis of 584 cases of acute poisoning admitted with a medical emergency to the Department of Medicine, GTB Hospital, Delhi, over a three-year period. The patients were analysed with respect to the age, sex, mode of poisoning, type of poison consumed and mortality. Of these, 42.63% were aged 20-30 years. Poisoning was used as a suicidal agent by 63.8% of the patients. The nature of the poison could not be ascertained in 15.92% of patients. Sedatives were involved in 13.36%. Aluminium phosphide poisoning was found in 11.82%. The overall mortality was estimated to be 13.18% with 53.2% being caused by the consumption of aluminium phosphide. There has been a change in the nature of poisons consumed and the number of cases of aluminium phosphide poisoning is declining. However, aluminium phosphide poisoning still remains a major threat as it carries a high mortality rate.
Asunto(s)
Hospitalización/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Intoxicación/epidemiología , Intoxicación/etiología , Enfermedad Aguda , Adolescente , Adulto , Compuestos de Aluminio/envenenamiento , Femenino , Humanos , Hipnóticos y Sedantes/envenenamiento , India/epidemiología , Masculino , Persona de Mediana Edad , Fosfinas/envenenamiento , Intoxicación/mortalidad , Intoxicación/prevención & control , Estudios Retrospectivos , Adulto JovenRESUMEN
AIM: Interaction of patient in marital dyad may have bearing on long-term patient outcome. Depression, subjective stress, and marital discord have been reported in healthy spouses of patients with end-stage renal disease (ESRD). Depressed patients on dialysis along with their spouses can function as depressed dyad. We looked at the incidence and factors associated with depression and marital stress among Indian hemodialysis patients and their spouses. METHODS: A total of 49 (32 males, 17 females) patients on maintenance hemodialysis and their spouses were independently administered Beck Depression Inventory (BDI), Revised Dyadic Adjustment Scale, and self-rated subjective quality-of-life scale. Their demographic parameters, socioeconomic status, and type of family (nuclear or joint) were also noted. RESULTS: About 57.1% of patients were depressed compared with 42.8% of spouses (p = 0.133). In both patients and spouses, BDI correlated with quality of life and perceived marital stress. About 36.7% of patients and 24.4% of spouses reported marital stress (p = 0.69). Male spouses had more marital stress compared with female spouses (p < 0.0001). Depression and marital stress in patients and spouses was not associated with socioeconomic status, literacy levels, and employment. Depression in patients had direct correlation with depression in spouse (r = 0.572, p < 0.0001) and degree of marital dissatisfaction in spouse (r = 0.623, p < 0.0001). Patients living in nuclear family were more depressed and had more marital stress. CONCLUSION: Married ESRD patients and their spouses function as a complex psychosocial dyad with significant two-way interactions. Social support, as is seen in joint families, leads to significantly lesser depression and better marital understanding.
Asunto(s)
Adaptación Psicológica , Depresión/epidemiología , Fallo Renal Crónico/terapia , Estado Civil , Satisfacción Personal , Diálisis Renal/psicología , Esposos/psicología , Adulto , Estudios Transversales , Depresión/etiología , Depresión/psicología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , India/epidemiología , Estado de Ejecución de Karnofsky , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/psicología , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
Heroin exposure can cause various complications like seizures, stroke, spongiform encephalopathy, transverse myelopathy, plexopathy, compartment syndrome, rhabdomyolysis and renal failure due to various mechanisms. We report here a young male who smoked heroin for the first time and developed transverse myelitis, rhabdomyolysis and acute kidney injury requiring dialysis. His renal recovery was complete by four weeks, while neurological improvement occurred 8 to 12 weeks later. This case suggests a common pathogenic mechanism of heroin intoxication involving multiple systems of the body.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Heroína/efectos adversos , Mielitis Transversa/inducido químicamente , Narcóticos/efectos adversos , Rabdomiólisis/inducido químicamente , Adulto , Heroína/administración & dosificación , Humanos , Inhalación , Imagen por Resonancia Magnética , Masculino , Mielitis Transversa/diagnóstico , Narcóticos/administración & dosificaciónRESUMEN
The cases of hemolytic uremic syndrome (HUS) preceeded by diarrhea are commonly labeled as D+ HUS. However, with severe renal failure or with delayed recovery, such cases should be evaluated for rarer associations like Factor H (FH), I and CD 46 deficiency or mutations. We report such a presentation of a young boy who initially came with diarrhea and had features of HUS with delayed renal recovery. He later turned out to have anti-FH antibody-related HUS.
Asunto(s)
Factor H de Complemento/inmunología , Diarrea/complicaciones , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/inmunología , Adolescente , Síndrome Hemolítico Urémico Atípico , Factor H de Complemento/genética , Diarrea/inmunología , Síndrome Hemolítico-Urémico/diagnóstico , Humanos , MasculinoRESUMEN
AIM: Oxidative stress (OS) and endothelial dysfunction are implicated in accelerated atherosclerosis in chronic kidney disease (CKD). We assessed endothelial function, OS, and carotid intimal medial thickness (CIMT) and their correlates in 44 CKD stage 5 patients (group III) before and after hemodialysis (HD), 40 patients of CKD stages 3 and 4 (group II), and 25 matched controls (group I). METHODS: OS was measured by serum concentration of antioxidants; vitamin C and fractional reducing ability of plasma (FRAP) and pro-oxidant; thiobarbituric acid reactive substances (TBARS). Ultrasonography of carotid artery for CIMT and of brachial artery for flow-mediated dilatation (endothelium-dependent dilatation, EDD) was done. RESULTS: TBARS increased significantly with severity of CKD. Antioxidants FRAP and vitamin C were significantly lower in CKD patients as compared with controls, but there was no significant difference between groups II and III. EDD decreased significantly with severity of CKD, whereas CIMT though higher in CKD patients as compared with controls was not significantly different between groups II and III. After a session of HD as compared with predialysis, levels of TBARS decreased, whereas those of FRAP, vitamin C, and EDD increased. On multivariate analysis, there was negative correlation of TBARS with glomerular filtration rate (GFR), serum albumin, hemoglobin, and EDD. Vitamin C had positive correlations with GFR, serum albumin, hemoglobin, and EDD. EDD had direct correlation with GFR, whereas CIMT correlated negatively with EDD. CONCLUSIONS: Endothelial dysfunction and OS occur early in CKD, are closely related to each other and structural atherosclerosis, and are proportional to decline in GFR.
Asunto(s)
Endotelio Vascular/fisiopatología , Estrés Oxidativo , Insuficiencia Renal Crónica/metabolismo , Adulto , Antioxidantes/metabolismo , Arterias Carótidas/diagnóstico por imagen , Endotelio Vascular/diagnóstico por imagen , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Oxidantes/sangre , Diálisis Renal , Insuficiencia Renal Crónica/diagnóstico por imagen , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia , Ultrasonografía , VasodilataciónAsunto(s)
Glomeruloesclerosis Focal y Segmentaria/complicaciones , Síndrome de Marfan/complicaciones , Adolescente , Corticoesteroides/uso terapéutico , Antihipertensivos/uso terapéutico , Fibrilinas , Estudios de Seguimiento , Glomeruloesclerosis Focal y Segmentaria/tratamiento farmacológico , Humanos , Losartán/uso terapéutico , Masculino , Síndrome de Marfan/tratamiento farmacológico , Síndrome de Marfan/genética , Proteínas de Microfilamentos/genética , Ramipril/uso terapéuticoRESUMEN
Dengue virus infection can clinically manifest as dengue fever, dengue shock syndrome and dengue hemorrhagic fever. Acute kidney injury as a result of dengue virus infection can occur due to various reasons including hypotension, rhabdomyolysis, sepsis and rarely immune complex mediated glomerular injury. However, glomerulonephritis associated with IgA Nephropathy in dengue virus infection has not been reported previously. We report a case of 15-year-old boy who was admitted with dengue fever and dialysis dependant acute kidney injury. Urine examination showed microscopic glomerular hematuria and proteinuria. Kidney biopsy showed mesangial proliferation with mesangial IgA dominant immune complex deposits and acute tubular necrosis. A repeated kidney biopsy 6 weeks after clinical recovery showed reversal of glomerular changes as well as resolution of mesangial IgA deposits.
Asunto(s)
Dengue/complicaciones , Glomerulonefritis por IGA/virología , Glomerulonefritis Membranoproliferativa/virología , Necrosis de la Corteza Renal/virología , Enfermedad Aguda , Adolescente , Antiinfecciosos/uso terapéutico , Biopsia , Dengue/diagnóstico , Dengue/inmunología , Dengue/terapia , Técnica del Anticuerpo Fluorescente , Glomerulonefritis por IGA/diagnóstico , Glomerulonefritis por IGA/inmunología , Glomerulonefritis por IGA/terapia , Glomerulonefritis Membranoproliferativa/diagnóstico , Glomerulonefritis Membranoproliferativa/inmunología , Glomerulonefritis Membranoproliferativa/terapia , Hematuria/virología , Humanos , Necrosis de la Corteza Renal/diagnóstico , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/terapia , Glomérulos Renales/patología , Masculino , Proteinuria/virología , Diálisis Renal , Resultado del Tratamiento , Orina/química , Orina/citologíaAsunto(s)
Neoplasias Renales/diagnóstico , Riñón/patología , Linfoma/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biopsia , Quimioterapia Adyuvante , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Resultado Fatal , Humanos , Riñón/cirugía , Neoplasias Renales/terapia , Linfoma/terapia , Masculino , Nefrectomía , Prednisolona/administración & dosificación , Resultado del Tratamiento , Vincristina/administración & dosificaciónAsunto(s)
Hiperpotasemia/etiología , Enfermedades Renales/terapia , Diálisis Renal , Taquicardia/etiología , Gluconato de Calcio/uso terapéutico , Enfermedad Crónica , Electrocardiografía , Humanos , Hiperpotasemia/terapia , Enfermedades Renales/complicaciones , Masculino , Taquicardia/diagnóstico , Taquicardia/terapia , Resultado del Tratamiento , Adulto JovenAsunto(s)
Derivación Arteriovenosa Quirúrgica , Implantación de Prótesis Vascular , Diálisis Renal , Extremidad Superior/irrigación sanguínea , Derivación Arteriovenosa Quirúrgica/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia , Humanos , Proyectos Piloto , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Embolia Pulmonar/tratamiento farmacológico , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Diagnóstico Diferencial , Ecocardiografía , Fibrinolíticos/administración & dosificación , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Masculino , Embolia Pulmonar/diagnóstico , Índice de Severidad de la Enfermedad , Tenecteplasa , Tomografía Computarizada por Rayos XRESUMEN
Renal involvement in leprosy has been reported rarely in the literature. Acute kidney injury in patients with leprosy is uncommon and may occur due to acute tubular necrosis, drug-induced interstitial nephritis and rarely crescentic glomerulonephritis. The latter with histologic confirmation of the diagnosis has been reported in very few cases of leprosy. A 25-year-old male, on therapy for multibacillary leprosy, was found to have deranged renal functions on evaluation for a history of nausea, vomiting, swelling and episode of haematuria. Kidney biopsy was performed twice over a period of 2 weeks, showing progression from diffuse proliferative glomerulonephritis to crescentic glomerulonephritis, pauci-immune in nature. The patient was treated aggressively with intravenous steroids, following which his renal functions stabilized. Crescentic glomerulonephritis, an extremely rare phenomenon in leprosy, should be considered in these patients presenting with features of acute kidney injury. Timely performed renal biopsy assists in accurate diagnosis and appropriate management of the patient, hence preserving renal parenchyma. Rapid progression from diffuse proliferative glomerulonephritis to crescentic glomerulonephritis in a patient with leprosy is described herein for the first time in the literature.