Asunto(s)
Colon/patología , Lantano/efectos adversos , Pelvis/diagnóstico por imagen , Diálisis Renal/efectos adversos , Úlcera/etiología , Anciano de 80 o más Años , Calcifilaxia/diagnóstico , Carcinoma/cirugía , Colectomía , Colon/efectos de los fármacos , Neoplasias del Colon/cirugía , Diagnóstico Diferencial , Humanos , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/patología , Masculino , Olécranon/cirugía , Pelvis/patología , Neoplasias de la Próstata/cirugía , Radiografía , Fracturas del Cúbito/cirugía , Extremidad Superior/patología , Pérdida de PesoRESUMEN
A 42-year-old man was transferred to the Emergency Department after his friends had found him unresponsive and confused in his room. He had been experiencing upper abdominal complaints for a period of several months. He had taken large amounts of a calcium carbonate/magnesium subcarbonate preparation (Rennie) and had consumed at least 3 litres of dairy products per day. His behaviour was reported as being more and more abnormal during the previous few weeks. On admission he was confused and agitated and had involuntary movements of his limbs. Laboratory investigation indicated a triple acid base disorder, i.e. metabolic alkalosis, respiratory alkalosis and high anion gap metabolic acidosis, with severe dehydration. The metabolic alkalosis was caused by the intake of large amounts of dairy and antacids: milk-alkali syndrome. The metabolic acidosis was the result of hypovolaemia and pre-renal renal failure and the respiratory alkalosis was caused by hyperventilation due to the organic psychosyndrome. The patient was treated with volume expansion by isotonic saline and the administration of potassium and he was sedated with low-dose midazolam, which led to a full respiratory compensation of the metabolic alkalosis. A few days following admission, both the plasma calcium concentration and renal function returned to normal; the acid-base disorder completely normalized and the organic psychosyndrome disappeared. On gastroduodenoscopy a gastric ulcer was found; biopsies revealed a signet ring cell adenocarcinoma of the stomach.
Asunto(s)
Acidosis/diagnóstico , Alcalosis/diagnóstico , Antiácidos/efectos adversos , Carcinoma de Células en Anillo de Sello/diagnóstico , Deshidratación/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Alcalosis/etiología , Alcalosis Respiratoria/diagnóstico , Alcalosis Respiratoria/etiología , Animales , Carbonato de Calcio/efectos adversos , Carcinoma de Células en Anillo de Sello/patología , Productos Lácteos/efectos adversos , Deshidratación/etiología , Humanos , Hipovolemia/complicaciones , Óxido de Magnesio/efectos adversos , Masculino , Leche/efectos adversos , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is associated with progressive loss of renal function and is one of the most important causes of renal failure in the elderly. Current treatment includes restoration of the renal arterial lumen by endovascular stent placement. However, this treatment only affects damage caused by ARAS due to the stenosis and ensuing post-stenotic ischemia. ARAS patients have severe general vascular disease. Atherosclerosis and hypertension can also damage the kidney parenchyma causing renal failure. Medical treatment focuses on the latter. Lipid-lowering drugs (statins) could reduce renal failure progression and could reduce the overall high cardiovascular risk. The additional effect on preserving renal function of stent placement as compared to medical therapy alone is unknown. Therefore, the STAR-study aims to compare the effects of renal artery stent placement together with medication vs. medication alone on renal function in ARAS patients. METHOD: Patients with an ARAS of > or = 50% and renal failure (creatinine (Cr) clearance < 80 mL/min/1.73 m2) are randomly assigned to stent placement with medication or to medication alone. Medication consists of statins, anti-hypertensive drugs and antiplatelet therapy. Patients are followed for 2 yrs with extended follow-up to 5 yrs. The primary outcome of this study is a reduction in Cr clearance > 20% compared to baseline. This trial will include 140 patients.