Mycobacterium fortuitum endocarditis in a patient with chronic renal failure on hemodialysis.

A case of infective endocarditis due to M. fortuitum in a 54 yr old female with chronic renal failure on hemodialysis is presented. Clinical, microbiological and autopsy findings are discussed.     

Diagnosis of aspergillus peritonitis in a renal dialysis patient by PCR and galactomannan detection

This report describes the use of the polymerase chain reaction (PCR) and galactomannan detection to detect aspergillus in the continuous ambulatory peritoneal dialysis (CAPD) fluid and blood of a patient with multiple myeloma on CAPD and immunosuppressive treatment. Diagnosis of aspergillosis was initially made by conventional culture of CAPD fluid, but the PCR and galactomannan assays also detected aspergillus DNA and antigen in the blood, respectively. This suggests that the PCR and galactomannan assays, previously suggested as useful in the management of invasive fungal infections in neutropenic haematological patients, may be suitable for application to a broad range of clinical situations and sample types.     

Enterococcus hirae septicemia in a patient with end-stage renal disease undergoing hemodialysis

Enterococcus hirae, member of theEnterococcus genus known to cause infection in animals, is rarely encountered in clinical practice. There are no published reports describing clinical features ofEnterococcus hirae infection in humans. A case ofEnterococcus hirae septicemia in a 49-year-old patient with end-stage renal disease undergoing hemodialysis is reported here. A review of the available literature regarding the clinical spectrum ofEnterococcus hirae infection in humans and the antimicrobial susceptibility ofEnterococcus hirae is also included.     

Hypercalcaemia due to hyperparathyroidism in a patient with chronic renal failure and renal carcinoma.

A 65-year-old woman with a history of a left heminephrectomy for renal carcinoma developed hypercalcaemia 11 years after the operation. The same kidney was found to contain a recurrent renal carcinoma. After the radical nephrectomy of the left kidney, hypercalcaemia remitted but reappeared 11 months later. The right kidney was small but functioned at a level of creatinine clearance of 10--15 ml/min. Metastatic work-up was negative, and secondary causes of hypercalcaemia were excluded. A neck exploration revealed a parathyroid adenoma. With parathyroid resection the serum calcium declined to normal, and the risk of hypercalcaemic nephropathy in the remaining kidney was precluded.     

Acute renal failure due to uric acid nephropathy in a patient with renal hypouricemia

Summary This report is about a 23-year-old man who required hemodialysis in connection with an acute renal failure resulting from uric acid nephropathy without hyperuricemia. After recovering renal function he showed extreme hypouricemia (0,1–0,3 mg/dl) and elevated uric acid clearance (100–300 ml/min). The fractional excretion of uric acid (Cua/Cer) could be suppressed by oral pyrazinamide and enhanced by probenecid. As no other renal tubular or metabolic abnormalities were detected, it is suggested that a markedly increased renal tubular urate secretion was responsible for the hypouricemia and also for the rare side-effect of an uric acid nephropathy in this patient.Abbreviations PZA pyrazinamide - GFR glomerular filtration rate - S_UA serum uric acid - UV_UA urinary excretion of uric acid - C_UA uric acid clearance - C_CR creatinine clearance     

Coagulation and fibrinolysis in patients with chronic renal failure on maintenance hemodialysis

Alteration of the coagulation-fibrinolysis system was examined in patients on maintenance hemodialysis. The mean values of fibrinogen, factor V, factor VII, factor VIII, vWF (activity and antigen), factor IX and factor XI were significantly higher in these patients than in control subjects (p less than 0.01), but factor XII alone was significantly lower. Fibrinolytic parameters (euglobulin lysis time, fibrin plate lysis, fibrin degradation products and alpha 2-plasmin inhibitor-plasmin complex) suggested a hyperfibrinolytic state and plasmin generation in the patients' circulation. These findings suggest that the alteration of the coagulation-fibrinolysis system is aggravated by repeated hemodialysis, either by the influence of the dialyzer itself or heparin.     

慢性肾功能衰竭患者血液透析发生院内感染的临床分析

目的分析慢性肾功能衰竭患者血液透析发生院内感染的临床特点以及相关危险因素。方法回顾性分析2005年5月至2010年5月期间在我院长期行血液透析的383例患者的相关临床资料,将其中160例患者出现了不同程度的院内感染设为感染组,223例患者未出现院内感染为未感染组。结果血液透析患者发生院内感染的发生率为41.78%,其中以肺部感染最为常见;感染组与未感染组患者之间的相关临床指标相比较,年龄、住院天数、是否左心衰、是否有糖尿病、是否存在低蛋白血症、插管时间以及C反应蛋白具有统计学差异（P〈0.05或0.01）,而性别、血肌酐、甘油三脂不具有统计学差异（P〉0.05）。结论对于长期血液透析患者,我们应该控制好各个危险因素,规范化管理防治院内感染的相关制度,对患者采取正规的营养支持、纠正贫血、抗感染等支持治疗,及时的作相关病原学检查,严防滥用抗生素。     

High-dose intravenous melphalan in a patient with multiple myeloma and oliguric renal failure

A light-chain myeloma was diagnosed as the underlying disease in a 52-year-old woman with acute oliguric renal failure. The patient was erroneously treated with high-dose intravenous melphalan (60 mg/m²). Because of this overdose treatment with granulocyte colony-stimulating factor was initiated, but pronounced absolute leukopenia (white blood cell count < 0.5 × 10⁹/l) developed and lasted for 13 days. Following melphalan treatment a continuous increase in urine volume was accompanied by a decrease of serum creatinine and blood urea nitrogen. Within 10 days after the administration of melphalan the patient no longer required hemodialysis. We conclude that high-dose chemotherapy in combination with hematopoietic growth factors should be considered in individual cases with newly diagnosed light-chain nephropathy.Abbreviations BUN blood urea nitrogen - G-CSF granulocyte colony-stimulating factor - WBC white blood cell count Correspondence to: M. Pecherstorfer     

The silent period in patients with chronic renal failure undergoing hemodialysis

Silent period was evaluated in 20 adult male patients with chronic renal failure undergoing hemodialysis. Readings were obtained by supramaximal stimulus to the median nerve, during maximum isometric effort of the abductor pollicis brevis muscle against resistance. Two types of abnormalities were observed, motor neuron hypoexcitability with elongated silent period, and motor neuron hyperexcitability with reduction or absence of silent period. Some abnormalities are probably linked with dialysis duration, but show no correlation to presence or absence of peripheral neuropathy. The silent period alterations described in this study could possibly correlate with some other clinical feature frequently seen in patients with chronic renal failure such as hypereflexia of the deep tendon reflexes.     

Severe haemolysis and renal failure in a patient with paroxysmal nocturnal haemoglobinuria.

Transfusion of about 60 ml of ABO incompatible plasma in 4 units of pooled platelets precipitated severe haemolysis, unmasking the emergence of paroxysmal nocturnal haemoglobinuria (PNH), in a patient with aplastic anaemia. In vitro tests showed that her red cells were lysed by both ABO compatible and incompatible plasma from normal donors. The behaviour of this case and the in vitro results suggest that it might be hazardous to relax the longstanding recommendation on transfusing patients with PNH by restricting the washing of blood components to those containing ABO incompatible plasma.     

A case report of brown tumor in a patient with chronic renal failure and renal cell carcinoma

We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast‐like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic findings, in correlation with the clinical history, radiographic features, markedly increased parathyroid hormone levels and other serologic studies, were diagnostic of the reactive lesion seen in brown tumor of hyperparathyroidism secondary to chronic renal failure.     

肾衰竭合并毛霉菌病

目的 探讨肾衰竭合并毛霉菌病的临床特点、诊断、治疗及预后。方法 报道1例慢性肾衰竭合并肺毛霉菌病,并使用二性霉素B治疗成功的病例;结合该例的特点,复习肾衰竭合并毛霉菌病的文献资料,不包括存在明确易感因素如腹膜透析相关性的毛霉菌性腹膜炎及去铁胺治疗者。结果 共15例,平均年龄（49.9 15.8）岁。鼻脑型占46.7%,其次为肺型和弥漫型,分别占33.3%和20%。46.7%于死亡后尸检诊断,总死亡率为73.3%。7例接受治疗者,死亡率为42.9%。未接受治疗者,无1例存活。结论 毛霉菌病是肾衰竭患者致死性的感染性疾病,早期诊断、及时联合使用大剂量抗真菌药物、外科清创术或局部引流是改善预后的关键。     

Myoglobinuria and transient acute renal failure in a patient revealing hypothyroidism

Muscle involvement in hypothyroidism commonly manifests as fatigue, myalgias, stiffness and slowed reflexes. We report a case of transient acute renal failure related to rhabdomyolysis and myoglobinuria in a 40 year old man that revealed the diagnosis of hypothyroidism with myopathy. The patient had proximal muscle weakness and tenderness, markedly raised muscle enzymes and deranged renal functions that normalised with thyroid replacement therapy. Hypothyroidism, though rare, should be considered a definite and authentic cause of rhabdomyolysis.     

Progressive renal failure in a patient after one and two-thirds nephrectomy

Summary We report on a patient who lost one and two-thirds of his kidneys following surgery because of bilateral renal cell carcinoma. The serum creatinine following surgical intervention increased to about 7 mg% and fell to serum values of about 3 mg% in the year after one and two-thirds nephrectomy. The patient's renal function remained stable for 18 months, then it started to deteriorate and the patient developed progressive renal failure with proteinuria. The course of the disease suggests that an intrinsic renal mechanism was operative, which relates to glomerular hyperfiltration following surgical loss of renal tissue.