Phenazopyridine associated acute interstitial nephritis and review of literature

Phenazopyridine is a urinary analgesic; commonly seen side-effects of this drug include, orange discoloration of urine, methemoglobinemia, yellowish skin discoloration, hepatitis and acute renal failure. Various case reports with phenazopyridine associated acute renal failure secondary to acute tubular necrosis have been reported in the literature. Acute kidney injury in these patients is caused by either direct injury to renal tubular epithelial cells or secondary to pigment induced nephropathy from hemolytic anemia. Hypoxic injury from phenazopyridine-induced methemoglobinemia has been well documented. We report a case of biopsy proven acute interstitial nephritis, associated with therapeutic doses of phenazopyridine without any evidence of methemoglobinemia or other mechanism of renal injury. Clinicians should be aware of the toxicity of this commonly used drug and should look closely for signs of renal insufficiency. Identifying and stopping the offending medication stays as the first step, but recent studies indicate that early steroid administration improves renal recovery, as well as decreasing the risk of progression to chronic kidney disease with fibrosis and consequent permanent renal damage.     

Acute kidney injury due to tubular intraluminal monoclonal light chain crystals mimicking acute pyelonephritis

Tubular intraluminal inflammatory cells may be seen in kidney biopsies of patients with pyelonephritis, cell-mediated transplant rejection, autoimmune tubulointerstitial nephritis, allergic reactions, or in association with monoclonal light chain casts. When casts in a native kidney are primarily composed of granulocytes, the cause is most commonly acute pyelonephritis due to an ascending bacterial urinary tract infection. We report a 57-year-old man with acute kidney injury and an intense intraluminal neutrophil response to monoclonal lambda light chain crystal containing casts.     

Moderate-dose glucocorticoids as salvage therapy for severe pneumonia in renal transplant recipients: a single-center feasibility study

This study aimed to assess the effectiveness and safety of moderate-dose glucocorticoids (GCs) with mechanical ventilation as salvage therapy for renal transplant recipients with severe pneumonia, which was non-responsive to conventional treatment. A retrospective study was conducted involving renal transplant recipients diagnosed with severe pneumonia and did not respond to conventional treatment. All immunosuppressants were then completely withdrawn, and the patients were initially administered with methylprednisolone at doses of 2.0–2.5?mg/kg/day once every 12?h. This dosage was continued until oxygenation improved, and the treatment was gradually tapered (by 20?mg every 2–3 days) to the previous maintenance dosage. Ten patients were recruited from year 2008 to 2012. Two patients who underwent emergency endotracheal intubation were intubated on days 3 and 8, respectively, another one died from recurrent pneumothorax. The mean PaO₂/FiO₂ of the nine survivors was significantly increased by the increasing treatment duration; whereas the lung injury scores (LIS) and the sequential organ failure assessment (SOFA) score were both significantly decreased. The use of moderate-dose GCs may play a role as salvage therapy for renal transplant recipients with severe pneumonia. However, further study with larger trials to is needed.     

C1q nephropathy in an old woman with acute renal failure: a case report and literature review

Reports on the clinical entity of C1q nephropathy have focused on older children and young adult, data on old people are rare. In this report, we would introduce a 77-year-old woman who was diagnosed as C1q nephropathy by means of electron microscopic and immunofluorescence examination. Facial and lower extremity edema was the main reason for her to go for medical treatment, and she developed into acute renal failure within 5?d. Complete remission was observed after hemodialysis and steroid drugs treatments.     

Risk factors for acute kidney injury (AKI) in infants with melamine-associated urolithiasis and follow-up: a multi-center retrospective analysis

An epidemic of urinary tract stones was noted among infants in China, 2008. This event was believed to be associated with consumption melamine-contaminated powdered formula. The patients with symptoms and clinical manifests had already been analyzed in our previous studies. In this study, our aim is to investigate the risk factors of melamine-associated acute kidney injury (AKI) and the potential relationship toward children growth in our five years follow-up. A total of 619 infants with melamine-associated urolithiasis were admitted into 20 different hospitals in the Gansu province, China. All clinical data were divided into AKI and control groups according to the occurrence of AKI. Univariate and multivariate analyses were performed with a logistic regression model to assess the independent risk factors of AKI. Logistic regression analysis revealed that the odds ratio (OR) of AKI was 19.62 in the group of infants who consumed Sanlu® milk powdered infant milk formula. A higher prevalence of AKI was observed in infants age of 6–11 months (OR: 9.59, p?p?p?相似文献   

A retrospective study of short- and long-term effects on renal function after acute renal infarction

Purpose: Acute renal infarction is often missed or diagnosed late due to its rarity and non-specific clinical manifestations. This study analyzed the clinical and laboratory findings of patients diagnosed with renal infarction to determine whether it affects short- or long-term renal prognosis. Methods: We retrospectively reviewed the medical records of 100 patients diagnosed as acute renal infarction from January 1995 to September 2012 at Gyeongsang National University Hospital, Jinju, South Korea. Results: Acute kidney injury (AKI) occurred in 30 patients. Infarct size was positively correlated with the occurrence of AKI (p?=?0.004). Compared with non-AKI patients, AKI occurrence was significantly correlated with degree of proteinuria (p?p?=?0.035). AKI patients had higher levels of aspartate transaminase (p?p?p?=?0.027). AKI after acute renal infarction was more common in patients with chronic renal failure (CRF) (eGFR?60?mL/min (p?=?0.003). Most patients recovered from AKI, except for seven patients (7%) who developed persistent renal impairment (chronic kidney disease progression) closely correlated with magnitude of infarct size (p?=?0.015). Six AKI patients died due to combined comorbidity. Conclusions: AKI is often associated with acute renal infarction. Although most AKI recovers spontaneously, renal impairment following acute renal infarction can persist. Thus, early diagnosis and intervention are needed to preserve renal function.     

Schistosomiasis as a rare cause of recurrent acute appendicitis – A case report

INTRODUCTION

We are presenting a case of schistosomiasis in a 41 year old lady who presented with right iliac fossa pain for 3 years. The pain worsened and the frequency increased in the last 3 months prior to referral. The ultrasound was unremarkable. Her bowel habits were normal and there was no vomiting. There was no blood in the stool or in the urine.

PRESENTATION OF CASE

The abdomen was soft except on deep palpation. There was slight tenderness in the right lower quadrant. A repeat ultrasound was unremarkable. The full blood count was within the normal range. A diagnosis of recurrent acute appendicitis was made and an interval appendicectomy was performed.

DISCUSSION

Histopathology results revealed schistosomiasis of the appendix. There was no acute inflammation but there was fibrous obliteration of the distal lumen of the appendix and reactive lymphoid hyperplasia.

CONCLUSION

This is the first case in a country with relatively clean drinking water. There are no irrigation schemes but there are seasonal rivers and streams. The patient admits to swimming in these streams during childhood. Clinical features of schistosomiasis were not elicited.     

Acute compartment syndrome secondary to disruption of the perforating branch of the peroneal artery following an acute inversion injury to the ankle

INTRODUCTION

Although ankle sprain by inversion is common in daily practice, acute compartment syndrome following ankle inversion injury is unusual. Only a few cases of this uncommon entity have been reported.

PRESENTATION OF CASE

This report describes a case of acute compartment syndrome following severe inversion of an ankle injury secondary to disruption of the perforating branch of the peroneal artery 3 h after the trauma. Although emergent fasciotomy was performed, residual weakness of ankle dorsiflexion still presented six months after surgery.

DISCUSSION

To the best of our knowledge, this case is the third in literature on an acute compartment syndrome following severe inversion ankle injury secondary to disruption of the perforating branch of the peroneal artery.

CONCLUSION

This report underscores the importance of considering compartment syndrome when individual has an inversion ankle injury, even when no fracture exists.     

成人急性腹泻抗菌药物治疗最佳适应证的探索性研究

目的：分析夏秋季急性腹泻患者的临床资料,探索抗菌药物治疗最佳适应证。方法收集2012年4月至10月,本院肠道门诊就诊的3027例患者的临床资料,分析其临床表现与实验室检查结果及治疗效果,探索抗感染治疗的最佳适应证。结果成人急性腹泻患者中,20～30岁人群发病率较高,女性较多,普通留便率较低,感染性因素所致者居多,抗菌药物治疗需要谨慎。结论急性腹泻是夏秋季发病率较高的疾病之一,与饮食习惯、食品卫生等多种因素相关,食品卫生监管部门需加大管理力度,治疗上需要加强抗菌药物使用指征的探索。     

非吸收性抗生素利福昔明的临床应用进展

非吸收性抗生素在临床中具有特殊的治疗价值,利福昔明作为代表药物在急性肠道感染、肠易激综合征、炎性肠病、结肠憩室病,以及肝性脑病等疾病的治疗中有着很好的疗效和广泛的应用前景.此文对利福昔明治疗相关疾病的临床疗效及安全性研究进展作了综述,为临床合理用药提供参考.