Pub Date : 2011-12-01Epub Date: 2011-10-06DOI: 10.1093/ndtplus/sfr111
G H Neild, Francisco Javier Diaz-Crespo, Cristina Galeano, Ana Maria Fernandez-Rodriguez, Roberto Marcen Letosa, Carlos Quereda Rodriguez-Navarro
The patient is a 68-year-old male with a history of chronic kidney disease of unknown cause. He received a kidney transplant 25 years ago and was treated with double immunosuppression therapy with everolimus and methyl-prednisolone. He also has a history of multiple tumours (skin and parotid). The patient presented to the emergency department with a 10-day history of fever associated with pain, swelling and erythematous lesions in the middle third of the right leg. The patient denied previous history of local trauma, abdominal pain and urinary symptoms. During admission, these lesions progressed to bullae with serum-haematic content, which subsequently formed necrotic background ulcers with irregular borders, exposing the underlying muscle tissue (Figure 1A and B). Blood and ulcer secretion cultures were performed, with isolation of Escherichia coli, initiating treatment with intravenous meropenem. The necrotic lesions were surgically debrided (Figure 1C), and free skin grafts were performed to correct the defects of the skin. Infectious process was controlled within 1 month of systemic antibiotic therapy and achieved complete cure of the lesions with discharge at 45 days after admission. Bullous necrotizing cellulitis is an infection caused in most cases by E. coli, mainly in immunocompromised patients. This serious complication has been previously described in childhood nephritic syndrome, diabetes mellitus and haemodialysis patients, but this is the first case described in a kidney transplant recipient. The estimated mortality of this entity is ∼50% and treatment consists of prolonged antibiotic therapy against gram-negative micro-organisms and occasionally surgical repair of necrotic tissues may be required. This kind of serious infectious complication must be taken into account in kidney transplant patients with torpid evolution cellulitis. Fig. 1. Skin lesions of bullous necrotizing cellulitis in a renal transplant recipient. A-B: Necrotic skin and exposure of the muscle fascia; C: Debridement of soft tissues and drainage of subcutaneous abscesses.
{"title":"Bullous necrotizing cellulitis in kidney transplant recipient.","authors":"G H Neild, Francisco Javier Diaz-Crespo, Cristina Galeano, Ana Maria Fernandez-Rodriguez, Roberto Marcen Letosa, Carlos Quereda Rodriguez-Navarro","doi":"10.1093/ndtplus/sfr111","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr111","url":null,"abstract":"The patient is a 68-year-old male with a history of chronic kidney disease of unknown cause. He received a kidney transplant 25 years ago and was treated with double immunosuppression therapy with everolimus and methyl-prednisolone. He also has a history of multiple tumours (skin and parotid). The patient presented to the emergency department with a 10-day history of fever associated with pain, swelling and erythematous lesions in the middle third of the right leg. The patient denied previous history of local trauma, abdominal pain and urinary symptoms. During admission, these lesions progressed to bullae with serum-haematic content, which subsequently formed necrotic background ulcers with irregular borders, exposing the underlying muscle tissue (Figure 1A and B). Blood and ulcer secretion cultures were performed, with isolation of Escherichia coli, initiating treatment with intravenous meropenem. The necrotic lesions were surgically debrided (Figure 1C), and free skin grafts were performed to correct the defects of the skin. Infectious process was controlled within 1 month of systemic antibiotic therapy and achieved complete cure of the lesions with discharge at 45 days after admission. Bullous necrotizing cellulitis is an infection caused in most cases by E. coli, mainly in immunocompromised patients. This serious complication has been previously described in childhood nephritic syndrome, diabetes mellitus and haemodialysis patients, but this is the first case described in a kidney transplant recipient. The estimated mortality of this entity is ∼50% and treatment consists of prolonged antibiotic therapy against gram-negative micro-organisms and occasionally surgical repair of necrotic tissues may be required. This kind of serious infectious complication must be taken into account in kidney transplant patients with torpid evolution cellulitis. \u0000 \u0000 \u0000 \u0000Fig. 1. \u0000 \u0000Skin lesions of bullous necrotizing cellulitis in a renal transplant recipient. A-B: Necrotic skin and exposure of the muscle fascia; C: Debridement of soft tissues and drainage of subcutaneous abscesses.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 6","pages":"451"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33187144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sir, I read with much interest the case report by Bellomo et al. [1]. I would like to make two comments: (i) a toxicological analysis on biological specimens, such as urine and serum, should have been done in order to increase the diagnostic accuracy [2] and (ii) the description of the clinical spectrum and outcome of the disease made by the authors is misleading because it can induce the readers to consider it a mild disease. Actually, the clinical spectrum and outcome of accidental wildfowl-mediated (quails, skylarks, chaffinches, robins) nicotinic plant poisoning are very large and variable. Plants containing nicotine and nicotine-like alkaloids that have been reported to be poisonous to humans include Conium maculatum, Nicotiana glauca and Nicotiana tabacum, Laburnum anagyroides and Caulophyllum thalictroides [3]. They contain the toxic alkaloids nicotine, anabasine, cytosine, n-methylcytisine, coniine, n-methylconiine and gamma-coniceine [3]. These alkaloids act agonistically at nicotinic-type acetylcholine (cholinergic) receptors. The nicotinic-type acetylcholine receptor can vary both in its subunit composition and in its distribution within the body (the central and autonomic nervous systems, the neuromuscular junctions and the adrenal medulla). Agonistic interactions at these variable sites may explain why alkaloids have diverse effects depending on the administered dose and duration of exposure [3]. Twenty years ago, we reported the largest series ever published of accidental hemlock poisoning [4]: it included 17 patients poisoned in Apulia (South Italy) between 1972 and 1990: in 14 of them, toxicological analysis was performed on the same day of hospital admission which detected coniine. Neurotoxic effects were observed in all cases: in six coniine-poisoned patients, flaccid paralysis involved respiratory muscles following the typical curare progression. In others of our coniine-intoxicated subjects, muscle hypotonia without loss of voluntary movements was observed, probably because of the smaller amounts of poison ingested. Nicotinic effects of coniine were also present: stimulation (sialorrhoea, nausea, vomiting, abdominal cramps, diarrhoea) being followed by mucosal dryness, gastrointestinal hypotonia and mydriasis [4]. The 17 patients intoxicated by coniine experienced muscle pains, which started some hours after the ingestion of the poison (rhabdomyolysis). Five patients developed the clinical features of acute kidney injury from the first day of intoxication. Ten patients were simply treated on forced diuresis sometimes with gastrolavage; six patients were transferred to the intensive care unit and required artificial respiration; the five subjects who suffered acute kidney injury were treated with haemodialysis or peritoneal dialysis; in one patient, plasmaphaeresis seems to have improved an initially severe clinical picture. The outcome was favourable in 13 cases: 4 patients (∼24%) died, 3 of them from complications linked t
{"title":"The clinical spectrum and outcome of accidental wildfowl-mediated nicotinic plant poisoning.","authors":"Carlo Basile","doi":"10.1093/ndtplus/sfr098","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr098","url":null,"abstract":"Sir, \u0000 \u0000I read with much interest the case report by Bellomo et al. [1]. I would like to make two comments: (i) a toxicological analysis on biological specimens, such as urine and serum, should have been done in order to increase the diagnostic accuracy [2] and (ii) the description of the clinical spectrum and outcome of the disease made by the authors is misleading because it can induce the readers to consider it a mild disease. Actually, the clinical spectrum and outcome of accidental wildfowl-mediated (quails, skylarks, chaffinches, robins) nicotinic plant poisoning are very large and variable. Plants containing nicotine and nicotine-like alkaloids that have been reported to be poisonous to humans include Conium maculatum, Nicotiana glauca and Nicotiana tabacum, Laburnum anagyroides and Caulophyllum thalictroides [3]. They contain the toxic alkaloids nicotine, anabasine, cytosine, n-methylcytisine, coniine, n-methylconiine and gamma-coniceine [3]. These alkaloids act agonistically at nicotinic-type acetylcholine (cholinergic) receptors. The nicotinic-type acetylcholine receptor can vary both in its subunit composition and in its distribution within the body (the central and autonomic nervous systems, the neuromuscular junctions and the adrenal medulla). Agonistic interactions at these variable sites may explain why alkaloids have diverse effects depending on the administered dose and duration of exposure [3]. Twenty years ago, we reported the largest series ever published of accidental hemlock poisoning [4]: it included 17 patients poisoned in Apulia (South Italy) between 1972 and 1990: in 14 of them, toxicological analysis was performed on the same day of hospital admission which detected coniine. Neurotoxic effects were observed in all cases: in six coniine-poisoned patients, flaccid paralysis involved respiratory muscles following the typical curare progression. In others of our coniine-intoxicated subjects, muscle hypotonia without loss of voluntary movements was observed, probably because of the smaller amounts of poison ingested. Nicotinic effects of coniine were also present: stimulation (sialorrhoea, nausea, vomiting, abdominal cramps, diarrhoea) being followed by mucosal dryness, gastrointestinal hypotonia and mydriasis [4]. The 17 patients intoxicated by coniine experienced muscle pains, which started some hours after the ingestion of the poison (rhabdomyolysis). Five patients developed the clinical features of acute kidney injury from the first day of intoxication. Ten patients were simply treated on forced diuresis sometimes with gastrolavage; six patients were transferred to the intensive care unit and required artificial respiration; the five subjects who suffered acute kidney injury were treated with haemodialysis or peritoneal dialysis; in one patient, plasmaphaeresis seems to have improved an initially severe clinical picture. The outcome was favourable in 13 cases: 4 patients (∼24%) died, 3 of them from complications linked t","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 6","pages":"457-8"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33192424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gianni Bellomo, Giorgio Gentili, Claudio Verdura, Giuseppe Calabrò, Maria Luisa Miele
We wish to thank Dr Basile for his comments on our recently published case report [1]; in particular, we would like to clarify the following issues: we did not measure coniine levels as the lab technique was not readily available at our hospital, and its results would not have changed the treatment strategy; we made it clear in the Discussion that the course of the disease is variable and can be complicated by renal failure and shock. The focus of our case report was on rhabdomyolysis and the inclusion of coturnism in its differential diagnosis; an exhaustive review of the clinical spectrum of nicotinic poisoning lies beyond the scope of our short report.
{"title":"Reply.","authors":"Gianni Bellomo, Giorgio Gentili, Claudio Verdura, Giuseppe Calabrò, Maria Luisa Miele","doi":"10.1093/ndtplus/sfr099","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr099","url":null,"abstract":"We wish to thank Dr Basile for his comments on our recently published case report [1]; in particular, we would like to clarify the following issues: we did not measure coniine levels as the lab technique was not readily available at our hospital, and its results would not have changed the treatment strategy; we made it clear in the Discussion that the course of the disease is variable and can be complicated by renal failure and shock. The focus of our case report was on rhabdomyolysis and the inclusion of coturnism in its differential diagnosis; an exhaustive review of the clinical spectrum of nicotinic poisoning lies beyond the scope of our short report.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 6","pages":"458"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33192425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Improvement in dialysis outcomes requires a paradigm shift in haemodialysis provision and service design. Haemodialysis at home, recommended by the National Institute for Health and Clinical Excellence, can lead to outcome benefits but has a range of implementation barriers. This article describes the various initiatives in the UK at local, regional and national levels, to provide greater patient choice and autonomy, overcome adoption barriers and enable greater uptake of this modality.
{"title":"Resurgence in home haemodialysis: perspectives from the UK.","authors":"Sandip Mitra, Mark Brady, Donal O'Donoghue","doi":"10.1093/ndtplus/sfr133","DOIUrl":"10.1093/ndtplus/sfr133","url":null,"abstract":"<p><p>Improvement in dialysis outcomes requires a paradigm shift in haemodialysis provision and service design. Haemodialysis at home, recommended by the National Institute for Health and Clinical Excellence, can lead to outcome benefits but has a range of implementation barriers. This article describes the various initiatives in the UK at local, regional and national levels, to provide greater patient choice and autonomy, overcome adoption barriers and enable greater uptake of this modality. </p>","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 Suppl 3","pages":"iii1-iii3"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/ee/sfr133.PMC4421464.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Self management and home-based dialysis therapies offer the prospect of improved patient experience and outcomes. To allow more patients to realize these benefits requires changes in technology which focus on maximizing the ease and minimizing the burdens of undertaking home dialysis. These developments are underway.
{"title":"Home haemodialysis: trends in technology.","authors":"Ken Farrington, Roger Greenwood","doi":"10.1093/ndtplus/sfr128","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr128","url":null,"abstract":"<p><p>Self management and home-based dialysis therapies offer the prospect of improved patient experience and outcomes. To allow more patients to realize these benefits requires changes in technology which focus on maximizing the ease and minimizing the burdens of undertaking home dialysis. These developments are underway. </p>","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 Suppl 3","pages":"iii23-iii24"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33161909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-12-01Epub Date: 2011-09-07DOI: 10.1093/ndtplus/sfr100
Elizabeth J Lindley, Gerard Boyle, David Gandy, Andrew Hardy, Maurice Harrington, Nicholas A Hoenich, Ian R Morgan, Brett Thompson
Based on this review of the plausibility of transmission of HCV via the haemodialysis circuit, the ART discussion group could see no merit in the use of dedicated machines. The group considers the current national, European and international guidelines for prevention of transmission of HCV to be appropriate in terms of both patient care and equipment management.
{"title":"How plausible is transmission of hepatitis C virus via the haemodialysis circuit?","authors":"Elizabeth J Lindley, Gerard Boyle, David Gandy, Andrew Hardy, Maurice Harrington, Nicholas A Hoenich, Ian R Morgan, Brett Thompson","doi":"10.1093/ndtplus/sfr100","DOIUrl":"10.1093/ndtplus/sfr100","url":null,"abstract":"Based on this review of the plausibility of transmission of HCV via the haemodialysis circuit, the ART discussion group could see no merit in the use of dedicated machines. The group considers the current national, European and international guidelines for prevention of transmission of HCV to be appropriate in terms of both patient care and equipment management.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 6","pages":"434-6"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33187137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Four years ago, the Council of the ERA-EDTA took the wise decision to publish a sister journal to Nephrology, Dialysis, Transplantation. The goal was to issue a bimonthly educational publication for young as well as seasoned nephrologists. Following some brainstorming, the title of the new journal was chosen as ‘NDT Plus’. It was indeed a ‘Plus’ that soon attracted a soaring number of submissions: comprehensive in-depth reviews, catching clinical reports, thoughtful teaching points, puzzling nephroquizzes and seductive images in nephrology. The Editorin-Chief was the same for NDT and NDT Plus, with the hard task of leading a ‘two-in-hand’ harness. The coach and pair worked their way successfully along. They still do. However, considering the fast pace of evolving interests among nephrologists, the coach driver and his team of editors wondered about a change. Would it not be a good idea to create more individuality for the two journals? A difficult quandary: the two horses got along well. The number of submissions had been growing. The readership was content. However, some voices ruffled this complacency. NDT Plus was educational alright, but not sufficiently ‘academic’. In fact, there was increasing demand for more and better. Reader, you can imagine the turmoil. More? Better? This was not asking for a revolution but rather for a complete change over. After some hesitancy the ERA-EDTA Council and Oxford University Press decided to go ahead without further stalling. New name. New cover. New editorial team. New content. This does not mean that NDT Plus has died. It is merely evolving, and we are confident that the first issue of the Clinical Kidney Journal, which you will discover in February 2012, will more than fulfil your expectations.
{"title":"NDT Plus introduces the Clinical Kidney Journal.","authors":"Alain Meyrier, Norbert Lameire","doi":"10.1093/ndtplus/sfr159","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr159","url":null,"abstract":"Four years ago, the Council of the ERA-EDTA took the wise decision to publish a sister journal to Nephrology, Dialysis, Transplantation. The goal was to issue a bimonthly educational publication for young as well as seasoned nephrologists. Following some brainstorming, the title of the new journal was chosen as ‘NDT Plus’. It was indeed a ‘Plus’ that soon attracted a soaring number of submissions: comprehensive in-depth reviews, catching clinical reports, thoughtful teaching points, puzzling nephroquizzes and seductive images in nephrology. The Editorin-Chief was the same for NDT and NDT Plus, with the hard task of leading a ‘two-in-hand’ harness. The coach and pair worked their way successfully along. They still do. However, considering the fast pace of evolving interests among nephrologists, the coach driver and his team of editors wondered about a change. Would it not be a good idea to create more individuality for the two journals? A difficult quandary: the two horses got along well. The number of submissions had been growing. The readership was content. However, some voices ruffled this complacency. NDT Plus was educational alright, but not sufficiently ‘academic’. In fact, there was increasing demand for more and better. Reader, you can imagine the turmoil. More? Better? This was not asking for a revolution but rather for a complete change over. After some hesitancy the ERA-EDTA Council and Oxford University Press decided to go ahead without further stalling. New name. New cover. New editorial team. New content. This does not mean that NDT Plus has died. It is merely evolving, and we are confident that the first issue of the Clinical Kidney Journal, which you will discover in February 2012, will more than fulfil your expectations.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 6","pages":"367"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33311846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis. This is in contrast to the nephrology professionals' opinion about the best dialysis therapy and their potential choice in the hypothetical situation of choosing a dialysis modality for themselves. Pre-dialysis education changes the distribution of dialysis modality significantly, as 50% of informed patients choose home dialysis. Close collaboration among nephrology professionals, patients and providers is required to make home therapy a reality for any interested patient.
{"title":"Thinking outside the box-identifying patients for home dialysis.","authors":"Brigitte Schiller, Hayley Munroe, Andrea Neitzer","doi":"10.1093/ndtplus/sfr123","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr123","url":null,"abstract":"<p><p>Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis. This is in contrast to the nephrology professionals' opinion about the best dialysis therapy and their potential choice in the hypothetical situation of choosing a dialysis modality for themselves. Pre-dialysis education changes the distribution of dialysis modality significantly, as 50% of informed patients choose home dialysis. Close collaboration among nephrology professionals, patients and providers is required to make home therapy a reality for any interested patient. </p>","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 Suppl 3","pages":"iii11-iii13"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
POEMS syndrome is a rare conglomeration of disorders associated with plasma cell dyscrasia. The acronym POEMS is derived from main features of the syndrome namely 'polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin lesions'. Other clinical features include presence of sclerotic bone lesions, Castleman's disease, papilledema, pleural effusion, edema, ascites, erythrocytosis and thrombocytosis. Myeloma is the most common plasma cell dyscrasia associated with POEMS syndrome. Renal involvement is rare and renal biopsy is characterized by glomerular involvement with membranoproliferative glomerulonephritis and endothelial injury. We report a case of a 67-year-old male who presented with clinical features satisfying the diagnostic criteria of POEMS syndrome and had rapidly progressive renal failure. Renal biopsy showed extensive interstitial infiltration by plasma cells and concomitant presence of classic polyarteritis nodosa. Although association with small-vessel vasculitis has been reported in patients with POEMS syndrome, to the best of our knowledge, this is the first report of POEMS syndrome associated with medium-sized vessel vasculitis.
{"title":"POEMS syndrome with renal plasmacytoma and classic polyarteritis nodosa: a case report.","authors":"Pranaw Kumar Jha, Mahesha Vankalakunti, Ravishankar Bonu, Kishore Babu, H Sudarshan Ballal","doi":"10.1093/ndtplus/sfr137","DOIUrl":"https://doi.org/10.1093/ndtplus/sfr137","url":null,"abstract":"<p><p>POEMS syndrome is a rare conglomeration of disorders associated with plasma cell dyscrasia. The acronym POEMS is derived from main features of the syndrome namely 'polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin lesions'. Other clinical features include presence of sclerotic bone lesions, Castleman's disease, papilledema, pleural effusion, edema, ascites, erythrocytosis and thrombocytosis. Myeloma is the most common plasma cell dyscrasia associated with POEMS syndrome. Renal involvement is rare and renal biopsy is characterized by glomerular involvement with membranoproliferative glomerulonephritis and endothelial injury. We report a case of a 67-year-old male who presented with clinical features satisfying the diagnostic criteria of POEMS syndrome and had rapidly progressive renal failure. Renal biopsy showed extensive interstitial infiltration by plasma cells and concomitant presence of classic polyarteritis nodosa. Although association with small-vessel vasculitis has been reported in patients with POEMS syndrome, to the best of our knowledge, this is the first report of POEMS syndrome associated with medium-sized vessel vasculitis. </p>","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 6","pages":"406-9"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ndtplus/sfr137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33313794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carol Rhodes, Nicola Beech, Lindsay Chesterton, Richard Fluck
Home based dialytic therapy is underutilized in most renal centres. This article describes a nurse led and delivered approach to problem solving from a patient perspective, resulting in an increase in prevalent and incident patient numbers on home HD and peritoneal dialysis. Overall, between 2004 and 2010 home-based therapies have risen from 61 to 119 prevalent patients, with a fall in in-centre patient numbers.
{"title":"Integrating peritoneal and home haemodialysis: a nurse's perspective from a single centre.","authors":"Carol Rhodes, Nicola Beech, Lindsay Chesterton, Richard Fluck","doi":"10.1093/ndtplus/sfr127","DOIUrl":"10.1093/ndtplus/sfr127","url":null,"abstract":"<p><p>Home based dialytic therapy is underutilized in most renal centres. This article describes a nurse led and delivered approach to problem solving from a patient perspective, resulting in an increase in prevalent and incident patient numbers on home HD and peritoneal dialysis. Overall, between 2004 and 2010 home-based therapies have risen from 61 to 119 prevalent patients, with a fall in in-centre patient numbers. </p>","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"4 Suppl 3","pages":"iii14-iii15"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/a5/sfr127.PMC4421459.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33156207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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