Renal infarction is a very rare disease. Due to the non-specific clinical presentation, diagnosis is often missed or delayed. As the result, a prolonged period of ischemia and irreversible renal damage is common. The broad availability of high-quality computed tomography (CT) imaging has made it possible to identify the cases early and initiate prompt treatment. We report a case of renal infarction that presented with acute abdomen. A 56-year-old man with the medical history of hypertension and diabetes mellitus presented to emergency department with a complaint of sudden onset of severe right lower abdominal pain for 1 day. CT scan of abdomen with contrast showed the striated appearance of the right kidney with hypoperfusion and wedge-shaped hypodensities throughout the kidney. After an extensive workup, no apparent cause of renal infarct was found. Due to the absence of underlying cause of atrial fibrillation or hypercoagulable disorder, no anticoagulation was started and he was discharged home on aspirin. Although the incidence of renal infarction is uncommon, it should always be suspected in the patient presenting with flank pain with nausea, vomiting, and fever, especially in presence of risk factor like atrial fibrillation and elevation of lactose dehydrogenase (LDH) with normal or mildly elevated aminotransferases. Early diagnosis and management of renal infarction is important to prevent a prolonged period of ischemia and irreversible damage. World J Nephrol Urol. 2018;7(2):53-55 doi: https://doi.org/10.14740/wjnu338e
{"title":"Idiopathic Renal Infarct as a Rare Cause of Acute Abdominal Pain: A Case Report and Review of Literature","authors":"Yadav Pandey, K. Joshi, A. Goel, Priya Priyambada","doi":"10.14740/WJNU338E","DOIUrl":"https://doi.org/10.14740/WJNU338E","url":null,"abstract":"Renal infarction is a very rare disease. Due to the non-specific clinical presentation, diagnosis is often missed or delayed. As the result, a prolonged period of ischemia and irreversible renal damage is common. The broad availability of high-quality computed tomography (CT) imaging has made it possible to identify the cases early and initiate prompt treatment. We report a case of renal infarction that presented with acute abdomen. A 56-year-old man with the medical history of hypertension and diabetes mellitus presented to emergency department with a complaint of sudden onset of severe right lower abdominal pain for 1 day. CT scan of abdomen with contrast showed the striated appearance of the right kidney with hypoperfusion and wedge-shaped hypodensities throughout the kidney. After an extensive workup, no apparent cause of renal infarct was found. Due to the absence of underlying cause of atrial fibrillation or hypercoagulable disorder, no anticoagulation was started and he was discharged home on aspirin. Although the incidence of renal infarction is uncommon, it should always be suspected in the patient presenting with flank pain with nausea, vomiting, and fever, especially in presence of risk factor like atrial fibrillation and elevation of lactose dehydrogenase (LDH) with normal or mildly elevated aminotransferases. Early diagnosis and management of renal infarction is important to prevent a prolonged period of ischemia and irreversible damage. World J Nephrol Urol. 2018;7(2):53-55 doi: https://doi.org/10.14740/wjnu338e","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"53-55"},"PeriodicalIF":0.0,"publicationDate":"2018-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41849802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Findlay, Y. Kwon, J. Sterling, Aisha Fatima, L. Moorthy, G. Halko, Evita T. Sadimin, J. Barone
Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that affects small and medium-sized arteries, leading to aneurysm formation and ischemia in different organs of the body. Although not common, testicular manifestations have been documented. We discuss a case of 18-year-old male with minocycline-induced systemic PAN who presented with unilateral testicular pain. The definitive diagnosis was made after testicular biopsy demonstrating focally necrotizing vasculitis affecting small and medium vessels. Following the diagnosis he was discharged on prednisone, and was started on rituximab by his rheumatologist. He is clinically much improved during his surveillance follow-up visits with his rheumatologist and urologist. Minocycline-induced polyarteritis nodosa can present with constitutional symptoms and testicular pain among patients using the acne treatment. Prompt diagnosis is essential to ensure proper treatment and prevention of complications. Optimal management of these patients requires close collaboration amongst urologists and rheumatologists for accurate tissue diagnosis and close surveillance. World J Nephrol Urol. 2018;7(1):32-37 doi: https://doi.org/10.14740/wjnu337w
{"title":"Minocycline-Induced Polyarteritis Nodosa Presenting With Testicular Pain: A Case Report and Selected Review of the Literature","authors":"B. Findlay, Y. Kwon, J. Sterling, Aisha Fatima, L. Moorthy, G. Halko, Evita T. Sadimin, J. Barone","doi":"10.14740/WJNU337W","DOIUrl":"https://doi.org/10.14740/WJNU337W","url":null,"abstract":"Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that affects small and medium-sized arteries, leading to aneurysm formation and ischemia in different organs of the body. Although not common, testicular manifestations have been documented. We discuss a case of 18-year-old male with minocycline-induced systemic PAN who presented with unilateral testicular pain. The definitive diagnosis was made after testicular biopsy demonstrating focally necrotizing vasculitis affecting small and medium vessels. Following the diagnosis he was discharged on prednisone, and was started on rituximab by his rheumatologist. He is clinically much improved during his surveillance follow-up visits with his rheumatologist and urologist. Minocycline-induced polyarteritis nodosa can present with constitutional symptoms and testicular pain among patients using the acne treatment. Prompt diagnosis is essential to ensure proper treatment and prevention of complications. Optimal management of these patients requires close collaboration amongst urologists and rheumatologists for accurate tissue diagnosis and close surveillance. World J Nephrol Urol. 2018;7(1):32-37 doi: https://doi.org/10.14740/wjnu337w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"32-37"},"PeriodicalIF":0.0,"publicationDate":"2018-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45669081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Early identification of kidney diseases in children and adolescents is an important initial step in prevention of chronic kidney diseases (CKD). The current study was undertaken to screen asymptomatic school children in Nellore, Andhra Pradesh, and to detect the prevalence of renal disorders using urine dipstick method and associated risk factors. Method: Out of total 1,626 children, 883 (54.31%) were male children and remaining 743 (45.69%) were female students. During the first screening by urine dipstick method, 45 (2.77%) children were found to having urinary abnormalities which were further investigated by confirmatory complete urine analysis. Results: Finally 37 were diagnosed having urinary abnormalities. The prevalence rate of isolated hematuria (IH) was 0.62%; isolated proteinuria (IP) was 0.18%; combined hematuria and proteinuria (CHP) was 0.18% and urinary tract infection (UTI) was 1.23%. Renal stone was the cause in 20% cases while post-infectious golmerulonephritis (PIGN) and IgA nephropathy (IgAN) were the causes of hematuria in 10% cases each. Out of three cases of CHP, two (66.67%) cases were due to PIGN and one was due to membranoproliferative glomerulonephritis (MPGN). Totally 26 cases were confirmed having UTI. Out of these 26 cases, gram-negative bacilli were detected in 11 (42.31%) cases and gram-positive were detected in five (19.23%) cases. The prevalence rate of renal abnormalities among 6 - 7 years, 8 - 9 years, 10 - 11 years and 12 - 13 years students was 2.07%, 2.43%, 2.19 and 2.41% respectively. Out of 889 urban students, 19 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic urban student was 2.14%. Out of 737 rural students, 18 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic rural student was 2.44%. Prevalence of hematuria in male was 0.23 and in female 1.08 and the difference was statistically significant (P < 0.05) which indicated hematuria more in female asymptomatic students compared to male asymptomatic students. Age wise prevalence of IP ranged from 0% in 6 - 7 years age group and 12 - 13 years age group to 0.44% in 10 - 11 years age group. Prevalence of UTIs in male was 0.57 and in female 2.02, and the difference was statistically significant (P < 0.05) indicating that the prevalence of UTIs was significantly more in female asymptomatic students compared to male asymptomatic students. Conclusions: In conclusion, asymptomatic urinary abnormalities might be detected by urine screening program at school age. Further work-up should be offered to define the exact etiology of any abnormal finding. World J Nephrol Urol. 2018;7(1):17-24 doi: https://doi.org/10.14740/wjnu325w
{"title":"Urine Analysis as a Screening Tool in Early Detection of Renal Abnormalities in Asymptomatic School Children","authors":"K. Srinivasulu, K. V. Rao, K. P. Kumar","doi":"10.14740/wjnu325w","DOIUrl":"https://doi.org/10.14740/wjnu325w","url":null,"abstract":"Background: Early identification of kidney diseases in children and adolescents is an important initial step in prevention of chronic kidney diseases (CKD). The current study was undertaken to screen asymptomatic school children in Nellore, Andhra Pradesh, and to detect the prevalence of renal disorders using urine dipstick method and associated risk factors. Method: Out of total 1,626 children, 883 (54.31%) were male children and remaining 743 (45.69%) were female students. During the first screening by urine dipstick method, 45 (2.77%) children were found to having urinary abnormalities which were further investigated by confirmatory complete urine analysis. Results: Finally 37 were diagnosed having urinary abnormalities. The prevalence rate of isolated hematuria (IH) was 0.62%; isolated proteinuria (IP) was 0.18%; combined hematuria and proteinuria (CHP) was 0.18% and urinary tract infection (UTI) was 1.23%. Renal stone was the cause in 20% cases while post-infectious golmerulonephritis (PIGN) and IgA nephropathy (IgAN) were the causes of hematuria in 10% cases each. Out of three cases of CHP, two (66.67%) cases were due to PIGN and one was due to membranoproliferative glomerulonephritis (MPGN). Totally 26 cases were confirmed having UTI. Out of these 26 cases, gram-negative bacilli were detected in 11 (42.31%) cases and gram-positive were detected in five (19.23%) cases. The prevalence rate of renal abnormalities among 6 - 7 years, 8 - 9 years, 10 - 11 years and 12 - 13 years students was 2.07%, 2.43%, 2.19 and 2.41% respectively. Out of 889 urban students, 19 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic urban student was 2.14%. Out of 737 rural students, 18 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic rural student was 2.44%. Prevalence of hematuria in male was 0.23 and in female 1.08 and the difference was statistically significant (P < 0.05) which indicated hematuria more in female asymptomatic students compared to male asymptomatic students. Age wise prevalence of IP ranged from 0% in 6 - 7 years age group and 12 - 13 years age group to 0.44% in 10 - 11 years age group. Prevalence of UTIs in male was 0.57 and in female 2.02, and the difference was statistically significant (P < 0.05) indicating that the prevalence of UTIs was significantly more in female asymptomatic students compared to male asymptomatic students. Conclusions: In conclusion, asymptomatic urinary abnormalities might be detected by urine screening program at school age. Further work-up should be offered to define the exact etiology of any abnormal finding. World J Nephrol Urol. 2018;7(1):17-24 doi: https://doi.org/10.14740/wjnu325w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"2018-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49660293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The aim of the study was to evaluate the utility of multiparametric magnetic resonance imaging (mp-MRI)-transrectal ultrasound (TRUS) cognitively targeted biopsy in identifying the most significant cancerous lesion in the prostate to decrease the incidence of pathologic upgrading after radical prostatectomy. Methods: We conducted a retrospective review of all radical prostatectomies at the American University of Beirut Medical Center between January 2016 and 2017. Pathology reports for both, TRUS biopsy and surgically resected specimens were analyzed and compared using SPSS. Results: Among 66 patients who underwent radical prostatectomy, 44 patients underwent a standard random 12-core biopsy of the prostate, while 22 patients underwent 4 - 5 cognitively targeted biopsies. Biopsy Gleason scores were compared to surgically resected specimens. Of mp-MRI targeted biopsies, 86% were identical to the surgical specimen, while 14% were upgraded. Of the random biopsy, 55% patients upgraded after surgery, while 38% were concordant with the random biopsy result. Moreover, 13/24 patients who upgraded after random biopsy, did so from Gleason 6 (3+3) to Gleason 7 (3+4). The difference in pathological upgrading among both groups is statistically significant, and confirms the importance of MRI-TRUS cognitively targeted biopsy in identifying the highest risk lesion. This may have significant implications on the choice of treatment prior to embarking on surgical resection of prostate cancer. Conclusion: MRI-TRUS targeted biopsy is more accurate than random biopsy in identifying the most significant cancerous lesion, resulting in a decreased incidence of pathologic upgrading after prostatectomy. This may have significant implications on the choice of treatment especially in low risk prostate cancer. Larger scale multicenter studies are required. World J Nephrol Urol. 2018;7(1):12-16 doi: https://doi.org/10.14740/wjnu285w
{"title":"The Impact of MRI-TRUS Cognitively Targeted Biopsy on the Incidence of Pathologic Upgrading After Radical Prostatectomy","authors":"R. Saoud, Albert El-Haj, R. Khauli, M. Bulbul","doi":"10.14740/WJNU285W","DOIUrl":"https://doi.org/10.14740/WJNU285W","url":null,"abstract":"Background: The aim of the study was to evaluate the utility of multiparametric magnetic resonance imaging (mp-MRI)-transrectal ultrasound (TRUS) cognitively targeted biopsy in identifying the most significant cancerous lesion in the prostate to decrease the incidence of pathologic upgrading after radical prostatectomy. Methods: We conducted a retrospective review of all radical prostatectomies at the American University of Beirut Medical Center between January 2016 and 2017. Pathology reports for both, TRUS biopsy and surgically resected specimens were analyzed and compared using SPSS. Results: Among 66 patients who underwent radical prostatectomy, 44 patients underwent a standard random 12-core biopsy of the prostate, while 22 patients underwent 4 - 5 cognitively targeted biopsies. Biopsy Gleason scores were compared to surgically resected specimens. Of mp-MRI targeted biopsies, 86% were identical to the surgical specimen, while 14% were upgraded. Of the random biopsy, 55% patients upgraded after surgery, while 38% were concordant with the random biopsy result. Moreover, 13/24 patients who upgraded after random biopsy, did so from Gleason 6 (3+3) to Gleason 7 (3+4). The difference in pathological upgrading among both groups is statistically significant, and confirms the importance of MRI-TRUS cognitively targeted biopsy in identifying the highest risk lesion. This may have significant implications on the choice of treatment prior to embarking on surgical resection of prostate cancer. Conclusion: MRI-TRUS targeted biopsy is more accurate than random biopsy in identifying the most significant cancerous lesion, resulting in a decreased incidence of pathologic upgrading after prostatectomy. This may have significant implications on the choice of treatment especially in low risk prostate cancer. Larger scale multicenter studies are required. World J Nephrol Urol. 2018;7(1):12-16 doi: https://doi.org/10.14740/wjnu285w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"12-16"},"PeriodicalIF":0.0,"publicationDate":"2018-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49386743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Urolithiasis presents serious hazard which significantly elevates the cost of national health expenditure in almost every part of both the hemispheres. There is high risk of hospitalization with loss of valuable human resource and decreased productivity along with it. Risk factors still evade the exact etiology and search for optimal serum panel is still in its infancy. Urolithiasis incidence has gradually increased in last 3 decades which suggests that some constant metabolic and urinary parameters are implicated in the risk of occurrence of urinary stone. The present study is intended to identify a panel of serum parameters, urinary parameters, radiological characteristics and correlating it with the clinical severity of stone disease. Methods: The present study was conducted at the Department of Urology at GMCH Guwahati. The authors retrospectively analyzed 151 patients undergoing stone surgery from a period of January 2016 to August 2017. Data comprised of all serum and urinary examinations done 1 week preoperatively and radiological scans within 1 month before surgery. Spearman test was used to determine correlation and analysis of variance (ANOVA) was applied for comparison between more than two categories. Results: Stone multiplicity was positively correlated with upper tract stone sides (r = 0.530, P < 0.01), large stone volume (r = 0.172, P < 0.02), stone recurrence, urinary infection and urine protein. Upper tract stone sides number was positively correlated with upper tract obstruction sides (r = 0.542, P < 0.03), large stone volume (r = -0.321, P < 0.01). Upper tract obstruction sides number was positively correlated with large stone volume (r = -0.848, P < 0.01). Conclusions: Results demonstrated that urinary tract obstruction and total stone volume significantly correlated with abnormal serum panel, urinary profile and were harbinger of complex stone pattern. World J Nephrol Urol. 2018;7(1):25-31 doi: https://doi.org/10.14740/wjnu332w
{"title":"Correlative Analysis Between Severity of Urolithiasis and Laboratory Parameters and Its Implication in Evaluation of the Probable Risk Profile","authors":"Rajeev T.P., Y. Singh, S. Barua, D. Sarma","doi":"10.14740/WJNU332W","DOIUrl":"https://doi.org/10.14740/WJNU332W","url":null,"abstract":"Background: Urolithiasis presents serious hazard which significantly elevates the cost of national health expenditure in almost every part of both the hemispheres. There is high risk of hospitalization with loss of valuable human resource and decreased productivity along with it. Risk factors still evade the exact etiology and search for optimal serum panel is still in its infancy. Urolithiasis incidence has gradually increased in last 3 decades which suggests that some constant metabolic and urinary parameters are implicated in the risk of occurrence of urinary stone. The present study is intended to identify a panel of serum parameters, urinary parameters, radiological characteristics and correlating it with the clinical severity of stone disease. Methods: The present study was conducted at the Department of Urology at GMCH Guwahati. The authors retrospectively analyzed 151 patients undergoing stone surgery from a period of January 2016 to August 2017. Data comprised of all serum and urinary examinations done 1 week preoperatively and radiological scans within 1 month before surgery. Spearman test was used to determine correlation and analysis of variance (ANOVA) was applied for comparison between more than two categories. Results: Stone multiplicity was positively correlated with upper tract stone sides (r = 0.530, P < 0.01), large stone volume (r = 0.172, P < 0.02), stone recurrence, urinary infection and urine protein. Upper tract stone sides number was positively correlated with upper tract obstruction sides (r = 0.542, P < 0.03), large stone volume (r = -0.321, P < 0.01). Upper tract obstruction sides number was positively correlated with large stone volume (r = -0.848, P < 0.01). Conclusions: Results demonstrated that urinary tract obstruction and total stone volume significantly correlated with abnormal serum panel, urinary profile and were harbinger of complex stone pattern. World J Nephrol Urol. 2018;7(1):25-31 doi: https://doi.org/10.14740/wjnu332w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"7 1","pages":"25-31"},"PeriodicalIF":0.0,"publicationDate":"2018-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48848295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lesch-Nyhan disease is a rare genetic condition that presents as a deficiency in the hypoxanthine-guanine phosphoribosyltransferase (HGPRT) enzyme of the purine nucleotide recycling pathway. Patients with Lesch-Nyhan commonly present with uric acid urolithiasis, but rare cases of xanthine stone formation have been reported. Treatment for these recurrent xanthine stones has proven difficult and there remains no standard protocol for this presentation. Impaired renal function is of critical concern with current treatment practices and outcomes. We report a case of a 3-year-old boy with Lesch-Nyhan disease who presented with recurrent obstructing xanthine stones. World J Nephrol Urol. 2017;6(3-4):29-31 doi: https://doi.org/10.14740/wjnu311w
{"title":"Recurrent Xanthine Stone Formation in a Lesch-Nyhan Patient: A Case Report","authors":"A. Bernstein, M. Liszewski, Beth A. Drzewiecki","doi":"10.14740/WJNU311W","DOIUrl":"https://doi.org/10.14740/WJNU311W","url":null,"abstract":"Lesch-Nyhan disease is a rare genetic condition that presents as a deficiency in the hypoxanthine-guanine phosphoribosyltransferase (HGPRT) enzyme of the purine nucleotide recycling pathway. Patients with Lesch-Nyhan commonly present with uric acid urolithiasis, but rare cases of xanthine stone formation have been reported. Treatment for these recurrent xanthine stones has proven difficult and there remains no standard protocol for this presentation. Impaired renal function is of critical concern with current treatment practices and outcomes. We report a case of a 3-year-old boy with Lesch-Nyhan disease who presented with recurrent obstructing xanthine stones. World J Nephrol Urol. 2017;6(3-4):29-31 doi: https://doi.org/10.14740/wjnu311w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"6 1","pages":"29-31"},"PeriodicalIF":0.0,"publicationDate":"2017-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42391097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Calciphylaxis or calcific uremic arteriolopathy (CUA) is a rare disorder of calcium and phosphate metabolism most often manifesting in end-stage renal disease (ESRD) patients. The typical clinical picture is that of a necrotic cutaneous ulceration with focal or diffuse distribution, most often manifesting on the lower extremities. We report a 49-year-old Caucasian male with ESRD on hemodialysis who presented to the emergency department with complaints of lower extremity pain and multiple cutaneous necrotic lesions on his lower extremities. Patient reports seeking assistance from several medical providers over a 3-month period. Upon admission and further evaluation, a diagnosis of calciphylaxis was made clinically and confirmed by a skin biopsy. Sodium thiosulfate was initiated and the clinical picture improved significantly. Sodium thiosulfate is traditionally used as an antidote for cyanide poisoning, and it has demonstrated beneficial outcomes in most patients afflicted with CUA. The rationale behind sodium thiosulfate therapy in CUA is its role in chelating calcium into calcium thiosulfate, which increases its solubility leading to improved renal clearance. It is essential to raise awareness amongst physicians and medical practitioners alike, as early recognition and initiation of appropriate treatment can improve the patients’ quality of life and more importantly, decrease mortality. World J Nephrol Urol. 2017;6(3-4):25-28 doi: https://doi.org/10.14740/wjnu298e
{"title":"Calciphylaxis: Early Detection and Off-Label Treatment With Sodium Thiosulfate","authors":"N. London, A. Eter","doi":"10.14740/wjnu298e","DOIUrl":"https://doi.org/10.14740/wjnu298e","url":null,"abstract":"Calciphylaxis or calcific uremic arteriolopathy (CUA) is a rare disorder of calcium and phosphate metabolism most often manifesting in end-stage renal disease (ESRD) patients. The typical clinical picture is that of a necrotic cutaneous ulceration with focal or diffuse distribution, most often manifesting on the lower extremities. We report a 49-year-old Caucasian male with ESRD on hemodialysis who presented to the emergency department with complaints of lower extremity pain and multiple cutaneous necrotic lesions on his lower extremities. Patient reports seeking assistance from several medical providers over a 3-month period. Upon admission and further evaluation, a diagnosis of calciphylaxis was made clinically and confirmed by a skin biopsy. Sodium thiosulfate was initiated and the clinical picture improved significantly. Sodium thiosulfate is traditionally used as an antidote for cyanide poisoning, and it has demonstrated beneficial outcomes in most patients afflicted with CUA. The rationale behind sodium thiosulfate therapy in CUA is its role in chelating calcium into calcium thiosulfate, which increases its solubility leading to improved renal clearance. It is essential to raise awareness amongst physicians and medical practitioners alike, as early recognition and initiation of appropriate treatment can improve the patients’ quality of life and more importantly, decrease mortality. World J Nephrol Urol. 2017;6(3-4):25-28 doi: https://doi.org/10.14740/wjnu298e","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"6 1","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2017-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45036992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Recent studies highlight a role for vitamin D (VD) in the growth and differentiation of various cell types. The biologically active form of vitamin D3 is 1,25-dihydroxyvitamin D3. Most cells of the body including prostate cells have vitamin D receptor (VDR) and VD metabolizing enzymes, and can respond to 1,25-VD. Literature supports multipronged effects of 1,25-VD in the prevention of prostate carcinoma development and progression. However, the relationship between prostate carcinoma and VD is still not entirely understood. There are no studies conducted on the association of VD and prostate carcinoma among the Asian population and our study is the first of its kind in literature and hence the need for the same. Methods: All men more than 50 years of age who presented to our hospital between July 2015 and July 2017 with lower urinary tract symptom (LUTS), and had a suspicious digital rectal examination (DRE) and hypoechoic areas on transrectal ultrasound (TRUS), were considered for the study. Those patients whose biopsies came as malignancy were taken as study subjects and patients with a negative biopsy were taken as controls. VD and serum prostatic-specific antigen (PSA) was done for all patients undergoing biopsy. Results: Eighty-six men underwent prostate biopsy for suspicious DRE with hypoechoic areas on TRUS. Out of the 86 men, 66 men had a positive histopathology, suggestive of adenocarcinoma of the prostate gland (group A), and the remaining 20 men (group B) had a negative biopsy. All patients diagnosed with malignancy had severe VD deficiency and was found to be statistically significant. Conclusion: VD deficiency is a risk factor for development of prostate carcinoma and there is a strong correlation between them. Further trials are however required to study the effect of VD supplementation on the natural course of the disease. World J Nephrol Urol. 2017;6(3-4):21-24 doi: https://doi.org/10.14740/wjnu317w
{"title":"Association of Vitamin D With Prostate Carcinoma: A Single Institutional Observational Study","authors":"S. Choubey, Gotam Pipara, S. Mittal","doi":"10.14740/WJNU317W","DOIUrl":"https://doi.org/10.14740/WJNU317W","url":null,"abstract":"Background: Recent studies highlight a role for vitamin D (VD) in the growth and differentiation of various cell types. The biologically active form of vitamin D3 is 1,25-dihydroxyvitamin D3. Most cells of the body including prostate cells have vitamin D receptor (VDR) and VD metabolizing enzymes, and can respond to 1,25-VD. Literature supports multipronged effects of 1,25-VD in the prevention of prostate carcinoma development and progression. However, the relationship between prostate carcinoma and VD is still not entirely understood. There are no studies conducted on the association of VD and prostate carcinoma among the Asian population and our study is the first of its kind in literature and hence the need for the same. Methods: All men more than 50 years of age who presented to our hospital between July 2015 and July 2017 with lower urinary tract symptom (LUTS), and had a suspicious digital rectal examination (DRE) and hypoechoic areas on transrectal ultrasound (TRUS), were considered for the study. Those patients whose biopsies came as malignancy were taken as study subjects and patients with a negative biopsy were taken as controls. VD and serum prostatic-specific antigen (PSA) was done for all patients undergoing biopsy. Results: Eighty-six men underwent prostate biopsy for suspicious DRE with hypoechoic areas on TRUS. Out of the 86 men, 66 men had a positive histopathology, suggestive of adenocarcinoma of the prostate gland (group A), and the remaining 20 men (group B) had a negative biopsy. All patients diagnosed with malignancy had severe VD deficiency and was found to be statistically significant. Conclusion: VD deficiency is a risk factor for development of prostate carcinoma and there is a strong correlation between them. Further trials are however required to study the effect of VD supplementation on the natural course of the disease. World J Nephrol Urol. 2017;6(3-4):21-24 doi: https://doi.org/10.14740/wjnu317w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"6 1","pages":"21-24"},"PeriodicalIF":0.0,"publicationDate":"2017-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43683735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. B. Lasfar, Y. Guedri, S. Mrabet, D. Zellama, A. Hassine, W. Sahtout, A. Azzebi, S. Toumi, A. Fradi, S. B. Ammou, A. Achour
We experienced a case manifesting progressive multifocal leucoencephalopathy (PML) in peritoneal dialysis (PD). A 27-year-old male patient had received a chronic PD therapy for 4 years. He had a past medical history of hypertension and myelodysplastic syndrome. He complained of hemiparesis with sudden onset and behavioral disorders. The patient seemed indifferent, incoherent with deficit walking. The cranial nerve examination showed a left central facial paralysis. Brain CT scan showed a paramedian right low density area not systemized, located in the corpus callosum and the centrum semiovale. Brain MRI confirmed the presence of PML by the detection of signal abnormalities in bilateral and asymmetrical white matter. The culture of cerebral spinal fluid was negative. The patient underwent six sessions of plasma exchange with favorable evolution. Few cases of PML have been reported in hemodialysis patients and no case has been previously described in PD. In our case, under immunocompromised conditions, precipitating factors appear multifactorial. Depressed immune system induced by chronic dialysis as well as liver disease and myelodysplasia might contribute to the development of florid clinical manifestation of PML. World J Nephrol Urol. 2017;6(3-4):35-39 doi: https://doi.org/10.14740/wjnu316w
{"title":"A Case Report of Progressive Multifocal Leukoencephalopathy in Peritoneal Dialysis","authors":"L. B. Lasfar, Y. Guedri, S. Mrabet, D. Zellama, A. Hassine, W. Sahtout, A. Azzebi, S. Toumi, A. Fradi, S. B. Ammou, A. Achour","doi":"10.14740/wjnu316w","DOIUrl":"https://doi.org/10.14740/wjnu316w","url":null,"abstract":"We experienced a case manifesting progressive multifocal leucoencephalopathy (PML) in peritoneal dialysis (PD). A 27-year-old male patient had received a chronic PD therapy for 4 years. He had a past medical history of hypertension and myelodysplastic syndrome. He complained of hemiparesis with sudden onset and behavioral disorders. The patient seemed indifferent, incoherent with deficit walking. The cranial nerve examination showed a left central facial paralysis. Brain CT scan showed a paramedian right low density area not systemized, located in the corpus callosum and the centrum semiovale. Brain MRI confirmed the presence of PML by the detection of signal abnormalities in bilateral and asymmetrical white matter. The culture of cerebral spinal fluid was negative. The patient underwent six sessions of plasma exchange with favorable evolution. Few cases of PML have been reported in hemodialysis patients and no case has been previously described in PD. In our case, under immunocompromised conditions, precipitating factors appear multifactorial. Depressed immune system induced by chronic dialysis as well as liver disease and myelodysplasia might contribute to the development of florid clinical manifestation of PML. World J Nephrol Urol. 2017;6(3-4):35-39 doi: https://doi.org/10.14740/wjnu316w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"6 1","pages":"35-39"},"PeriodicalIF":0.0,"publicationDate":"2017-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46677843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Szczykowska, S. Brzósko, M. Rakowska, B. Naumnik
Pulmonary-renal syndrome is a rare clinical syndrome defined by a combination of diffuse alveolar hemorrhage and rapidly progressive crescentic glomerulonephritis. It is not a single entity, but is caused by a wide variety of diseases including Goodpasture’s syndrome associated with autoantibodies against glomerular and alveolar basement membrane (anti-glomerular basement membrane (anti-GBM)). Anti-GBM disease is an autoimmune disorder, estimated to occur in less than one case per million population. A 59-year-old previously healthy man presented with acute kidney injury (AKI, stage 3, KDIGO) with signs of nephritic syndrome, progressive oliguria, dyspnea with mild hemoptysis, cruses edema and elevated blood pressure. Serologic results were all negative except very low titer of anti-proteinase 3 antibodies. Chest radiograph revealed diffuse pulmonary infiltrations. Renal biopsy demonstrated necrotizing crescentic glomerulonephritis with linear pattern for immunoglobulin G along the entire GBM in immunofluorescent staining. Based on whole clinical picture, the diagnosis of Goodpasture’s syndrome was done and the intensive treatment, including plasmapheresis, cyclophosphamide and prednisone, along with hemodialysis was provided. Improvement of patient’s general condition was achieved. Despite recovery of diuresis, attempt to discontinue hemodialysis was found unsuccessful. The case proves the importance of diagnostic vigilance in patients presenting with AKI. Although supportive, in many cases, serology tests can be negative or ambiguous and should not prevent profound diagnostic process including kidney biopsy. Late diagnosis in the course of anti-GBM disease, in spite of proper treatment, correlates with less favorable kidney outcomes. World J Nephrol Urol. 2017;6(1-2):10-13 doi: https://doi.org/10.14740/wjnu301w
{"title":"Goodpasture’s Syndrome With Ambiguous Serology: A Case Report","authors":"J. Szczykowska, S. Brzósko, M. Rakowska, B. Naumnik","doi":"10.14740/WJNU301W","DOIUrl":"https://doi.org/10.14740/WJNU301W","url":null,"abstract":"Pulmonary-renal syndrome is a rare clinical syndrome defined by a combination of diffuse alveolar hemorrhage and rapidly progressive crescentic glomerulonephritis. It is not a single entity, but is caused by a wide variety of diseases including Goodpasture’s syndrome associated with autoantibodies against glomerular and alveolar basement membrane (anti-glomerular basement membrane (anti-GBM)). Anti-GBM disease is an autoimmune disorder, estimated to occur in less than one case per million population. A 59-year-old previously healthy man presented with acute kidney injury (AKI, stage 3, KDIGO) with signs of nephritic syndrome, progressive oliguria, dyspnea with mild hemoptysis, cruses edema and elevated blood pressure. Serologic results were all negative except very low titer of anti-proteinase 3 antibodies. Chest radiograph revealed diffuse pulmonary infiltrations. Renal biopsy demonstrated necrotizing crescentic glomerulonephritis with linear pattern for immunoglobulin G along the entire GBM in immunofluorescent staining. Based on whole clinical picture, the diagnosis of Goodpasture’s syndrome was done and the intensive treatment, including plasmapheresis, cyclophosphamide and prednisone, along with hemodialysis was provided. Improvement of patient’s general condition was achieved. Despite recovery of diuresis, attempt to discontinue hemodialysis was found unsuccessful. The case proves the importance of diagnostic vigilance in patients presenting with AKI. Although supportive, in many cases, serology tests can be negative or ambiguous and should not prevent profound diagnostic process including kidney biopsy. Late diagnosis in the course of anti-GBM disease, in spite of proper treatment, correlates with less favorable kidney outcomes. World J Nephrol Urol. 2017;6(1-2):10-13 doi: https://doi.org/10.14740/wjnu301w","PeriodicalId":91634,"journal":{"name":"World journal of nephrology and urology","volume":"6 1","pages":"10-13"},"PeriodicalIF":0.0,"publicationDate":"2017-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49622270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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