Brucellosis with kidney failure

Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. The most frequent symptoms are constitutional symptoms. While involvement of the bones, joints, and liver is not rare, brucellosis may rarely involve the kidney. We present a case of brucellosis with hepatitis, pancytopenia, peripheral arthritis, and kidney failure

Successful treatment of mucormycosis after kidney transplantation

Fungal infections are rare but represent serious complications following organ transplantation. We present a case of mucormycosis primarily affecting the paranasal sinuses in a 51-year-old man with a kidney allograft. The patient presented with headache, left facial and orbital pain, nasal discharge, and elevation of serum creatinine 18 months after kidney transplantation. Laboratory tests revealed cyclosporine nephrotoxicity, cytomegalovirus infection, and prediabetes. Imaging findings were compatible with left maxillary, ethmoidal, and sphenoidal sinusitis. Diagnosis was made based on pathologic findings and detection of typical fungal hyphea in the infected tissues. The patient was successfully treated by discontinuation of cyclosporine and mycophenolate mofetil, initiation of systemic amphotericin B, and aggressive surgical debridement

Low dose doxepin for treatment of pruritus in patients on hemodialysis

Pruritus is one of the frequent discomforting complications in patients with end-stage renal disease. We prospectively evaluated the effectiveness of doxepin, an H1-receptor antagonist of histamine, in patients with pruritus resistant to conventional treatment. A randomized controlled trial with a crossover design was performed on 24 patients in whom other etiologic factors of pruritus had been ruled out. They were assigned into 2 groups and received either placebo or oral doxepin, 10 mg, twice a day for 1 week. After a 1-week washout period, the 2 groups were treated conversely. Subjective outcome was determined by asking the patients described their pruritis as completely improved, relatively improved, or remained unchanged/worsened. Complete resolution of pruritus was reported in 14 patients [58.3%] with doxepin and 2 [8.3%] with placebo [P < .001]. Relative improvement was observed in 7 [29.2%] and 4 [16.7%], respectively. Overall, the improving effect of doxepin on pruritus was seen in 87.5% of the patients. Twelve patients [50.0%] complained of drowsiness that alleviated in all cases after 2 days in average. One patient refused to continue the treatment due to its sedative effect. We suggest that doxepin, a tricyclic antidepressant with anti-H1 receptor effect, can help improve pruritus resistant to antihistamines in end-stage renal disease patients who undergo hemodialysis. A low dose of doxepin is safe while effective and its main adverse effect, drowsiness, is temporary and can be easily tolerated by the patients

Montelukast for treatment of refractory pruritus in patients on hemodialysis

One of the most common complaints in patients with end-stage renal disease [ESRD] is uremic pruritus. In the recent years, many drugs have been proposed for its treatment which have had paradoxical outcomes. We studied the antipruritus effect of montelukast sodium, a leukotriene receptor antagonist, in patients on hemodialysis. The study was conducted as randomized, single-blind, placebo-controlled crossover study in 5 hemodialysis centers. Sixteen patients with refractory pruritus were selected and were divided into 2 groups to receive firstly montelukast and then placebo, or vice versa. Patients were treated by montelukast tablets, 10 mg daily, for 20 days and the washout period was 14 days. Of 16 patients whom were included in the study, 1 died during the placebo period of myocardial infarction and another patient who received montelukast for 20 days faced hemoglobin decrease during the placebo period diagnosed as myelodysplastic syndrome. At the end of the treatment with montelukast, pruritus was reduced by 35% [95% CI, 9.5% to 62.5%], while it was reduced 7% [95% CI, 0.5% to 15.9%] with placebo [P = .002]. The patients' compliance was assessed satisfactory, except for 1 patient who exited the study due to anemia. Montelukast is more effective than placebo in the treatment of uremic pruritus not responding to the currently available antipruritus drugs, and it can be considered as a new and rather safe and effective treatment option in uremic patients