ABSTRACT
Os autores relatam um caso de Poliangiíte Microscópica em paciente idosa, diabética, que apresentou quadro agudo de dor abdominal, edema dos membros inferiores, dor nas panturrilhas e poliartralgia. Evoluiu com insuficiência renal aguda, sendo dializada. Surgiram púrpuras não palpáveis generalizadas. Enquanto se submetia a hemodialíse, sofreu dispnéia súbita, sendo entubada e aspirado grande quantidade de sangue vivo, falecendo em seguida. A necropsia no Serviço de Patologia do HUAP-UFF revelou aspectos de Poliangiíte Microscópica.
The autors present one fatal case lung hemorrhage caused by microscopic polyangiitis, that was confirmed by postmortem examination. She was a diabetic old woman who complained of acute abdominal pain, purpuric cutaneous lesions myalgia and arthralgia followed by acute renal failure requiring hemodialysis. She had a sudden death in respiratory failure and through the tracheal tube a lange volume of blood was aspirated.
Subject(s)
Humans , Female , Aged , Autoimmune Diseases , Hemorrhage , LungABSTRACT
CONTEXT: Hyperphosphatemia has an important role in the development of bone and mineral abnormalities in end-stage renal disease (ESRD). OBJECTIVE: To compare the phosphorus binding power and the hypercalcemic effect of calcium acetate and calcium carbonate in hemodialysis patients. TYPE OF STUDY: Crossover, randomized, double-blind study. PLACE: A private hospital dialysis center. PARTICIPANTS: Fifty-two patients who were undergoing regular hemodialysis three times a week ([Ca++] dialysate = 3.5 mEq/L). PROCEDURES: Half of the patients were started on 5.6 g/day of calcium acetate and, after a 2 week washout period, received 6.2 g/day of calcium carbonate. The other half followed an inverse protocol. MAIN MEASUREMENTS: Clinical interviews were conducted 3 times a week to monitor for side effects. Determinations of serum urea, calcium, phosphorus, hematocrit, Kt/V and blood gas analysis were obtained before and after each treatment. RESULTS: Twenty-three patients completed the study. A significant increase in calcium plasma levels was only observed after treatment with calcium carbonate [9.34 mg/dl (SD 0.91) vs. 9.91 mg/dl (SD 0.79), P < 0.01]. The drop in phosphorus levels was substantial and significant for both salts [5.64 mg/dl (SD 1.54) vs. 4.60 mg/dl (SD 1.32), P < 0.01 and 5.89 mg/dl (SD 1.71) vs. 4.56 mg/dl (SD 1.57), P < 0.01, for calcium acetate and calcium carbonate respectively]. The percentage reduction in serum phosphorus (at the end of the study) per milliequivalent of salt administered per day tended to be higher with calcium acetate but statistical significance was not found. CONCLUSION: Calcium acetate can be a good alternative to calcium carbonate in the handling of hyperphosphatemia in ESRD patients. When calcium acetate is used, control of hyperphosphatemia can be achieved with a lower administration of calcium, perhaps with a lower risk of hypercalcemia