ABSTRACT
Hyponatremia in patients with central nervous system disorders is suggestive of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and volume restriction is recommended for its correction. However, if volume depletion is present in a situation otherwise compatible with SIADH, cerebral salt wasting syndrome (CSWS) should be considered as the cause of the hyponatremia to avoid hypovolemic shock that may be induced by the standard management of SIADH, i.e. volume restriction. We present a case of a 17-year-old male patient with CSWS associated with tuberculous meningitis. The clinical feature of the patient comprised hyponatremia, excessive natriuresis, polyuria, and hypovolemia. Following the administration of saline and fludrocortisone, natriuresis and polyuria were decreased, and the hyponatremia improved
Subject(s)
Adolescent , Humans , Male , Central Nervous System Diseases , Fludrocortisone , Hyponatremia , Hypovolemia , Inappropriate ADH Syndrome , Natriuresis , Polyuria , Shock , Tuberculosis, Meningeal , Wasting SyndromeABSTRACT
Immunosuppressive medications after renal allograft transplantation have impacted the course of acute and chronic rejection: however, they have no defined effects on the prevention of recurrent and Glomerulonephritis (GN) in an allograft kidney. Authors experienced a case of rapidly progressive glomerulonephritis (RPGN). The 35-year-old female patient developed a rapid deterioration of renal function 4 years after renal transplantation. The allograft biopsy showed crescentic glomerulonephritis evolving from membranoproliferative glomerulonephritis (MPGN) type I. She was given pulse steroid and oral cyclophosphamide therapy immediately after the renal biopsy. Graft function stabilized and proteinuria decreased even though graft function did not recover to pre-treatment level and low grade proteinuria persisted.
Subject(s)
Adult , Female , Humans , Allografts , Biopsy , Cyclophosphamide , Glomerulonephritis , Glomerulonephritis, Membranoproliferative , Kidney Transplantation , Kidney , Proteinuria , TransplantsABSTRACT
Purpose : The clinical features and microbiologic characteristics of acute pyelonephritis (APN) have been changing due to an increased prevalence of chronic disease, overuse and/or misuse of antibiotics and so on. We investigated the causative organisms and their antibiotic sensitivity profile and clinical manifestation with the purpose to suggest a proper empirical therapy of the disease. METHODS: We analysed the medical records of 246 APN patients older than 15 years who were admitted at Hallym University, Kandong Sacred Heart Hospital from January 1997 to December 2001, excluding hospital-acquired infections. RESULTS: Patients were 46.2+/-19.0 years old with male : female ratio of 1 : 10.2. The severity score was 4.43+/-1.63 out of 8. The average duration of hospital admission was 6.1+/-2.8 days and all of the cases were cured without a complication such as septic shock or renal abscess. In 133 cases, their etiologic microorganisms were identified, among which E. coli was the most common (91.7%). Antibiotic sensitivity of the isolated E. coli strains were as follows; 29.8% to ampicillin, 44.2% to trimethoprim/sulfamethoxazol, 75% to ciprofloxacin, 86.8% to cefazolin and 99.2% to amikacin. CONCLUSION: E. coli was the most common pathogen of community-acquired APN. Ampicillin, trimethoprim/sulfamethoxazol and cephalothin are inappropriate for its empirical therapy. Ciprofloxacin, 3rd generation cephalosporins and aminoglycosides are effective as the first-line empirical agent.
Subject(s)
Female , Humans , Male , Abscess , Amikacin , Aminoglycosides , Ampicillin , Anti-Bacterial Agents , Cefazolin , Cephalosporins , Cephalothin , Chronic Disease , Ciprofloxacin , Heart , Medical Records , Prevalence , Pyelonephritis , Shock, SepticABSTRACT
Purpose : The clinical features and microbiologic characteristics of acute pyelonephritis (APN) have been changing due to an increased prevalence of chronic disease, overuse and/or misuse of antibiotics and so on. We investigated the causative organisms and their antibiotic sensitivity profile and clinical manifestation with the purpose to suggest a proper empirical therapy of the disease. METHODS: We analysed the medical records of 246 APN patients older than 15 years who were admitted at Hallym University, Kandong Sacred Heart Hospital from January 1997 to December 2001, excluding hospital-acquired infections. RESULTS: Patients were 46.2+/-19.0 years old with male : female ratio of 1 : 10.2. The severity score was 4.43+/-1.63 out of 8. The average duration of hospital admission was 6.1+/-2.8 days and all of the cases were cured without a complication such as septic shock or renal abscess. In 133 cases, their etiologic microorganisms were identified, among which E. coli was the most common (91.7%). Antibiotic sensitivity of the isolated E. coli strains were as follows; 29.8% to ampicillin, 44.2% to trimethoprim/sulfamethoxazol, 75% to ciprofloxacin, 86.8% to cefazolin and 99.2% to amikacin. CONCLUSION: E. coli was the most common pathogen of community-acquired APN. Ampicillin, trimethoprim/sulfamethoxazol and cephalothin are inappropriate for its empirical therapy. Ciprofloxacin, 3rd generation cephalosporins and aminoglycosides are effective as the first-line empirical agent.