Polioencefalomalacia asociada a exceso de azufre dietético en bovinos de engorde a corral

Polioencefalomacia (PEM) es un término patológico que se refiere a la necrosis cerebro-cortical. En bovinos las causas más frecuentes son déficit de fibra (acidosis ruminal), déficit de tiamina y exceso de azufre (S) dietéticos. El objetivo de este trabajo es describir un brote de PEM en bovinos de engorde a corral consumiendo exceso de S. El establecimiento afectado suministraba una dieta de terminación compuesta por 45% de burlanda de maíz, pero 25 días antes del problema se incrementó su inclusión al 70%. Se efectuó una visita al establecimiento en la cual se recolectaron datos clínicos y epidemiológicos, y se realizó la necropsia de un animal muerto para estudios patológicos y bacteriológicos. Adicionalmente se recolectaron muestras de agua de bebida y alimento balanceado. Se recomendó tratar con tiamina a los animales afectados, con respuesta favorable en la mayoría de los casos. En el examen patológico de cerebro se observó edema y hemorragias, con necrosis cortical severa. El cultivo bacteriológico de encéfalo resultó negativo. El agua de bebida contenía 1 g/l de sulfatos y el alimento balanceado 0.48% de S, de modo que el consumo estimado de S total fue de 0.58%. El exceso dietético de S podría haber estado implicado en el desarrollo de este brote de PEM, siendo éste el primer reporte en Argentina.

Polioencephalomacia (PEM) refers to cerebrocortical necrosis. In bovine the most frequent causes of PEM are dietary fiber deficit, thiamine deficiency and excess of sulfur (S). The objective of this work is to report an outbreak of PEM in feedlot cattle consuming S excess. The affected farm provided a finishing diet composed of 45% corn destillers grains with solubles, but 25 days before of the problem the inclusion of this component was increased in the diet (up to 70%). Clinical and epidemiological data were collected and the autopsy of a dead animal was performed for pathological and bacteriological studies. Additionally, drinking water and balanced meal samples were carried out. Affected animals were treated with thiamine, with a favorable response. In the pathological examination of the brain, edema and hemorrhages were observed, with severe cortical necrosis. The bacteriological culture of encephalon was negative. The drinking water contained 1 g / l of sulphates and the food 0.48% of S, so that the total estimated consumption of S was 0.58%. Dietary S excess could have favored the occurrence of this PEM outbreak. To the best of our knowledge, this is the first etiological description of S dietary excess associated with PEM in Argentina.

A Case of Renal Cortical Necrosis in a 15-year-old Boy with Acute Kidney Injury

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.

Pattern of renal pathology in fatal envenomation by indian cobra (naja naja).

Deaths due to poisonous snakebite are a significant health related problem especially the rural heartland of in tropical countries. Renal involvement in snakebite is well documented especially so in bites by the Viperidae group. The Elapidae family consisting of cobra and kraits among other varieties are mainly considered neurotoxic. The venom of neurotoxic variety predominantly has direct depressing action on the respiratory center and neuromuscular junction. We investigated the renal changes at autopsy and histology of fatal cobra bites. This series included autopsy examination of 14 cases of fatal cobra bite in our hospital-based study. Dissected kidneys were sectioned, stained with hematoxylin & eosin stain and histological examination was done under light microscope. Five cases from head injury subject were used as control. The study reveals renal involvement in 64.28 %of fatal bites by Indian cobra (Naja naja) primarily considered neurotoxic. The major renal changes were tubular necrosis 1(7.14%), cortical necrosis 3 (21.42%) and interstitial nephritis 3(21.42%). This fact is worth giving due consideration during management and monitoring of cases of envenomation by cobra.

Renal pathological changes in poisonous snake bite.

There are more than 3000 species of snakes in the world but only about 350 are venomous. With approximately 10000 deaths occurring annually in India, a large proportion of snake bites occur when people work barefoot in the fields or while walking at night or early morning through fields or along roads. Although, nearly all snakes with medical relevance can induce nephropathy, leading to Acute Renal Failure (ARF), it is unusual except with bites by Russell‟s Viper, E. Carinatus and members of the genera Crotalus and Bothrops. In India, ARF is mostly associated with Russell‟s Viper and E. Carinatus bites. The incidence of ARF following Russell‟s Viper or E. Carinatus bites is 13-32% in India. A histopathological study was conducted on renal autopsy specimens from those subjects who were admitted to IPGME&R and SNP Hospital, Kolkata as a result of development of acute renal failure following poisonous snake bite. Acute tubular necrosis (100%) and Acute cortical necrosis (25%) were the most significant renal histopathological changes. Glomerular lesions were also present in 30% of cases.

A Case of Hypoglycemic Brain Injuries with Cortical Laminar Necrosis

We report a case of 68-yr-old male who died from brain injuries following an episode of prolonged hypoglycemia. While exploring controversies surrounding magnetic resonance imaging (MRI) findings indicating the bad prognosis in patients with hypoglycemia-induced brain injuries, we here discuss interesting diffusion-MRI of hypoglycemic brain injuries and their prognostic importance focusing on laminar necrosis of the cerebral cortex.

Complete Recovery of Renal Function in Bilateral Renal Cortical Necrosis: A Case Report / 대한신장학회지

Acute bilateral renal cortical necrosis (BRCN) is a rare cause of renal failure. It has been reported that contrast-enhanced computed tomography provides characteristic findings of BRCN which correlates well with the histopathology making it an important non-invasive diagnostic modality during early phase of BRCN, improving survival rate and prognosis with early diagnosis and treatment. This report presents a case of 73-year old woman with BRCN due to hemolytic uremic syndrome. The patient recovered from anuria and showed complete recovery to normal renal function of her age and serum creatinine level after early initiation of hemodialysis. Furthermore, a normal radiologic finding of kidney was obtained after 52 days from onset of the disease by contrast-enhanced computed tomography. At present, she is preserved within the normal range renal function without renal replacement therapy.

A Case of Acute Bilateral Renal Cortical Necrosis Associated with Peritonitis and Intra-abdominal Operation / 대한신장학회지

Renal cortical necrosis (RCN) is a rare cause of acute renal failure in which there is a complete or partial destruction of the renal cortex with sparing of the medulla. We report here a case of acute bilateral RCN associated with intra-abdominal operation. A 70-year-old female patient was admitted to our hospital because of abdominal pain secondary to perforated diverticulits in sigmoid colon. A segmental resection of the sigmoid colon and end-to-end anastomosis was performed on the third hospital day. Two days later, she suddenly developed oligo-anuria and she was treated with hemodialysis. A contrast-enhanced abdominal computed tomography scan showed lack of enhancement of the renal cortex with enhancement of the renal medulla. On the 21th hospital day, renal biopsy was done and microscopic examination of the specimen revealed RCN. Since then, she has been on regular hemodialysis for over six months with no signs of renal recovery. Occult sepsis associated with peritonitis and intra-abdominal operation seems to be the most possible etiologic factor of RCN in our patient.

Two Cases of Acute Renal Cortical Necrosis Diagnosed by Contrast-Enhanced Computerized Tomography / 대한신장학회지

Renal cortical necrosis (RCN) is a relatively rare cause of acute renal failure. In the past, the incidence of RCN was more higher in obstetrical patients than in non-obstetric patients. But during the last 15 years, the prevalence of RCN in non-obstetric patients have overwhelmed the obstetrical patients. Renal biopsy was an only gold standard diagnostic method for RCN in the past even though it was not performed frequently because of the serious clinical circumstances and coagulopathy generally accompanied by RCN, especially during the early period. Recently, contrast-enhanced computerized tomography was found to provide very characteristic representative findings. Therefore, the importance of contrast-enhanced computerized tomography as non-invasive diagnostic procedure during the initial phase of RCN is stressed. We report two cases of RCN which we have diagnosed early by using contrast-enhanced computerized tomography and treated by hemodialysis.

Acute Bilateral Renal Cortical Necrosis Associated with Diclofenac Sodium / 대한신장학회잡지

Acute bilateral renal cortical necrosis is relatively unusual cause of acute renal failure (ARF). We report a rare case of acute bilateral renal cortical necrosis associated with diclofenac sodium. A 57-year-old man visited to our hospital with progressive oligoanuria for three days. Four days earlier, after diclofenac sodium 150 mg was injected intramuscularly at local hospital, he experienced anaphylactic shock. Our laboratory findings revealed the existence of fibrin split, thrombocytopenia, coagulopathy, and microangiopathic hemolytic anemia (MAHA). These findings were compatible with disseminated intravascular coagulation (DIC). The radiocontrast enhancement CT scan showed a bilateral lack of enhancement of the renal cortex after contrast infusion, enhancement of renal medulla, and the absence of renal excretion of the contrast dye. Renal biopsy showed a cortical necrosis with congested acellular glomuruli and necrotic tubules. Empiric treatment including hemodialysis was commenced. Although his renal function was not completely recovered, he is now being followed up at this hospital without dialysis.

A Case of Bilateral Renal Cortical Necrosis Associated with Acute Pancreatitis / 대한신장학회잡지

Bilateral cortical necrosis accounts for up to 2% of cases of acute renal failure. More than half of cases of bilateral renal cortical necrosis occure in association with pregnancy complicated by antipartum or postpartum hemorrhage. Other causes including severe bacterial infections, hemolytic uremic syndrome, trauma, postoperative shock, burns, Acute pancreatitis, diabetic ketoacidosis, snake venoms, and phosphorus poisoning. A 53-year-old woman presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and computed tomography. The patient recovered from the attack of pancreatitis but remained anuric. Then, we report this case of acute renal cortical necrosis associated with acute pancreatitis.

A Case of Bilateral Renal Cortical Necrosis Associated with Acute Pancreatitis / 대한신장학회잡지

Bilateral cortical necrosis accounts for up to 2% of cases of acute renal failure. More than half of cases of bilateral renal cortical necrosis occure in association with pregnancy complicated by antipartum or postpartum hemorrhage. Other causes including severe bacterial infections, hemolytic uremic syndrome, trauma, postoperative shock, burns, Acute pancreatitis, diabetic ketoacidosis, snake venoms, and phosphorus poisoning. A 53-year-old woman presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and computed tomography. The patient recovered from the attack of pancreatitis but remained anuric. Then, we report this case of acute renal cortical necrosis associated with acute pancreatitis.

A Case of Diffuse Cortical Necrosis after Glue Sniffing / 대한신장학회잡지

The renal cortical necrosis occurs in approximately 2% of adult patients with acute renal failure. The causes of renal cortical necrosis were usually associated with obstetrical problems. However, the distinctive changes occurred over the past 15 years in the etiology with a high incidence of non-obstetric causes than obstetric ones. We experienced a rare case of diffuse bilateral renal cortical necrosis in 16-year-old man who had a history of glue sniffing. To our knowledge, this is the first report in our country. A 16-year-old man was admitted with vague flank pain and oliguria. There was history of frequent adhesive glue sniffing. Laboratory data were as follows : BUN 77mg/dL, creatinine, 9.3mg/dL, protein 3+, RBC many/HPF, WBC 1-4/HPF in urinalysis, HBsAg(-), Anti-HBs(+), C(3)10.5mg/dL, C(4)7.4mg/dL), IgG 1,865mg/mL, IgA 512mg/mL. The kindey size was normal in ultrasonography. Renal cortex was diffusely not enhanced in MIJ Tl weighted image. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy. In this case, adhesive glue sniffing may be a cause of acute cortieal necrosis.

A Case of Acute Cortical Necrosis Associated with Uterine Leiomyoma / 대한신장학회잡지

Uterine myoma is the most common neoplasm of women and occurs in up to 20% of reproductive women. Leiomyoma may undergo secondary degeneration such as hyaline degeneration, sarcomatous change, and necrosis. This report presents a case of acute cortical necrosis(ACN) and disseminated intravascular coagulation caused by a uterine myoma necrosis. The uterine myoma of this patient was diagnosed and observed 10 months ago at other hospital. She complained of low abdominal pain with vaginal bleeding and anuria from the previous day. The laboratory findings were as follows:platelets 49,000/ mm3; prothrombin time 38%(normal control, 12 seconds); aPTT 41seconds(normal control, 26seconds); fibrinogen 81mg/dL; FDP<10 microgram/mL; BUN/sCr 23/ 2.9mg/dL. Acute cortical necrosis was diagnosed by radiologic grounds including abdominal computerized tomography(CT), which demonstrated decreased cortical contrast enhancement, normal medullary contrast enhancement, and preserved cortico-medullary differentiation. The patient was treated conservatively and underwent a CAPD operation later in her hospital course. On the 135th day after diagnosis, the ultrasonography, done in outpatient department, revealed the decreased size of both kidneys, respectively 7.5cm and 7.8cm. Urine output was about 800cc/day and the creatinine clearance of this patient was 9.2mL/ min.

A Case of Acute Cortical Necrosis in Patient with Polycystic Kidney Disease / 대한신장학회잡지

Acute cortical necrosis is a rare cause of the acute renal failure. It is frequently associated with complications of pregnancy. The renal biopsy is the key of diagnosis of these disease. However, the contrast enhanced CT scan can be a tool for the diagnosis of acute renal cortical necrosis, because of its noninvasiveness and constant findings(enhancement of subcapsular rim, nonenhancement of the renal cortex, enhancement of medulla, and lack of excretion of contrast media to the collecting system). This is a case of acute renal cortical necrosis diagnosed by CT scan. She had an anuria for 16 days and feature of hemolytic uremic syndrome and polycystic kidney.