Résumé
Background. Pleural effusions of diverse aetiologies are encountered in patients with chronic kidney disease (CKD). The objectives of the present study were to examine the frequency of occurrence, causes, clinical features and management strategies of pleural effusion in patients with CKD including renal transplant recipients. Methods. A prospective cross-sectional observational analysis of pleural effusion in adult patients with CKD (stages 3 to 5) attending the Departments of Nephrology and Respiratory Medicine of a tertiary care institution in Eastern India was performed over a period of one year (February 2010 to January 2011). Results. Pleural effusion was found in 29 out of 430 patients with CKD (6.7%) and in two out of 34 post-renal transplant recipients (5.9%) evaluated during the study period. The mean age was 37.35±1.8 (mean±SEM [standard error of mean]) with a male to female ratio of 2:1. Exudates and transudates were found in equal frequencies. Heart failure was the single most common cause (41.9%, 13 of 31). Tuberculosis (TB) (n=8, 25.8%) and uraemic effusions (n=6, 19.4%) were responsible for the majority of exudates. Unilateral effusion with a normal heart size had a positive predictive value of 83.3% for nonheart failure aetiology. Conclusions. Symptomatic pleural effusion was present in a small proportion of 6.7%; (n=29) patients with CKD including post-renal transplant recipients. Heart failure, TB and uraemic effusions accounted for most of the cases. Differentiating TB from uraemic effusion requires a combined clinico-pathological approach and this differentiation is absolutely necessary for proper management.
Sujets)
Adulte , Études transversales , Prise en charge de la maladie , Exsudats et transsudats , Femelle , Humains , Inde/épidémiologie , Transplantation rénale/effets indésirables , Mâle , Acuité des besoins du patient , Épanchement pleural/diagnostic , Épanchement pleural/épidémiologie , Épanchement pleural/étiologie , Épanchement pleural/physiopathologie , Prévalence , Études prospectives , Insuffisance rénale chronique/complications , Insuffisance rénale chronique/épidémiologie , Insuffisance rénale chronique/physiopathologie , Insuffisance rénale chronique/chirurgie , Facteurs de risqueRésumé
Occurrence of concurrent multiple primary malignancies with different histopathological presentations of the same organ at the same time is often not diagnosed and rarely reported in the literature. We present a case of multiple primary lung cancers with hepatic metastasis where the patient had a moderately differentiated adenocarcinoma of the right lower lobe and a moderately differentiated squamous cell carcinoma of the right upper lobe.