ABSTRACT
In small peripheral nephrological hospitals it can sometimes be difficult to obtain an early diagnosis and to ensure a state-of-the-art treatment. In the most complex cases, in fact, patients must be transferred to the closest Nephrological Referral Center in order to recover kidney function or improve the chance of survival. Other challenges are represented by the progressive ageing of the population and by the management of oncological patients developing kidney complications, for which it would be desirable to create dedicated clinics. However, small hospitals also offer many advantages, such as better work management, the opportunity to attend many training initiatives and congresses, and the ability to better balance career with family needs. Cooperating in smaller teams and the harmony that develops with the other physicians and nurses allows us to offer the best healthcare to nephropathic patients who live far away from the major Referral Centers. Each peripheral Center can also represent an essential resource for the major Center because it acts as the first point of contact with patients, taking care of identifying the situations that need the attention of the Referral Center and, subsequently, taking charge of the follow-up in conservative or replacement therapy.
Subject(s)
Hospitals , Nephrology , Hospital Administration , Humans , ItalyABSTRACT
A case of transcutaneous diethylene glycol poisoning with severe acute kidney injury, but a positive outcome, is described. A man without significant medical history was admitted to our hospital due to anuria, gastrointestinal symptoms, and hypertension. Ultrasonography excluded vascular damage and postrenal obstruction. Laboratory tests showed acute kidney injury and metabolic acidosis with increased anion gap; hemodialysis therapy was started. The brother of the patient reported that the patient had been smearing his skin with brake fluid containing diethylene glycol to treat a "dermatitis." Only supportive therapy was given due to the lack of a specific antidote. Continuous venovenous hemofiltration was performed. The kidney biopsy showed acute toxic proximal tubulonecrosis, without deposition of oxalate crystals. His neurologic condition worsened dramatically; supportive care was continued. Over time, acute kidney injury and neurologic damage gradually improved; 33 days after admission, he went to a rehabilitation unit for 5 months, with complete clinical recovery. Historically, diethylene glycol has been the cause of large-scale poisonings from ingestion of contaminated drugs. The clinical evolution is unpredictable. Treatment is not well defined; early hemodialysis treatment reduces levels of toxic metabolites, and fomepizole could be useful in cases with an early diagnosis. A comparison of the characteristics of diethylene glycol versus ethylene glycol poisoning is given.
