ABSTRACT
When a patient presents with renal failure, it is often difficult to ascertain whether the individual is suffering from acute or chronic renal failure. Fingernail creatinine might help to differentiate between the two. To test this possibility, the relationship between the fingernail creatinine and the serum creatinine obtained concurrently or 1 or more months previously was examined in 22 normal adults, nine patients with acute renal failure, seven patients with chronic renal failure not undergoing dialysis, 16 maintenance hemodialysis patients, and 33 patients with a functioning renal transplant who had been transplanted 0.2 to 3.9 months (n = 21) or 4.3 to 33 months previously (n = 12). Fingernail creatinine was significantly greater than normal in the patients with chronic renal failure, patients undergoing maintenance hemodialysis, and patients who had a functioning renal transplant implanted 0.2 to 3.9 months previously. In contrast, fingernail creatinine was not different from normal in the patients with acute renal failure and in patients who had a functioning renal transplant placed 4.3 to 33 months previously. In the maintenance hemodialysis patients, fingernail creatinine showed the strongest correlation with the serum creatinine obtained between 5 and 10 months previously, with the highest correlation at 9 months. In the renal transplant recipients, the fingernail creatinine decreased to normal or near normal values within approximately 90 to 120 days after transplantation. These findings indicate that fingernail creatinine may reflect the serum creatinine values several months previously. The fingernail creatinine may help to identify whether patients have recent onset as compared with longstanding renal failure.
Subject(s)
Creatinine/analysis , Kidney Diseases/diagnosis , Nails/chemistry , Acute Kidney Injury/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Adult , Creatinine/blood , Diagnosis, Differential , Female , Humans , Kidney Diseases/blood , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/diagnosis , Kidney Transplantation , Male , Renal DialysisABSTRACT
Os autores apresentam um caso incomum de paciente com pancreatite aguda e insuficiência renal aguda que necessitou de diálise peritoneal e desenvolveu quadro de desconforto respiratório decorrente de um hidrotórax agudo como complicaçäo de processo dialítico. O diagnóstico foi feito pelo elevado nível de glicose no líquido pleural (455mg/dL) e concomitante glicemia de 81mg/dL. Esta intercorrência parece decorrer de um defeito diafragmático que comunica as cavidades peritoneal e pleural. O tratamento consiste na pronta interrupçäo da diálise peritoneal, com melhora da sintomatologia
Subject(s)
Humans , Male , Adult , Peritoneal Dialysis/adverse effects , Hydrothorax/etiology , Acute Disease , Acute Kidney Injury/complications , Pancreatitis/complications , Pancreatic Pseudocyst/complicationsABSTRACT
Report a case of a patient suffering from acute pancreatitis with renal failure, who needed peritoneal dialysis and developed acute hydrothorax as a complication of the procedure. The diagnosis was made by the high levels of glucose on pleural effusion (455 mg/dL) and glycemia of 81 mg/dL). This complication probably occurs because of a pathological diaphragmatic defect, communicating peritoneal and pleural cavities. The treatment consists of prompt interruption of peritoneal dialysis with improvement of symptomatology.
Subject(s)
Hydrothorax/etiology , Peritoneal Dialysis/adverse effects , Acute Disease , Acute Kidney Injury/complications , Adult , Humans , Male , Pancreatic Pseudocyst/complications , Pancreatitis/complicationsABSTRACT
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, suppress renal prostaglandins and markedly reduce renal perfusion and diuretic response in some renal disorders. Mild renal impairment may occur in healthy subjects. Pharmacodynamic characteristics of certain NSAIDs, such as the nonacetylated salicylates, suggest that they may have less deleterious renal effects. We compared the renal effects of standard therapeutic doses of indomethacin, ibuprofen, aspirin, and the nonacetylated salicylate, diflunisal, in 6 healthy supine volunteers. Only indomethacin significantly reduced creatinine clearance (by 13%) and renal plasma flow (by 23%; p less than 0.05). Indomethacin also tended to reduce furosemide-induced diuresis and natriuresis, and this effect was significantly greater than with diflunisal (p less than 0.05). Serum thromboxane, a reflection of platelet cyclo-oxygenase activity, was reduced by 99% with aspirin, ibuprofen and indomethacin, but by only 78% with diflunisal. Nonacetylated salicylates may be the preferred drugs, at least in short-term usage, when it is necessary to minimize the effects of NSAIDs on platelet or kidney function.
