ABSTRACT
AIM: This report describes a case of kidney failure secondary to orlistat, a lipase inhibitor commonly used in the treatment of obesity. CASE REPORT: An 80-year-old man with type 2 diabetes who was being treated with orlistat developed rapidly progressive kidney failure. Low-grade albuminuria argued against diabetic nephropathy. Renal biopsy showed tubulointerstitial nephritis associated with numerous calcium oxalate crystals. Enteric hyperoxaluria was attributed to the orlistat treatment. The latter was stopped and the patient received calcium supplements. Six months after orlistat withdrawal, oxaluria was normalized and kidney function stabilized. CONCLUSION: Oxalate nephropathy may result from hyperoxaluria secondary to orlistat treatment. This suggests that kidney function and oxaluria be closely monitored in patients taking orlistat.
Subject(s)
Anti-Obesity Agents/adverse effects , Diabetes Mellitus, Type 2/drug therapy , Kidney Diseases/chemically induced , Lactones/adverse effects , Aged, 80 and over , Anti-Obesity Agents/therapeutic use , Humans , Hyperoxaluria , Lactones/therapeutic use , Male , OrlistatABSTRACT
OBJECTIVE AND IMPORTANCE: Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent inherited kidney disorder, and liver involvement represents one of its major extra-renal manifestations. Although asymptomatic in most patients, polycystic liver disease (PLD) can lead to organ compression, severe disability and even become life-threatening, thereby warranting early recognition and appropriate management. CLINICAL PRESENTATION: We report the case of a 56-year-old woman with ADPKD and severe weight loss secondary to a giant hepatic cyst compressing the pylorus. Partial hepatectomy was required after failure of cyst aspiration and sclerotherapy, and patient's condition improved rapidly. DISCUSSION AND CONCLUSIONS: We discuss the presentation and classification of compressing liver cysts, and the available therapeutic alternatives for this potentially severe complication of ADPKD.
Subject(s)
Cysts/etiology , Liver Diseases/etiology , Polycystic Kidney, Autosomal Dominant/complications , Weight Loss , Cysts/surgery , Female , Humans , Liver Diseases/surgery , Middle AgedABSTRACT
OBJECTIVE AND IMPORTANCE: Bartonella henselae infections are among the most common causes of fever and lymphadenopathies, but can lead to severe complications in immunocompromised hosts; early recognition of these infections is of paramount importance in immunocompromised patients. CLINICAL PRESENTATION: Here we report the case of a renal transplant recipient who presented with fever, lymphadenopathies, and a splenic abscess secondary to Bartonella henselae infection, successfully treated with doxycycline. DISCUSSION AND CONCLUSIONS: We discuss the various clinical presentations of Bartonella henselae infections in immunocompromised patients and the available diagnostic tools for this potentially severe complication.
Subject(s)
Bartonella henselae , Cat-Scratch Disease/diagnosis , Fever/etiology , Immunocompromised Host , Lymphadenitis/etiology , Splenic Diseases/diagnosis , Abscess/diagnosis , Abscess/etiology , Abscess/therapy , Cat-Scratch Disease/etiology , Cat-Scratch Disease/therapy , Fever/diagnosis , Fever/therapy , Humans , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Lymphadenitis/diagnosis , Lymphadenitis/therapy , Male , Middle Aged , Splenic Diseases/etiology , Splenic Diseases/therapyABSTRACT
OBJECTIVES: Measuring the exact glomerular filtration rate (GFR) is difficult. Iohexol can be used instead of inulin or labeled EDTA or DTPA. In recent years, different studies have validated GFR-estimating equations in adults. Validation of these estimations in adolescents and elderly is lacking. With this study, we aim to develop a simplified (only 1-3 blood collections) iohexol protocol to measure the true GFR for patients of all ages and try to develop GFR-estimating equations for adolescents and the elderly. DESIGN AND SETTING: Participants of different ages will be recruited: 50 adolescent (14-18 years) and 30 adults (20-65 years), 60 elderly (65-80 years) and 60 very elderly (80+ years old) stratified based on their GFR. Biometric data, serum creatinine and cystatin C will be measured. After injecting 5 mL iohexol, 9 blood samples will be taken between 20 and 360 min. First, the GFR will be calculated by using the double exponential decay method and different GFRs based on 1-3 blood samples, which will be compared with the GFR of the abovementioned 9 samples. Second, the GFR will be calculated by using new and existing equations and compared to the true GFR. DISCUSSION: The availability of a reliable GFR measurement is important in situations such as screening patients for kidney donation or when taking potentially nephrotoxic treatments. This study will allow us to develop a simplified protocol for measuring the true GFR in all ages and will allow us to validate existing equations and develop new eGFR equations for adolescents and the elderly.
Subject(s)
Contrast Media , Glomerular Filtration Rate , Iohexol , Adolescent , Adult , Aged , Aged, 80 and over , Creatinine/blood , Cystatin C/blood , Female , Humans , Kidney Diseases/diagnosis , Male , Middle Aged , Reproducibility of Results , Young AdultABSTRACT
Haemodialysis patients have acquired immunity disturbances, co-morbidities and a vascular access, factors predisposing them to infection and bacteraemia. Clostridium perfringens is an anaerobic bacterium potentially causing severe infections, including rarely septic arthritis. We report the first case of Clostridium perfringens septic arthritis in a haemodialysis patient and suggest a haematogenous spread. After rapid joint lavage combined with appropriate anti-microbial therapy, the patient recovered.
Subject(s)
Arthritis, Infectious/diagnosis , Arthritis, Infectious/microbiology , Clostridium perfringens , Diabetic Nephropathies/complications , Diabetic Nephropathies/therapy , Hip Joint , Renal Dialysis , Adult , Arthritis, Infectious/therapy , Diabetic Nephropathies/microbiology , Humans , MaleABSTRACT
Myopathy, including rhabdomyolysis, is a well-known, albeit rare complication of statin therapy. Predisposing factors include comorbidities and the concomitant use of cytochrome P-450 (CYP) 3A4 inhibitors. We report a case of severe simvastatin-induced rhabdomyolysis triggered by the addition of amiodarone to previously well-tolerated chronic statin therapy. Physicians should be aware of the risk of this potentially severe drug interaction. The dose of simvastatin should be reduced (to 20 mg daily) when concomitant treatment with amiodarone is required, or preference should be given to pravastatin, rosuvastatin or fluvastatin, which are not metabolised by the CYP 3A4.
Subject(s)
Amiodarone , Atrial Fibrillation/drug therapy , Cytochrome P-450 CYP3A/metabolism , Hypercholesterolemia/drug therapy , Rhabdomyolysis , Simvastatin , Aged, 80 and over , Amiodarone/administration & dosage , Amiodarone/adverse effects , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Comorbidity , Creatine Kinase/blood , Dose-Response Relationship, Drug , Drug Interactions , Humans , Hypercholesterolemia/complications , Hypercholesterolemia/metabolism , Hypolipidemic Agents/administration & dosage , Hypolipidemic Agents/adverse effects , Inactivation, Metabolic , Male , Rhabdomyolysis/etiology , Rhabdomyolysis/metabolism , Rhabdomyolysis/therapy , Severity of Illness Index , Simvastatin/administration & dosage , Simvastatin/adverse effects , Treatment OutcomeABSTRACT
We report moderate renal failure in a 50-year-old man with a history of recent colonoscopy after oral sodium phosphate purgative use. We initially missed the correct diagnosis, but renal biopsy revealed signs of acute phosphate nephropathy. The patient had residual renal impairment at 8-month follow-up. Greater awareness of this complication is needed amongst health care professionals. The preventive strategies are discussed.
