ABSTRACT
OBJECTIVE: To report about a case of acute renal failure due to absence of communication between physician and patient. CASE SUMMARY: A 78 year old man with human immunodeficiency virus (HIV) accessed our hospital and was brought to our attention in August 2011 for severe renal failure. Clinical history revealed that he had been taking highly active antiretroviral therapy with lamivudine/abacavir and fosamprenavir since 2006. In April 2011 due to an augmentation in creatinine plasma levels, a reduction in lamivudine dosage to 100 mg/day and the prescription of abacavir 300 mg/day became necessary. Unfortunately, the patient took both lamivudine and abacavir therefore the association of the two medications (lamivudine/abacavir) lead to asthenia and acute renal failure within a few days. CONCLUSIONS: This case emphasizes the importance about how physicians must pay very careful attention during drug prescription, most particularly, as far as elderly patients are concerned. In fact, communication improvement between physicians and patients can prevent increase of adverse drug reactions related to drug dispensing, with consequential reduction of costs in the healthcare system.
Subject(s)
Acute Kidney Injury/chemically induced , Asthenia/chemically induced , Dideoxynucleosides/adverse effects , Lamivudine/adverse effects , Medication Errors , Aged , Antiretroviral Therapy, Highly Active/adverse effects , Dideoxynucleosides/administration & dosage , HIV Infections/drug therapy , Humans , Lamivudine/administration & dosage , MaleSubject(s)
Methylprednisolone/therapeutic use , Nephrotic Syndrome/drug therapy , Adolescent , Adult , Age Factors , Aged , Blood Proteins/analysis , Blood Sedimentation , Child , Cholesterol/blood , Creatinine/blood , Female , Glomerular Filtration Rate , Glomerular Mesangium/pathology , Glomerulonephritis, Membranoproliferative/complications , Glomerulonephritis, Membranoproliferative/drug therapy , Glomerulonephritis, Membranous/complications , Glomerulonephritis, Membranous/drug therapy , Humans , Image Processing, Computer-Assisted/instrumentation , Male , Nephrotic Syndrome/etiology , Nephrotic Syndrome/pathology , Proteinuria/drug therapy , Proteinuria/etiology , Retrospective Studies , Treatment Outcome , Triglycerides/blood , Videotape RecordingABSTRACT
Recent clinical investigations have demonstrated that an early restriction of dietary protein intake may reduce the rate of progression of chronic renal failure in humans. In this study the effects of a restricted-protein diet on kidney function in type I diabetic patients with clinical nephropathy were evaluated. Sixteen patients (9 men, 7 women) with mean age 37.1 +/- 9.8 yr, mean duration of diabetes 17.7 +/- 6.6 yr, proteinuria greater than 0.5 g/24 h, and serum creatinine concentration of 0.7-1.9 mg/dl were studied. Patients were randomly divided into two groups. The low-protein diet (LPD) group comprised seven patients who were kept for 4.5 +/- 1 mo on a diet containing 0.71 +/- 0.12 g X kg-1 X day-1 protein. The normal-protein diet (NPD) group comprised nine patients as controls maintained for 11.7 +/- 7 mo on their usual diabetic diet containing 1.44 +/- 0.12 g X kg-1 X day-1 protein. All patients were studied every 1-2 mo. Metabolic control was assessed by evaluation of 5-8 blood glucose determinations/day and by glycosylated hemoglobin, whereas renal function was evaluated by albumin, IgG and beta 2-microglobulin urinary excretion rates, serum creatinine concentration, and creatinine clearance. At each visit, serum concentrations of total protein, albumin, phosphate, calcium, and electrolytes and weight and blood pressure were also measured. A significant reduction (434 +/- 244 to 205 +/- 212 micrograms/min, mean +/- SD) in albumin excretion rate was found in all LPD patients after dietary protein restriction, with a significant reincrease (689 +/- 201 micrograms/min) in the same patients several months after interruption of diet.(ABSTRACT TRUNCATED AT 250 WORDS)
