ABSTRACT
BACKGROUND: The systemic consequences of esthetic filler injections are poorly understood. CASE PRESENTATION: We report a patient with a past history of subcutaneous injection of aesthetic filler material in the lower legs, who presented with post-infectious glomerulonephritis following necrotic leg ulcers at the injection site. Kidney biopsy revealed the presence of translucent, non-birefringent microspherical bodies compatible with polymethylmetacrylate (PMMA) microspheres in some capillary lumens. This had not previously been described. PMMA is a biphasic aesthetical filler composed of polymethylmetacrylate microspheres suspended in a biodegradable bovine collagen carrier. The solid phase (PMMA microspheres) persists in tissues for years. Although PMMA was thought to not disseminate systemically, tissue necrosis may have favored systemic dissemination of the microspheres, although entry in the circulation and microembolization at the time of administration cannot be ruled out. CONCLUSIONS: In conclusion, aesthetic filler implants may cause microembolization into small vessels. Recognition of the characteristic morphology may expedite diagnosis and avoid unnecessary further testing.
Subject(s)
Biocompatible Materials , Cosmetic Techniques/adverse effects , Dermal Fillers/adverse effects , Embolism/chemically induced , Foreign-Body Migration/etiology , Glomerulonephritis/chemically induced , Polymethyl Methacrylate/adverse effects , Acute Disease , Biopsy , Dermal Fillers/administration & dosage , Embolism/diagnosis , Embolism/therapy , Female , Fluorescent Antibody Technique , Foreign-Body Migration/diagnosis , Foreign-Body Migration/therapy , Glomerulonephritis/diagnosis , Glomerulonephritis/therapy , Humans , Injections, Subcutaneous , Microspheres , Middle Aged , Polymethyl Methacrylate/administration & dosage , Predictive Value of Tests , Streptococcal Infections/complicationsABSTRACT
BACKGROUND: There are seasonal variations in serum 25-hydroxyvitamin D (25OHD) levels related to sun exposure. Recent guidelines suggest a target serum 25OHD level >30 ng/ml in chronic kidney disease patients. However, vitamin D supplementation dosing and monitoring regimens are not well established in hemodialysis patients. The aim of this study was to assess the interplay between season and 25OHD supplementation according to guidelines on 25OHD levels in hemodialysis patients. METHODS: We retrospectively reviewed data collected prospectively over 12 months in 32 stable hemodialysis patients receiving 25OHD supplements (mean dose 30,600 IU/month) under routine clinical care following the Spanish Society of Nephrology guidelines. RESULTS: Higher serum 25OHD was observed during the summer, peaking in June and August. Despite a trend towards a higher 25OHD dose in winter the prevalence of 25OHD deficiency was still >40 % in winter. Furthermore, despite a higher dose of calcium-based phosphate binders, there was a trend toward lower serum calcium in winter. Season, together with residual diuresis and dry weight, was a significant independent contributor to a multivariate lineal regression model that explained 25 % of serum 25OHD variability, while a 25OHD dose did not contribute significantly in this 25OHD-supplemented population. CONCLUSION: Winter vitamin D deficiency is prevalent in hemodialysis patients despite supplementation with 25OHD according to clinical guidelines. More intensive monitoring or pre-emptive winter dose increases should be evaluated to achieve guideline targets.
Subject(s)
Renal Dialysis , Renal Insufficiency, Chronic/therapy , Seasons , Vitamin D Deficiency/epidemiology , Vitamin D Deficiency/prevention & control , Vitamin D/analogs & derivatives , Vitamin D/therapeutic use , Aged , Aged, 80 and over , Calcium/blood , Dietary Supplements , Dose-Response Relationship, Drug , Female , Humans , Linear Models , Male , Middle Aged , Practice Guidelines as Topic , Prevalence , Prospective Studies , Renal Insufficiency, Chronic/blood , Retrospective Studies , Spain , Vitamin D/administration & dosage , Vitamin D/bloodABSTRACT
Macroscopic haematuria of glomerular origin has been associated with acute kidney injury. We report a patient with IgA nephropathy, macroscopic haematuria and acute kidney injury. Systemic anticoagulation may have aggravated haematuria. There was extensive interstitial and intratubular red blood cell extravasation, and interstitial haemosiderin deposits. The abundant presence of macrophages expressing the haemoglobin scavenger receptor CD163 and of cells stained for oxidative stress markers (NADPH-p22 phox and heme-oxigenase-1) in areas of interstitial haemorrhage and red blood cell cast-containing tubules provided evidence for a role for free haemoglobin in tubulointerstitial renal injury in human glomerular disease.
Subject(s)
Acute Kidney Injury/etiology , Glomerulonephritis, IGA/complications , Hematuria/complications , Hemorrhage/complications , Acute Kidney Injury/diagnosis , Antigens, CD/metabolism , Antigens, Differentiation, Myelomonocytic/metabolism , Biopsy , Erythrocytes/pathology , Female , Glomerulonephritis, IGA/diagnosis , Hematuria/diagnosis , Heme Oxygenase-1/metabolism , Hemorrhage/diagnosis , Hemosiderin/metabolism , Humans , Kidney Glomerulus/metabolism , Kidney Glomerulus/pathology , Macrophages/pathology , Middle Aged , NADPH Oxidases/metabolism , Receptors, Cell Surface/metabolismABSTRACT
BACKGROUND: Our aim was to analyze the longitudinal changes in cardiac biomarker levels in hemodialysis patients with high comorbidity treated in our special hospital unit. We hypothesize that strict volume control strategy (salt-restricted diet, extended dialysis sessions and dry weight clinical assessment and reassessment in every session) could prevent progression of left-ventricular damage and, therefore, progressive increment in cardiac biomarker levels over time. METHODS: This is a longitudinal cohort study including 46 dialysis patients in which a strategy of strict volume control has been adopted. N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin T and C-reactive protein (CRP) levels were measured at baseline and prospectively at 4, 8 and 12 months. The possible association between volume control and cardiac biomarker levels was analyzed. RESULTS: Dry weight could be reduced (p < 0.01) over time. A reduction in systolic BP (p < 0.05) and in CRP levels (p < 0.05) was observed, whereas NT-proBNP and troponin T values remained stable. However, patients in the high quartile of NT-proBNP at baseline showed a reduction (p = 0.02) in troponin T over time with no significant trend (p = 0.08) to progressive reduction in NT-proBNP values. CONCLUSIONS: Strict volume control in dialysis patients may prevent progressive increment in cardiac biomarker levels over time. The impact seems to be higher among patients with higher levels at baseline in whom strict volume control can even reduce cardiac biomarker levels on follow-up.
Subject(s)
Kidney Failure, Chronic/blood , Kidney Failure, Chronic/rehabilitation , Renal Dialysis/methods , Renal Replacement Therapy/methods , Ventricular Dysfunction, Left/blood , Ventricular Dysfunction, Left/prevention & control , Biomarkers/blood , C-Reactive Protein , Combined Modality Therapy , Female , Humans , Kidney Failure, Chronic/complications , Longitudinal Studies , Male , Middle Aged , Natriuretic Peptide, Brain , Peptide Fragments , Troponin T , Ventricular Dysfunction, Left/etiologyABSTRACT
Kahalalide compounds are peptides that are isolated from a Hawaiian herbivorous marine species of mollusc, Elysia rufescens, and its diet, the green alga Bryopsis sp. Kahalalide F and its synthetic analogues are the most promising compounds of the Kahalalide family because they show antitumoral activity. Linear solid-phase syntheses of Kahalalide F have been reported. Here we describe several new improved synthetic routes based on convergent approaches with distinct orthogonal protection schemes for the preparation of Kahaladide analogues. These strategies allow a better control and characterization of the intermediates because more reactions are performed in solution.
