ABSTRACT
Neuromyopathy is a rare side effect of chronic colchicine therapy, most often occurring in patients with chronic renal failure. Drugs interacting with colchicine metabolism through CYP(3)A(4) and P-glycoprotein can accelerate accumulation and toxicity. We describe a case of an interaction between clarithromycin and colchicine resulting in acute neuromyopathy, and we conclude that combined use of macrolides and colchicine should be avoided.
Subject(s)
Anti-Bacterial Agents/adverse effects , Clarithromycin/adverse effects , Colchicine/adverse effects , Kidney Failure, Chronic/physiopathology , Neuromuscular Diseases/chemically induced , Tubulin Modulators/adverse effects , ATP Binding Cassette Transporter, Subfamily B, Member 1 , Aged , Anticholesteremic Agents/adverse effects , Cytochrome P-450 CYP3A , Drug Interactions , Humans , Male , Risk Factors , Simvastatin/adverse effectsABSTRACT
Many patients with asymptomatic haematuria are primarily referred to urological examination. To analyse the efficiency of this strategy, we investigated the diagnostic process in 134 patients with asymptomatic haematuria (91 macroscopic and 43 microscopic) who were referred to our urology department. The frequency of diagnostic procedures was urine culture: 91%, cystoscopy: 87%, intravenous urography: 86%, ultrasound: 73%, examination of urinary sediment: 20%. In 70 patients (52%), a urological diagnosis was made. In the remaining 64 patients, the urinary sediment was examined for the presence of dysmorphic erythrocytes and erythrocyte casts in 17 patients (27%). Signs of glomerular haematuria were found in nine of them (53%). The diagnostic strategy in these patients with asymptomatic haematuria was not discordant from several published algorithms but appeared neither efficacious nor efficient. We estimate that when examination of the urinary sediment would have been performed at the start of work-up, 25% of patients could have spared from extensive urological investigation.
Subject(s)
Hematuria/etiology , Adult , Aged , Algorithms , Diagnosis, Differential , Diagnostic Techniques, Urological , Female , Humans , Kidney Diseases/complications , Kidney Diseases/diagnosis , Kidney Glomerulus , Male , Middle Aged , Retrospective Studies , Unnecessary ProceduresABSTRACT
Examination of the urinary sediment is a simple and indispensable tool in the diagnostic approach to patients with asymptomatic haematuria. Various glomerular and nonglomerular diseases can cause haematuria. A well-trained expert can distinguish between these two forms of haematuria by examining the urinary sediment under a simple light microscope. In glomerular haematuria, dysmorphic erythrocytes and erythrocyte casts are found, whereas in nonglomerular haematuria the erythrocytes are monomorphic and erythrocyte casts are absent. However, few people have sufficient expertise in the examination of the urinary sediment, and consequently this investigation is performed far too seldom. A few years ago, a simple method of fixation of the urinary sediment became available. Fixed specimens can be stored at room temperature for at least two weeks, which enables the sending of a fixed specimen to an expert examiner by regular mail. In this way, the urinary sediment can more frequently be used as the initial investigation in the diagnostic route of patients with asymptomatic haematuria.
