ABSTRACT
Heparin-induced thrombocytopenia (HIT) type II (HIT II), is an immune-mediated complication of heparin therapy, associated with arterial and venous thrombosis. Herein we have reported a case of a 23-year-old woman who developed HIT following a living related donor, preemptive, renal transplantation. The patient was preoperatively exposed to both unfractionated and low-molecular-weight heparin as she underwent five hemodialysis sessions. HIT caused right common and external iliac vein and renal graft artery thrombosis, resulting in graft loss. Heparin-free hemodialysis was continued, and the patient was successfully treated with anticoagulation by the direct thrombin inhibitor lepirudin for both the thromboses and for hemodialysis. Finally, she was accepted for the continuous ambulatory peritoneal dialysis program. This report highlighted the importance of clinical awareness as far as previous heparin exposure is concerned for establishing an early diagnosis and delivering treatment of this life-threatening prothrombotic complication of heparin administration.
Subject(s)
Heparin, Low-Molecular-Weight/adverse effects , Kidney Transplantation/adverse effects , Renal Dialysis , Thrombocytopenia/chemically induced , Adult , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Female , Hematocrit , Hirudins , Humans , Living Donors , Platelet Count , Pulmonary Embolism/diagnosis , Recombinant Proteins/therapeutic use , Renal Dialysis/adverse effects , Thrombocytopenia/classification , Treatment OutcomeABSTRACT
A 24-year-old male with end-stage renal disease (ESRD) and disproportionately high uric acid plasma concentration was admitted to our unit. After studying the patient's medical history, as well as that of the entire family, hyperuricemia was discovered in his brother, while microscopic examination of his brother's and mother's urine revealed abundant uric acid crystals. After performing purine metabolic studies, it was determined that the two siblings suffered from partial hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency (Kelley-Seegmiller syndrome). This report highlights the importance of clinical awareness and a thorough examination of the patient's medical history for establishing an early diagnosis and commencing treatment for such rare inherited metabolic disorders to prevent renal failure.
Subject(s)
Hypoxanthine Phosphoribosyltransferase/blood , Kidney Failure, Chronic/etiology , Lesch-Nyhan Syndrome/complications , Adult , Diagnosis, Differential , Humans , Kidney Failure, Chronic/enzymology , Lesch-Nyhan Syndrome/enzymology , Lesch-Nyhan Syndrome/genetics , Male , PedigreeABSTRACT
In the present paper, a nonlinear compartmental model for theophylline pharmacokinetics is developed. The analytical solution of the model, in parametric form, is derived under plateau conditions for plasma metabolite concentration. The parameters are obtained from plasma and urine data using best fitting techniques and their values are used in order to calculate maintenance intravenous infusion. Numerical simulation is then performed in order to compare the drug concentration obtained by our approach with that of alternative intravenous regimens. The differences argue for individualized dosage regimens, since theophylline is a drug with a narrow therapeutic window and its concentration at the active sites strongly depends on characteristic parameters of the patient's response. Our results show that it is possible to estimate the patients' parameters during the first 8 h after intravenous administration of the drug and these parameters can be used to design an individualized dosage regimen in patients receiving theophylline intravenously.
