Bilateral nephrectomy for uncontrolled hypertension in hemodialysis patient: a forgotten option?

Resistant arterial hypertension in chronic hemodialysis patients is still a therapeutical challenge despite the development of modern antihypertensive drugs and dialysis procedures. Bilateral nephrectomy seems to be a forgotten option, although it has given good results. We present a case of a 39-year-old female chronic hemodialysis patient, in whom the problem of uncontrolled renal parenchymal hypertension remained despite multiple drug therapy and the ultrafiltration intensification. The problem was solved by bilateral nephrectomy. We discuss the role of bilateral nephrectomy for arterial hypertension control in chronic hemodialysis patients and the surgical and non-surgical options of nephrectomy.

Plasma exchange treatment for acute hyperlipidemic pancreatitis with falsely low levels of serum triglycerides - a case report.

Hypertriglyceridemia is a well-recognized cause of acute pancreatitis. We present a patient with acute hypertriglyceridemic pancreatitis. At presentation serum triglycerides were severely elevated (104 mmol/l) and were decreasing the next day (11 mmol/l). However, based on increasing levels of serum lipase, worsening respiratory failure and evidently lipemic serum, we decided to perform plasma exchange, and patient's condition improved dramatically. Repeated laboratory test of the serum obtained before the first plasma exchange revealed that the actual value of serum triglycerides was 57 mmol/l. A clinically-driven decision is crucial when treating patients with hypertriglyceridemic acute pancreatitis as the serum triglyceride levels can be falsely low.

Splenic rupture in systemic amyloidosis - case presentation and review of the literature.

INTRODUCTION: Splenic rupture and hemorrhage into the abdominal cavity is an extremely unusual and rare complication of internal disease. Hemopathies, inflammatory or infiltrative diseases affecting the spleen are possible causes for such a complication. Splenomegaly is a factor, which may significantly increase the risk of rupture. CASE REPORT: The authors present the case of a 52-year-old patient with established systemic amyloidosis. In the past he had received treatment for undefined hepatic disease and anemia, which was established during the treatment of pathological vertebral fractures. Unfortunately, during the initial treatment he did not consent to a liver biopsy, which would have determined the etiology of the disease. Systemic infiltrative disease, affecting the spleen and other organs, was confirmed posthumously. Described are those forms of amyloidosis which usually represent an unfavorable course of the disease. CONCLUSION: Presented is a patient with a rare form of primary amyloidosis and fatal complication, spleenic rupture.