Subject(s)
Humans , Male , Aged, 80 and over , Kidney Failure, Chronic , Rhabdomyolysis , Rosuvastatin Calcium , Abiraterone Acetate , HypothyroidismABSTRACT
Presentamos el caso de un varón afecto por neumonía SARS-CoV-2 grave, que a la vez comienza con una glomerulonefritis rápidamente progresiva p-ANCA positiva. Se comentan las distintas posibilidades terapéuticas haciendo hincapié en la idoneidad de su administración según el momento evolutivo de la infección. (AU)
We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection. (AU)
Subject(s)
Humans , Male , Nephrology , Coronavirus Infections/epidemiology , Anti-Glomerular Basement Membrane Disease/therapy , Pneumonia/therapy , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , AortitisABSTRACT
We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.
ABSTRACT
BACKGROUND: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear. OBJECTIVES: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome. METHODS: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak. RESULTS: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05). CONCLUSIONS: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.
Subject(s)
Anticoagulants/therapeutic use , COVID-19/complications , Heparin, Low-Molecular-Weight/therapeutic use , Thrombosis/drug therapy , Thrombosis/etiology , Aged , Aged, 80 and over , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/drug therapy , Disseminated Intravascular Coagulation/etiology , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Thrombophilia/diagnosis , Thrombophilia/drug therapy , Thrombophilia/etiology , Thrombosis/diagnosis , Venous Thromboembolism/diagnosis , Venous Thromboembolism/drug therapy , Venous Thromboembolism/etiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Infarction/virology , Kidney/blood supply , Renal Insufficiency/virology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Betacoronavirus , Pandemics , Acute DiseaseABSTRACT
No disponible
Subject(s)
Humans , AIDS-Related Opportunistic Infections/diagnosis , Glomerulonephritis/diagnosis , Hepatitis C/complications , Leishmaniasis, Visceral/diagnosis , NecrosisABSTRACT
La relación entre parásitos y glomerulonefritis (GN) está bien documentada en determinadas parasitosis, no así en casos de Strongyloides stercolaris (S. stercolaris), donde hay pocos casos descritos, siendo la mayoría GN de cambios mínimos. Reportamos un caso de hiperinfestación por S. stercolaris en un paciente afectado de una GN membranosa tratado con corticoides por vía oral con resultado fatal para el paciente. Este caso nos aporta una doble enseñanza: en primer lugar, acerca de una asociación rara de estrongiloidiasis y GN membranosa, y en segundo lugar, sobre la importancia de establecer un diagnóstico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad clínica antes de iniciar cualquier tratamiento inmunosupresor
The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment
Subject(s)
Humans , Animals , Male , Middle Aged , Glomerulonephritis, Membranous/complications , Immunosuppressive Agents/adverse effects , Prednisone/adverse effects , Strongyloides stercoralis , Strongyloidiasis/complications , Systemic Inflammatory Response Syndrome/etiology , Cryptococcosis/complications , Delayed Diagnosis , Drug Therapy, Combination , Ecuador/ethnology , Enterococcus faecium , Escherichia coli Infections/complications , Fatal Outcome , Glomerulonephritis, Membranous/drug therapy , Glomerulonephritis, Membranous/urine , Gram-Positive Bacterial Infections/complications , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Lung Diseases, Fungal/complications , Meningitis, Bacterial/complications , Pneumonia, Bacterial/complications , Prednisone/therapeutic use , Shock, Septic/etiology , Stenotrophomonas maltophilia , Strongyloidiasis/diagnosisABSTRACT
The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.
Subject(s)
Glomerulonephritis, Membranous/complications , Immunosuppressive Agents/adverse effects , Prednisone/adverse effects , Strongyloides stercoralis , Strongyloidiasis/complications , Systemic Inflammatory Response Syndrome/etiology , Animals , Cryptococcosis/complications , Delayed Diagnosis , Drug Therapy, Combination , Ecuador/ethnology , Enterococcus faecium , Escherichia coli Infections/complications , Fatal Outcome , Glomerulonephritis, Membranous/drug therapy , Glomerulonephritis, Membranous/urine , Gram-Positive Bacterial Infections/complications , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Lung Diseases, Fungal/complications , Male , Meningitis, Bacterial/complications , Middle Aged , Pneumonia, Bacterial/complications , Prednisone/therapeutic use , Shock, Septic/etiology , Spain , Stenotrophomonas maltophilia , Strongyloidiasis/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Acute Kidney Injury/chemically induced , Atorvastatin/adverse effects , Purinergic P2 Receptor Agonists/adverse effects , Rhabdomyolysis/chemically induced , Rhabdomyolysis/complications , Ticagrelor/adverse effects , Drug Interactions , Fatal OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Lithiasis/etiology , Lithiasis/genetics , Urinary Tract Infections/complications , Allopurinol/administration & dosage , Renal Insufficiency, Chronic/etiology , Lithiasis/diagnosis , Hematuria/diagnosis , Lithiasis/drug therapy , Urinary Catheterization , Renal Insufficiency, Chronic/geneticsABSTRACT
No disponible
