Renal Leukemic Infiltration Overlapping Acute Focal Bacterial Nephritis during Myelodysplastic Syndrome: An Autopsy Case Report.

Renal leukemic infiltration is uncommon in myeloid neoplasms, including myelodysplastic syndromes (MDS). A 76-year-old male patient was admitted to our hospital with complaints of fever and dyspnea. He was diagnosed with MDS with multilineage dysplasia and acute focal bacterial nephritis (AFBN) based on clinical, laboratory, and radiological investigations. Antibiotic treatment temporarily improved his condition, but the radiological image of AFBN remained. His condition gradually deteriorated into multiple organ failure, and he unfortunately died on the 31st day of hospitalization. Autopsy findings revealed significantly increased p53-positive blasts in the bone marrow and renal parenchyma overlapping AFBN, suggesting leukemic transformation and renal infiltration. This case emphasizes the need to review the diagnosis when antibiotic treatment is ineffective in MDS patients with AFBN.

A review of direct-acting antivirals for the treatment of hepatitis C in patients with advanced chronic kidney disease.

Historically, standard treatment of hepatitis C virus (HCV) infection in patients with renal impairment has been limited by low cure rates and poor tolerability. The introduction of direct-acting antivirals (DAAs) has revolutionized the treatment of HCV with impressive cure rates >90% and low rates of adverse events. Despite these major advancements, treatment of patients with HCV and advanced chronic kidney disease (CKD) is a major challenge due to the lack of efficacy and safety data in this patient population. The purpose of this review is to summarize the available data for efficacy and safety of the following DAAs in treating HCV patients with advanced Stage 4 and 5 CKD: simeprevir, sofosbuvir, ledipasvir, ombitasvir, paritaprevir, dasabuvir, grazoprevir, elbasvir and daclatasvir.

Successful Treatment of Hepatitis C with Simeprevir, Sofosbuvir, and Ribavirin in an HIV Coinfected Liver Transplant Patient with Advanced Chronic Kidney Disease.

Although major advances have occurred in treating patients with hepatitis C virus (HCV) with the development of new direct-acting antivirals (DAAs), treatment of liver transplant recipients with HCV, human immunodeficiency virus (HIV) coinfection, and renal disease is challenging due to the lack of efficacy and safety data in this population. We report a case of successful HCV therapy in a postliver transplant HIV coinfected patient, with stage 4 chronic kidney disease, using an all-oral regimen of simeprevir, sofosbuvir, and ribavirin. The 51-year-old male achieved SVR24, and no specific HIV-related or transplant-related adverse events were documented during the treatment period. The new DAAs show promise for HIV coinfected patients and those with severe to end-stage renal disease (ESRD); however, robust clinical trials or large cohort studies will need to be conducted to confirm the efficacy and safety of these newer agents in this setting.

Hypertension, chronic obstructive pulmonary disease, diabetes and depression among older methadone maintenance patients in British Columbia.

INTRODUCTION AND AIMS: Risk factors in older methadone maintenance treatment (MMT) patients may put them at a greater risk of acquiring chronic diseases; however, this group might experience barriers to treatment resulting in reduced recommended prescriptions. The research objective for this study was to assess whether MMT patients were significantly different from a matched control group in terms of medications dispensed for hypertension, chronic obstructive pulmonary disease (COPD), diabetes and depression. DESIGN AND METHODS: The research design was a case-control study, where prescription claims data from the British Columbia database were used. MMT patients 50 years of age and older were randomly selected, and control subjects were individually matched in terms of age, sex, social assistance coverage and geographic jurisdiction. RESULTS: Each group consisted of 199 participants. Odds ratios (OR) were calculated to compare the odds of MMT patients to non-MMT patients on a first-line medication for each chronic disease under investigation. The MMT group was significantly more likely to receive medications for COPD (OR = 32.68, P < 0.001) and depression (OR = 4.07, P < 0.001), and no significant differences for hypertension (OR = 0.86) or diabetes (OR = 0.74). DISCUSSION: Higher rates of COPD among MMT clients is likely explained by elevated smoking, and higher rates of depression may be explained by multiple disadvantages associated with substance use. Although the groups were similar for diabetes prescriptions, the MMT group likely experienced barriers to receiving treatment since prior research suggests their rates should be elevated due to methadone use.