ABSTRACT
Small body mass index is associated with increased mortality in chronic hemodialysis patients. The reasons for this observation are unclear but may be related to body composition. This study aimed to investigate the body composition in chronic hemodialysis patients. The difference between body mass and the sum of muscle, bone, subcutaneous, and visceral adipose tissue masses, measured by whole body magnetic resonance imaging, was defined as the high metabolic rate compartment representing the visceral mass. Protein catabolic rate was calculated from urea kinetics. Forty chronic hemodialysis patients (mean age 54.7 years; 87.5% African Americans; 45% females) were studied. High metabolic rate compartment expressed in percent of body weight was inversely related to body weight (r=-0.475; P=0.002) and body mass index (r=-0.530; P<0.001). In a multiple linear regression model, protein catabolic rate was significantly correlated only with high metabolic rate compartment (r=0.616; P<0.001). Assuming that protein catabolic rate in addition to protein intake reflects urea and uremic toxin generation, it follows that high metabolic rate compartment is the major compartment involved in their generation. Consequently, uremic toxin production rate may be relatively higher in patients with low body weight and low body mass index as compared to their heavier counterparts. The poorer survival observed in smaller dialysis patients may be related to these relative differences.
Subject(s)
Body Composition/physiology , Body Size/physiology , Energy Metabolism/physiology , Renal Dialysis/mortality , Adult , Aged , Basal Metabolism/physiology , Body Mass Index , Cross-Sectional Studies , Female , Humans , Linear Models , Male , Middle AgedSubject(s)
Nephrosis, Lipoid/physiopathology , Adult , Female , Humans , Recurrence , Remission, SpontaneousABSTRACT
Unlike hepatitis B and C, renal involvement has been extremely uncommon in patients with hepatitis Avirus (HAV) infection. Nephrotic syndrome has been documented as a rare complication in association with HAV infection. In this report, we describe a patient with serologically documented HAV infection, who presented with nephrotic syndrome. The renal biopsy showed an immunoglobulin A- (IgA) dominant glomerulonephritis (GN) with subendothelial immune deposits. This is the second biopsy-proven case report of a patient with acute HAV associated with IgA-dominant immune complex glomerulonephritis and nephrotic syndrome. This is perhaps the first case in which a patient experienced both IgA-dominant glomerulonephritis and cutaneous cryoglobulinemic vasculitis.
Subject(s)
Glomerulonephritis, IGA/complications , Hepatitis A/complications , Glomerulonephritis, IGA/pathology , Hepatitis A/pathology , Humans , Male , Middle AgedABSTRACT
We present the case of a 50-year-old man who underwent kidney biopsy for nephrotic syndrome. In addition to a membranous pattern, anti-glomerular basement membrane (anti-GBM) staining was noted before manifestations of anti-GBM disease. Hematuria and renal failure ensued 2 weeks later. In addition, he had simultaneous circulating levels of anti-GBM antibody and both perinuclear (P-) and cytoplasmic (C-) antineutrophil cytoplasmic antibody (ANCA).
Subject(s)
Anti-Glomerular Basement Membrane Disease/immunology , Antibodies, Antineutrophil Cytoplasmic/blood , Glomerulonephritis, Membranous/immunology , Anti-Glomerular Basement Membrane Disease/complications , Anti-Glomerular Basement Membrane Disease/pathology , Glomerulonephritis, Membranous/complications , Glomerulonephritis, Membranous/pathology , Humans , Male , Middle AgedABSTRACT
Kayexalate (Roxane Labs, Columbus, OH) in sorbitol is commonly administered by the oral and rectal route for the treatment of hyperkalemia in patients with renal failure. It is believed to have minimal toxicity because it functions as a cation exchanger and is not absorbed. We herein report on a patient who developed identical serpiginous ulcers in the stomach and the terminal ileum after the use of Kayexalate. We believe that this drug could have significant gastrointestinal toxicity in specific patient groups and suggest tentative guidelines, both for the identification of such patients and for the safer use of Kayexalate in these circumstances.
Subject(s)
Cation Exchange Resins/adverse effects , Cecal Diseases/chemically induced , Cecal Diseases/pathology , Ileal Diseases/chemically induced , Ileal Diseases/pathology , Polystyrenes/adverse effects , Stomach Ulcer/chemically induced , Administration, Oral , Adult , Cation Exchange Resins/administration & dosage , Female , Humans , Polystyrenes/administration & dosage , UlcerSubject(s)
Ferritins/blood , Renal Dialysis , Renal Insufficiency/blood , Humans , Renal Insufficiency/therapySubject(s)
Graft Rejection/therapy , Immunosuppression Therapy/methods , Kidney Transplantation/immunology , Wiskott-Aldrich Syndrome/surgery , Adult , Azathioprine/therapeutic use , Cyclosporine/blood , Cyclosporine/therapeutic use , Female , Humans , Male , Methylprednisolone/therapeutic use , Muromonab-CD3/therapeutic use , Prednisone/therapeutic useABSTRACT
The number of people smoking free-base cocaine, or "crack," has increased dramatically in recent years. Concomitantly, the literature describing complications of such use has grown as well. Adverse pulmonary effects are being increasingly noted, such as respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, and pulmonary barotrauma. These and other pulmonary effects are reviewed.
