Subject(s)
Nephritis, Interstitial/chemically induced , Omeprazole/adverse effects , Acute Disease , Aged , Humans , Male , RecurrenceABSTRACT
Lung hemorrhage and antiglomerular basement membrane (anti-GBM) antibody mediated nephritis define Goodpasture's syndrome. We present the case of a 19-year-old Caucasian woman with unique clinical findings of Goodpasture's syndrome. Our patient initially presented with leukocytoclastic vasculitis of the skin followed by the development of nephritis and lung hemorrhage. An open lung biopsy done prior to diagnosing anti-GBM antibody disease demonstrated an intense eosinophilic vasculitis. Skin vasculitis has only been rarely reported, and to our knowledge this is the first reported case of pulmonary eosinophilic vasculitis associated with Goodpasture's syndrome.
Subject(s)
Anti-Glomerular Basement Membrane Disease/complications , Eosinophilia/complications , Pulmonary Circulation , Vasculitis/complications , Adult , Anti-Glomerular Basement Membrane Disease/pathology , Biopsy , Eosinophilia/pathology , Female , Humans , Kidney/pathology , Lung/pathology , Skin/blood supply , Skin/pathology , Vasculitis/pathologyABSTRACT
The effect of dialyzer membrane and design on hemostatic parameters during hemodialysis were evaluated in a prospective controlled study. This study demonstrated that hemodialysis is associated with significant platelet activation and loss, which are influenced by both dialyzer configuration and membrane composition. In addition, use of the cuprophan membrane is associated with greater perturbations of the vascular endothelium, as reflected in changes in factor VIII-related von Willebrand factor and 6-keto-prostaglandin F1 alpha concentrations not seen with the polyacrylonitrile membrane. Of the dialyzers studied, the polyacrylonitrile membrane in a hollow-fiber configuration appears to minimize platelet loss and activation, and to minimize increases in factor VIII-related von Willebrand factor and 6-keto-prostaglandin F1 alpha.
Subject(s)
Antigens/metabolism , Blood Platelets/physiology , Factor VIII/immunology , Hemostasis , Kidneys, Artificial , Membranes, Artificial , Renal Dialysis , von Willebrand Factor/metabolism , 6-Ketoprostaglandin F1 alpha/blood , Acrylic Resins , Cellulose/analogs & derivatives , Equipment Design , Factor VIII/metabolism , Humans , Male , Middle Aged , Platelet Count , Prospective Studies , Random AllocationABSTRACT
Marked declines in platelet numbers were noted in association with hemodialysis. This resulted in gastrointestinal bleeding and the need for packed RBC and platelet transfusions. This hemodialysis-associated thrombocytopenia was ameliorated by changing the dialyzer in use. The gastrointestinal bleeding stopped and the need for platelet transfusions was obviated. The degree of platelet loss during hemodialysis is probably affected by the composition of the dialyzer membrane used as well as other factors. Hemodialysis-associated thrombocytopenia may be a contributing factor in the increased bleeding tendency noted in hemodialysis patients.
