ABSTRACT
Propylthiouracil is a drug used in the treatment of hyperthyroidism for more than 60 years. Adverse side effects are seen in 1-5% of patients. Renal complications of the drug including glomerulonephritis and vasculitis are rarely seen. Cases of propylthiouracil-induced rapidly progressive glomerulonephritis and vasculitis are reported in association with antineutrophil cytoplasmic autoantibodies. Here we report a case of positive antineutrophil cytoplasmic autoantibodies rapidly progressive glomerulonephritis (RPGN) associated with propylthiouracil treatment.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Hyperthyroidism/drug therapy , Propylthiouracil/adverse effects , Vasculitis/chemically induced , Vasculitis/pathology , Aged , Angiotensin-Converting Enzyme Inhibitors , Atrophy , Humans , Kidney/drug effects , Kidney/pathology , Kidney Glomerulus/drug effects , Kidney Glomerulus/pathology , Male , Propranolol/therapeutic use , Ramipril/therapeutic useABSTRACT
Kimura disease presents as a benign subcutaneous mass. Although it principally affects the skin and soft tissues, there is a high prevalence of related renal disease. We report a case of Kimura disease from western Asia, presenting itself as nephrotic syndrome, and this case was seen at a nontransplant kidney presenting with focal segmental glomerulonephritis.
Subject(s)
Angiolymphoid Hyperplasia with Eosinophilia/complications , Glomerulosclerosis, Focal Segmental/etiology , Adult , Angiolymphoid Hyperplasia with Eosinophilia/pathology , Biopsy , Cyclosporine/therapeutic use , Diagnosis, Differential , Follow-Up Studies , Glomerulosclerosis, Focal Segmental/pathology , Glomerulosclerosis, Focal Segmental/therapy , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Kidney/pathology , Lymph Nodes/pathology , Male , Neck , Prednisolone/therapeutic use , Renal DialysisABSTRACT
BACKGROUND: Anemia is an important predictor of mortality and morbidity in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Erythropoietin (EPO) is an expensive drug, which increases the cost of therapy. In addition, anemia persists in 20-30% of cases despite EPO treatment. In this study, which depended on the idea that the clearance of moderate and high molecular weight erythropoiesis inhibitors leads to an improvement in terms of anemia, we aimed to investigate the effect of high-flux dialysis on anemia and EPO requirement in patients undergoing HD. METHODS: The study included 48 patients with ESRD on chronic HD treatment who could not reach the target hemoglobin (Hb) level, despite treatment with at least 200 IU/kg/week subcutaneous EPO. Patients were randomized into two groups and HD was performed with polysulphone low-flux dialyzer (Fresenius F6 HPS) or polysulphone high-flux dialyzer (Fresenius F60) for 6 months. RESULTS: Although the EPO doses were significantly lower (p<0.001) in the high-flux dialysis group, Hb levels showed a significant increase (p<0.001). In the low-flux dialysis group, Hb levels showed no significant increase, despite the steady increase in EPO doses. In the high-flux group, the reduction of beta2-microglobulin (b2-MG) and phosphorus levels during dialysis was significantly higher when compared to the low-flux group (p<0.001). During the follow-up period, while b2-MG levels decreased significantly in the high-flux group (p<0.05), there was an increase in the low-flux group (p<0.05). Kt/V(urea) values showed no significant difference throughout the study. CONCLUSIONS: Our results suggest that high-flux dialysis use is effective and this can be an alternative method in terms of controlling renal anemia and reducing the cost of therapy. These beneficial effects of high-flux dialysis are probably mediated by the improved clearance of moderate and high molecular weight toxins.
