ABSTRACT
INTRODUCTION: Pre-eclampsia is one of the leading causes of maternal and fetal mortality and morbidity. It occurs in 7% of all the pregnancies and accounts for 80% of the cases of pregnancy-induced hypertension. Diagnosis of pre-eclampsia in patients with pre-existing chronic kidney disease, proteinuria, and hypertension is a dilemma. The fractional excretion of urea has been described as a marker for renal perfusion. Since pre-eclampsia is associated with a marked decline in renal perfusion, we explored the utility of the fractional excretion of urea as a marker for pre-eclampsia. MATERIALS AND METHODS: Urine and serum chemistries were evaluated in 6 pregnant women with pre-eclampsia on their first visit, immediately prior to delivery, and postpartum. For each of these three measurements, the fractional excretion of urea was calculated and proteinuria was assessed by random urine protein-creatinine ratio or 24-hour urine protein studies. RESULTS: In patients diagnosed with pre-eclampsia, the fractional excretion of urea decreased substantially from higher values obtained during the 3rd trimester to values consistent with renal hypoperfusion (< 35%) just prior to delivery, and it rapidly normalized immediately after delivery. CONCLUSIONS: Alterations in fractional excretion of urea, which suggest a decreased renal perfusion, may be a useful tool in supporting the diagnosis of preeclampsia.
Subject(s)
Pre-Eclampsia/metabolism , Urea/metabolism , Adolescent , Adult , Biomarkers/blood , Biomarkers/urine , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Pre-Eclampsia/diagnosis , Pregnancy , Pregnancy Outcome , Young AdultABSTRACT
Renal insufficiency occurs in a considerable proportion of patients with sickle cell disease. Common advanced glomerular lesions include focal segmental glomerulosclerosis and nonimmune membranoproliferative glomerulonephritis. Due to the paucity of data supporting an immune-mediated pathophysiology, anti-inflammatory and immunosuppressive therapies have not been successfully evaluated in such patients. We present a case of membranoproliferative glomerulonephritis in a postpartum patient with sickle cell disease, where treatment with steroids was helpful.
Subject(s)
Anemia, Sickle Cell/complications , Glomerulonephritis, Membranoproliferative/etiology , Adult , Female , Glomerulonephritis, Membranoproliferative/drug therapy , Humans , Postpartum PeriodSubject(s)
Candidiasis , Nephritis, Interstitial/diagnostic imaging , Nephritis, Interstitial/microbiology , Acute Disease , Administration, Oral , Adult , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , Candidiasis/diagnosis , Candidiasis/drug therapy , Caspofungin , Diagnosis, Differential , Echinocandins/administration & dosage , Echinocandins/therapeutic use , Female , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Gallium Radioisotopes , Humans , Injections, Intravenous , Lipopeptides , Radionuclide ImagingABSTRACT
BACKGROUND: A 54-year-old male with a history of multiple admissions for alcohol intoxication was admitted to hospital with right flank pain. He received a high-dose lorazepam infusion for alcohol withdrawal during hospitalization and developed severe hyperosmolality, high anion gap metabolic acidosis, and acute kidney injury on his eighth day of hospitalization. INVESTIGATIONS: Serum chemistries, arterial blood gas analysis, and measurement of serum propylene glycol, ethylene glycol and methanol levels. DIAGNOSIS: Propylene glycol toxicity. MANAGEMENT: Discontinuation of lorazepam infusion, administration of fomepizole, hemodialysis for five consecutive days, hemodynamic support, and follow-up of serum osmolality as a measure of propylene glycol decay.
Subject(s)
Acute Kidney Injury/chemically induced , Alcohol Withdrawal Delirium/drug therapy , Anti-Anxiety Agents/adverse effects , Lorazepam/adverse effects , Pharmaceutical Vehicles/adverse effects , Propylene Glycol/adverse effects , Acidosis/chemically induced , Acute Kidney Injury/therapy , Anti-Anxiety Agents/administration & dosage , Drug Compounding , Humans , Infusions, Intravenous , Lorazepam/administration & dosage , Male , Middle Aged , Osmolar Concentration , Pharmaceutical Vehicles/pharmacokinetics , Propylene Glycol/pharmacokinetics , Renal DialysisABSTRACT
Propylene glycol is a commonly used solvent for oral, intravenous, and topical pharmaceutical preparations. Although it is considered safe, large intravenous doses given over a short period of time can be toxic. Underlying renal insufficiency and hepatic dysfunction raise risk for toxicity. Toxic effects include hyperosmolality, increased anion gap metabolic acidosis (due to lactic acidosis), acute kidney injury, and sepsis-like syndrome. Treatment of toxicity includes hemodialysis to effectively remove propylene glycol. Prevention is best achieved by limiting the dose of propylene glycol infused.
Subject(s)
Acute Kidney Injury/chemically induced , Acute Kidney Injury/therapy , Propylene Glycol/adverse effects , Solvents/adverse effects , Acute Kidney Injury/diagnosis , Half-Life , Humans , Incidence , Kidney/metabolism , Kidney/physiopathology , Osmolar Concentration , Propylene Glycol/blood , Renal Dialysis , Risk FactorsSubject(s)
Cerebrovascular Disorders/complications , Cerebrovascular Disorders/diagnosis , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/complications , Adult , Brain/pathology , Comorbidity , Female , Humans , Hydrocortisone/therapeutic use , Kidney Diseases/drug therapy , Magnetic Resonance Imaging/methods , Prednisone/therapeutic use , Seizures , Syndrome , Treatment OutcomeABSTRACT
Primary adrenal lymphoma (PAL) with adrenal insufficiency is a rare entity that has a unique presentation and prognosis when compared to other high-grade B-cell Non-Hodgkin's Lymphomas (NHL). Radiologic characteristics and image-guided biopsy are helpful in diagnosis. Current chemotherapy of choice is CHOP [Cyclophosphamide, Hydroxydaunomycin (doxorubicin), Oncovin (vincristine sulfate) and Prednisone]. More cases need to be documented to formulate an effective approach to PAL.
