RESUMEN
The toxic effects of paracetamol in overdose quantities are well recognised but the occurrence of anaphylactoid reactions to paracetamol is infrequently identified by consumers and health care professionals. Nevertheless adverse reactions to this drug, even in therapeutic doses, can have fatal or near fatal consequences. A case of an anaphylactoid reaction to paracetamol is described.
Asunto(s)
Acetaminofén/efectos adversos , Analgésicos no Narcóticos/efectos adversos , Anafilaxia/inducido químicamente , Hipersensibilidad a las Drogas/etiología , Anciano , Femenino , Humanos , RecurrenciaRESUMEN
Disseminated primary varicella zoster infection in renal transplant patients can result in severe and often fatal illness. The disease tends to be much more severe in adults with an 80% mortality in the only reported series (1). We report 3 cases of severe disseminated varicella zoster in adult renal transplant patients who all survived. Early diagnosis, institution of intravenous acyclovir 10 mg/kg tds, zoster immunoglobulin, cessation of azathioprine treatment and aggressive supportive care may improve an otherwise bleak prognosis.
Asunto(s)
Varicela/etiología , Trasplante de Riñón , Aciclovir/administración & dosificación , Aciclovir/uso terapéutico , Adulto , Azatioprina/administración & dosificación , Azatioprina/uso terapéutico , Varicela/diagnóstico , Varicela/tratamiento farmacológico , Coagulación Intravascular Diseminada/etiología , Femenino , Estudios de Seguimiento , Herpesvirus Humano 3/inmunología , Humanos , Inmunoglobulinas/administración & dosificación , Inmunoglobulinas/uso terapéutico , MasculinoRESUMEN
We report a 35-year-old woman who developed herpes simplex virus (HSV) type 1 interstitial nephritis following a cadaveric renal transplant. Transplant function was poor and a transplant nephrectomy was performed 23 days post-transplant. Histological changes characteristic of herpes virus infection were seen on the renal biopsy with positive immunoperoxidase staining for HSV. HSV 1 was cultured from the transplant nephrectomy specimen.
Asunto(s)
Herpes Simple/patología , Trasplante de Riñón/patología , Nefritis Intersticial/etiología , Adulto , Cadáver , Femenino , Humanos , Técnicas para Inmunoenzimas , Riñón/microbiología , Nefrectomía , Reoperación , Simplexvirus/aislamiento & purificación , Factores de TiempoRESUMEN
Peliosis hepatis is described in a renal transplant recipient and in a patient who was receiving long-term haemodialysis. This uncommon liver lesion has been reported in a number of patients, including 18 renal transplant recipients and two patients with chronic renal failure. However, its cause, clinical features, natural history and clinical significance remain to be determined. We emphasize that, although it is rare, peliosis hepatis should be considered in long-term haemodialysis and renal transplant patients who exhibit hepatomegaly and/or splenomegaly and/or disordered liver function (in particular, elevation of hepatic alkaline phosphatase levels).
Asunto(s)
Trasplante de Riñón , Hepatopatías/etiología , Peliosis Hepática/etiología , Diálisis Renal , Adulto , Azatioprina/efectos adversos , Biopsia , Humanos , Terapia de Inmunosupresión/efectos adversos , Hígado/patología , Masculino , Persona de Mediana Edad , Peliosis Hepática/patología , Factores de TiempoRESUMEN
Between 1978 and 1984, 19 patients at Royal Perth Hospital (RPH) underwent parathyroidectomy for secondary (renal) hyperparathyroidism. This represented 6.0% of the overall dialysis population treated at RPH during this period of time. The mean duration of pre-operative dialysis for these 19 patients was 48 months, compared with a mean duration of 30 months for the overall dialysis population. The principal indications for parathyroidectomy were symptomatic hyperparathyroid bone disease (10), hypercalcaemia (six), progressive lower limb ischaemia (two) and painful peri-articular calcification (one). The complications of chronic renal failure that were most consistently improved by parathyroidectomy were the clinical, radiological and biochemical manifestations of hyperparathyroid bone disease and hypercalcaemia. Features such as pruritus, soft tissue calcification, vessel wall calcification and peripheral ischaemia responded less predictably. Hyperparathyroid bone disease and hypercalcaemia remain the principal indications for parathyroidectomy in chronic renal failure. Profound postoperative hypocalcaemia was the major early postoperative management problem (seven patients) and was closely linked with the severity of pre-operative hyperparathyroid bone disease. It was also seen more frequently in those patients undergoing total parathyroidectomy with immediate autotransplantation of parathyroid tissue (TP-A), than in those in whom residual parathyroid tissue was left in situ (subtotal parathyroidectomy or STP). Recurrent hyperparathyroidism (four patients) was the major late postoperative complication, but was more frequently the result of a supernumerary or previously overlooked fourth parathyroid gland (three), than due to hyperplasia of residual parathyroid tissue (one). STP and TP-A were equally effective in controlling or reversing renal hyperparathyroidism, but the former was associated with a lower incidence of postoperative management problems and should be the preferred operation in this group of patients.
Asunto(s)
Fallo Renal Crónico/complicaciones , Glándulas Paratiroides/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Hipercalcemia/etiología , Hiperparatiroidismo Secundario/cirugía , Hipocalcemia/etiología , Hipoparatiroidismo/etiología , Masculino , Métodos , Persona de Mediana Edad , Osteítis Fibrosa Quística/etiología , Osteítis Fibrosa Quística/cirugía , Glándulas Paratiroides/patología , Glándulas Paratiroides/trasplante , Complicaciones Posoperatorias , Cuidados Preoperatorios , Recurrencia , Factores de Tiempo , Trasplante AutólogoRESUMEN
Two iodine-sensitive women in whom potassium bromide solution was used as a radiocontrast agent for retrograde pyelography developed similar clinical conditions culminating in renal failure. Renal failure was due to upper urinary tract obstruction from fibrosis and fat necrosis in each case. Similar histological findings have been described in rabbit bladder exposed to sodium bromide solution. Different patterns of exposure corresponded with different sites of major damage in the two cases. One patient, who had repeated studies of the pelvicalyceal system with potassium bromide developed papillary necrosis. Systemic exposure to bromide-releasing compounds (in animals) and to bromides (in humans) has also been associated with papillary necrosis.
Asunto(s)
Bromuros/efectos adversos , Fallo Renal Crónico/etiología , Compuestos de Potasio , Potasio/efectos adversos , Obstrucción Ureteral/etiología , Urografía/efectos adversos , Adulto , Medios de Contraste/efectos adversos , Necrosis Grasa/diagnóstico , Necrosis Grasa/etiología , Femenino , Humanos , Fallo Renal Crónico/diagnóstico , Persona de Mediana Edad , Síndrome , Obstrucción Ureteral/diagnóstico , Urografía/métodosRESUMEN
A case of haemorrhagic cystitis caused by adenovirus type 11, which occurred in a female patient 13 weeks after renal transplantation is described. The patient lacked neutralising antibody to adenovirus type 11 before transplantation, but this antibody was present in the serum of the kidney donor. The patient developed antibody to adenovirus type 11, and this virus was isolated from her throat and urine. The data suggest that the infection was transmitted by the kidney graft.
Asunto(s)
Infecciones por Adenoviridae/microbiología , Infecciones por Adenovirus Humanos/microbiología , Cistitis/etiología , Trasplante de Riñón , Enfermedad Aguda , Adenovirus Humanos/inmunología , Adenovirus Humanos/aislamiento & purificación , Adulto , Anticuerpos Antivirales/análisis , Pruebas de Fijación del Complemento , Cistitis/inmunología , Cistitis/microbiología , Femenino , Hemorragia/etiología , Humanos , Pruebas de NeutralizaciónRESUMEN
The results of cadaveric renal transplantation in one centre over 12 years are reviewed. One hundred and sixty-eight grafts have been performed in 147 recipients. At one year after transplantation, patient survival rate was 86%, and graft survival rate was 63%. Analysis of factors influencing graft survival show that the age of recipients, the lack of blood transfusions, and the use of poorly matched grafts (three to four HLA mismatches against 0 to two mismatches), all had adverse effect on survival. Death was a significant cause of graft loss in patients over the age of 45 years. Patients who had not received blood transfusions, and who received grafts which were mismatched for three to four HLA antigens, did especially badly, graft survival rate at six months being only 24% compared with that of 70% in patients who received blood transfusions.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón , Adolescente , Adulto , Factores de Edad , Transfusión Sanguínea , Cadáver , Femenino , Estudios de Seguimiento , Histocompatibilidad , Humanos , Masculino , Persona de Mediana Edad , Trasplante HomólogoRESUMEN
A case of localized ureteric stricture in a woman with analgesic nephropathy is reported. The problems of diagnosis and management are briefly discussed.
Asunto(s)
Analgésicos/efectos adversos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/complicaciones , Obstrucción Ureteral/etiología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Three cases of acute renal failure after snake bite are presented. All required dialysis and the recovery phase was prolonged in each case. Investigations show that microangiopathic haemolytic anaemia was associated with the acute renal failure.
Asunto(s)
Lesión Renal Aguda/etiología , Mordeduras de Serpientes/complicaciones , Adulto , Anemia Hemolítica/etiología , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Anticoagulantes/administración & dosificación , Dipiridamol/administración & dosificación , Trasplante de Riñón , Administración Oral , Anticoagulantes/uso terapéutico , Cadáver , Ensayos Clínicos como Asunto , Dipiridamol/uso terapéutico , Rechazo de Injerto , Prueba de Histocompatibilidad , Humanos , Riñón/inmunología , Riñón/patología , Pruebas de Función Renal , Estudios Prospectivos , Factores de Tiempo , Supervivencia Tisular , Trasplante HomólogoAsunto(s)
Cefalexina/efectos adversos , Psicosis Inducidas por Sustancias/etiología , Cefalexina/uso terapéutico , Trastornos del Conocimiento/inducido químicamente , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Convulsiones/inducido químicamente , Uremia/complicacionesAsunto(s)
Consumo de Bebidas Alcohólicas , Electrocardiografía , Factores de Edad , Australia , Cerveza , Peso Corporal , Enfermedades Cardiovasculares/diagnóstico , Carotenoides/sangre , Colesterol/sangre , Dieta , Cardiopatías/etiología , Humanos , Hipertensión/etiología , Masculino , Persona de Mediana Edad , Ocupaciones , Esfuerzo Físico , Fumar/complicacionesRESUMEN
A proprietary aspirin, phenacetin, and caffeine preparation given to rats in a dose equivalent to that taken by patients with analgesic nephropathy produced papillary necrosis in 55%. There was a higher incidence in rats deprived of fluids overnight.Papillary necrosis was not noted in rats receiving twice as much phenacetin.These findings support the argument that phenacetin should not be singled out as the substance responsible for analgesic nephropathy in man.