Urinary tract tuberculosis misdiagnosed and treated as renal carcinoma in the presence of diffuse interstitial nephritis: a case report.

BACKGROUND: Urinary tract tuberculosis (UTTB) is a common form of extrapulmonary tuberculosis (TB) which can infrequently present as renal carcinoma, leading to serious errors in the diagnosis and treatment of UTTB. CASE PRESENTATION: A 76-year-old Syrian man presented with gross hematuria as the main symptom. A urinary endoscopic examination and pelvic multi-slice computed tomography imaging increased the suspicion of a speared renal mass in the right urinary tract. The patient was treated for renal cancer. After nephrectomy and ureterctomy, the histopathology of the resected mass confirmed the diagnosis of UTTB and interstitial nephritis. CONCLUSION: This case should serve to increase the attention of clinicians to perform an accurate diagnosis step by step. This is especially important if they have a patient similar to the case described here who presents with a renal mass, to avoid serious results such as the loss of an essential organ system.

Changes in QT intervals in patients with end-stage renal disease before and after hemodialysis.

Increased dispersion of QT intervals is known to predispose to ventricular arrhythmias and sudden cardiac death. To assess the effect of hemodialysis (HD) on QT and corrected QT (QTc) intervals and their dispersions in chronic hemodialyzed patients we studied 85 patients (male/female = 48/37; mean age 44 +/- 17 year) on chronic hemodialysis. Simultaneous 12-lead ECG was recorded before and after HD in a standard setting. The QT intervals for each lead were measured manually by one observer using calipers. Each QT interval was corrected for heart rate: QTc= QT/ mean square root of R-R (in milliseconds [ms]). ECG parameters, body weight, blood pressure, heart rate, electrolytes (Na+, K+, Ca++, phosphate), urea, and creatinine were measured before and after HD. The mean of pre and post dialysis cycle intervals was 828 +/- 132 ms and 798 +/- 122 ms respectively; the difference was not significant. The mean of QTmax intervals changed significantly from 446 +/- 47 to 465 +/- 72 ms (P < 0.05). The mean of corrected QTcmax intervals increased significantly from 472 +/- 38 to 492 +/- 58 ms (P < 0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 60 +/- 29 to 76 +/- 32 ms (P < 0.05) from 72 +/- 46 to 98 +/- 56 ms (P < 0.05), respectively. During HD, the serum potassium and phosphate levels decreased whereas the calcium levels increased. We conclude that QT and QTc interval and dispersion increase in HD patients.

The role of theophylline in prevention of radiocontrast media-induced nephropathy.

Contrast media induced nephropathy (CIN) results in significant morbidity and mortality. We therefore investigated whether theophylline (adenosine antagonist) reduces the incidence of contrast media induced nephropathy. Two hundred and eighty patients were randomly assigned to prophylactic administration of hydration with sodium bicarbonate plus theophylline (either orally or intravenously) (n=128) or hydration with sodium bicarbonate only (n=152). Blood Urea, creatinine, and glomerular filtration rate (MDRD) were measured before and after administration of contrast media. Both groups were similar in clinical characteristics and amount of contrast used. Theophylline prophylaxis significantly reduced the incidence of CIN (1.6% vs 7.9%; P= 0.015). Compared to low-risk patients, Theophylline prophylaxis significantly reduced the incidence of CIN in moderate and high-risk patients (0% vs 8.8%; P= 0.022 and 9.1% vs 42.1%; P= 0.014 respectively). In conclusion, prophylactic administration of theophylline reduces the incidence of CIN in moderate and high-risk patients for CIN.