Assuntos
Linfócitos B/efeitos dos fármacos , Glomerulonefrite Membranosa/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Rituximab/uso terapêutico , Adulto , Idoso , Linfócitos B/imunologia , Feminino , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/imunologia , Recidiva , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Cyclophosphamide is frequently used to treat cancer, autoimmune and renal diseases, such as rapidly progressive glomerulonephritis. Its side effects are well-known, including bone marrow depression, infections, alopecia, sterility, bladder malignancy and hemorrhagic cystitis. Moreover, in some cases cyclophosphamide use has been related to the onset of hyponatremia, by development of a syndrome of inappropriate antidiuresis. Indeed, severe hyponatremia has been previously reported in patients treated with high-dose or moderate-dose of intravenous cyclophosphamide, while only few cases have been reported in patients treated with low dose. Here, we discuss a case of a syndrome of inappropriate antidiuresis followed to a single low-dose of intravenous cyclophosphamide in a patient with a histological diagnosis of acute glomerulonephritis, presenting as acute kidney injury. After cyclophosphamide administration (500 mg IV), while renal function gradually improved, the patient developed confusion and headache. Laboratory examinations showed serum sodium concentration dropped to 122 mmol per liter associated with an elevated urinary osmolality of 199 mOsm/kg, while common causes of acute hyponatremia were excluded. He was successfully treated with water restriction and hypertonic saline solution infusion with the resolution of the electrolyte disorder. This case, together with the previous ones already reported, highlights that electrolyte profile should be strictly monitored in patients undergoing cyclophosphamide therapy in order to early recognize the potentially life-threatening complications of acute water retention.
RESUMO
Spontaneous renal bleeding mainly occurs in patients with polycystic kidney diseases or cancer. Indeed, despite the high prevalence of simple cysts, their spontaneous atraumatic rupture is a rare event. Underlying mechanisms may involve the increase of intracystic pressure and/or the development of a haemorrhage into the cyst. Management of this condition includes surgery, interventional radiology or conservative strategies. Here, we report a case of spontaneous rupture of a simple renal cyst, successfully managed with conservative treatment.
Assuntos
Doenças Renais Císticas/terapia , Idoso de 80 Anos ou mais , Humanos , Doenças Renais Císticas/complicações , Masculino , Ruptura EspontâneaRESUMO
Urinalysis is a key part of the clinical evaluation of patients with kidney disease. It can provide several useful information for the diagnosis and management of diseases of kidneys and urinary tract. In particular, urine color can be affected by the presence of blood, infection and endogenous metabolites, such as bilirubin, or exogenous, for instance those derived from drugs. Therefore, the analysis of urine color may be helpful in identifying different clinical conditions. Here we report a case of a patient who presented purple-colored urine, the so-called " Purple urine bag syndrome", discussing the predisposing factors and the pathogenesis of this condition. We believe that this information can be useful to clinicians who might face this particular situation.