Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 7 Articles
Tuberculosis is a multiorgan disease with varied clinical presentations and is reemerging due to increasing immigration and\r\nglobalization.We present the case of an immigrant female patient who developed acute renal failure with clinical and biochemical\r\nfeatures suggestive of lupus nephritis but with a timely renal biopsy showing caseating granulomata in the renal parenchyma\r\nconsistent with renal tuberculosis. Despite treatment with antituberculosis treatment and resolution of TB on repeat renal biopsy,\r\nshe remained haemodialysis dependent. We discuss the diagnostic challenges faced in this presentation and also explore possible\r\ndifferential diagnoses. This rare presentation highlights the importance of renal biopsy in the diagnosis and treatment of acute\r\nrenal failure and the atypical presentation of tuberculosis....
We are presenting a case of renal failure with anti-GBM and p-ANCA antibodies positive. Patients with dual antibodies are considered\r\nto be a vasculitis-variant of anti-GBM antibody nephritis. These patients may have atypical presentation and it may delay\r\ndiagnosis and treatment. Recurrence rate is higher in these patients. We reviewed the literature of cases and studies on cresenteric\r\nglomerulonephritis with anti-GBM and p-ANCA positive patients.We recommend that patients suspected with pulmonary-renal\r\nsyndrome should be checked for anti-GBM and p-ANCA antibodies, should undergo renal biopsy and should should have close\r\nlong term follow up to watch for recurrence....
Background: Family members of persons with pre-dialysis chronic kidney disease may experience feelings of\r\nvulnerability and insecurity as the disease follows its course. Against this background, the aim of the present study\r\nwas to explore empowerment in outpatient care as experienced by these family members.\r\nMethods: An inductive approach for qualitative data analysis was chosen. The study sample comprised 12 family\r\nmembers of pre-dialysis patients at an outpatient kidney clinic. Two interviews with each family member were\r\nsubjected to content analysis to gain an understanding of empowerment from the family members� perspective.\r\nResults: Having strength to assume the responsibility was the main theme that emerged from the following five\r\nsub-themes: Being an involved participant, Having confirming encounters, Trusting in health-care staff,\r\nComprehending through knowledge, and Feeling left out. Four of these five sub-themes were positive. The fifth\r\nsubtheme illuminated negative experience, indicating the absence of empowerment.\r\nConclusions: Family members� experience of empowerment is dependent on their ability to assume the\r\nresponsibility for a relative with chronic kidney disease when needed. The findings emphasise the need for a family\r\nperspective and the significance of a supportive environment for family members of persons in outpatient care....
Lyme borreliosis is a chronic illness caused by tick-transmitted spirochete Borrelia burgdorferi. Borreliosis can be extremely\r\nthreatening if it is not diagnosed and treated in early stages. Kidneys are not typically involved in the disease. However, in\r\ninfected dogs, Lyme nephritis is present in 5ââ?¬â??10% of cases. It is associated with rapidly progressing renal failure. Histopathological\r\nexamination shows mesangial proliferative glomerulonephritis with diffuse tubular necrosis, (Dambach et al. (1997)). In available\r\nliterature, there were reports of humanââ?¬â?¢s glomerulonephritis associated with Borrelia burgdorferi infection. These cases refer to\r\nmembranous and mesangial proliferative glomerulonephritis (Kirmizis and Chatzidimitriou (2010), ZachÃ?¨aus (2008), and Kirmizis\r\net al. (2004)). In this paper, we present the case of minimal-change disease (MCD) as a result of Borrelia burgdorferi infection....
Kidney stones probably grow during crystalluria by crystal sedimentation and aggregation (AGN) on stone surfaces. This process\r\nhas to occur within urinary transit time (UT) through the kidney before crystals are washed out by diuresis. To get more\r\ninformation, we studied by spectrophotometry the formation and AGN of Ca oxalate (Ca Ox) crystals which were directly\r\nproduced in urine of 30 stone patients and 30 controls by an oxalate (Ox) titration. Some tests were also performed after removing\r\nurinary macromolecules (UMs) by ultrafiltration. To induce rapid crystallization, high Ox additions (0.5ââ?¬â??0.8mM) were necessary.\r\nThe most important finding was retardation of crystal AGN by UM. In urine of 63% of controls but only 33% of patients, no AGN\r\nwas observed during an observation of 60 minutes (P < 0.05). Also growth and sedimentation rate of crystals were significantly\r\nreduced by UM. For stone metaphylaxis, especially for posttreatment residuals, avoiding dietary Ox excesses to prevent crystal\r\nformation in the kidney and increasing diuresis to wash out crystals before they aggregate are recommended....
Background: Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group recommended that\r\npatients with CKD should be assigned to stages and composite relative risk groups according to GFR (G) and\r\nproteinuria (A) criteria. Asians have among the highest rates of ESRD in the world, but establishing the prevalence\r\nand prognosis CKD is a problem for Asian populations since there is no consensus on the best GFR estimating\r\n(eGFR) equation. We studied the effects of the choice of new Asian and Caucasian eGFR equations on CKD\r\nprevalence, stage distribution, and risk categorization using the new KDIGO classification.\r\nMethods: The prevalence of CKD and composite relative risk groups defined by eGFR from with Chronic Kidney\r\nDisease-Epidemiology Collaboration (CKD-EPI); standard (S) or Chinese(C) MDRD; Japanese CKD-EPI (J-EPI), Thai GFR\r\n(T-GFR) equations were compared in a Thai cohort (n = 5526)\r\nResults: There was a 7 fold difference in CKD3-5 prevalence between J-EPI and the other Asian eGFR formulae.\r\nCKD3-5 prevalence with S-MDRD and CKD-EPI were 2 - 3 folds higher than T-GFR or C-MDRD. The concordance\r\nwith CKD-EPI to diagnose CKD3-5 was over 90% for T-GFR or C-MDRD, but they only assigned the same CKD stage\r\nin 50% of the time. The choice of equation also caused large variations in each composite risk groups especially\r\nthose with mildly increased risks. Different equations can lead to a reversal of male: female ratios. The variability of\r\ndifferent equations is most apparent in older subjects. Stage G3aA1 increased with age and accounted for a large\r\nproportion of the differences in CKD3-5 between CKD-EPI, S-MDRD and C-MDRD.\r\nConclusions: CKD prevalence, sex ratios, and KDIGO composite risk groupings varied widely depending on the\r\nequation used. More studies are needed to define the best equation for Asian populations....
Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard\r\ntreatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones\r\nand the use of double-J stent in infants.Material andMethods. A prospective clinical trial study performed on 50 infants with renal\r\ncalculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of\r\nour study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal\r\ncalculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7\r\nmonth �± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from\r\n6mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required\r\nonly one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short\r\nterm, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in\r\ninfants with stones larger than 13 mm....
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