1/97. Renal hemorrhage in polyarteritis nodosa: diagnosis and management.We report a patient with biopsy-proven polyarteritis nodosa with massive hemorrhage from presumed interlobar artery rupture. The use of interventional radiology techniques such as embolization are discussed in the acute management of such patients. Embolization by interventional radiology should be considered a useful alternative to surgery in these patients. The utility of angiography as a diagnostic and therapeutic tool is demonstrated in this case.- - - - - - - - - - ranking = 1keywords = polyarteritis, polyarteritis nodosa, nodosa, arteritis (Clic here for more details about this article) |
2/97. systemic vasculitis with bilateral perirenal haemorrhage in chronic myelomonocytic leukaemia.The cases of two patients with chronic myelomonocytic leukaemia associated with periarteritis nodosa-like, antineutrophil cytoplasmic antibody negative, systemic vasculitis, are reported. A 61 year old man was admitted with fever, diffuse myalgia, and abdominal pain. blood and bone marrow examination showed chronic myelomonocytic leukaemia. Vasculitis of the gall bladder was responsible for acalculous cholecystitis. A massive spontaneous bilateral perirenal haemorrhage occurred. A 73 year old woman with chronic myelomonocytic leukaemia had been followed up for one year when unexplained fever occurred. Two months after the onset of fever, sudden abdominal pain was ascribed to spontaneous bilateral renal haematoma related to bilateral renal arterial aneurysms. Neuromuscular biopsy showed non-necrotising periarteriolar inflammation. To our knowledge, systemic vasculitis has never been reported in chronic myelomonocytic leukaemia. In our two cases a non-random association is suggested because (a) chronic myelomonocytic leukaemia is a rare myelodysplastic syndrome, (b) spontaneous bilateral perirenal haematoma is not a usual feature of periarteritis nodosa.- - - - - - - - - - ranking = 0.048244907722496keywords = nodosa, arteritis (Clic here for more details about this article) |
3/97. Imaging studies in renal failure. Emphasis of selection and sequencing in the clinical evaluation.The focus of this review will be on the current role of imaging studies in the clinical evaluation of patients with acute and chronic renal failure. We will stress the application of these studies in specific clinical settings in an effort to indicate the current value, and also to suggest fruitful areas for future clinical investigation. It is clear that imaging studies are an essential component in the evaluation of acute and chronic renal failure. physicians who manage such patients must choose appropriately from a variety of available studies to obtain a maximal information with the least risk to their patients. This selection is influenced by local conditions, the most important among these being the experience and technical skill of those involved. attention to detail is particularly important and it is critical that the studies be done at the appropriate time in the evaluation. There will be emphasis on the evolving role of imaging studies in evaluating these patients.- - - - - - - - - - ranking = 2.5966166536113E-5keywords = essential (Clic here for more details about this article) |
4/97. giant cell arteritis "causing" AA-amyloidosis with rapid renal failure.giant cell arteritis (GCA) is a systemic vasculitic disease, which in very rare cases causes inflammatory complications such as secondary amyloidosis. We describe a well-documented case, with a clinically mild course, of biopsyproven giant cell arteritis as the only apparent cause of systemic AA-amyloidosis. The deterioration in renal function due to amyloid deposition occurred rapidly and only a few months after manifestation of giant cell arteritis and was not reversible by steroid treatment. The renal arteries were normal and there was no glomerulonephritis due to giant cell arteritis. This unique case demonstrates that giant cell arteritis with a mild clinical course is closely associated with early-onset severe secondary amyloidosis.- - - - - - - - - - ranking = 0.0028902881802194keywords = arteritis (Clic here for more details about this article) |
5/97. Mycotic abdominal aortic aneurysm: a fatal sequel to concomitant prostatic and renal aspergillosis. Case report and review of the literature.We report the first case of aspergillus mycotic aneurysm as a sequel to concomitant prostatic and renal aspergillosis. The patient had undergone left nephrectomy and transurethral resection of prostate for aspergillus infection one year ago. He again presented with LUTS and backache and clinical examination showed visible pulsations in the epigastrium. CT-scan abdomen showed a pseudoaneurysm of the abdominal aorta. The aneurysm was repaired in situ with homografting and omental wrap. However, the patient succumbed to septicemia on the tenth postoperative day. Adjunctive surgery is usually essential as medical management alone has been unsatisfactory. It is imperative that these cases should be followed closely to detect the disease recurrence and complications at the earliest.- - - - - - - - - - ranking = 2.5966166536113E-5keywords = essential (Clic here for more details about this article) |
6/97. Severe renal impairment in the case of classic polyarteritis nodosa.A 14-year-old boy with classic polyarteritis nodosa (cPAN) and a clinical picture resembling rapidly progressive glomerulonephritis (RPGN) is described. He had severe hypertension, malaise, weight loss, fever, myalgia, and rapid deterioration of renal function. Renal biopsy revealed acute necrotizing vasculitis. angiography showed small saccular aneurysmatic dilatations in the intrarenal branches of the right renal artery and the intrahepatic branches of the hepatic artery. cPAN was diagnosed and pulse methylprednisolone (MP), pulse cyclophosphamide (CYC) and subsequently oral prednisolone were given. Clinical and laboratory findings improved dramatically and remission was attained rapidly. The patient has remained in remission for the last 11 months. cPAN should be considered in patients who present with severe systemic symptoms and hypertension. Progressive renal insufficiency can occur during the acute course of cPAN due to renal vascular involvement without glomerulonephritis. Prompt and aggressive corticosteroid and cytotoxic therapy is essential to suppress disease activity and to maintain remission.- - - - - - - - - - ranking = 1.0001167114505keywords = polyarteritis, polyarteritis nodosa, nodosa, arteritis, necrotizing, essential (Clic here for more details about this article) |
7/97. ANCA-associated necrotizing/granulomatous glomerulonephritis in an elderly patient; importance of the renal biopsy.ANCA-associated glomerulonephritis may present initially with renal symptoms, especially in elderly patients. We report a case of ANCA-associated glomerulonephritis in an 80-year-old female presenting with renal insufficiency and proteinuria. There was no evidence of systemic illness at admission. The major finding in the renal biopsy was the presence of granulomas. Additional testing for anti-neutrophil cytoplasmic antibodies (ANCA) was suggested. The ANCA test was positive confirming the diagnosis of ANCA-associated necrotizing/granulomatous glomerulonephritis. The patient responded well to adequate treatment with immunosuppressive therapy. This case demonstrates the importance of the renal biopsy in cases of ANCA-associated glomerulonephritis presenting with renal symptoms.- - - - - - - - - - ranking = 0.00045372642000825keywords = necrotizing (Clic here for more details about this article) |
8/97. giant cell arteritis and renal amyloidosis: report of a case.polymyalgia rheumatica and giant cell arteritis are rarely associated with renal diseases such as amyloidosis. Here is a case of a 72-year-old man, who developed some renal failure and a nephrotic syndrome while presenting clinical symptoms of giant cell arteritis. Percutaneous renal biopsy showed secondary amyloidosis, and temporal artery biopsy revealed some lesions which suggested temporal arteritis. In spite of aggressive steroid treatment, chlorambucil, and colchicine, the patient's renal function continued to deteriorate and the patient is now being given hemodyalisis.- - - - - - - - - - ranking = 0.0022480019179484keywords = arteritis (Clic here for more details about this article) |
9/97. Spontaneous renal subcapsular hematoma renal angiography as a diagnostic aid.Prior to the development of angiography, a definite diagnosis of spontaneous subcapsular renal hematomaa was not often made preoperatively. The classic triad of blood loss, pain, and mass on the affected side is seldom presented by the patient. The one constant finding on scout film is an enlarged renal shadow, presenting a problem in differential diagnosis. Chief among cause of subcapsular renal hemorrhage are trauma, tumor, infarct, arteritis, and bleeding diathises. Selective renal arteriography gives specific information about the renal vascular supply and the state of the renal parenchyma not available by other means. diagnosis of subcapsular renal hematom is facilitated by this modality. A correct diagnosis of subcapsular renal hematoma may well spare an otherwise innocent kidney. A review of current literature was undertaken, and three documented cases of spontaneous subcapsular hematoma diagnosed prior to surgery and confirmed at surgery are presented.- - - - - - - - - - ranking = 0.00032114313113549keywords = arteritis (Clic here for more details about this article) |
10/97. Delayed ANCA positivity in pulmonary-renal syndrome.A 57-year-old man was admitted due to rapidly progressive renal failure and pulmonary edema. Chest X-ray showed a bilateral lung infiltrate, while a normal myocardial contractility was reported by echocardiography. Though initially ANCA were absent, a necrotizing vasculitis with polymorphonuclear leukocyte infiltrate was observed in a kidney biopsy specimen. Renal histology was compatible with microscopic polyangiitis because of necrotizing lesions located at small vessels and at glomeruli that were not crescentic. Corticosteroids and immunosuppressive treatment was played with significant clinical improvement. Six months later, the patient died of a gastrointestinal hemorrhage due to bowel perforation by vasculitic lesion. This time high p-ANCA positivity was detected and at renal histology crescentic glomeruli were observed.- - - - - - - - - - ranking = 0.0001814905680033keywords = necrotizing (Clic here for more details about this article) |
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