11/247. Immune hemolytic anemia caused by sensitivity to a metabolite of etodolac, a nonsteroidal anti-inflammatory drug.BACKGROUND: Immune hemolytic anemia can be caused by sensitivity to many different drugs. In some instances, the sensitizing compound can be identified by in vitro testing, but results are often negative. One reason for this is that a drug metabolite formed in vivo can be the sensitizing agent, but the responsible metabolites have rarely been identified at a chemical level. This report describes a patient who developed severe, Coombs-positive hemolytic anemia on two occasions after taking the nonsteroidal anti-inflammatory drug etodolac. Studies were performed to characterize etodolac metabolites to which this patient was sensitive. CASE REPORT: serum was tested for antibody in the presence and absence of drug using conventional methods and urine from individuals taking etodolac as a source of drug metabolites. Urinary metabolites of etodolac were identified by high-pressure liquid chromatography analysis. Glucuronide conjugates of etodolac and the 6-OH metabolite of etodolac were synthesized in a rat liver microsomal system to obtain reference standards. RESULTS: The patient's serum gave only trace ( /-) reactions with normal RBCs in the presence of etodolac but reacted strongly (4 ) in the presence of urine from an individual taking this drug. The active urinary metabolites were identified as etodolac glucuronide and 6-OH etodolac glucuronide. CONCLUSION: This patient appears to have experienced acute, severe immune hemolytic anemia on two occasions because of sensitivity to the glucuronides of etodolac and 6-OH etodolac. In patients suspected of having drug-induced immune hemolytic anemia, RBC-reactive antibodies can sometimes be detected by using urine from an individual taking the implicated medication as the source of drug metabolites in in vitro reactions. For patients who present with acute immune hemolysis, a careful history of drug exposure should be taken, and, where indicated, confirmatory testing should be performed to identify the sensitizing drug and prevent inadvertent reinduction of hemolysis at a later time.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
12/247. Acute carbon monoxide poisoning as the cause of rhabdomyolysis and acute renal failure.Acute renal failure (ARF) is a severe complication of acute CO poisoning which, combined with other organ lesions, may result in lethal outcome. In all vague cases of ARF with nontraumatic rhabdomyolysis, CO poisoning should be considered as a possible etiologic factor. The diagnosis is made on the basis of several simple laboratory tests: determination of carboxyhemoglobin concentration, demonstration of myoglobin in urine or pigment granulated cylindres in urinary sediment, positive orthotoluidine test, and high CPK values originating from skeletal musculature. Many authors report on excellent prognosis in ARF due to nontraumatic rhabdomyolysis of various causes. Our case report shows that the prognosis of CO poisoned patient greatly depends on timely and appropriate treatment, severity of damage to other organs, and success of the treatment of complications such as hospital infections.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
13/247. Local thrombolytic treatment for renal arterial embolism.OBJECTIVE: To determine the utility of local thrombolysis in the treatment of acute renal arterial occlusion. methods: We used local thrombolytic treatment in a female patient, aged 76, with 72 h of anuria, right lumbar and flank pain. She had a 3-year history of ischemic heart disease and atrial fibrillation controlled with digital treatment. Also, she was nephrectomized on the left side 33 years ago for lithiasic pyonephrosis. A normal right urinary tract was demonstrated with ultrasound examination, KUB radiography and retrograde pyelography. The next step was diagnostic abdominal angiography and local thrombolytic treatment with streptokinase. RESULT: Thrombolysis with streptokinase was successful following 72 h of renal artery occlusion. After 24 months the patient is doing well. CONCLUSION: Local intra-arterial thrombolysis is the treatment of choice in renal artery occlusion.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
14/247. Acute myeloid leukaemia with trilineage myelodysplasia complicated by masked diabetes insipidus.We describe a rare case of acute myeloid leukaemia with trilineage myelodysplasia complicated by central diabetes insipidus. In the present case, diabetes insipidus was masked by corticosteroid deficiency due to hypopituitarism and clinical symptoms presented after administering methylprednisolone. Although the remission of leukaemia was not achieved by chemotherapy, excessive urinary output was well-controlled by nasal administration of 1-desamino-8-D-arginine vasopressin (DDAVP) during the course.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
15/247. Delayed onset of uveitis in TINU syndrome.We report here the clinical features and outcomes of two patients who presented idiopathic tubulo-interstitial nephritis and uveitis syndrome (TINU syndrome) with ocular disease following the onset of nephropathy. The initial symptoms were renal impairment with asthenia, anorexia and weight loss. An increase in urinary beta2-microglobulin was noticed at the initial checkup in both patients. Renal biopsies showed interstitial cellular infiltration without granulomas or tubular atrophy. No glomerular and vascular alterations were seen and immunofluorescent staining was uniformly negative. Systemic steroid therapy was given and renal function returned to normal within three months. Anterior uveitis occurred in both patients eight months later and responded well to local steroid therapy. Renal involvement in TINU syndrome mostly has a favorable outcome. Despite the possibility of spontaneous regression, systemic steroids may be beneficial in reducing the development of interstitial fibrosis.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
16/247. Managing patients with a distended bladder.A distended bladder is a serious medical situation that requires prompt intervention to drain urine and promote patient comfort. The presence of suprapubic pain distinguishes acute urinary retention from chronic retention. After decompression of the bladder, patients must be monitored closely for post-decompression complications. Additional nursing management may include preparing patients for surgery or additional diagnostic tests.- - - - - - - - - - ranking = 217.57027444244keywords = urinary retention, retention, urinary (Clic here for more details about this article) |
17/247. Acute poststreptococcal glomerulonephritis following circumcision.A case of acute poststreptococcal glomerulonephritis following circumcision is presented. An 11-year-old boy was subjected to ritual circumcision, which was complicated by the infection of the wound and development of oliguria, edema, hematuria and hypertensive encephalopathy 2 weeks later. The diagnosis of poststreptococcal glomerulonephritis was established upon the isolation of streptococcus pyogenes, increased antistreptolysin O (ASTO) and antiDNAse B titers and hypocomplementemia. The clinical course was uneventful with resolution of the nephritic signs, normalization of the complement and clearance of the urinary abnormalities. To the best of our knowledge this is the first case of poststreptococcal glomerulonephritis following infection of the circumcision wound.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
18/247. An unusual case of acute urinary retention in young females.urinary retention is an unusual problem in females and may be psychogenic, especially in the young. However it is important to remember that there are also organic causes for retention. We present 2 cases of an uncommon cause of urinary retention in the young female, namely hematocolpos.- - - - - - - - - - ranking = 863.81801789112keywords = urinary retention, retention, urinary (Clic here for more details about this article) |
19/247. Transient renal glycosuria in a patient with acute pyelonephritis.glycosuria was detected in a 37-year-old Chinese woman by a urinary examination in a local clinic with clinical evidence of acute pyelonephritis (APN). Transient glycosuria is an unusual complication of acute pyelonephritis in non-diabetic patients. As there is growing prevalence of type 2 diabetes in the population worldwide, it must be recognized that mistaken diagnosis of diabetes mellitus by glycosuria may predispose patients to an unfavorable hypoglycemic episode. Thus definite diagnosis of diabetes mellitus should be made only after recovery of APN by means of urinalysis or by simultaneous blood glucose concentration analysis.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
20/247. Severe bradyarrhythmia in a patient with Alzheimer's disease and a patient with cerebral ischaemia, both induced by acute distension of the bladder.Two case reports are presented of bradycardia in two elderly patients, which was resistant to atropine but which resolved immediately the acute bladder distension was treated. Generally, a sympathetic cardiac response is expected, and this paradoxical response may be due not only to lesions of the reflex loop involving both the vagal and the sympathetic nerves, but also to endocrinological factors. As acute urinary distension is not uncommon on geriatric wards, bradyarrhythmia due to bladder distension should be considered in elderly patients.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
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