1/10. Renal tubular dysfunction in a patient with beta-thalassemia minor.beta-thalassemia minor is a hemoglobinopathy which has been known as a symptomless carrier state. Although there are many causes leading to renal tubular dysfunction, beta-thalassemia minor has not been reported among them in reviewing the literature. In a 20-year-old male patient referred to us because of glucosuria detected with dipstick, there was also anemia (hemoglobin, 11.5 g/dl; mean cell volume, 60 fl; and mean cell hemoglobin concentration, 19.5 pg). The 24-hour urinary glucose excretion rate was 5 g and, additionally, he had tubular proteinuria (albumin/beta(2)-microglobulin ratio in urine was 17.32). Based upon the detailed evaluation for both asymptomatic urinary abnormality and anemia, he was diagnosed as having renal tubular dysfunction and beta-thalassemia minor (hemoglobin a(1)was 91%, and hemoglobin a(2)was 9%). In conclusion, further reports are needed to reveal whether there is an association between these two distinct disorders.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
2/10. Metabolic changes following gastroplasty in prader-willi syndrome--a case report.A vertical banded gastroplasty was performed in an adult female patient with prader-willi syndrome in an attempt to prevent the metabolic deterioration caused by polyphagia. After her operation, the patient felt satiated with the scheduled amount of food and one month later, her fasting blood sugar concentration (FBS) decreased from 521 to 125 mg/dl, and her urinary sugar excretion (US) from 257 to 9 g/day. Both glucose tolerance and insulin secretion were also improved. However, these parameters subsequently became worse after dietary control was lost since the surgical procedure alone was unable to continue to suppress the insatiable desire to eat food. Both her glucose tolerance and insulin secretion by the 31st postoperative month were better than before the surgery, but worse than at one month after the surgery. At the end of the surgery, but worse than at one month after the surgery. At the end of the 34th postoperative month, even under the temporary administration of 0.625 mg/day of glibenclamide, her FBS was 158 mg/dl and US, 38.1 g/day. Her body weight had also increased to over her preoperative value. Based on these results, we conclude that the effect of gastroplasty to prevent metabolic deterioration in our patient with Prader-Willi syndrome gradually diminishes.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
3/10. The functional response to furosemide in a case of de Toni-Debre-Fanconi disease.The case of a 13-year-old boy with the advanced clinical picture of the idiopathic DeToni-Debre-fanconi syndrome is described, on whom acute studies of proximal tubular functions and of the effect of furosemide thereon were performed. sodium bicarbonate loading corrected the hyperchloremic acidosis, but induced an increase of urinary bicarbonate loss of over 20% of the filtered amount. furosemide corrected bicarbonate reabsorption in spite of the presence of metabolic alkalosis. The urinary excretion of alpha-amino nitrogen, glucose, and phosphates decreased and tubular reabsorption of the two latter increased under furosemide. On a chronic treatment with furosemide and dietary sodium chloride restriction, correction of hyperchloremic acidosis, hypophosphatemia and rickets was achieved.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
4/10. liver transplantation in a 23-year-old tyrosinaemia patient: effects on the renal tubular dysfunction.Orthotopic liver transplantation was performed on a 23-year-old female with hereditary tyrosinaemia. The disorder was diagnosed at 7 years of age due to severe rickets, and the patient was treated with a diet restricted in phenylalanine and tyrosine. Nineteen months before the transplantation she had an acute episode of diffuse gastrointestinal bleeding due to portal hypertension. Three subsequent bleeding episodes with accompanying ascites and signs of encephalopathy were considered life-threatening. Nine months after the liver transplantation the patient is well, but serum transaminases are slightly elevated. Without dietary restrictions serum tyrosine and inorganic phosphate are normalized, no succinylacetone can be detected in serum, and urinary excretion of p-hydroxyphenyllactate and p-hydroxyphenylpyruvate is normal. Excretion of amino acids, glucose and beta 2-microglobulin decreased significantly after the transplantation but is still elevated. The succinylacetone concentration in urine is about 20% of the preoperative level. After an oral tyrosine load, succinylacetone excretion increased sevenfold but no deterioration of the renal tubular function was observed and no tyrosine metabolites were detectable in serum. The findings indicate that the defective tyrosine metabolism occurs in the kidneys, but does not produce tubular dysfunction. The residual tubular dysfunction of the patient is probably due to irreversible damage of the tubular epithelium.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
5/10. "Upside-down" contrast-urine level in glycosuria: CT features.Contrast-urine levels are often encountered in CT of the urinary bladder. Opacified urine occupies the dependent portion of the bladder, while unopacified urine layers above it. We report a case in which this relationship was reversed. An explanation of this phenomenon is proposed.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
6/10. Hyperosmolar diabetes presenting as acute urinary retention: report of three cases.Three elderly patients presented at one hospital in a 2-week period with acute urinary retention precipitated by the hyperosmolar non-ketotic diabetic state. In each case routine urine testing was reported as showing 1 per cent glycosuria. The first two patients were admitted at night and blood glucose estimations were not done. This led to a delay of 16 and 12 h respectively before the appropriate therapy was instituted. It is suggested that this clinical presentation, previously unreported, may not be a rarity and represents an avoidable cause of death in patients with acute urinary retention.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
7/10. Hyperosmolar non-ketotic coma in diabetic stroke patients.Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar coma during the first ten days after admission for stroke. Common to all three were normal plasma osmolality and slightly elevated plasma creatinine levels on admission, treatment with diuretics, parenteral dextrose administration before and low urinary glucose output during the coma. In the five days preceding the coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary glucose output preceded extreme hyperglycaemia and coma. Two of the three patients died, both from extensive thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. A close monitoring of fluid and dextrose administration seems mandatory in diabetic stroke patients, in particular if renal function is impaired or if diuretics are given. insulin treatment should be considered in all diabetic patients during the first days after a stroke.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
8/10. Gas chromatography-mass spectrometric studies of canine urinary metabolism.After the urine was treated with urease, lyophilized, and trimethylsilylated, it was examined for metabolic profiles in Dalmatian dogs and Shetland sheepdogs by gas chromatography-mass spectrometry (GC/MS), which simultaneously analyzes organic acids, amino acids, sugars, sugar alcohols, purine and pyrimidine bases, and nucleosides. The profiles were compared with those from human specimens. As clarified in past studies, Dalmatian dogs showed an extreme decrease in allantoin, which is the final product of purine metabolism in the canine of other species, and a marked detection of uric acid peak. This finding suggests that purine metabolism in Dalmatian dogs is different from that in the other species. Only two Shetland sheepdogs, whose mother had chronic renal failure, showed a marked excretion of uric acid, as in Dalmatian dogs. In addition, some Dalmatian dogs, who were maintained on a protein-restricted diet, showed a little excretion of uric acid. A large amount of uric acid is detected in combination with pentose-monosaccharides, hexose-monosaccharides and sugar alcohols in neonatal human urine in comparison with the present dog samples. A marked difference between the canine and the humans is that phenylacetylglycine, which is derived from the aromatic amino acid phenylalanine, is excreted in the canine urine. Phenylacetylglycine is not detected in the human urine, and there have been no reports of its excretion in canine urine.- - - - - - - - - - ranking = 2keywords = urinary (Clic here for more details about this article) |
9/10. light chain myeloma with features of the adult fanconi syndrome: six years remission following one course of melphalan.A 41-year-old woman, presenting with renal failure, renal glucosuria and moderate anemia, was found to have light chain myeloma, indicated by a kappa chain M-component in the serum, heavy urinary excretion of kappa chains and plasma cell infiltration of the bone marrow. After administration of one course of melphalan, resulting in transient pancytopenia, the light chains disappeared completely, renal function returned to normal, glucosuria disappeared and the Hb concentration normalized. During an observation period of six years she has remained in good health and there has been no sign of relapse.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
10/10. Tubulointerstitial nephritis induced by the leukotriene receptor antagonist pranlukast.A 7-year-old boy with asthma was receiving the leukotriene receptor antagonist pranlukast (Ultair; SmithKline Beecham; Pittsburgh) as part of an open-label clinical trial. The patient's asthma improved, and he remained asymptomatic; but routine study evaluations 9 to 12 months into therapy showed microhematuria, proteinuria, glucosuria, anemia, and renal insufficiency. Renal biopsy demonstrated changes classic for acute allergic tubulointerstitial nephritis (ATIN), with mixed interstitial inflammatory infiltrate including eosinophils. Within 6 months of pranlukast withdrawal, anemia resolved and urinary sediment and renal function normalized. The case demonstrates that hypersensitivity reaction to pranlukast and resultant ATIN is possible, and that periodic urine testing in patients receiving pranlukast should be considered.- - - - - - - - - - ranking = 0.5keywords = urinary (Clic here for more details about this article) |
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