11/48. hepatitis b virus infection and the response to erythropoietin in end-stage renal disease.In patients with end-stage renal disease (ESRD), viral or bacterial infections are postulated to abolish or impair response to recombinant erythropoietin (Epogen). However, previous reports revealed that response to Epogen among hemodialysis patients with a particular viral infection--human immunodeficiency virus (hiv)--seems to be variable and is independent of illness severity. To further explore the issue of response to Epogen in hemodialysis patients with viral infection, we retrospectively studied four patients with hepatitis b virus infection over a 3 month period to compare their response to Epogen and endogenous erythropoietin levels with those of a control group of patients without hepatitis b virus infection. Weekly predialysis hematocrit, and monthly serum albumin concentration, transferrin saturation as well as percent reduction of urea were obtained from patient records, and mean values were calculated for each subject. Mean age of the patients (n = 4) was 63 /- 7.5 years compared with 55 /- 23 years for the control subjects (n = 4)(p = 0.02). The mean hematocrit of the study patients was 33.7 /- 2.8% compared with 34.7 /- 4.9% in the control subjects (p = 0.49), and the mean endogenous erythropoietin level in the study patients was 27 /- 22 mlU/ml compared with 5.7 /- 1.9 mlU/ml in the control group (p = 0.001). The mean dose of thrice weekly Epogen, both at onset of the study and when endogenous erythropoietin was measured, was 61 /- 19 U/kg body weight in the patients, compared with 74 /- 8 U/kg body weight in the control subjects (p = 0.002). We conclude that patients with ESRD and hepatitis B surface antigenemia respond to Epogen as well as their counterparts without hepatitis b virus infection. In addition, patients with hepatitis B surface antigenemia have much higher serum levels of endogenous erythropoietin and require less exogenous erythropoietin injections than their counterparts.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
12/48. HBV-related cutaneous periarteritis nodosa in a patient 16 years after renal transplantation: efficacy of lamivudine.Cutaneous periarteritis nodosa (PAN) is a clinical feature characterized by chronic, benign course; its pathogenesis is unknown. In patients submitted to renal transplantation cutaneous PAN is a rare complication. We report a case of cutaneous PAN associated with the reappearance of hepatitis B antigen 16 years after kidney transplantation. A 44-year-old man underwent successful renal transplantation in June 1980. In December 1996 he presented multiple painful erythematous subcutaneous nodules on both legs. skin lesion biopsy showed the presence of cutaneous PAN. Six months later laboratory data demonstrated the presence of HbsAg. HBeAg, HBcAb and detectable HBV-dna serum by polymerase-chain-reaction (PCR) assay. Anti-HBs and anti-HBe proved negative. In July 1998 the laboratory tests showed an important increase of HBV-dna (5.1 billion by Branched dna), and so lamivudine (100 mg/day) was introduced. HBV-dna became undetectable by PCR after 3 months of therapy. Seven months later a new skin biopsy was performed. The typical signs of PAN were no longer evident. As HBV infecion was demonstrated six months after the clinical appearance of the PAN, in a patient who was believed to be immune to the virus, it is possible that, in the early stages, the hepatitis B antigen title was methodologically indeterminable, but sufficient to form circulating immune complexes responsible for vasculitis primer. lamivudine therapy resulted efficacious in favouring the regression of cutaneous PAN, but its long-term efficacy requires further evaluation as regards potential selection of drug resistant hepatitis b virus (HBV) mutants during treatment.- - - - - - - - - - ranking = 0.6keywords = hepatitis (Clic here for more details about this article) |
13/48. Efficacy of famciclovir in the treatment of lamivudine resistance related to an atypical hepatitis b virus mutant.Reactivation of chronic hepatitis b virus (HBV) infection is a major cause of morbidity and mortality after renal transplantation. Although lamivudine is an effective treatment for chronic hepatitis B, the development of drug resistance due to mutations in the tyrosine-methionine-aspartate-aspartate (YMDD) motif is a major concern, especially in immunosuppressed patients who require prolonged therapy. Treatment with famciclovir has not been effective in the majority of patients who developed lamivudine resistance due to methionine-to-valine mutation at position 550, because this mutation has been uniformly associated with leucine-to-methionine mutation at position 526, a mutation that is associated with resistance to famciclovir. We describe a renal transplant recipient with an uncommon lamivudine-resistant HBV variant, in which methionine-to-valine/isoleucine mutation at position 550 was associated with wild-type sequence at position 526. The severe hepatitic flare consequent to the lamivudine resistance in this patient was successfully treated with famciclovir, indicating that both M550V and M550I mutants with preserved wild-type sequence at position 526 of HBV reverse transcriptase are susceptible to famciclovir. Our experience shows that famciclovir can be useful in selected patients with otherwise potentially fatal hepatitic flares related to lamivudine resistance, and that analysis of mutations in the HBV variant can be helpful in the choice of antiviral therapy.- - - - - - - - - - ranking = 1.2keywords = hepatitis (Clic here for more details about this article) |
14/48. Disseminated varicella infection in adult renal allograft recipients: four cases and a review of the literature.Disseminated varicella-zoster (VZV) infection is a rare complication after renal allotransplantation in adults. We report four patients, among them one with combined VZV and cytomegalovirus infection. The main complications were hepatitis, pneumonitis, and disseminated intravascular coagulation. A review of the literature from 1981 to 2000 revealed 34 additional cases of disseminated varicella infection in adult renal allograft recipients with an overall mortality of 34%. Among these patients 82% suffered from primary varicella, 18% had a reactivation. High-dose acyclovir therapy combined with reduction of immunosuppression lead to reduction of mortality from 53% before 1990 to 22% after 1990. No immunosuppressive drug is significantly associated with a higher risk of disseminated VZV infection. immunization against VZV in adults is still a matter of controversy. Whereas passive immunization is performed only for prophylactic but not therapeutic purpose, active immunization is routinely performed in children and may also be recommended for adults before renal transplantation.- - - - - - - - - - ranking = 0.2keywords = hepatitis (Clic here for more details about this article) |
15/48. A down syndrome patient treated by peritoneal dialysis.down syndrome patients are apparently not suited for peritoneal dialysis because of lacking cooperation. We report on an adult down syndrome patient living in a difficult social environment suffering from ESRD due to posterior urethral valve. Comorbid conditions include decreased left ventricular function, hepatitis B carrier stage and hypothyroidism. The committed mother of the patient treats the patient successfully by peritoneal dialysis for a period of two years without episode of peritonitis.- - - - - - - - - - ranking = 0.2keywords = hepatitis (Clic here for more details about this article) |
16/48. hepatitis c therapy with long term remission after renal transplantation.hepatitis c virus infection (HCV) is common in patients with end-stage renal disease (ESRD) and long observation periods have shown the detrimental effect of HCV infection on patient and graft survival after renal transplantation. At present, interferon is the most important agent for the treatment of hepatitis c in ESRD; however, limited information exists concerning the long-term response of patients who undergo renal transplantation after successful antiviral therapy. We describe the evolution of HCV infection in a dialysis patient with hepatitis c who was successfully treated with interferon alpha and then underwent renal transplantation. He received aggressive immunosuppression during the induction phase and for allograft rejection; however, regular screening showed complete absence of biochemical and virological relapse of HCV over a 6-year post-transplantation period. We conclude that interferon can offer excellent response in selected dialysis patients with hepatitis c. Alternative strategies with newer antiviral agents are currently under active investigation.- - - - - - - - - - ranking = 0.6keywords = hepatitis (Clic here for more details about this article) |
17/48. Acute hepatitis associated with oral levofloxacin therapy in a hemodialysis patient.levofloxacin is a fluoroquinolone antibiotic commonly used to treat respiratory, urinary tract, skin and soft-tissue infections. levofloxacin is generally well tolerated and has fewer reported side effects than other fluoroquinolones. We present a case of levofloxacin-associated severe hepatocellular injury. The hepatitis resolved soon after discontinuation of levofloxacin.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
18/48. immunoglobulin a nephropathy in a renal allograft of a black transplant recipient.Although IgA nephropathy (IgA N) is reportedly the most common form of primary glomerulonephritis worldwide, there is a very low incidence of IgA N in Black Americans, and IgA N in Black patients with renal allografts has not been reported. In this report, we present the case of a Black patient with endstage renal disease presumed secondary to hypertensive nephrosclerosis who developed nephrotic range proteinuria due to IgA N in a cadaveric renal allograft 2 years following transplantation. biopsy of the allograft in the immediate post-transplantation period had revealed no evidence of IgA N. Chronic active hepatitis related to hepatitis c preceded the development of proteinuria by approximately 1 year, raising the possibility that IgA N in the renal allograft was secondary to the liver disease. The clinical and histological features of primary IgA N and IgA N secondary to liver diseases are discussed.- - - - - - - - - - ranking = 0.4keywords = hepatitis (Clic here for more details about this article) |
19/48. Fatal pneumonia caused by corynebacterium group JK after treatment of staphylococcus aureus pneumonia.A 76-year-old man who was admitted to the hospital because of chronic renal insufficiency and chronic hepatitis died of corynebacterium group JK pneumonia, after showing a slight improvement by treatment of staphylococcus aureus with sulbactam/cefoperazone and minocycline. Transtracheal aspiration (TTA) just before his death revealed numerous gram-positive bacilli phagocytized by many neutrophils and more than 10(8) colony forming units (CFU)/ml of corynebacterium group JK. A drug susceptibility test showed corynebacterium group JK was resistant to many antibiotics, with the exception of vancomycin and amikacin.- - - - - - - - - - ranking = 0.2keywords = hepatitis (Clic here for more details about this article) |
20/48. Living related renal transplantation for end-stage renal disease after liver transplantation from a brain-dead donor.We report a case in which a living related renal transplantation was successfully performed for end-stage renal disease that had progressed after a liver transplantation from a brain-dead donor for liver cirrhosis associated with type C hepatitis. Because the transplanted liver function had been excellent with the use of tacrolimus and mycophenolate mofetil, the same immunosuppressive agents with prednisolone were employed for the renal transplantation. Both grafts are functioning well without recurrence of hepatitis at 10 months after the renal transplantation. From our experience, renal transplantation should not be contraindicated even if the patient has undergone liver transplantation or has hepatitis c viral infection.- - - - - - - - - - ranking = 0.6keywords = hepatitis (Clic here for more details about this article) |
| <- Previous || Next -> |