Cases reported "Uremia"

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11/59. Allograft diabetic nephropathy may progress to end-stage renal disease.

    Mesangial expansion and glomerular basement membrane thickening characteristic of diabetic nephropathy recur in diabetic recipients of renal allografts from non-diabetic donors but progression to renal failure is minimally documented. Three female renal allograft recipients (aged 40, 62 and 73 yr), who developed end-stage renal disease (ESRD) due to recurrent diabetic nephropathy (two patients) and de novo diabetes (one patient) are reported. Onset of proteinuria, uncontrolled hypertension, azotemia, renal allograft pathologic findings and the need for hemodialysis were analyzed. None of the kidney donors (one cadaver, two living related) had known diabetes or perturbed glucose metabolism pre-transplantation. The three patients presented had different varieties of diabetes; type 1, type 2 and new onset diabetes after transplantation (NODAT). In each subject, proteinuria was detected by dipstick at a mean of 8.3 yr (range 8-9) post-transplantation and increased to the nephrotic range (3.7-4.8 g/day) inducing hypoalbuminemia and azotemia. A histopathologic diagnosis of allograft diabetic nephropathy was made in a mean of 11.7 yr (range 10-14), based on glomerular basement membrane thickening, nodular and diffuse intercapillary glomerulosclerosis, arteriolosclerosis, and tubular atrophy with marked tubular basement membrane thickening characteristic of advanced diabetic nephropathy. All three patients manifested uremia and resumed hemodialysis. Two patients died from sepsis within 2 months and one patient died 2.5 yr later after resumption of maintenance hemodialysis. We infer that recurrent or de novo diabetic nephropathy in renal allografts follows a clinical decade-long course irrespective of diabetes. Reports of ESRD due to allograft diabetic nephropathy (ADN) have been limited because of shorter survival of diabetic transplant recipients and few kidney biopsies performed in patients with chronic allograft dysfunction. The occurrence of allograft diabetic nephropathy in some, but not all patients, however, suggests that individual genetic variability modulates disease expression.
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12/59. Clopidogrel-associated acute migratory arthritis following kidney-pancreas transplantation.

    Clopidogrel is a potent inhibitor of platelet aggregation and has been used as an alternative, or as an adjunct to aspirin in reducing the risk of thrombosis. A 34-year-old uremic type 1 male diabetic patient who underwent simultaneous kidney-pancreas transplantation was given clopidogrel as he was allergic to aspirin. He developed polyarthralgia one week later, followed in a few days by symmetrical migratory polyarthritis, which resolved completely on withdrawing the drug. The implications to clinical management in a transplant setting are discussed.
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ranking = 2.5
keywords = kidney
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13/59. Uraemic gangrene syndrome.

    Cutaneous gangrene and vascular calcinosis are described in a patient with chronic kidney failure and hyperparathyreodism. A review of 67 earlier described cases suggests that the symptoms constitute a unique syndrome.
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14/59. Destructive spondyloarthropathy with beta 2-microglobulin amyloid deposits in a uremic patient before chronic hemodialysis.

    We report a case of erosive arthropathies discovered radiologically before dialysis in a uremic patient with Alport syndrome. This patient had no hereditary amyloidosis or causes of acquired generalized amyloidosis (no chronic infections or inflammatory disease, neoplasia, lymphoma or monoclonal gammapathy). Erosive spondyloarthropathies of the cervical spine at the C5-C6 and C6-C7 levels, erosive arthropathy of the right acromioclavicular joint, metacarpal lacuna of the right hand, and lacuna of the left femoral neck were discovered 24 months before starting dialysis in this patient with chronic renal insufficiency of 17 years duration. Puncture of the vertebral disc before starting dialysis took a fragment showing amyloid deposits with permanganate-sensitive congo red staining and positive staining with anti-beta 2-microglobulin antibodies. This observation suggests that beta 2-microglobulin amyloidosis in uremia may not be exclusively related to chronic kidney replacement therapy, but to uremia per se, especially when the latter is of long duration.
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15/59. Herpesnephropathy.

    Two cases of acute renal insufficiency occurred in association with episodes of severe encephalitis due to herpes simplex type I. The possibility was considered that the renal failure was due to viral infection of the kidneys, and animal experiments were carried out in an attempt to confirm this. Young new zealand albino rabbits were infected i. v. with HSV type I; the virus antigen was detected in the kidney of 8 of 10 animals, and IgG was found on the GBM in 9 of 19 animals. Viruria was observed in 12 of the 29 infected animals, and electronmicroscopic examination confirmed the presence of immune complexes in the glomeruli.
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16/59. Organic manic syndrome associated with advanced uraemia due to polycystic kidney disease.

    Mania secondary to advanced uraemia caused by polycystic disease of the kidneys in a 62-year-old woman involved a complex interplay of physical, psychological and social factors. psychotherapy and thioridazine led to full recovery.
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ranking = 2.5
keywords = kidney
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17/59. Uraemia--a rare presentation of non-Hodgkin's lymphoma.

    Kidney involvement by Non-Hodgkin's lymphoma is very common microscopically but rarely a cause of uraemia even when the parenchymatous involvement is considerable. Renal failure in cases of lymphoma is secondary to ureteral obstruction, hypercalcaemia, urate nephropathy, gammopathy or immunologically mediated nephrosis. This is a case where the patient presented to the ophthalmic O.P.D. with blurring of vision and admitted with full blown uraemia. He could not be saved and at autopsy, a gastrointestinal lymphoma was found in the caecum. His uraemia was due to massive parenchymatous involvement of the kidney, there being no ureteral obstruction, hypercalcaemia, urate or immunologically mediated nephropathy. Very few cases are reported in literature with such a presentation.
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keywords = kidney
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18/59. review of patients' responses to epoetin alfa therapy.

    The efficacy of epoetin alfa (recombinant human erythropoietin) has been tested for treating the anemia associated with end-stage renal disease. This anemia is caused by severely decreased levels of erythropoietin, 90% of which is ordinarily produced by healthy kidneys. Treatment with epoetin alfa successfully corrected the anemia of 97% of 333 patients, as evidenced by hematocrit levels that increased by at least 6 percentage points or reached a study target level of 35%, 2 points above current guidelines. The 127 patients who previously required red cell transfusions to maintain an adequate hematocrit became completely transfusion independent after receiving epoetin alfa. Furthermore, treatment with this growth factor alleviated many of the symptoms of uremia, such as loss of energy and appetite. The major side effect observed with epoetin alfa treatment was increased diastolic blood pressure; however, this was well controlled by additional antihypertension medication. There have been no reports of antibody formation in response to this drug. Thus, epoetin alfa is a safe and effective means of treating the anemia caused by chronic renal insufficiency.
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ranking = 0.5
keywords = kidney
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19/59. Primary non-Hodgkin's lymphoma of the kidney.

    A 53-year-old woman was admitted to the hospital because of end-stage renal failure of unknown etiology. She had to begin hemodialysis a few days later. An open biopsy showed non-Hodgkin's lymphoma of the kidney. The patient died after the first cycle of chemotherapy and necroscopy confirmed that the lymphomatous involvement of the kidney was primary. From the current literature we are not aware of other cases of primary non-Hodgkin's lymphoma of the kidney.
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ranking = 3.5
keywords = kidney
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20/59. Severity of acquired renal cysts in native kidneys and renal allograft with long-standing poor function.

    To identify factors related to the development of uremic acquired cystic disease of the kidney, native and grafted kidneys were examined in four men and three women after kidney transplantation. The incidence and severity of cystic transformation of native kidneys and grafts were compared by plain computed tomographic scans. In a uremic environment (serum creatinine level of greater than or equal to 265 mumol/L [3 mg/dL] for an average of 5.0 years; range, 2.8 to 8.2 years), acquired renal cysts were formed in both the native kidneys and the graft in three of the male and one of the female patients. cysts were extensive in the native kidneys but relatively infrequent in the grafts in three of the men. One male subject was found to have acquired cysts only in the native kidney. Acquired renal cysts developed even in grafts undergoing chronic rejection, and increased numbers were found in native kidneys that were in uremic conditions for long periods, both before and after renal transplantation. These results suggest that the duration of uremia is the most important factor in the development of acquired renal cysts.
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ranking = 6
keywords = kidney
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