Pseudohyperkalemia associated with essential thrombocytosis; a hint for better clinical practice

Abstract A 75‐year‐old man was admitted with a diagnosis of diabetic ketoacidosis and hyperkalemia. During the treatment, he developed refractory hyperkalemia. Following our review, diagnosis of pseudohyperkalaemia secondary to thrombocytosis was made. We report this case to remind the importance of clinical suspicion of this phenomenon to prevent its serious consequences

Partial nephrectomy of a horseshoe kidney associated with renal cell carcinoma and ureteral stone: A clinical case report

Key Clinical Message Although anatomical and vascular abnormalities of the horseshoe kidney might be challenging, complete preoperative imaging evaluations and accurate organ‐sparing surgical planning can lead to much lower complications. Abstract Horseshoe kidney (HK) is one of the most common renal fusion anomalies. Renal carcinoids are rarely reported in HK patients. Here, we described a rare case of advanced right renal cell carcinoma (RCC) along with proximal left ureter stone in a 41‐year‐old man who presented with a complaint of turbid urine. Early blood tests revealed a blood urea nitrogen of 44 mg/dL and serum creatinine of 1.35 mg/dL. The urine analysis showed microscopic hematuria (6–8 RBCs) and few calcium oxalate crystals. The imaging evaluations revealed an HK anomaly with a solid mass on the right side and a 4 mm stone in the proximal left ureter. The findings suggested RCC which was confirmed by histopathology examination. Consequently, the patient was scheduled for an organ‐preserving open surgery of a right kidney tumor with concomitant left ureterolithotomy. The 16‐month follow‐up showed no urological complications, metastasis, or tumor proliferation. Although the anatomical and vascular abnormalities of HK might be challenging, organ‐sparing surgical treatment should be considered in feasibly resectable tumors. Complete preoperative imaging evaluations to identify the characteristics of HK, as well as accurate surgical planning, can lead to much lower complications

Successful pregnancy in an end-stage renal disease woman on chronic hemodialysis

Successful conception in a female patient on hemodialysis (HD) is considered a high-risk pregnancy and associated with maternal and fetal complications. Thus, most such pregnancies lead to abortion or termination to preserve maternal health. Here, we report a successfully-delivered case of a 19th-week-diagnosed pregnancy in a 35-year-old mother with end-stage renal disease (ESRD). We present the case of a 35-year-old female with ESRD, diagnosed 10 years ago secondary to glomerulonephritis. The patient underwent the deceased–donor renal transplantation once, which unfortunately was rejected. During the initial tests for second-time kidney transplantation, a human chorionic gonadotropin-beta (beta-hCG) positive with a level of 9953 mIU/mL was reported, suggesting the pregnancy. The transvaginal ultrasonography confirmed the pregnancy at an approximate gestational age of 19 weeks. As a result, the patient underwent four and half hours of intensive HD five times a week and continued until 36 weeks of pregnancy. At 36 weeks, the patient presented to Shariati hospital, Tehran, Iran, with low- back pain. Consequently, a cesarean section (C/S) was performed, and the baby boy was born with a nine of ten Apgar score. Although successful pregnancy is possible for women with ESRD, it requires special multidisciplinary care. Intensive HD and regular fetal monitoring have improved the pregnancy outcome in this population. However, the risk of severe complications is still for the health of the mother and her offspring

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature

Key clinical message PB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial. Abstract Parvovirus B19‐associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53‐year‐old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/μL, RBC count of 1.89/μL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/μL, MCV 89, reticulocyte count 0.8%, and serum iron 221 μg/dL. Upon further evaluation, the RT‐PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT‐PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/μL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT‐PCR was negative, while the parvovirus B19 RT‐PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment

Guillain–Barre syndrome after antithymocyte globulin administration in a kidney transplant recipient: A case report and literature review

Key Clinical Message This report describes a rare case of developing Guillain–Barre syndrome (GBS) following receiving rabbit antithymocyte globulin (ATG) after kidney transplantation to prevent acute allograft rejection in a 34‐year‐old man. The patient presented severe pain in the right temporomandibular joint, fever, chills, myalgia, polyarthralgia, and bone pain. Twelve hours later, he developed quadriplegia, paresthesia, and a limited range of active motions in all extremities. No antecedent viral or bacterial infection was identified. The EMG/NCV evaluation displayed acute inflammatory sensory‐motor polyneuropathy. After the administration of GBS treatment, the neurologic symptoms started to improve. Over a few days, the reflexes came back completely, and the patient was able to walk. To our knowledge, this is the second case report of ATG‐related GBS after kidney transplantation

Maternal serum uric acid level and maternal and neonatal complications in preeclamptic women: a cross-sectional study

Background: Preeclampsia is associated with maternal and neonatal complications. It has been indicated that increased uric acid might have a predictive role on preeclampsia. Objective: We aimed to investigate the relationship between the level of uric acid with maternal and neonatal complications in women with preeclampsia. Materials and Methods: In this cross-sectional study, 160 singleton preeclamptic women at more than 28 wk gestational age were included. Hemoglobin, hematocrit, platelet count, liver and uric acid tests, and maternal and neonatal complications were assessed. The severity of preeclampsia, placental abruption, preterm labor, thrombocytopenia, elevated alanine aminotransferase and aspartate aminotransferase (ALT and AST), HELLP syndrome, eclampsia and required hospitalization in the ICU was considered as the maternal complication. Fetal complications were: small for gestational age (SGA), intrauterine fetal death, hospitalization in the neonatal intensive care unit, and Apgar scor

Relationship between follicular fluid and serum levels of vitamin C and oocyte morphology and embryo quality in patients undergoing in vitro fertilization

Objectives: This study aimed to determine the relationship between follicular fluid (FF) and serum level of vitamin C and oocytes morphology and embryo quality in patients undergoing in vitro fertilization (IVF). Materials and Methods: This is a cross-sectional study which was conducted on 50 women undergoing IVF in Al-Zahra hospital in Rasht, Iran during 2014. Vitamin C level in FF and serum were measured using high-performance liquid chromatography (HPLC). Retrieval oocyte morphology and obtained embryo quality were evaluated using inverted optical microscope. Results: In our study 434 oocytes and 199 embryos were assessed. Frequencies of metaphase II (MII) oocytes were significantly higher at 1-1.5 mg/dL level of vitamin C in FF (86.4%) and 0.5-1 mg/dL serum level of vitamin C (83.2%). Odds of having MII oocytes at the 1-1.5 mg/dL level of vitamin C in FF (odds ratio [OR] = 15.02, 95% CI = 2.77-81.54) was 15 times greater than the level of 1.5-2.3 mg/dL. The most frequency of embryo with Z1 or Z2 quality were observed at 0.1-0.5 mg/dL level of vitamin C in FF (69.3%) and 0.5-1 mg/dL level of vitamin C in serum (84.3%). odds of having embryo with Z1 or Z2 quality, at the 0.1-0.5 mg/dL level of vitamin C in FF (OR = 3.08, 95% CI = 1.21-7.83), was 3 times greater compared to the 1-2.3 mg/dL level. Conclusion: At the certain level of vitamin C in FF, clinicians may have oocytes with higher maturity and embryos with better quality

Increased Serum Levels of Soluble TNF-α Receptor Is Associated With ICU Mortality in COVID-19 Patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has infected over 112M patients and resulted in almost 2.5M deaths worldwide. The major clinical feature of severe COVID-19 patients requiring ventilation is acute respiratory distress syndrome (ARDS) possibly associated with a cytokine storm. Objectives: To elucidate serum levels of TNF-α and soluble TNF-Receptor 1 (sTNFR1) in patients with severe and mild COVID-19 disease as determinants of disease severity. Methods: We determined serum TNF-α and sTNFR1 concentrations in 46 patients with laboratory-confirmed COVID-19 (17 patients with severe disease within the intensive care unit [ICU] and 29 non-severe, non-ICU patients) and 15 healthy controls upon admission using ELISA. Subjects were recruited between March-May 2020 at the Masih Daneshvari Hospital Tehran, Iran. Results: Serum levels of sTNFRI were significantly higher in ICU patients (P<0.0001) and non-ICU patients (P=0.0342) compared with healthy subjects. Serum sTNFR1 were significantly higher in ICU patients than in non-ICU patients (P<0.0001). Serum TNF-α levels were greater in ICU and non-ICU patients than in the healthy subjects group (p<0.0001). The sTNFRI concentration in ICU (r=0.79, p=0.0002) and non-ICU (r=0.42, p=0.02) patients positively correlated with age although serum sTNFRI levels in ICU patients were significantly higher than in older healthy subjects. The sTNFRI concentration in ICU patients negatively correlated with ESR. Conclusions: The study demonstrates higher sTNFRI in ICU patients with severe COVID-19 disease and this be a biomarker of disease severity and mortality. Future studies should examine whether lower levels of systemic sTNFR1 at admission may indicate a better disease outcome

Increased serum levels of soluble TNF-α receptor is associated with mortality of ICU COVID-19 patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has infected over 112M patients and resulted in almost 2.5M deaths worldwide. The major clinical feature of severe COVID-19 patients requiring ventilation is acute respiratory distress syndrome (ARDS) possibly associated with a cytokine storm. Objectives: To elucidate serum levels of TNF-α and soluble TNF-Receptor 1 (sTNFR1) in patients with severe and mild COVID-19 disease as determinants of disease severity. Methods: We determined serum TNF-α and sTNFR1 concentrations in 46 patients with laboratory-confirmed COVID-19 (17 patients with severe disease within the intensive care unit [ICU] and 29 non-severe, non-ICU patients) and 15 healthy controls upon admission using ELISA. Subjects were recruited between March-May 2020 at the Masih Daneshvari Hospital Tehran, Iran. Results: Serum levels of sTNFRI were significantly higher in ICU patients (P<0.0001) and non-ICU patients (P=0.0342) compared with healthy subjects. Serum sTNFR1 were significantly higher in ICU patients than in non-ICU patients (P<0.0001). Serum TNF-α levels were greater in ICU and non-ICU patients than in the healthy subjects group (p<0.0001). The sTNFRI concentration in ICU (r=0.79, p=0.0002) and non-ICU (r=0.42, p=0.02) patients positively correlated with age although serum sTNFRI levels in ICU patients were significantly higher than in older healthy subjects. The sTNFRI concentration in ICU patients negatively correlated with ESR. Conclusions: The study demonstrates higher sTNFRI in ICU patients with severe COVID-19 disease and this be a biomarker of disease severity and mortality. Future studies should examine whether lower levels of systemic sTNFR1 at admission may indicate a better disease outcome