Cólico nefrítico como presentación clínica de un aneurisma complicado. A propósito de un caso

A 76-year-old man presented to the emergency department four hours after the onset of colic pain in the left flank and genital irradiation. Three hours after being discharged with diagnosis of non complicated renal colic, he came back presenting symptoms and signs of shock. Laboratory evaluation revealed leukocytosis, anemia, hematuria and elevated serum creatinine. Two abdominal ultrasonographies were performed with no demonstration of specific pathology. Eventually, a Computed Tomography was needed to confirm the diagnosis of complicated hypogastric artery aneurysm. Several conditions may mimic renal colic caused by lithiasis such as ectopic pregnancy, intestinal obstruction, acute mesenteric ischemia, pyelonephritis, aortic aneurysm, etc. Most of them have a great mortality rate without an early diagnosis and management.Paciente de 76 años que acude por dolor lumbar tipo cólico irradiado a genitales de 4 horas de evolución. Tres horas después de ser diagnosticado y de cólico nefrítico no complicado, volvió a Urgencias con síntomas y signos de shock. Se objetiva leucocitosis, anemia, hematuria y elevación de creatinina plasmática. Dos ecografías abdominales que fueron inespecíficas. Finalmente se requirió la realización de una tomografía computarizada (TC) para confirmar el diagnóstico de aneurisma de arteria hipogástrica izquierda complicado. Muchas patologías como embarazo ectópico, obstrucción intestinal, isquemia mesentérica aguda, pielonefritis, aneurismas aórticos, etc., pueden simular un cólico nefrítico por litiasis. La mayoría de estas patologías tienen una elevada tasa de mortalidad sin un diagnóstico y tratamiento precoces

SARS-CoV-2 infection induces a dual response in liver function tests: Association with mortality during hospitalization

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with abnormal liver function tests. We hypothesized that early altered liver biochemistries at admission might have different clinical relevance than subsequent changes during hospitalization. A single-center retrospective study was conducted on 540 consecutive hospitalized patients, PCR-diagnosed with SARS-CoV-2. Liver test abnormalities were defined as the elevation of either gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST), above the upper limit of normality set by our laboratory. Linear mixed models (LMM) evaluated longitudinal associations, incorporating all available follow-up laboratory chemistries. By the end of the follow-up period, 502 patients (94.5%) were discharged (109 (20.5%) died). A total of 319 (64.3%) had at least one abnormal liver test result at admission. More prevalent were elevated AST (40.9%) and GGT (47.3%). Abnormalities were not associated with survival but with respiratory complications at admission. Conversely, LMM models adjusted for age and sex showed that longitudinal increases during hospitalization in ferritin, GGT, and alkaline phosphatase (ALP), as well as a decreased albumin levels, were associated with reduced survival. This dual pattern of liver damage might reconcile previous conflicting reports. GGT and ALP trajectories could be useful to determine who might need more surveillance and intensive care