Association between serum calcium levels and prognosis, hematoma volume, and onset of cerebral hemorrhage in patients undergoing hemodialysis

Background: High serum calcium levels should be avoided in patients on hemodialysis (HD) because they can induce cardiovascular diseases and worsen the patient\u27s prognosis. In contrast, low serum calcium levels worsen the prognosis of patients with cerebral hemorrhage in the general population. So far, whether serum calcium levels in patients on HD are associated with cerebral hemorrhage remains unknown. This study aimed to reveal the association between serum calcium and cerebral hemorrhage in patients on HD, including in-hospital death, volume of hematoma, and onset of cerebral hemorrhage. Methods: This cross-sectional case-control study included 99 patients on HD with cerebral hemorrhage at a single center between July 1, 2007 and December 31, 2017. Controls included 339 patients on HD at a single HD center between July 1, 2011 and June 30, 2012. Data on serum calcium level, patient demographics, and comorbid conditions were collected, and associations between cerebral hemorrhage and subsequent death were evaluated by multivariate logistic regression analysis. Further, the association of these backgrounds and hematoma volume was evaluated by multiple regression analysis. Results: Of the 99 patients, 32 (32%) died from cerebral hemorrhage. The corrected serum calcium level (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.43-4.35; P < 0.001) and antiplatelet drug use (OR, 3.95; 95% CI, 1.50-10.4; P = 0.005)had significant effects on the prognosis. Moreover, the corrected serum calcium (P = 0.003) and antiplatelet drug use (P = 0.01) were significantly correlated with hematoma volume. In the patients, the corrected serum calcium level (OR, 1.54; 95% CI, 1.07-2.22; P = 0.02) was associated with the onset of cerebral hemorrhage, as was pre-hemodialysis systolic blood pressure (per 10 mmHg) (OR, 1.40; 95% CI, 1.23-1.59; P < 0.001). Conclusions: Although the precise mechanisms remain unknown, a high serum calcium level is associated with cerebral hemorrhage in patients on HD. Thus, we should pay attentions to a patient\u27s calcium level

Lingual metastasis as an initial presentation of renal cell carcinoma.

Distant metastasis of malignant neoplasm to the oral soft tissue is extremely rare. We report a case of renal cell carcinoma (RCC) metastasizing to the tongue. A 47-year-old man visited our hospital with chief complaint of a lump on the middle third of the dorsum of his tongue and the lesion fell off from the tongue. Although histopathological diagnosis of the mass was granuloma teleangiectaticum, similar nodule reappeared in the same area 2 weeks later. The second lesion was composed of granuloma teleangiectaticum and aggregation of neoplastic clear cells in ductal arrangement. The clear cells were immunohistochemically positive for EMA and CD10. The abdominal CT scan revealed a 5.5 cm mass in the left kidney, suggesting RCC. Thus, the lingual lesion was consistent with metastatic RCC. There has been no recurrence for 2 years after the radical nephrectomy and local excision of the tongue.The original publication is available at www.springerlink.co

Immunohistochemical and Lectin-Histochemical Patterns of Renal Non-Neoplastic and Neoplastic Epithelium: Utility of the Patterns in the Differential Diagnosis of Renal Epithelial Tumors

Renal tumors are considered to be composed of several distinct subtypes with different cell origin. In this study, we tried to find useful immunohistochemical and lectin histochemical patterns for the differential diagnosis and the origin of the tumor relative to the components of the nephron. Typical cases of clear cell carcinoma, granular cell carcinoma, chromophobe cell carcinoma, collecting-duct carcinoma, papillary carcinoma and oncocytoma, as well as sufficient margin of normal renal parenchyma were stained immunohistochemically and lectin-histochemically, using antibodies and lectins reported to show differences in reactivity. Non-neoplastic epithelial cells showed specific reactivity according to the nephron segments. Some of our staining results tended to differ from those reported earlier by other investigators. Neoplastic lesions showed specific immunoreactivities and the staining results were similar to those of the normal nephron segment, suggesting the origin of the respective tumors. Our results suggest that testing the immunoreactivity pattern using a panel of antibodies and lectins is useful for the differential diagnosis of renal neoplastic lesions

A case report validating the usefulness of cell-free and concentrated ascites reinfusion therapy for the treatment of exacerbation of chronic renal failure caused by lymphorrhea after surgery for bile duct cancer

This is a case study on a 72-year-old man receiving continuous outpatient treatment since 2008 after a diagnosis of chronic renal failure due to diabetic nephropathy. In August 2010, he underwent pylorus-preserving pancreaticoduodenectomy for a middle bile duct carcinoma. He was transferred to our department at 39 days after surgery because of exacerbation of renal function, as well as prolonged ascites and anorexia after the surgery. The tests for malignant tumor, bacterial infection, tuberculosis, and ascitic fluid due to cirrhosis, done after his transfer, all showed negative results. Postoperative lymphorrhea was diagnosed on the basis of his clinical course and the feature of the ascites being similar to serum. Because the exacerbation of renal function was thought to be caused by a reduction of renal blood flow due to lymphorrhea, cell-free and concentrated ascites reinfusion therapy (CART) was performed for a total of two times. Consequently, the patient showed an increase in urine volume and improvement of renal function: creatinine was decreased to 1.99 mg/dL from 3.86 mg/dL. His course of ascites was observed conservatively with CART treatment, and the ascites gradually decreased and disappeared. We report a case that validates the usefulness of CART for treating exacerbation of chronic renal failure caused by lymphorrhea after surgery

A case report validating the usefulness of cell-free and concentrated ascites reinfusion therapy for the treatment of exacerbation of chronic renal failure caused by lymphorrhea after surgery for bile duct cancer

This is a case study on a 72-year-old man receiving continuous outpatient treatment since 2008 after a diagnosis of chronic renal failure due to diabetic nephropathy. In August 2010, he underwent pylorus-preserving pancreaticoduodenectomy for a middle bile duct carcinoma. He was transferred to our department at 39 days after surgery because of exacerbation of renal function, as well as prolonged ascites and anorexia after the surgery. The tests for malignant tumor, bacterial infection, tuberculosis, and ascitic fluid due to cirrhosis, done after his transfer, all showed negative results. Postoperative lymphorrhea was diagnosed on the basis of his clinical course and the feature of the ascites being similar to serum. Because the exacerbation of renal function was thought to be caused by a reduction of renal blood flow due to lymphorrhea, cell-free and concentrated ascites reinfusion therapy (CART) was performed for a total of two times. Consequently, the patient showed an increase in urine volume and improvement of renal function: creatinine was decreased to 1.99 mg/dL from 3.86 mg/dL. His course of ascites was observed conservatively with CART treatment, and the ascites gradually decreased and disappeared. We report a case that validates the usefulness of CART for treating exacerbation of chronic renal failure caused by lymphorrhea after surgery

Immunohistochemical and Lectin-Histochemical Patterns of Renal Non-Neoplastic and Neoplastic Epithelium: Utility of the Patterns in the Differential Diagnosis of Renal Epithelial Tumors

Renal tumors are considered to be composed of several distinct subtypes with different cell origin. In this study, we tried to find useful immunohistochemical and lectin histochemical patterns for the differential diagnosis and the origin of the tumor relative to the components of the nephron. Typical cases of clear cell carcinoma, granular cell carcinoma, chromophobe cell carcinoma, collecting-duct carcinoma, papillary carcinoma and oncocytoma, as well as sufficient margin of normal renal parenchyma were stained immunohistochemically and lectin-histochemically, using antibodies and lectins reported to show differences in reactivity. Non-neoplastic epithelial cells showed specific reactivity according to the nephron segments. Some of our staining results tended to differ from those reported earlier by other investigators. Neoplastic lesions showed specific immunoreactivities and the staining results were similar to those of the normal nephron segment, suggesting the origin of the respective tumors. Our results suggest that testing the immunoreactivity pattern using a panel of antibodies and lectins is useful for the differential diagnosis of renal neoplastic lesions