Acute kidney injury on chronic kidney disease: From congestive heart failure to light chain deposition disease and cast nephropathy in multiple myeloma

Acute on chronic renal failure is a common but notably broad diagnosis. We present a 64-year-old man with a history of diastolic heart failure and chronic kidney disease, admitted for an elevated creatinine. History and physical examination were suggestive of decompensated heart failure; however, the careful interpretation of urinalysis rendered the diagnosis of multiple myeloma. On renal biopsy, the patient was found to have light chain deposition disease with cast nephropathy. Combination lesions in multiple myeloma are rare and require diligent histopathology for detection, including light microscopy, immunofluorescence and electron microscopy. These patients portray different demographics, renal manifestations, oncologic characteristics and outcomes, and hence, further studies isolating these combined lesions are warranted

A rare presentation of the Klinefelter's syndrome

A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter's syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and siblings. His laboratory tests showed high levels of FSH and normal levels of LH and testosterone. With regards to all these findings, we suspected that there might be an occult Klinefelter's syndrome. So, we made his karyotype that showed a 47XXY pattern. Because there are only a few number of cases that have occult Klinefelter's syndrome in the basis of chronic renal failure, we decided to report this case

A rare presentation of the Klinefelter's syndrome

A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter's syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and siblings. His laboratory tests showed high levels of FSH and normal levels of LH and testosterone. With regards to all these findings, we suspected that there might be an occult Klinefelter's syndrome. So, we made his karyotype that showed a 47XXY pattern. Because there are only a few number of cases that have occult Klinefelter's syndrome in the basis of chronic renal failure, we decided to report this case

Weekly irinotecan in a patient with metastatic colorectal cancer on hemodialysis due to chronic renal failure

Background: The cytotoxic treatment of patients suffering from advanced or metastatic cancer undergoing hemodialysis due to chronic renal failure still remains a problem, since for those patients pharmacokinetic and pharmacodynamic data on most cytotoxic agents are lacking. Case Report: We report a 45-year-old male who suffered from chronic renal failure and was diagnosed with stage-3 colorectal cancer (CRC) in February 2000. After surgical removal of the tumor an adjuvant chemotherapy of dose-reduced i.v. bolus 5-fluorouracil and folinic acid was begun (Mayo protocol). Due to excessive gastrointestinal toxicity, therapy was discontinued after the first cycle. In April 2000 liver metastases were diagnosed. The patient was then put on a weekly schedule of dose-reduced CPT-11 (50 mg/m(2), 80 mg total). No hematological or non-hematological toxicity grade 3/4 was observed. Due to excellent tolerability and lack of severe side effects the dose was increased up to 80 mg/m2 (140 mg total) weekly. A dose escalation to 100 mg/m(2) (180 mg total) resulted in severe diarrhea (grade 4). Within 2 months of treatment the patient achieved a lasting partial remission until April 2001 (12 months). A significant progression of hepatic metastases required an alternative treatment regimen beginning in July 2001 (HAI, hepatic artery infusion). Conclusion: This case report demonstrates the feasibility and efficacy of a weekly treatment with dose-reduced CPT-11 in a patient with metastatic CRC on hemodialysis due to chronic renal failure

Pulmonary tuberculosis and some underlying conditions in Golestan Province of Iran, during 2001-2005

Context: Pulmonary tuberculosis has been a major health problem in Golestan province of Iran. Aims: This descriptive cross-sectional study was performed to evaluate the frequency of coexisting medical conditions and their effects on some epidemiologic factors in patients with pulmonary tuberculosis. Setting and Design: This was a descriptive cross-sectional study. Methods and Material: Demographic information, time of admission in the hospital and coexisting medical conditions (diabetes, chronic renal failure/hemodyalysis, corticosteroids consumption and malignancies) were extracted from the patient's file. Statistical analysis used: Chi-square test was used to assess the relationship between variables. Results: Two hundred forty three patients with pulmonary tuberculosis during 5 years were studied. Out of all, 162 cases (66.7%) did not have any co-morbidities. Diabetes mellitus was found to be the most prevalent condition (23.05%) followed by chronic renal failure, corticosteroid consumption and malignancy ranking second, third and forth in the list (5.8%, 2.5% and 2 respectively). The mean age of the patients was 50.15±19 years old. In the group without co morbidities, male/ female ratio was 1.41/1, but co morbidity with diabetes was significantly more prevalent in females (p<0.05). Conclusions: We suggest screening of tuberculosis in patients with chronic renal failure and diabetes mellitus in our area. Also for patients with pulmonary tuberculosis, diabetes screening should be considered essential

kurz und kn@pp news : Nr. 11 [engl. Fassung]

* Prize for excellent teaching * Drug prescription safety and renal failure * Prof. Gerlach on the Health Research Council of the German Ministry for Education and Research * Health in Old Age * DEGAM against IGeLn * A Meeting of Experts on Chronic Heart Failure* Preis für exzellente Lehre * Verordnungssicherheit bei niereninsuffizienten Patienten * Prof. Gerlach im Gesundheits-forschungsrat des BMBF * Gesundheit im Alter * DEGAM gegen IGeLn * Expertentreffen chronische Herzinsuffizien

Renal AA-amyloidosis in intravenous drug users - a role for HIV-infection?

Background: Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades. Methods: Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany. Results: Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1--2 years. Conclusions: AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU

Association between Hemodialysis Adequacy, Family Support, and Quality of Life in Chronic Renal Failure Patients

Background: Hemodialysis is one of renal replacement therapy for patients with chronic renal failure (CRF). The quality of hemodialysis is largely determined by the recommended dose of hemodialysis. Biological and psychological changes are often faced by patients undergoing hemodialysis, which can affect their quality of life. Family support is an important factor that serves as a support system for the patients to face the health problems. This study aimed to determine the association between hemodialysis adequacy, family support, and quality of life in chronic renal failure patients. Subjects and Method: This was an analitic observational study with cross sectional design. It was conducted at Kasih Ibu Hospital, Surakarta, Central Java. A total sample of 102 patients with chronic renal failure who underwent hemodialysis were selected for this study using random sampling. The dependent variable was quality of life. The independent variables were hemodialysis adequacy and family support. The quality of life was assessed using the WHOQoL questionnaire. The hemodialysis adequacy was measured by Ureum Reduction Rate (URR) formula. Family support was measured by family support questionnaire. The data were analyzed using Chi Square test, Mann Whitney test, and logistic regression Results: Patients with chronic renal failure had better quality of life if they underwent adequate hemodialysis (OR= 5.34 95% CI= 2.20 to 12.98 p= 0.001) and received strong family support (OR= 7.74; 95% CI= 3.13 to 19.13 p= 0.001). Conclusion: Quality of life of the patients with chronic renal failure is determined by hemodialysis adequacy and family support. Keywords: chronic renal failure, hemodialysis, adequacy, family support, quality of lif

Perbedaanindeks Massa Tubuh (IMT) Pada Pasien Gagal Ginjal Kronik Dengan DM Dan Tanpa DM Yang Menjalani Hemodialisis Rutin Di RSUD Dr. Moewardi

Chronic kidney disease (CKD) is a disease that leads to progressive kidney function decline, and usually ends with renal failure. The prevalence of CKD in Indonesia is 0.2% and increases with age. DM ranks second as the cause of CKD. Hemodialysis becomes a therapy for patients with chronic renal failure to replace damaged kidney function. BMI is an important predictor that can describe the survival of chronic renal failure patients undergoing routine hemodialysis. To know the difference of BMI in patients with chronic renal failure with DM and without DM undergoing routine hemodialysis in RSUD Dr. Moewardi. Observational analytic research with cross sectional study design. The subjects of the study were patients suffering from chronic renal failure with DM and without DM undergoing routine hemodialysis in RSUD Dr. Moewardi. Sampling technique is done by purposive sampling technique. Data were obtained from medical records of patients who began undergoing routine hemodialysis in August 2016 to January 2017. Statistical analysis of this study using the Mann-Whitney test. This study used 48 samples, consisting of 24 patients with chronic renal failure with DM undergoing routine hemodialysis and 24 patients with chronic renal failure without DM undergoing routine hemodialysis. The difference in BMI in patients with chronic renal failure with DM undergoing routine hemodialysis 19.62 ± 4.21 kg / m2 compared with patients with chronic renal failure without DM undergoing routine hemodialysis 20.65 ± 1.60 kg / m2 with p <0.001. There is a difference of BMI in patients with chronic renal failure with DM and without DM undergoing routine hemodialysis