1,721,042 research outputs found
Ertapenem Neurotoxicity in Patients with Kidney Damage: A Case Report
No full textErtapenem, a member of the carbapenem group of antibiotics, is a broad-spectrum antibiotic that is effective against multidrug-resistant gram-positive and gram-negative infections. In patients with acute or chronic kidney damage, one of the most serious side effects of ertapenem is neurotoxicity. Various clinical conditions such as seizures, hallucinations, delirium, confusion, and nystagmus may occur. Previous history of cerebral pathologies is a known risk factor for ertapenem-associated neurotoxicity. Immediate discontinuation of treatment is required. Although the symptoms usually resolve rapidly, cases with longer duration of symptoms have also been reported. Close monitoring of neurological status in such patients is essential
Leucemia mieloide aguda en un paciente geriátrico con antecedentes de enfermedad de cambios mínimos
No full textBackground: The increase in the incidence of malignancies globally, and the increase in the usage frequency and types of new anti-cancer drugs, have made onconephrology more important in our clinical practice. Paraneoplastic glomerulonephritis constitutes an important part of this approach as well.
Purpose: The association of AML-nephrotic syndrome is relatively less defined in the literature compared to other hematological malignancies.
Case presentation: In this article, we present a case of acute myelocytic leukemia in a patient who was diagnosed with minimal change disease many years ago.
Discussion and Conclusion: Hematological malignancies-MCD association, is one of the best described examples of paraneoplastic glomerulonephritis. We know that cancer can be clinically diagnosed years after the detection of renal disease in paraneoplastic glomerulonephritis. In this case; rationality of follow-up, not only during the diagnosis of glomerulonephritis but also periodically in the long term, especially in clinical situations such as MCD that occur in geriatric patients, should be discussed.Introducción: El aumento en la incidencia de neoplasias malignas a nivel mundial, y el aumento en la frecuencia de uso y tipos de nuevos medicamentos contra el cáncer, han hecho que la onconefrología sea más importante en nuestra práctica clínica. Asimismo, la glomerulonefritis paraneoplásica también constituye una parte importante de este enfoque.
Propósito: La asociación de LMA-síndrome nefrótico está relativamente menos definida en la literatura a comparación de otras neoplasias malignas hematológicas.
Presentación del caso: En este artículo presentamos un caso de leucemia mielocítica aguda en un paciente al que se le diagnosticó enfermedad de cambios mínimos hace años.
Discusión y Conclusión: La asociación de neoplasias hematológicas malignas-MCD, es uno de los ejemplos mejor descritos de glomerulonefritis paraneoplásica. Sabemos que el cáncer puede diagnosticarse clínicamente años después de la detección de la enfermedad renal en la glomerulonefritis paraneoplásica. En este caso, debe discutirse la racionalidad del seguimiento, no solo durante el diagnóstico de glomerulonefritis, sino también periódicamente a largo plazo especialmente en situaciones clínicas como la ECM que se presenta en pacientes geriátricos
An Old Enemy: Still Nephrotoxic
No full textTubulointerstitial nephritis (TIN) presents histopathologically as tubulitis and oedema/inflammation and fibrosis, affecting the renal tubules and interstitium with relative sparing of the glomeruli and vasculature. It can be acute or chronic or acute on chronic and has a wide range of etiologies. In this article, we report a case of a 44-year male who presented with acute TIN, associated with the use of diclofenac at therapeutic doses, that resolved with treatment but later progressed to chronic TIN after the patient resumed diclofenac therapy. The case is discussed in the context of literature regarding the nephrotoxic effects of nonsteroidal anti-inflammatory drugs (NSAIDs)
ASSOCIATION OF PROTON PUMP INHIBITORS USE AND RENAL FUNCTIONS IN ELDERLY
No full textAmaç: Son dönemlerde proton pompa inhibitörlerinin yan etkilerinden ve özellikle de renal etkilerinden daha sık söz
edilmektedir. Akut tübülointerstisyel nefrit, akut böbrek hasarı, kronik böbrek hasarının progresyonu gibi klinik durumlara
neden olabileceği düşünülmektedir. Biz bu çalışmamızda nefroloji polikliniğimize başvuran yaşlı hastalarda proton pompa
inhibitörü kullanım sıklığını, proteinüri ve böbrek hasarıyla olan ilişkisini inceledik. Yöntem: Bir yıllık sürede nefroloji
polikliniğine başvuran 75 yaş ve üzerindeki hastaların dosyaları incelenmiştir. Bulgular: 75 yaş ve üzeri nefroloji polikliniğine
başvuran hastalarımızda proton pompa inhibitörü kullanma sıklığı yüksektir. Proton pompa inhibitörü kullanan yaşlı hastalarda
kronik böbrek hasarı birlikteliği istatistiksel olarak anlamlı olmasa da daha sık bulunmuştur. Tartışma: Proton pompa
inhibitörlerinin bilinçsiz ve/veya endikasyon dışı kullanımı renal fonksiyonlarda bozulmayla ilişkili olabilir. Proton pompa
inhibitörü kullanmak zorunda olan hastalarda renal fonksiyonlar takip edilmelidir.Introduction: Recently, side effects and especially renal effects of proton pump inhibitors have been pronounced more frequently. It is thought that they may lead to clinical situations as acute tubulointerstitial nephritis, acute kidney injury and progression of chronic kidney injury. In this study, we investigated the frequency of proton pump inhibitor use and its association with proteinuria and kidney injury in older patients admitted to our nephrology outpatient clinic. Methods: The medical records of patients aged 75 years and older who applied to the nephrology outpatient clinic for a period of one year were examined.Results: The frequency of proton pump inhibitors use is high in our 75 years and older patients admitted to the nephrology outpatient clinic. In elderly patients using proton pump inhibitors, the association with chronic kidney injury was found to be more frequent, although not statistically significant.Conclusion: Unaware and/or off-label use of proton pump inhibitors may be associated with impaired renal function. Renal functions should be monitored in patients who have to use a proton pump inhibito
Предиктори смертності у пацієнтів з гострим пошкодженням нирок, які лікувались безперервною вено-венозною гемодіафільтрацію: ретроспективне одноцентрове дослідження
No full textContinuous renal replacement therapy (CRRT) is an increasingly preferred treatment that is easier to use in patients with hemodynamic impairment and can be applied in critical care settings. There are various subtypes of CRRT, one of which is continuous venovenous hemodiafiltration (CVVHDF). In this study, we examined the general characteristics of intensive care patients who underwent CVVHDF. Methods. The clinical and biochemical data of 123 patients who underwent CVVHDF in the intensive care units of our center between February 2012 and November 2014 were analyzed retrospectively. Patients who died during the course of therapy were compared with those who survived. Results. The study included 123 patients, 73 males (59.3%) and 50 females (40.7%). The mean age was 64.4 years. Eighty-eight patients (71.5%) died during CVVHDF while 35 patients survived (28.5%). Hemodynamic parameters such as systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse pressure were significantly lower in patients who died compared to survivors (p<0.001). Mean lactic acid level was significantly higher in the deceased group than in the surviving group (8.54 mmol/L vs. 3.68 mmol/L, p<0.001, chi-square test). Conclusions. Low bicarbonate level, low systolic arterial blood pressure, and older age were significant independent predictors of mortality in this study. Mortality rates were significantly higher among patients with lactic acidosis and those over 66 years of age. Lactic acid levels can be used to predict mortality in patients undergoing CVVHDF
FRAILTY AND RELATED FACTORS IN ELDERLY PATIENTS WITH CHRONIC KIDNEY DISEASE
No full textIntroduction: Chronic kidney disease and frailty are two crucial clinical conditions increasing in prevalence globally. Both lead to severe complications that increase mortality and morbidity in patients. Conditions that may potentiate frailty in chronic kidney disease patients may complicate the follow-up of chronic disease and complicate long-term survival in this patient group. In this study, we aimed to evaluate frailty and related factors in chronic kidney disease patients over 65 years of age who were on dialysis and who were not. Materials and Methods: This cross-sectional study was carried out in geriatric chronic kidney disease patients followed in nephrology outpatient clinics or undergoing routine hemodialysis. Frailty was assessed using a scoring scale. Laboratory findings and their relationship with demographic and epidemiological data were investigated. Results: One hundred eighty-eight patients aged 65 and over were included in our study. Of the patients, 92 were female, and 96 were male. The mean age was 72.86 years. We found frailty in 82 patients (43.6%). Female gender, over 75 years old, under dialysis treatment, low-income status, and low education level were parameters significantly associated with frailty. In the regression analysis, we found that economic status and dialysis were variables that independently affected frailty in chronic kidney disease patients. Conclusions: In our study, the frequency of frailty was found to be high. Practical management and early assessment of frailty seem rational with the basic nephrological approach in patients with chronic kidney disease. Considering the high mortality rate among frail patients, we think these patients should be followed up more closely
Rhabdomyolysis following electrical injury without acute kidney injury
No full textObjective: Rhabdomyolysis is an important etiology for developing acute kidney injury (AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to be a lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the form of severe and widespread pain, tenderness, weakness in the muscles and dark urine. It is characterized by the disruption of cell integrity in myocytes as a result of widespread damage to skeletal muscles and the passage of intracellular components into the circulation. Case Presentation: Here we presented a case report of a young man who had rhabdomyolysis induced by electrical injury which is relatively less common among the other etiological factors with preserved renal functions. He had electrical injury related wounds on extremities. Urgent intravenous fluid therapy was initiated as soon as his admission to the emergency department (ED), without delay. Conclusion: AKI is very common due to the nephrotoxic effect of myoglobinuria and the prerenal status. It is rare that AKI does not develop in patients with a severe increase in creatinine kinase. It is a very important point to start effective fluid therapy in a short time
Evaluación de receptores de trasplante renal que no usan esteroides con panel de anticuerpos reactivos y anticuerpos específicos del donante
No full textBackground: Steroids are the mainstream drugs of immu-nosuppressive regimen in renal transplantation. They are successfully used on induction, maintenance and rejection treatment. Due to complications caused by steroids, treatments are switched to immunosuppressive agents. Graft dysfunction risk caused by reduced total immunosuppression disturbs clinicians very often. We documented the differences among patients by means of clinical presentation and PRA/DSA levels between patients who are using steroids and patients that were prescribed for steroid-free regimen. Methods: 82 individuals who did not use steroid and 52 patients on steroid treatment were included with similar rates of age, sex, primary renal disease, dialysis type, posttransplant follow-up duration and donor type. Pre and posttransplant PRA, DSA levels, posttransplant and current graft function and comorbidities were evaluated. Results: Individuals who do not use steroids were found to have a lower posttransplant creatinine level and glomerular filtration rate (GFR) compared to steroid users. Posttransplant and current spot urinary protein/creatinine rates were also lower in the steroid-free group. However DM, BKVN and induction therapy rates were higher in the steroid-free group. PRA and DSA levels were similar in both groups. On the other hand, posttransplant PRA-I levels were significantly higher in those with less steroid use time. Conclusions: Although steroid free regimens usually worry the clinicians, they can be preferred in patients with low immunological risk for rejection to avoid its side effects such as uncontrolled diabetes, obesity, musculoskeletal problems and cataract
Immunological results of long-term use of mammalian target of rapamycin (Mtor) inhibitors and its effects on renal graft functions
No full textBackground: Material/Methods: Results: Conclusions: Calcineurin inhibitor drugs (CNI), which are the basis of immunosuppression in kidney transplantation, contribute to renal graft loss, with increased morbidity and mortality due to their potentially harmful effects on the renal graft, cardiovascular system, and tumor pathology. For this reason, the mammalian target of rapamycin inhibitors (mTORi) such as sirolimus (SRL) and everolimus (EVE) has been preferred more frequently, as they are associated with fewer complications and longer graft function. We enrolled 89 adult renal transplant patients (37 patients on mTORi and 52 on CNI) who had similar age, sex, primary renal disease, dialysis type, post-transplant follow-up period, and donor type. We analyzed and compared the data between patients using mTORi for longer than 5 years and those using CNI regarding pre-and post-transplant panel reactive antibody (PRA), and donor-specific antibody (DSA), as well as post-transplantation and current graft functions. Although those using mTORi for more than 5 years had significantly higher mismatch rates (P=0.024) than those using CNI, there was no significant change in PRA and DSA levels. Transplant time was longer in mTORi users (P=0.025). The switch time to mTORi in patients ranged from 0 to 19 years, but the average was 4 years. As expected, actual spot urine protein/creatinine was significantly higher in those using mTORi (P=0.009). Diabetes mellitus (DM) and BK virus nephropathy (BKVN) rates were significantly higher due to switching the regimen from CNI to mTORi. Long-term use of mTORi does not appear to be an immunological problem
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