1,721,020 research outputs found
Aggressive B cell lymphomas in elderly patients. Curative or palliative treatment strategy?
No full textAggressive lymphomas are more frequent in elderly patients and the median age at diagnosis is 64 years. Rational treatment decisions for elderly patients are difficult to make and often influenced by other factors, such as comorbidities and social status as well as experience and preferences of treating physicians. The results of published studies are summarized and discussed in this article. Recommendation for decision-making in this patient collective are presented. This article is based on a PubMed search using the terms aggressive lymphoma, elderly and therapy and on the evaluation of data from the German high-grade non-Hodgkin lymphoma study group. Even in elderly patients with aggressive lymphomas a combined immunochemotherapy including anthracyclines is the only curative treatment approach with a 5-year overall survival of approximately 75 % in fit elderly patients. The decision on whether such a regimen is feasible or a palliative life-extending concept should be selected, can only be made after a prephase therapy for individual patients. In addition, comorbidities and social factors, such as limitations in daily life activities must be incorporated into the treatment plan in this patient population. Geriatric assessments may aid the establishment of rational approaches. The final decision has to be made by the treating physician in close interaction with the patient and relatives
Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection
Full text linkBackground
Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive.
Case Presentation
The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis.
Conclusions
Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified
Radioimmunotherapy for consolidation and relapse therapy for aggressive B-cell non-Hodgkin lymphoma: Retrospective analysis of the International RIT-Network.
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