1/8. A case of uremia-associated pleural effusion in a peritoneal dialysis patient.The development of pleural effusions in ESRD patients is a relatively common occurrence. uremia, currently a rare cause of effusion, can lead to the development of hemorrhagic pleural fluid collections in patients who are underdialyzed. Uremic pleural effusions should be considered when common etiologies of effusions such as volume overload, congestive heart failure (CHF), infection, and malignancy have been excluded. uremia-associated serosal injury allows transudation of fluid into the pleural space, and defective platelet function contributes to the hemorrhagic nature of the effusion. Although uremic effusions may occur less frequently in peritoneal dialysis patients, we present a patient who developed this complication due to a peritoneal dialysis regimen that was inadequate by current Dialysis Outcomes Quality Initiative guidelines. The pleural effusion resolved with an intensified dialysis regimen in the absence of a change in the underlying volume status.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Insudative hyalin cap lesions of diabetic glomerulosclerosis.Peripheral hyalin cap lesions of glomerular capillaries are a common finding in diabetic renal disease. Although these have been referred to as exudative in nature, most studies ascribe an insudative process in their pathogenesis. We report a case of diabetic renal disease in which glomeruli demonstrated both late and early developmental stages of peripheral cap lesions in which the presence of plasma constituents was indicative of an insudative process.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Reversible acute renal failure due to churg-strauss syndrome.Renal disease in churg-strauss syndrome is generally thought to be benign in nature, thereby distinguishing this rare condition from other necrotizing vasculitides. We report a case in which acute renal failure developed during the aggressive vasculitic phase of the illness requiring dialysis therapy. After one week of daily haemodialysis treatment the patient had become encephalopathic associated with marked peripheral eosinophilia. Treatment with prednisolone resulted in a marked improvement in both clinical condition and renal function.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Unilateral nodular diabetic glomerulosclerosis: recurrence of an experiment of nature.The case of a 60-year-old diabetic patient with a fully developed diabetic glomerulosclerosis in one kidney, but only ischemic lesions in the contralateral one, which was 'protected' by a renal artery stenosis, is presented. The only other report of such a peculiar observation was made by Berkman and Rifkin on a patient who died in 1940. Because of the rather high incidence of diabetes and of renal artery stenosis, the scarcity of this 'experiment of nature' is astonishing and can be barely explained by a precise timing of the two pathological conditions. Despite rather detailed information on the clinical and paraclinical evolution of the present patient, the exact sequence of events could not be determined with certitude. Both cases bring a strong support for the role of glomerular hyperperfusion-hypertension in the pathogenesis and evolution of diabetic nephropathy and provide a theoretical basis for the importance of keeping the arterial pressure low in diabetics.- - - - - - - - - - ranking = 5keywords = nature (Clic here for more details about this article) |
5/8. Normo-osmolar, nonketotic, hyponatremic diabetic syndrome associated with impaired renal function.A case is reported of a nonketotic woman with diabetes who presented with a blood glucose of 72.8 mmol/L (1310 mg/dl), plasma sodium of 92 mmol/L, normal osmolality, impaired renal function, and alert clinical state. Before the implication of the unusual nature of the metabolic disturbance was fully considered, the initial treatment was with a rapid infusion of saline. On consideration, however, it was postulated that as her hyperglycemia had developed, the expected osmotic diuresis was prevented by the impairment of her renal function. This had allowed compensatory hyponatremia to develop to maintain normal osmolality and protect the patient from coma. The high-dose saline infusion was stopped, and she was successfully treated with insulin and potassium but only minimal saline. The use of large quantities of saline in normo-osmolar, nonketotic, hyponatremic diabetic syndrome associated with impaired renal function and alert mental state is unnecessary and potentially dangerous.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. Ultrasound and nuclear medicine in evaluation of renal disease.Multiple diagnostic imaging techniques are currently available to the clinician but the complementary nature of these techniques is frequently overlooked. A case is presented to illustrate the contributions of ultrasound, radiology, and nuclear medicine in evaluating renal disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. Renal papillary necrosis: an update.The clinical and diagnostic features of renal papillary necrosis (RPN) of 27 patients were studied. diabetes mellitus was the most frequent (56%) condition associated with RPN. Analgesic abuse, sickle hemoglobinopathy and urinary tract obstruction were present in 4 patients each; in 6 of these 12 patients these conditions were present as a coexistent disease with diabetes mellitus. There was evidence of an acute or chronic infection of the urinary tract in 18 patients, as a coexistent condition with another underlying disease that itself can cause RPN in 14 patients and as the only cause of RPN in another 4. Thus, the presence of more than one diagnostic condition which might be implicated in the causation of RPN was present in 15 patients or 55% of the cases in this series. When infection was excluded, six patients or 22% of the cases had two coexisting diseases, each of which has been implicated as a cause of RPN. This observation underlines the multifactorial nature of this entity and might explain why RPN is not encountered more frequently in each of the various primary diseases with which it has been associated. The average age of the patients at the time of diagnosis was 53 years for women and 56 years for men. Only six of the patients were younger than 40 years, and three of these had sickle hemoglobinopathy. The diagnosis of RPN was based on x-ray findings in eight patients, on the histologic examination of papillary tissue in urine in one, and on autopsy findings in the rest. Papillary necrosis was bilateral in three-fourths of the cases. The clinical picture varied. Most of the patients (67%) presented with chills and fever. flank pain and dysuria were present in 11 patients (41%). As a rule oliguria was rare and progressive uremia was uncommon. In cases diagnosed at post-mortem, the patients had succumbed to infection or to a primary severe extrarenal disorder with the possibility of RPN having been entertained clinically in only half these cases prior to autopsy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Iatrogenic placement of a Tenckhoff catheter in the bladder of a diabetic patient after penectomy.The placement of permanent peritoneal catheters for dialysis of patients with renal failure is safe and has been popular since its modification by Tenckhoff. The majority of complications associated with these catheters are infectious in nature, manifesting as peritonitis or insertion site skin infections. Occasionally, serious complications may occur. We report the iatrogenic placement of a Tenckhoff catheter in the bladder of a penectomized patient. Consideration to this surgically altered lower genitourinary tract may have avoided this rare complication as well as aided in the postoperative management of this patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |