1/5. The course of pregnancy in a patient with nail-patella syndrome.INTRODUCTION: The nail-patella syndrome is a rare autosomal dominant condition with high penetrance. pregnancy in such a patient is rare and we believe this to be the first report of a live birth occurring in a patient with nail-patella syndrome. CLINICAL PICTURE: A 25-year-old patient presented in her first pregnancy with nephrotic syndrome associated with characteristic bone abnormalities and nail dysplasia and was later diagnosed to have nail-patella syndrome. In her second pregnancy, the course of her pregnancy was complicated by further deterioration of renal function with superimposed pre-eclampsia resulting in early delivery at 28 weeks. CONCLUSION: Such pregnancies should be regarded as high risk and managed jointly with the renal physician in a tertiary care centre to ensure an optimal outcome to the mother and baby.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Nephrotoxicity of interferon alfa-ribavirin therapy for chronic hepatitis c.The nephrotoxicity associated with interferon therapy for chronic hepatitis c infection has not been clearly defined. We describe a patient with chronic hepatitis c infection who developed the nephrotic syndrome during treatment with interferon and ribavirin. Renal biopsy revealed focal segmental glomerulosclerosis. She had a virologic and biochemical response to the antiviral therapy, and the nephrotic syndrome improved after termination of antiviral therapy. We place our case report in context with a review of the literature on nephrotoxicity associated with interferon therapy. Because our patient had no other obvious reason for the nephrotic syndrome, we are postulating that it may be secondary to interferon-ribavirin therapy. The temporal relation between the administration of the drug and the detection of toxic affects (nephrotic syndrome) and subsequent improvement upon withdrawal also supports a causative role for interferon-ribavirin. Although nephrotoxicity is rare, it should be emphasized that it can occur anytime after the start of interferon therapy, and physicians treating patients with chronic hepatitis c must be aware of this idiosyncratic, unpredictable, and potentially serious adverse event.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. amyloidosis complicating cystic fibrosis.Two patients with cystic fibrosis developed acute onset nephrotic syndrome and died within three months of presentation. Examination of renal biopsy specimens indicated amyloid. The onset of proteinuria or a fall in baseline renal function should alert the physician to this rare complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. A transplant of real life.A case of steroid-resistant nephrotic syndrome with focal segmental glomerulosclerosis leading to renal failure in a 4-year-old girl is described by her mother, with special emphasis on the problems resulting from recurrence of this disease, with graft loss in three successive kidney transplants. This report chronicles the gradual evolution from a family's initial heavy dependence upon medical solutions to their ultimate primary emphasis upon spiritual values, with medicine seen as the support toward achieving the child's psychological well-being and spiritual growth. The physician's role in balancing medical decision making, non-medical alternatives, and demands on limited and precious resources in such difficult cases is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Problems and pitfalls in providing acute and short-term pain relief with nonsteroidal anti-inflammatory agents.NSAIDs are extremely versatile and effective analgesics and anti-inflammatory agents that are generally very safe to use in young, healthy adults. However, physicians should be aware of those patients who are at greater risk of toxicity from their use and avoid or modify NSAID treatment in these individuals. Certain newer NSAIDs seem to offer lower gastric or renal toxicity and might be preferable in high-risk patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |