1/8. cyclosporine-associated thrombotic microangiopathy during daclizumab induction: a suggested therapeutic approach.A woman on daclizumab developed thrombotic microangiopathy secondary to cyclosporine after a living-unrelated kidney transplant. Despite cyclosporine discontinuation, hemolysis persisted. The second dose of daclizumab was postponed 24 h, and after a maximum of two sessions of plasmapheresis (to avoid further modifications in daclizumab schedule) with plasma exchange, daclizumab was administered. Plasma infusions were prescribed until D-dimer and fibrinogen-degradation products normalized; thereafter, FK-506 was started without recurrence of the hemolytic picture and renal function restored. This observation suggests that in patients on daclizumab who develop thrombotic microangiopathy secondary to immunosuppressants, if discontinuation of the offending drug is unsuccessful, plasmapheresis with plasma exchange can be performed when the lowest levels of daclizumab exist, followed by daclizumab infusion. Plasma prescription must be continued thereafter until D-dimer and figrinogen-degradation products normalize. However, if hemolysis persists when daclizumab levels are high, plasma infusions are useful and plasmapheresis avoided. FK-506 administration did not result in recurrence of hemolysis during daclizumab induction.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/8. Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation.BACKGROUND: The prevalence of renal itch in patients on dialysis is approximately 30%, but its treatment is often ineffective. We describe an index case of a hemodialysis (HD) patient suffering from painful diabetic neuropathy (PDN) treated with gabapentin; the first administration of the drug led to the complete remission of the concomitant uremic pruritus. Subsequently, we report the results of a pilot evaluation aimed at testing the effectiveness and safety of low gabapentin doses in HD patients with uremic pruritus. methods: Five consecutive HD patients unresponsive to antihistamines received 4-week gabapentin treatment at a starting dose of 100 mg after every thrice-weekly HD, which was subsequently adjusted based on clinical response. Puritus severity was evaluated by means of a visual analogue scale (VAS) before each HD session on days 0, 2, 4, 7, 14, 21, 28 and 35. safety was assessed using adverse event data. RESULTS: All patients experienced a rapid subjective improvement in pruritus, with the mean VAS score decreasing from 8.4-1.6 after the first drug administration. Three patients required a dose increase to 100 mg four times a week to obtain better itch control. Two patients experienced complete itch remission. CONCLUSION: Although a double-blind placebo-controlled clinical trial should be conducted to better elucidate the efficacy and toxicity of gabapentin in patients with uremic itch, our data suggest that gabapentin could be considered an effective and safe alternative treatment for uremic pruritus.- - - - - - - - - - ranking = 2keywords = administration (Clic here for more details about this article) |
3/8. Nesiritide therapy in a term neonate with renal disease.A term (39-wk-old) male neonate exhibited respiratory distress and anuria within 2 days of birth. The patient was diagnosed with pulmonary hypertension, polycystic kidney disease, and heart failure; his initial B-type natriuretic peptide concentration was 2460 pg/ml. After minimal response to loop diuretics, the patient was given an infusion of nesiritide 0.01 microg/kg/minute, with no loading dose. urine output increased over 400%, and cardiac function improved. Nesiritide was titrated to 0.03 microg/kg/minute with no hypotension, decreased renal function, or adverse cardiac sequelae over the next 6 days. No subsequent changes in cardiac function occurred during the infant's stay in a progressive care unit, but he died at age 5.5 months due to sepsis. This case report demonstrates the successful first use of nesiritide therapy in a neonate with renal disease. Further studies are warranted to evaluate the safety and administration of this agent in the neonatal patient population.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/8. Caroli's disease associated with polycystic kidney: its noninvasive diagnosis.We present a case of Caroli's disease, a relatively uncommon congenital abnormality, together with CT, US, and scintigraphic findings. The patient had chronic renal failure, complicated by polycystic kidney. No hepatic fibrosis was observed. Intrahepatic biliary lithiasis and gallstones were detected, but the patient was asymptomatic. Because surgery on an abnormal biliary tract may increase the risk of cholangitis, and intravenous administration of contrast media could be invasive in patients with polycystic kidney, CT, US, and scintigraphy are considered to play an important role in diagnosis. Noninvasive diagnostic procedures in Caroli's disease are described in this report.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/8. Hepatic abscess in a patient with polycystic liver disease. A case report.A patient with a liver abscess and underlying polycystic renal and liver disease is described. The liver abscess was diagnosed on the clinical findings and accurately localized by ultrasonography. Tube drainage and antibiotic administration resulted in a rapid recovery. The polycystic liver disease, which was previously undiagnosed and asymptomatic, was an unexpected finding at laparotomy.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/8. Interactions between treatment with 1,25(OH)2D3 and glucocorticoids in uremic patients after kidney transplantation.3 patients undergoing maintenance hemodialysis and receiving 1,25(OH)2D3 for osteomalacic bone disease received cadaveric kidney grafts and concomitant glucocorticoid therapy. The administration of pharmacological doses of glucocorticoids increased the dosage of 1,25(OH)2D3 needed to maintain a normal serum calcium level 7- to 10-fold in 2 patients whose renal grafts failed to function, but there was no decrease in sensitivity to 1,25(OH)2D3 in 1 patient whose renal graft functioned normally. These data suggest that steroids given to a uremic patient may block certain effects normally produced by 1,25(OH)2D3. An end-organ defect due to the combined effects of steroids and uremia is possible.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/8. Renal cancer complicating acquired cystic kidney disease.Acquired cystic kidney disease (ACKD) occurs in the setting of prolonged azotemia and is therefore common in dialysis patients. It is characterized by epithelial proliferation, and its major complication is the development of renal cancer. The incidence of renal cancer is significantly increased in ACKD patients and is probably increased overall in the ESRD population as well. Those ESRD patients with suspicious symptoms, prolonged predialysis azotemia, or a dialysis duration of longer than 3 yr, or those who are candidates for a renal transplant should be screened for ACKD. Sonography or computed tomographic scanning are useful as initial screening tools. However, although more expensive and requiring contrast administration, the contrast-enhanced computed tomographic scan is the definitive imaging procedure by which to initially evaluate a renal mass. A suspicious renal mass is a patient who is a surgical candidate is an indication for a radical nephrectomy.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
8/8. diagnosis and treatment of a solitary infected hepatic cyst in two patients with adult polycystic kidney disease.We report on two women (one 52-year-old who underwent kidney transplantation 15 months ago and the other, 71-year-old, undergoing hemodialysis) both with adult polycystic kidney disease who had to be hospitalized because of recurrent fever attacks up to 40 degrees C without any remarkable abdominal symptoms. staphylococcus hominis and E. coli were recovered respectively from blood cultures of both patients. Evidence for the presence of a solitary infected cyst in the liver could only be obtained by computed tomography (CT) with i.v. administration of a contrast medium. In both cases the infected liver cyst was non-operatively drained with a CT-guided percutaneous catheter and therefore the necessity of laparotomy was avoided.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |