1/6. Atypical eclampsia: a case report and review.Up to one-third of cases of eclampsia occur in the postpartum period. Often there is evidence of preeclampsia, which alerts the physician to be prepared for the possibility of seizures. eclampsia is an obstetrical emergency often requiring intensive care and monitoring. This reports the case of a 33-year-old gravida 5 para 4 abortus 1 who presented ten days postpartum with eclampsia. The patient had no history of hypertension, edema, or proteinuria during her prenatal visits or hospitalization, and has no history of preeclampsia or eclampsia in previous pregnancies. This case illustrates the rare occurrence of eclampsia late in the postpartum period and the equally rare onset of eclampsia without prior evidence of preeclampsia during her pregnancy. It is followed by a brief review of the relevant literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Fibrillary glomerulonephritis.The occurrence of fibrillary glomerulonephritis is unusual in taiwan, whereas it occurs in approximately 1% of renal biopsy specimens taken in the united states of American. This disease is characterized by extracellular randomly arranged non-branching congo red-negative microfibrils within glomeruli. The microfibrils are less than 30 nm in diameter, and electron microscopy is essential for diagnosis. Differential diagnosis of the deposition of extracellular non-branching microfibrils within glomeruli is important because discrete diseases have different therapeutic and prognostic implications. The report will discuss two cases of biopsy-proved fibrillary glomerulonephritis who presented with proteinuria, hematuria, renal insufficiency, and hypertension. It is noteworthy that the renal function persistently went downhill, even though the physician treated the patients with corticosteroids, pulse treatment and immunosuppressive agents.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Renal disease in type I glycogen storage disease.Although kidney enlargement occurs in Type I glycogen storage disease, renal disease has not been considered a major problem. death from renal failure in three patients known to us prompted a study of renal function in this disorder. Of the 38 patients with Type I glycogen storage disease under our care, the 18 children under 10 years old had normal renal function. Fourteen of the 20 older patients (13 to 47 years) had disturbed renal function, manifested by persistent proteinuria; many also had hypertension, hematuria, or altered creatinine clearance. Progressive renal insufficiency developed in 6 of these 14 patients, leading to three deaths from renal failure. At the onset of proteinuria, creatinine clearance was increased in seven patients (3.05 /- 0.68 ml per second per 1.73 m2 of body-surface area; range, 2.47 to 4.13 [normal range, 1.33 to 2.33 ml per second per 1.73 m2]). Renal biopsies were performed in three patients after an average of 10 years of proteinuria. All three biopsies demonstrated focal segmental glomerulosclerosis in various stages of progression. Our data suggest that chronic renal disease is a frequent and potentially serious complication of Type I glycogen storage disease. In addition to treating hypoglycemia vigorously, physicians should monitor renal function carefully in patients with this disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. urinalysis and clinical renal disease.urinalysis is a simple, efficient, and accurate guide in the diagnosis of renal disease. By determining a patient's history and obtaining a physical examination, the physician is very often able to diagnose a patient's renal lesion. Heavy proteinuria and a microscopic sediment containing red cells and red cell casts strongly suggest acute glomerulonephritis. The causes of this nephropathy are legion. On the other hand, mild proteinuria and a lack of microscopic findings suggest nephrosclerosis, interstitial nephritis, or acute tubular necrosis in the proper clinical setting. When glomerular disease produces nephrotic syndrome, the various types of glomerular disease can be diagnosed accurately without biopsy in a high percentage of cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. An individualized approach to the hypertensive patient with renal disease: six illustrative case studies.One of the biggest challenges in medicine is the area of therapeutics, wherein the physician attempts to match the needs of the individual patient with a specific agent from the pharmacopeia, at the dose that might be best suited to treat the individual's problem. A great deal of the art of medicine is involved in this "matching process," in which the scientific aspects of diagnosis and therapy meet with the physician's knowledge of clinical pharmacology. The abbreviated case histories of six patients who came to the author with specific questions regarding therapy of their hypertension and renal impairment illustrate the fact that one of any number of therapies might have reduced blood pressure in these patients, but in each, there was a specific reason to attempt a single approach first. If physicians could better understand and extrapolate the results of clinical research to the treatment of specific patients, choice of therapy might become more successful.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
6/6. Aminoglycoside-associated Fanconi's syndrome: an underrecognized entity.The fanconi syndrome is an array of multiple proximal renal tubular dysfunctions occurring in association with several exogenous toxins, such as aminoglycosides. These antibiotics remain the drugs of choice in most gram-negative infections, but nephrotoxicity is the main drawback for them. Furthermore, the nephrotoxic effects may be overlooked with routine analyses. With the purpose of making physicians aware of this underrecognized complication, we are reporting here 3 cases of Fanconi's syndrome related to the administration of high-dose aminoglycosides (ranging from 3.6 to 15 g) with normal serum urea nitrogen and creatinine levels. The pattern of aminoaciduria demonstrated high increases in neutral amino acids, followed by dibasic and near-normal acidic amino acids. We also report the urinary excretion rates of total protein and beta2-microglobulin and protein electrophoresis results. We compared these cases with others reported in the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |