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We present two patients with Hantaan virus infection, admitted to the Department of Nephrology, Skopje, at the same time, with the same clinical presentation (chills, fever, abdominal pain, hemorrhages, nausea, headache, proteinuria, hematuria, oliguria, acute renal failure) but with different pathohistological findings and different disease courses. In the first case diffuse proliferative glomerulonephritis was found, with a complete recovery of renal function after a month, with a mild proteinuria and erythruria during the second and the third month. In the second case, glomeruli were normal in general, with slight mesangial proliferation found in two out of twenty, but interstitial edema, lymphocyte infiltrations and tubular changes were noted. Complete recovery was not noted after 3 months of follow-up. The patient is now without hemodialysis treatment, with polyuria, in the stable phase of chronic renal failure which is not improving.
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PMID:Different pathohistological presentations of acute renal involvement in Hantaan virus infection: report of two cases. 198 98

The 11 cases of malaria admitted to Kaohsiung Medical College Hospital in the past 10 years were analyzed to assess the characteristics of patients who acquired malaria parasite infection. Nine of the patients contracted malaria in Southeast Asia. Two men had received antimalarial chemoprophylaxis before they went abroad and another two men relapsed after antimalarial treatment. The initial symptoms and signs were nonspecific, including fever, chills, abdominal pain and hepatosplenomegaly. Seven patients responded well to the antimalarial regimens. Two persons developed meningeal malaria. Resistance to chloroquine and primaquine and even to quinine was noted in another two cases. Hypoglycemia was diagnosed in one of latter two patients who developed heavy parasitemia (26%), acute renal failure and died 5 days after treatment. Peripheral blood smear examination is a simple and quick method to make a diagnosis in any suspicious case. Resistance to chloroquine and primaquine is not uncommon, especially in those who acquired the infection in Southeast Asia. Changing to more potent agents and aggressive management in complicated cases is necessary.
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PMID:Clinical experience on malaria. 205 63

We experienced a case of a 44 year old man who had ingested potassium bromate solution for suicide attempt. Soon after the ingestion, nausea, vomiting, abdominal pain and diarrhea developed in him. Several hours later, he began to complain of auditory disturbance and, in addition, anuric acute renal failure occurred. Direct hemoperfusion and hemodialysis was performed on the patient for the treatment purpose. Five weeks later, he was released from hemodialysis procedure. Gradually, on the other hand, progressing anemia was observed until 90th hospital day, which slowly improved thereafter. Further, pruritus, lower leg pain, headache, tinnitus and loss of sense of taste, etc. were observed in the clinical course. Renal biopsy was performed on the 119th hospital day and the specimen showed the regenerative stage of acute tubular necrosis. In our case, acute renal failure was reversible and, many other clinical manifestations were observed. However slight anemia and irreversible severe auditory disturbance remained unimproved.
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PMID:[A case of acute potassium bromate intoxication]. 222 63

Hemolytic-uremic syndrome (HUS) of childhood is a triad of acute hemolytic anemia, thrombocytopenia, and acute renal failure associated with a gastrointestinal prodrome. From 1977 to 1988, 134 patients with HUS were admitted to this institution. All patients presented with abdominal pain and diarrhea, which was virtually always bloody. Seventy-eight patients (60%) required dialysis. Five patients died (4%). One patient died as a result of colon perforation, the other four patients died of other nonsurgical complications of HUS. Three patients underwent exploratory laparotomy. One patient had a hemoperitoneum from mesenteric and transmural bleeding of the entire intraabdominal colon. Another patient had undergone surgery elsewhere for presumed intussusception with pancolitis found at exploration. Fourteen days postoperatively, he had a spontaneous perforation of the transverse colon. The third patient presented with pancolitis and perforation of the transverse colon. Despite surgical intervention he died on the sixth postoperative day. One other patient was treated conservatively for pancreatitis, which developed 3 weeks after her presentation with HUS. Complications requiring surgical intervention in HUS are rare, potentially lethal, and usually involve the colon.
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PMID:Surgical complications of the hemolytic-uremic syndrome. 227 21

In the summer of 1984 there occurred 2 outbreaks of infection with Yersinia pseudotuberculosis 5a. 58 persons ate meat products, vegetables and rice at a Japanese barbecue restaurant. 39/58 (67%) developed symptoms. In 19/39 persons an infection with Y. pseudotuberculosis could be diagnosed by stool cultures and/or serological techniques. Fever occurred in all patients, exanthema in 68% and abdominal pain in 68%. Thus, human yersiniosis due to Y. pseudotuberculosis 5a could be a febrile disease with exanthema and gastrointestinal disturbances. A transient acute renal failure developed around the 10th day of illness in 4 children. The source and mode of spread of this infection could not be clarified.
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PMID:Two outbreaks of Yersinia pseudotuberculosis 5a infection in Japan. 265 21

We report two cases of acute interstitial nephritis associated with Yersinia pseudotuberculosis infection. The patients had fever, abdominal pain, vomiting and acute renal failure coinciding with elevated agglutination antibody titer for Y. pseudotuberculosis. Renal biopsy revealed interstitial nephritis in both patients. Although it is well known that yersiniosis sometimes affects glomeruli, this is the first report to demonstrate acute interstitial nephritis in patients with Y. pseudotuberculosis infection.
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PMID:Acute interstitial nephritis associated with Yersinia pseudotuberculosis infection. 266 63

Thirteen cases of hemorrhagic fever with renal syndrome (HFRS) have been observed in the Nancy area. Ten occurred during the summer of 1983 and three in April and May 1985. The clinical characteristics were in each case very typical: abrupt onset with high fever, myalgia, intense lumbar and abdominal pain, pulsatile headache, inflammatory syndrome, WBC count increase and thrombocytopenia. Acute renal failure occurred a few days later with oliguria (9 cases out of 13), massive proteinuria (9/13) and hematuria (6/13). All patients recovered without sequelae within 8-10 days. Renal biopsy performed in 8 patients showed slight tubular lesions with interstitial mononuclear cell infiltrate, congestion and diffuse interstitial edema, and in 2 cases hemorrhagic extravasation. No glomerular lesions were observed. Clinical, histological and epidemiological characteristics of these 13 French cases are highly similar to those of the Scandinavian Nephropathia Epidemica reports. The epidemiology of HFRS remains unclear as do its pathophysiological mechanisms.
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PMID:[Hemorrhagic fever with renal syndrome. Apropos of 13 cases observed in Lorraine]. 287 52

A 34-year-old quadripara was hospitalized in the 33rd gestational week due to an acute hypertensive crisis, headache, upper abdominal pain, icterus, and proteinuria. Laboratory testing revealed hemolysis, hepatic dysfunction, and thrombopenia. The values returned toward normal after delivery by cesarean section. Diffuse bleeding in the surgical wound and acute renal failure necessitated two relaparotomies, intensive hemotherapy, and hemodialysis. Mother and child were released in good condition. Anesthesiological and obstetrical aspects of the HELLP syndrome are discussed.
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PMID:[The HELLP syndrome--a rare form of preeclampsia. Anesthesiologic and obstetric aspects]. 291 50

For evaluation of the efficacy of early treatment with ampicillin on the clinical course of Yersinia pseudotuberculosis infection in children, 136 patients were randomly assigned to receive either ampicillin or placebo. Subjects were those who were diagnosed as having Kawasaki syndrome and those who satisfied three of the following four criteria: fever; rash; abdominal symptoms; and a history of ingestion of untreated drinking water. Fifty-six patients had evidence of Y. pseudotuberculosis infection bacteriologically and/or serologically. Twenty-six were assigned to placebo and 28 to ampicillin. Ampicillin therapy did not show a significant benefit in shortening the duration of fever, diarrhea and abdominal pain or in preventing rash, erythema nodosum and acute renal failure. After 5 days of treatment none of the patients in the ampicillin group excreted the organism in the stool whereas 19 (90%) of 21 in the placebo group did (P less than 0.001). Ampicillin did not show a clinical benefit but reduced the fecal excretion of the organism.
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PMID:Ampicillin vs. placebo for Yersinia pseudotuberculosis infection in children. 305 77

Six cases of acute renal failure associated with mefenamic acid therapy are described. Five patients were non-oliguric and five patients had clinical features of salt and water depletion. In these patients the presenting symptoms were abdominal pain, diarrhoea and vomiting. Renal biopsy in five patients showed interstitial nephritis and mesangial proliferation. All patients recovered without specific therapy after withdrawal of the drug, but in four patients mild renal impairment persisted. These findings indicate that both interstitial and mesangial changes are common features of acute renal failure due to mefenamic acid therapy.
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PMID:Mefenamic acid nephropathy: an interstitial and mesangial lesion. 314 90


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