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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report on a 12-year-old female patient with steroid-dependent nephrotic syndrome due to focal segmental glomerulosclerosis (FSGS) since her 3rd year of life. She was twice treated with oral cyclophosphamide and received antihypertensive treatment with atenolol and enalapril. After 3 years without any control or therapy, she presented in a reduced general condition with hypertensive crisis and a blood pressure of 220/130 mmHg, headache, vomiting and loss of vision. Additionally, renal insufficiency (creatinine 11.4 mg/dl, urea 157 mg/dl), with oliguria, anaemia and a severe relapse of nephrotic syndrome, was present. Initial treatment with steroids, albumin-furosemide infusions and antihypertensive drugs was unsuccessful, and dialysis treatment was necessary. Renal biopsy showed an advanced stage of the known FSGS and, surprisingly, a thrombotic microangiopathy. Further diagnostic investigations revealed no signs of haemolytic-uraemic syndrome, but echocardiography showed left ventricular hypertrophy, and hypertensive retinopathy grade 3 was diagnosed, making severe hypertension the most likely reason for the thrombotic microangiopathy. While adequate antihypertensive treatment led to regress of left ventricular hypertrophy and hypertensive retinopathy, renal function did not recover, and the patient remained dialysis-dependent. In conclusion, severe hypertension in chronic kidney disease can lead to target organ damage and thrombotic microangiopathy, which may further worsen renal function.
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PMID:Thrombotic microangiopathy as a complication in a patient with focal segmental glomerulosclerosis. 1788 57

The study describes an attempt to record leptospirosis in Raichur taluk/district, in Karnataka, by serological test such as microscopic test and IgM by ELISA. A house to house survey was done in six villages of Krishna river basin. Cases were interviewed regarding chief complaints like, fever, headache and oliguria, age, sex and treatment given with diclofenac, doxycycline, tetracycline and vitamin B complex. A total of 1516 cases were treated. The age of the patients ranged between 10 and 71 years. Most of them were agricultural workers. Out of 15 blood samples 12 samples sent to DHO Office, 3 were negative for leptospirosis, the density of rats were increased in all villages, the mode of transmission was food and water contamination, duration of incubation period was 5 to 10 days. Health education, for the community was undertaken to take measures against rats. Causative agent may be Leptospirosis interrogans, 3 cases were referred to Civil Hospital, Raichur and Navodaya Medical College, Raichur. Community participation was excellent. This study showed the presence of leptospirosis among the community of 6 villages, the disease is posing health hazards for agricultural workers in Raichur taluka villages.
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PMID:Control and prevention of rat fever (Leptospirosis) outbreak in six villages of Raichur district, Karnataka. 1840 89

Asymptomatic infection due to Strongyloides stercoralis may result in potentially fatal disease in immunodepressed patients. A case of Strongyloides stercoralis hyperinfection discovered at autopsy in a 55-year-old man who had been undergoing treatment for multiple myeloma is reported, emphasizing the clinical and pathological findings. One day earlier, he presented severe headache, abdominal pain and oliguria, from which he developed acute respiratory failure and septic shock. Because of difficulty in reaching this diagnosis, empirical treatment before starting immunosuppressive therapy may be the best strategy for preventing hyperinfection by this worm.
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PMID:[Strongyloides stercoralis hyperinfection: autopsy case report]. 1885 18

Familial renal hypouricemia is a hereditary disease characterized by extraordinary high renal uric acid clearance and is associated with acute renal failure (ARF). An 18-year-old sumo wrestler developed ARF after anaerobic exercise. Several hours after the exercise, he had a pain in the loins with oliguria, headache, and nausea. On admission, his serum uric acid was decreased despite the elevation of serum creatinine (9.5 mg/dL). The level of creatine kinase was normal and there was no myoglobinuria or urolithiasis. Magnetic resonance imaging showed no significant abnormality. Renal function improved completely within 2 weeks of hydration treatment. After remission, hypouricemia became obvious (1.0 mg/dL) from the initial level of uric acid (6.1 mg/dL) and fractional excretion of uric acid was 49%. Polymerase chain reaction of a urate anion exchanger known to regulate blood urate level (SLC22A12 gene: URAT1) demonstrated that homozygous mutations in exon 4 (W258X). Both parents showed heterozygous mutation of the URAT1 gene, but both siblings showed no mutation. Thus, we describe a Japanese sumo wrestler of familial renal hypouricemia complicated with anaerobic exercise-induced ARF, with definite demonstration of genetic abnormality in the responsible gene, URAT1.
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PMID:Acute renal failure after exercise in a Japanese sumo wrestler with renal hypouricemia. 1909 27

Acute renal failure is a significant complication of falciparum malaria and is associated with increased morbidity and mortality. It occurs rarely in children and is seen frequently among the adults. Malaria associated renal failure may occur as a sole complication or as a component of multiple complications. Some of the patients may have normal urination (non-oliguric) and usually have better prognosis even without renal replacement therapy. Only a few research studies are available from Indian subcontinent on malarial acute renal failure. The present study is a hospital based study from eastern India. Rourkela is situated in the western part of Orissa which contributes a large number of falciparum malaria cases. The study was conducted at the internal medicine department of Ispat General Hospital. The clinical presentation of malaria patients in 2001 were analysed with special emphasis on malarial acute renal failure. The difference between patients with or without renal failure was compared. Seven hundred eighteen patients admitted to Ispat General Hospital in 2001 above the age of 14 years were analysed. Of these, 84 (11.8%) had serum creatinine >3 mg/dl. Seventy-five patients were referred from different hospitals outside the township. The presenting complaints were fever (95%), oliguria (55%); loose motions (25%), and vomiting (51%). Headache was present in only 20% patients. Similarly, hypotension was encountered in about a third. Associated complications were significantly more common among patients having renal failure viz, Jaundice (77 versus 19%; p < 0.001), Cerebral malaria (59 versus 11%; p < 0.001), and hypoglycaemia (p < 0.05). The mortality in presence of acute renal failure was high (p < 0.001). Though malaria renal failure is a burning issue, still scant data is available in the literature, including India. The present study is an attempt to study the patients admitted to a referral hospital. The reason for high mortality is due to presence of multiple complications. The present study indicates that the presence of acute renal failure and jaundice together adversely influences the mortality. Hence, studies may be carried out to find out the reason of this changing trend as well as the methods to ameliorate/manage the situation.
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PMID:Malaria associated acute renal failure--experience from Rourkela, eastern India. 1955 96

Pre-eclampsia affects 5 - 8% of pregnancies in the USA and 3 - 14% of pregnancies worldwide. Classically, the syndrome includes hypertension and proteinuria that may be associated with edema, headache and worsening epigastric pain. This is postulated from vasospasm and endothelial cell damage. Hyponatremia in pre-eclamptic pregnancies has been described in few cases, most of which were twin pregnancies, and four of them had nephrotic syndrome. The management of hyponatremia requires a multidisciplinary approach and significant attention, as this condition can predispose to convulsions along with pre-eclampsia, thus, endangering the life of the mother and the child. We describe a case of a patient who developed pre-eclampsia and hyponatremia in the absence of proteinuria, at 34 weeks of a twin pregnancy; there was progression to oliguria with complete remission following delivery by cesarean section.
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PMID:Pre-eclampsia presenting as hyponatremia: an uncommon presentation of pre-eclampsia in a twin pregnancy - a case report and review of the literature. 1995 28

This study had the aim of describing an outbreak of yellow fever that occurred in the municipalities under the jurisdiction of the Regional Healthcare Administration of Diamantina, Minas Gerais, between 2002 and 2003, in which 36 cases were notified. This was an autochthonous outbreak of wild-type yellow fever. Failure of vaccinal coverage and low levels of detection of mild cases were found. Among the cases, 33 (91.7%) were male and the age range was from 16 to 67 years. Nineteen (52.8%) of the cases were classified as severe and 12 men (33.3%) died of the disease. All of the cases came from rural areas and presented fever, headache, vomiting, jaundice, myalgia, oliguria and signs of hemorrhage. Surveillance through laboratory tests was the determining factor in diagnosing the outbreak. By describing the epidemiological and clinic findings, this study contributes towards diagnosing and classifying this disease. It was deduced that there is a relationship between deforestation, and outbreaks, and that there is a potential regional risk of yellow fever because of the local development of tourism.
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PMID:[Yellow fever: study of an outbreak]. 1996 34

Leptospirosis, a common zoonotic disease, may present with variable clinical manifestations in between two extremes. Possibility must be excluded in any febrile patient with hepatorenal derangement. There are different reports regarding prevalence pattern, presentations and case fatality rate from different parts of the country. The purpose of this study was to find out the mode of presentation, biochemical profile and complications of leptospirosis cases in an apical level and make a comparison of same with other parts of India. Fifty-one consecutive cases of leptospirosis were selected for this study. Thorough clinical examination was done. ELISA test was done in the second week of illness. Haemogram, liver and renal function tests, coagulation profile, creatine phosphokinase (CPK), chest xray, ECG were done in all patients. Presenting features were fever (100%), myalgia (78.4%), headache (41.2%), jaundice (17.6%), oliguria (29.4%), respiratory distress (25.5%), bleeding manifestations (9.8%), altered sensorium (21.6%). Icterus was found in 74.5% of patients, hepatosplenomegaly in 72.5%, tachypnoea in 52.9%, bleeding manifestations in 35.3%, encephalopathy in 21.6%, hypotension in 15.7% and meningeal signs in 5.9% cases. Case fatality rate was 7.8%. From the study, it becomes evident that though severe leptospirosis has declined, mild leptospirosis has Increased. The reasons for decline of severe leptospirosis may be greater awareness, availability of better diagnostic tool along with widespread use of antibiotics. So, high index of suspicion may eventually reduce complications. It would be wise to start appropriate antibiotics empirically in suspected cases of leptospirosis.
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PMID:Leptospirosis: an institutional experience. 2248 21

Hemorrhagic fevers (HF) caused by viruses and bacteria are a major public health problem in China and characterized by variable clinical manifestations, such that it is often difficult to achieve accurate diagnosis and treatment. The causes of HF in 85 patients admitted to Dandong hospital, China, between 2011-2012 were determined by serological and PCR tests. Of these, 34 patients were diagnosed with Huaiyangshan hemorrhagic fever (HYSHF), 34 with Hemorrhagic Fever with Renal Syndrome (HFRS), one with murine typhus, and one with scrub typhus. Etiologic agents could not be determined in the 15 remaining patients. Phylogenetic analyses of recovered bacterial and viral sequences revealed that the causative infectious agents were closely related to those described in other geographical regions. As these diseases have no distinctive clinical features in their early stage, only 13 patients were initially accurately diagnosed. The distinctive clinical features of HFRS and HYSHF developed during disease progression. Enlarged lymph nodes, cough, sputum, and diarrhea were more common in HYSHF patients, while more HFRS cases presented with headache, sore throat, oliguria, percussion pain kidney area, and petechiae. Additionally, HYSHF patients displayed significantly lower levels of white blood cells (WBC), higher levels of creations kinase (CK) and alanine aminotransferase (ALT), while HFRS patients presented with an elevation of blood urea nitrogen (BUN) and creatinine (CREA). These clinical features will assist in the accurate diagnosis of both HYSHF and HFRS. Overall, our data reveal the complexity of pathogens causing HFs in a single Chinese hospital, and highlight the need for accurate early diagnosis and a better understanding of their distinctive clinical features.
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PMID:Co-circulation of multiple hemorrhagic fever diseases with distinct clinical characteristics in Dandong, China. 2458 7

The present survey aims at studying the opinions of three famous medical scholars in history (Rhazes, Avicinna, and Jorjani) on the diagnosis of diseases via urine examination and their compatiblity with modern science. Refering to original authentic sources in traditional medicine, including Al-Hawi (The Virtuous Life), Zakhireh-i Kharazmshahi (Thesaurus of the Shah of Khwarazm), and Al-Canon fi al Tibb (The Canon on Medicine), we compared the ideas of the authors with modern medicine. In traditional medicine, physicians would pay attention to the methods of urine collection and urinary features such as color, consistency, volume, frequency, odor, and foam as the means of diagnosis, all of which still serve as the bases for today's diagnostic approach. Moreover, symptoms of the diagnosis of the disease through urine are consistent in tradition and modern medicine; some examples are blood in the urine (hematuria), decreased urine output (oliguria), change in urine color together with headache (Alport syndrome), diluted urine (tubular dysfunction in reabsorption of water or initial polydipsy), and urinary floor with tiny bubbles (one of the main symptoms of proteinuria).
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PMID:A brief review of Rhazes, Avicenna, and Jorjani's views on diagnosis of diseases through urine examination. 2500 Nov 33


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