A black kidney has 3 major differential diagnoses: hemosiderosis, lipofuscin pigment and melanotic renal cell carcinoma. Excluding lipofuscin, the other 2 are accompanied by an abnormal renal function. We report on a 25-year-old man who intended to donate a kidney to his cousin. On the operating room table when we incised the left flank region and exposed the kidney, we found a firm and black kidney so the operation was cancelled due to potential vascular injuries. Days after the incomplete procedure, we reviewed the donor's biochemistry and imaging to reassess his renal function, but the results showed quite normal renal function again. The result of Ham test was also negative. Two weeks later, we began the operation, removed the same left kidney and found that it was in the same conditions as it was before. We took the opportunity to send needle biopsies of the kidney for histopathologic analysis. The analysis showed a melanotic kidney without pathological changes in glomeruli and interstitium and vessels. A black kidney may result in hemosiderin, lipofuscin or melanin deposits in the kidney, which can confirm the diagnosis; however, special tests for underlying disease and renal function should be considered. Some causes of black kidney lead to abnormal function, but our patients's kidney returned to normal.
Dual diagnosis of attention-deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) in adults has been an area of clinical and research interest. In the present study, we assessed the frequency of ADHD in drug-dependent patients. This is a descriptive cross-sectional study. We assessed the frequency of ADHD in 144 drug-dependent patients who were admitted for detoxification at Ebn-e-Sina psychiatric hospital between August 2007 and June 2008. All patients met DSM-IV-R criteria for substance dependency; diagnosis was made by two psychiatrists. Patients completed demographic characteristics questionnaire and were rated on Wender Utah Rating Scale and adult ADHD measurement scale. Those with higher than cut-off point of both scales were interviewed directly by a psychiatrist based on DSM-IV-R criteria for the best estimate diagnoses of ADHD. Eighteen (12.5%) of the substance-dependent patients were found to have ADHD as a child that persists to adulthood. Starting age of substance use was 22.09 + 7.25 years, substance use was earlier, and the duration of the use was longer, in those with ADHD. Most of the patients preferentially used opioid.In conclusion, the current study suggests high prevalence of ADHD in drugdependent patients. Patients with ADHD experience drug abuse earlier, so diagnosis and treatment of ADHD should start earlier.
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