A patient with Behçet’s syndrome developed hematuria, proteinuria, and rapidly progressive, severe, renal failure. Renal biopsy confirmed the presence of crescentic, necrotizing glomerulonephritis. Treatment with intravenous corticosteroids and oral cyclophosphamide (CTX) failed to arrest the decline in renal function. Intravenous pulse CTX was administered monthly for four treatment cycles with consequent improvement and stabilization of renal function, albeit at a markedly depressed glomerular filtration rate. The literature of case reports concerning crescentic glomerulonephritis in Behçet’s syndrome is briefly reviewed, and fails to provide a uniformly accepted method of treating this rare complication. Intravenous CTX may prove to be another therapeutic option for rapidly progressive glomerulonephritis in the setting of Behçet’s syndrome.
Subdural hematoma is an infrequent occurrence in association with hemodialysis. Because of its rarity, there is no widely accepted method of continuing dialysis in such patients. We describe a case of an interhemispheric subdural hematoma with apparent onset during hemodialysis, after which the patient was successfully managed with peritoneal dialysis for 7 weeks. Following this, hemodialysis was reinstated without recurrent intracranial hemorrhage. The strategy of prompt institution of peritoneal dialysis appears to be useful, and deserves serious consideration for long-term use in patients with subdural hematomas in light of the past record of high mortality with continued hemodialysis. However, it also appears that hemodialysis may be cautiously resumed after an appropriate interval of avoiding anticoagulation.
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