Summary Nine of ninety patients with sarcoidosis were found to have significant renal impairment. Epithelioid granulomata were present in five of eight patients who had renal biopsies and glomerular lesions were present in six. There was close correlation between hypercalcaemia, hyperuricaemia, nephrocalcinosis and creatinine clearance. In one patient, renal sarcoidosis complicated membrano-proliferative glomerulonephritis and one patient died in end-stage renal disease.
The Comrades Marathon is a gruelling test of man’s stamina and only trained athletes participate. It is sur prising that of over 2,000 contestants each year on a 90-km (56.25-mile) course, severe cardiac and renal damage does not occur more often. We are able, however, to report 10 cases over 9 years when renal damage did occur. 3 cases required haemodialysis; 1 had peritoneal dialysis; 2 patients had renal biopsies. Possible idiosyncratic factors are discussed as is the pathogenesis of acute tubular necrosis.
In developing countries, where the budget for drugs is limited and infectious disease rampant, sulphonamides are used as first-line treatment. The use of sulphonamides of both rapid and delayed action is fraught with major hazard on rare occasions. We therefore report the case of a young African who developed a fulminating skin lesion two days after sulphadimidine therapy and acute cardiomyopathy 28 days later. CASE HISTORYA 12-year-old African boy of the Luo tribe was admitted to Mulago Hospital, Kampala, on 10 February 1967, two days after treatment with sulphadimidine for otitis media. He had 6 g. of sulphadimidine over two days. A rash had appeared 24 hours before admission and had progressed rapidly to involve the entire body. Physical examination showed a young dehydrated subject in extremis. A generalized bullous eruption had involved over 90% of the body surface. Keratoconjunctivitis was prominent and there was an exudative lesion of his labial and oral mucosa. The glans penis was not involved. The skin, which appeared to be intact, was friable and peeled away on minor pressure (Nikolsky's sign). Scrapings from the base of a bulla showed no epithelial threads (Tzanck test negative). A diagnosis of Stevens-Johnson syndrome was made.Investigation on admission showed marked depletion of sodium, potassium, and chloride (Na 125 mEq/L., K 2.1 mEq/l., C1 88 mEq/l., bicarbonate 44 vols. %). There were many red blood cells in the urine. The haemoglobin was 11.4 g./100 ml. and the blood film showed eosinophilia of 28% in a total count of 8,400/cu. mm. The blood and faeces showed no significant infection by parasites. Six blood cultures were negative. Treatment was directed to the control of electrolyte and fluid balance (which restored normal electrolytic status after seven days), to the prevention of secondary infection by broad-spectrum antibiotics (tetracycline 500 mg. sixhourly orally), and to combating the fulminating dermatitis with large doses of corticosteroids. Initial therapy was hydrocortisone 200 mg. intravenously, then 100 mg. intramuscularly six-hourly for seven days, and finally prednisone 80 mg. orally daily in divided doses. Serous exudation from the skin demanded pressure dressings to prevent intractable serosanguineous loss. The haematocrit value was maintained by blood transfusion (6 pints (3.4 litres) in first seven days). After three weeks in hospital re-epithelization of the skin was satisfactory and critical care was relaxed, though corticosteroids and antibiotics were maintained in low dosage. At this stage the only sustained abnormality was an eosinophil count of 25%, the total white cell count being 7,600. Twenty-eight days after the initial illness he suddenly relapsed into a state of profound weakness. Dyspnoea was marked and tachycardia (150/min.) was noted. The jugular venous pressure was raised 8 cm. relative to the sternal angle, the blood pressure was 60/50 mm. Hg, and there were signs of congestive cardiac failure. In addition there was an associated summation gallop rhythm and t...
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