SUMMARYHyperamylasemia has been reported in more than 65% of patients with severe leptospirosis, and the true diagnosis of acute pancreatitis is complicated by the fact that renal failure can increase serum amylase levels. Based on these data we retrospectively analyzed the clinical and histopathological features of pancreas involvement in 13 cases of fatal human leptospirosis. The most common signs and symptoms presented at admission were fever, chills, vomiting, myalgia, dehydratation, abdominal pain and diarrhea. Trombocytopenia was evident in 11 patients. Mild increased of AST and ALT levels was seen in 9 patients. Hyperamylasemia was recorded in every patient in whom it was measured, with values above 180 IU/L (3 cases). All patients presented acute renal failure and five have been submitted to dialytic treatment. The main cause of death was acute respiratory failure due to pulmonary hemorrhage. Pancreas fragments were collected for histological study and fat necrosis was the criterion used to classify acute pancreatitis. Histological pancreatic findings were edema, mild inflammatory infiltrate of lymphocytes, hemorrhage, congestion, fat necrosis and calcification. All the patients infected with severe form of leptospirosis who develop abdominal pain should raise the suspect of pancreatic involvement.

The epidemic occurrence of VL in the region must convince authorities to adopt more adequate policies of disease control.

Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC), and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm 3 and platelets=664,000/mm 3 . Urinalysis showed an acid urine (pH=5.0), leukocyturia (2+/4+) and mild proteinuria (1+/4+). She was also oliguric (urinary volume <400mL/day). Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

Os anti-inflamatórios não esteroidais (AINEs) constituem atualmente a classe de medicamentos mais comumente prescrita no mundo todo. A frequência do seu uso tem crescido bastante nos últimos anos. A relação entre o uso de AINEs e a insuficiência renal já está bastante estabelecida e resulta de alterações na vasodilatação renal compensatória, além da liberação de citocinas pró-inflamatórias que causam lesão glomerular. O comprometimento renal constitui um dos principais responsáveis pelo alto índice de morbimortalidade associada ao uso indiscriminado dos AINEs. No presente artigo realizamos uma revisão da literatura existente acerca da nefrotoxicidade causada pelo uso dos AINEs, analisando a fisiopatologia e as principais manifestações clínicas das diversas formas de acometimento renal

A 39-year-old man arrived at the hospital emergency service with swollen legs and lower extremity compartment syndrome. He was oliguric and had serum creatinine and urea levels of 8.1 mg/dl and 195 mg/dl, respectively. The diagnosis of rhabdomyolysis was made through clinical and laboratory findings (creatine kinase activity of 26320 IU/l). The initial treatment consisted of fluid replacement and forced diuresis. The specific treatment for compartment syndrome, such as fasciotomy, was avoided in order to prevent infection. Partial recovery of renal function was recorded, after ten hemodialysis sessions. Complete recovery was observed after two months of follow-up.

Lithium has been widely used in the treatment of bipolar disorder. Its renal toxicity includes impaired urinary concentrating ability and natriuresis, renal tubular acidosis, tubulointerstitial nephritis progressing to chronic kidney disease and hypercalcemia. The most common adverse effect is nephrogenic diabetes insipidus, which affects 20-40% of patients within weeks of lithium initiation. Chronic nephropathy correlates with duration of lithium therapy. Early detection of renal dysfunction should be achieved by rigorous monitoring of patients and close collaboration between psychiatrists and nephrologists. Recent experimental and clinical studies begin to clarify the mechanisms by which lithium induces changes in renal function. The aim of this study was to review the pathogenesis, clinical presentation, histopathological aspects and treatment of lithium-induced nephrotoxicity.

Fatores de risco para óbito em pacientes idosos gravemente enfermos INTRODUCTIONThe elderly population is increasing all over the world. It is estimated that the population older than 80 years-old will increase 40% between 1995 and 2015.(1) The US census estimates that by 2050, approximately 20.1% (88.5 million) of the US population will be older than 65, and 4.3% (19.04 million) will be older than 85 years of age.(2) The consequence is an increase in chronic diseases and corresponding expectations of eventual decline in function. (3,4) Many investigators have reported rising numbers of elderly patients admitted to intensive care units (ICUs). (5)(6)(7) In the last years some studies regarding mortality in elderly patients have ABSTRACT Background:The elderly population is increasing all over the world. The need of intensive care by the elderly is also increasing. There is a lack of studies investigating the risk factors for death among critically ill elderly patients. This study aims to investigate the factors associated with death in a population of critically ill elderly patients admitted to an intensive care unit in Brazil.Methods: This is a retrospective cohort study including all elderly patients (>60 years) admitted to an intensive care unit in Fortaleza, Brazil, from January to December 2007. A comparison between survivors and nonsurvivors was done and the risk factors for death were investigated through univariate and multivariate analysis.Results: A total of 84 patients were included, with an average age of 73 ± 7.6 years; 59% were female. Mortality was 62.8%. The main cause

Background. Renal lesions in leprosy have been extensively described, including amyloidosis, glomerulonephritis, nephrosclerosis, tubulointerstitial nephritis and granulomas. Material and Methods. A retrospective study was designed to detect renal function abnormalities in 461 leprosy patients, without any co-morbidity, seen in a university hospital in northeast Brazil. The laboratory test results concerning renal function were examined in the patients' medical records. Results. The mean age was 39 ± 18 years and 217 (47%) were male. The mean duration of disease was 21 ± 38 months. Levels of creatinine above 1.4mg/dL had been detected in 40 patients (8.6%). The levels of creatinine and urea were higher in lepromatous leprosy patients. Proteinuria, hematuria and hemoglobinuria were significantly more frequent in this presentation of leprosy. Nephrotic levels of proteinuria (>3.5mg/dL) were found in three (2.1%) of 138 lepromatous leprosy patients. A positive association was found between duration of disease and high levels of creatinine in the general sample and in the lepromatous leprosy patients. There was no association between time of treatment and high levels of creatinine.Conclusion. Renal involvement in leprosy seems to be related to the quantity of bacilli present in the body. It is important to evaluate the renal function in all leprosy patients in order to detect any abnormality and prevent renal failure, which is still a potential cause of death in this disease.