BACKGROUND Waldenström's macroglobulinemia (WM) is a rare lymphoid neoplasia, which can have renal complications. These rarely occur, and most common renal manifestations are mild proteinuria and microscopic hematuria. Herein we describe a case of WM that presented with pseudothrombi depositing in capillaries associated with minimal change nephrotic syndrome and chronic kidney disease (CKD). CASE SUMMARY A 52-year-old man presented with features suggesting nephrotic syndrome. Extensive workups were done, and there were elevated serum levels of interleukin-6 and vascular endothelial growth factor (VEGF), capillary pseudothrombus accumulation associated with minimal change nephrotic syndrome, CKD, and WM. Treatment was directed at the patient’s WM with bortezomib, thalidomide, and dexamethasone whereby serum immunoglobulin M (IgM) decreased. The damage of IgM on the kidney was corrected; thus, the patient’s proteinuria and serum creatinine had improved. The patient is still under clinical follow-up. CONCLUSION It is essential for clinicians to promptly pay more attention to patients presenting with features of nephrotic syndrome and do extensive workups to come up with a proper therapy strategy.
BackgroundHypoglycemia is an important complication of severe malaria, especially in children and pregnant women. In 2017 Kikimi hospital changed quinine treatment policy from 15 mg/kg loading (plus 10 mg/kg 12hourly) to 20 mg/kg loading (plus 10 mg/kg 8-hourly) to comply with new WHO guidelines. This presented us with the opportunity to examine whether there was any dose relationship of quinine and hypoglycemia occurrence, in particular, in severe malaria in children from 5 to 144 months. MethodsThe study was retrospective of children aged 5 to 144 months admitted to KIkimi hospital with severe malaria between April 2017 and July 2018, before and after the introduction of the new quinine treatment regimen by the WHO. The patient's blood glucose at four hours was measured until intravenous quinine was stopped. Clinical events immediately before or simultaneously with each episode of hypoglycemia (glucose <= 3.0 mmol / l) were recorded.
Background: Renal involvement by systemic amyloidosis is one of the most common poor outcomes of the disease, usually manifested as nephrotic range proteinuria and can progress to end-stage renal disease(ESRD) with negative effects on the quality of life and survival of the patients. The objective of this meta-analysis was to determine prognostic factors of poor renal outcome in renal amyloidosis patients. The findings of this study may provide a clearer indication of the possibility of worsening state of renal function, which affect monitoring and therapeutic decisions. Methods:We searched for studies reporting on the renal outcomes in systemic amyloidosis, and cohort studies related to systemic amyloidosis prognosis and/or outcomes. Pooled mean differences, odds ratios and95% confidence intervals were computed using random-effect approach in Rev Man5.3®. Clinical, laboratory and renal biopsy prognostic factors were tested for heterogeneity and for overall effect. P-value<0.05 was considered statistically significant. Results: Our search resulted in 7 eligible articles involving 3016 participants in total. Five prospective cohort studies were included. 861 patients had poor renal functional outcomes which included deteriorating estimated glomerular filtration rate, progressing to chronic kidney disease or end-stage renal disease and ESRD-related mortality. Male gender AL (OR 1.58; 95% CI 0.16,15.52, p=0.70) and AA (OR 1.36; 95% CI0.09, 20.71, p=0.81), proteinuria (OR 1.03; 95% CI 0.40-1.66), serum creatinine (OR1.23; 95%CI 0.65-1.80), eGFR for AA (OR 0.42; 95% CI 0.24-0.72) and eGFR for AL (OR 0.33; 95% CI 0.12-0.91) were poor prognostic factors renal amyloidosis. There were insufficient data to systematically assess age a poor out come. Conclusion: The odds of having poor renal prognosis was increased in the male gender, the presence of proteinuria, elevated serum creatinine and decreased eGFR filtration rate. These results highlight the role of aggressive control of modifiable factors like proteinuria, the role of close medical monitoring of patients,t hat present with fatigue, edema, hypotension, and nephrotic syndrome. These clinical features are strongly associated with renal amyloidosis. Such patients should have a renal biopsy as soon as possible thus to minimize the risk of irreversible kidney damage that adversely affects the renal outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.