Background The occurrence of hyperkalemic renal tubular acidosis in the post-transplantation period is likely underestimate, and its identification remains important to offer adequate medical management. Transplanted recipients frequently present clinical and biological characteristics which are associated in the literature with the occurrence of this complication. Post-transplant exposure to drugs that cause hyperkalemic renal tubular acidosis may therefore appear risky. We conducted a single-center retrospective comparative study in which we compared patients with hyperkalemic renal tubular acidosis and a control group to identify clinical and biological factors significantly associated with this complication.Methods The Fisher’s exact test was applied to test whether there is a significant association between hyperkalemic renal tubular acidosis and qualitative variable. The Mann-Whitney test was applied for the quantitative variables. We performed a multivariate logistic regression excluding some variables and then selected the variables using a stepwise procedure. The best logistic model according to the Akaike Information Criterion was the final model.Results Kidney and heart transplant recipients appear to be at greater risk of developing this complication than lung transplant recipients (p = 0.016). No other qualitative variable showed a significant association with the occurrence of hyperkalemic RTA. We also found a significant difference in kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p < 0.01).Neither the residual serum tacrolimus level (p = 0.19) nor the creatinine level of renal transplant patients (p = 0.17) was significantly associated with hyperkalemic renal tubular acidosis. In multivariate logistic regression, the analysis of the final model confirms the significant impact of kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p = 0.013) in the occurrence of this complication.Conclusion In our study, the type of transplanted organ, kalemia, chloremia, and bicarbonatemia seem to be significantly associated with the occurrence of hyperkalemic renal tubular acidosis. It is essential to identify this complication and to treat hyperkalemia first before proposing additional treatments. Larger studies are needed to more accurately define transplanted patients at risk for hyperkalemic renal tubular acidosis.
Background Purple urine bag syndrome (PUBS) is a complication of bacterial colonisation of bladder catheters in which urine turns purple in the tubing, as well as in the catheter bag. This rare phenomenon can be very worrisome and stressful for the patients and their families, as well as for the healthcare team taking care of them. Recognising this complication is essential in order to avoid misdiagnosis and erroneous treatment. We report a case of PUBS in a 71-year-old female patient. Case presentation A 71-year-old woman with previous medical history of schizophrenia was admitted to the emergency department for anorexia and suspicion of psychotic decompensation. Acute urine retention and rectal faecal impaction were clinically suspected and confirmed by bladder ultrasound and rectal examination, respectively. The patient underwent bladder catheterisation as well as a rectal enema. The day after her admission, our medical team was approached by the nurse in charge of the patient because of purple urine in her catheter bag and tubing. The diagnosis of PUBS was made with the help of the Oxford urine chart. A dipstick urinalysis revealed alkaline urine (pH = 8), and the urine culture was subsequently positive for Proteus mirabilis, which is sensitive to quinolones, beta-lactams and nitrofurantoin. The bladder catheter was changed. The patient received empiric antibiotic therapy with Levofloxacin 500 mg once daily. After obtaining the antibiogram, the targeted antibiotic therapy was adapted with oral Cefuroxime 500 mg three times a day for a total duration of seven days of antibiotic therapy. There was no recurrence of purple urine. Conclusion PUBS is a rare complication of bacteriuria, which induces a purple colouration of the tubing as well as the catheter bag. It is a simple spot diagnosis, as there is no other known cause of purple urine. This is why we believe that the Oxford urine chart represents a very interesting and easily accessible tool to help clinicians to investigate any abnormal urine colour.
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