We report our experience of renal disease associated with bodybuilders who had been on high-protein diet, anabolic androgenic steroids (AASs), and growth hormone (GH) for years. A total of 22 adult males who volunteered information about use of high protein diet and AAS or GH were seen over a six-year period with renal disease. Kidney biopsy revealed focal segmental glomerulosclerosis (FSGS) in eight, nephroangiosclerosis in four, chronic interstitial nephritis in three, acute interstitial nephritis in two, nephrocalcinosis with chronic interstitial nephritis in two, and single patients with membranous glomerulopathy, crescentic glomerulopathy, and sclerosing glomerulonephritis. Patients with FSGS had a longer duration of exposure, late presentation, and worse prognosis. Those with interstitial disease had shorter exposure time and earlier presentation and had improved or stabilized after discontinuation of their practice. There is a need for health education for athletes and bodybuilders to inform them about the risks of renal disease involved with the use of high-protein diet, AAS, and GH.
We describe a patient who had developed hypercalcemic crisis, with altered mental status and renal failure, one year following aggressive corticosteroid-therapy for lupus nephritis. Her disease relapsed after successful live-related kidney transplantation 11 years ago. She had normal parathyroid hormone and 25-hydroxyvitamin D yet high 1,25 dihydroxyvitamin D. Four weeks later, she developed severe dyspnea and hypoxia with a reticulonodular pattern on chest computed tomography. Bacteriological and serological tests were negative for pathogens. However, bronchoalveolar lavage established the diagnosis of Pneumocystis jiroviceii pneumonia (PJP). Her pneumonia and hypercalcemia improved with Co-trimoxazole. The case indicates that severe hypercalcemia can herald PJP.
Skin is involved in 80% of systemic lupus erythematosus (SLE) and the second most affected after joint disease. Lupus-specific lesions include (a) acute ones viz. malar rash (80%), (b) subacute ones viz. photosensitive maculopapular dermatitis (50%), and (c) chronic ones viz. discoid rash. The lupus nonspecific lesions include; (a) nonscarring alopecia (86.67%), oral ulcers (56.67%), vasculitic lesions (33.34%), bullous lesions (10%), and Raynaud’s phenomenon (6.67%). In this case report, we describe a patient with SLE and antiphospholipid antibodies that had developed a transient facial form of Raynaud’s phenomenon that was not associated with disease activity and digital changes. Its association with SLE is discussed.
Introduction: Coronavirus disease 2019 (COVID-19) is an outbreak due to SARS-CoV-2, declared by the World Health Organization (WHO) as a global pandemic in March 2020. Patients with underlying diseases, such as those with end-stage kidney disease (ESKD) on dialysis, are at greater risk. Objectives: The aim of our study to assess the outbreak and impact of COVID-19 on dialysis patients. Patients and Methods: Our study prospectively assessed and followed 442 patients with ESKD undergoing dialysis [390 patients on maintenance hemodialysis (HD) and 52 patients on peritoneal dialysis (PD)] for outbreak and impact of COVID-19 on these patients during the period from April 22, 2020 until March 23, 2021 in Al Khezam dialysis center, Kuwait. Age, gender, nationality, original kidney disease, history of hypertension (HTN), diabetes mellitus (DM), ischemic heart disease (IHD), congestive heart failure (CHF), bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), history of pulmonary embolism (PE) and source of infection were analyzed. Symptoms as fever, fatigue, cough, loss of smell and taste and chest pain were recorded, the need for ICU admission, mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO), medications were recorded. The need to shift to continuous renal replacement therapy (CRRT) and outcomes (complications and mortality) were analyzed. Results: Our study reported that 102 out of 442 (23%) dialysis patients [97 out of 390 (24.8%) HD patients and 5 out of 52 (9.6%) PD patients] got infected with COVID-19 and reinfection reported in 4 out of 97 (4%) COVID-19 HD patients. Around 27% of COVID-19 HD patients had fever, 19% had fatigue, 8% had cough, 4% had loss of smell, 4% had loss of taste, 4% had chest pain and 40% of COVID-19 PD patients had fever. Fifteen out of 97 (15 %) COVID-19 HD patients needed ICU admission, 12 out of 97 (12 %) COVID-19 HD patients needed MV. A 33 out of 97 (34%) COVID-19 HD patients and 4 out of 5 (80%) COVID-19 PD patients needed to switch to CRRT. Mortality was 17 (15 HD and 2 PD) out of 102 (16.6 %) COVID-19 dialysis patients and common causes of death were sepsis, myocardial infarction (MI), heart failure and PE. Conclusion: Outbreak and mortality of COVID-19 infection is high in ESKD patients undergoing dialysis compared with general populations. Strict protocol for prevention of COVID-19 should be undertaken in dialysis centers and encourage of home dialysis and highly protective COVID-19 vaccination priority for dialysis patients.
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