Background. Gastric antral vascular ectasia (GAVE) is currently recognized as an important cause of upper gastrointestinal (GI) haemorrhage, being responsible for about 4% of non-variceal upper GI haemorrhages and typically presents in middle-aged females. GAVE, also called “watermelon stomach”, is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum. The pathogenesis is still obscure and many hypotheses have been proposed such as mechanical stress, humoral and autoimmune factors. In the last two decades, numerous therapeutic strategies have been proposed, including surgical, endoscopic, and medical choices, yet successful treatment of GAVE continues to be a challenge. Currently, given the rapid response, safety, and efficacy, endoscopic ablative modalities have largely usurped medical treatments as first-line therapy, particularly using argon plasma coagulation. The actual GAVE prevalence in patients with end-stage renal disease (ESRD) is not clear, yet in difficult cases it should be considered as a cause of erythropoietin resistance. Case presentation. We report four clinical cases of GAVE syndrome patients diagnosed with stage 4 to 5 chronic kidney disease. All patients presented with anaemia and GI haemorrhage, the origin of which turned out to be GAVE syndrome. Conclusions. GAVE syndrome is a serious condition in ESRD patients, especially in those presenting with treatment-refractory anaemia. Realization of its aetiology and characteristics is essential to suspect, diagnose, and treat gastric ectasia. Only proper diagnosis and well-timed disease treatment can significantly improve a patient’s medical condition and future prognosis.
SANTRAUKAReikšminiai žodžiai: grybai, apsinuodijimai, amanitinas, orelaninas, inkstai. Apsinuodijimas grybais yra reta ūminių inkstų ir kepenų pažeidimų priežastis, tačiau gali sukelti rimtų sveikatos sutrikimų ir baigtis mirtimi. Lietuvoje dažniausiai apsinuodijama musmirėmis (Amanita genties grybais) ir nuodingaisiais nuosėdžiais (Cortinarius orellanus), kurie atitinkamai sukelia Amanitino ir Orelano sindromus. Užsienyje nustatyta rabdomiolizės sukeltų mirties atvejų apsinuodijus nuodingąja ūmėde (Russula subnigricans). Apsinuodijus grybais, atsiranda ankstyvųjų simptomų -pykinimas, vėmimas, viduriavimas, arba vėlyvųjų -negrįžtamų inkstų ir kepenų pažeidimų, elektrolitų disbalansas, kvėpa-vimo ir kardiovaskulinės sistemos pokyčių. Intoksikacijos veikimo mechanizmas siejamas su DNR bei RNR sintezės inhibicija, oksidaciniais ląstelės pažeidimais. Lietuvoje diagnozė remiasi klinika ir surinkta anamneze, užsienyje atliekama inkstų biopsija ir ieškoma histologinių pokyčių. Specifinio gydymo nėra. Efektyviausias gydymas -palaikomasis: agresyvus skysčių atstatymas, elektrolitų balanso palaikymas, gyvybiškai svarbių funkcijų stabilizavimas. Sunkiais atvejais atliekama inkstų ar/ ir kepenų transplantacija. Norint apsaugoti save ir aplinkinius nuo apsinuodijimo grybais, svarbu atpažinti valgomus grybus, tinkamai apdoroti prieš valgant bei riboti vartojamų grybų kiekį. ABSTRACTKey words: mushrooms, poisoning, amanitin, orellanine, kidney. Although mushroom poisoning is a rare cause of renal and liver diseases, it can result in serious health problems and even death. In Lithuania, the most common poisonous mushrooms are Amanita phalloides (Amanita family) and Cortinarius orellanus (Cortinarius family), which respectively causes Amanitin and Orellanus syndromes. In foreign countries, Russula subnigricans (Russulaceae family) poisoning it is not unusual, which may cause rhabdomyolysis induced death. Early symptoms of mushroom poisoning are sickness, vomiting, diarrhea, while advanced symptoms include irreversible kidney and liver injury, electrolytes imbalance, respiratory and cardiovascular system disorders. Mushroom caused intoxication is linked with DNA and RNA synthesis inhibition and oxidative cell damage. In Lithuania, mushroom poisoning diagnosis is primarily based on clinical evidence and anamnesis, while in foreign countries kidney biopsy is also a common procedure. However, there is no specific therapy for mushroom poisoning and, hence, treatment is mainly supportive. In severe cases, kidney or/and liver transplantation may be necessary. Serious health disorders, which result from mushroom poisoning, highlight the importance to spread knowledge about the potential nephrotoxicity of mushrooms, proper preparation and even limited consumption. Skirmantė Rėkutė VUL Santariškių klinikos Santariškių g. 2, Vilnius
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