Anti-neutrophil cytoplasmic antibody-associated vasculitis and Goodpasture's glomerular basement membrane disease are the most common causes of diffuse alveolar hemorrhage, a life-threatening disease. Systemic lupus erythematosus and the antiphospholipid syndrome are also causes of alveolar hemorrhage. We retrospectively reviewed 15 cases of diffuse alveolar hemorrhage (DAH) associated with renal diseases. Diagnosis of DAH was based on the presence of bloody bronchoalveolar lavage fluid. There were three men and 12 women, with a mean age of 50.5 years (extremes: 24-74 years). Proteinuria and hematuria were observed, respectively, in 15 and 14 cases. Six patients revealed arterial hypertension. Crescentic glomerulonephritis was diagnosed with kidney biopsies in ten cases. The etiology of renal disease was microscopic polyangiitis (MPA) in seven cases, Wegener disease in four cases, systemic lupus erythematous in one case, cryoglobulinemia in one case, myeloma in one case and propyl-thiouracil-induced MPA in one case. Hemoptysis occurred in 14 cases. The mean serum level of hemoglobin was 7.1 g/dL (5.1-10 g/dL). The mean serum creatinine concentration was 7.07 mg/dL (2.4-13.7 mg/dL). Gas exchange was severely compromised, with an oxygenation index <80 mmHg in 14 patients and <60 mmHg in seven patients. Bronchoalveolar lavage was performed in 11 cases, and had positive findings for hemorrhage in all. Methylprednisolone pulses and cyclophosphamide were used in 14 patients. Plasmapheresis was performed in three cases. One patient received cycles of Dexamethasome-Melphalan. Three patients died as a result of DAH. The mortality rate in our study was 20%.
Background and Aims Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of Pregnancy related acute kidney injury(PRAKI) range from a minimal elevation in serum creatinine to severe renal failure requiring renal replacement therapy and may be associated with significant morbidity and mortality in young healthy women. This study aims to describe epidemiologic features, study clinical profile and outcomes of women with PRAKI and identify risk factors related to requiring hemodialysis among patients. Method We performed a retrospective study over a 5-year period (2015–2019) in a Tunisian intensive care unit. All patients presenting PRAKI were included. Results Ninety-six cases of PRAKI were listed. The rate of AKI during pregnancy-related hospitalizations was 16% .the average age was 31 ± 5 years. Most women were from urban areas (62%) but with insufficient prenatal care (57%).Seventy-eight percent underwent cesarean section delivery. PRAKI occurred in the postpartum in 79%of the cases. Oligo-anuria was the most common clinical feature of PRAKI, noted in 82% of our patients. The leading etiological causes were pre eclampsia, eclampsia, postpartum haemorrhage and sepsis respectively, in 49%, 38%, and 24% of the cases. Hemodialysis was required in 23% of cases. In the adjusted regression analysis, factors associated with dialysis were insufficient prenatal care (p=0,010 ; O Ra=24,113), HELLP syndrome (p=0,003 ; ORa=35,129), disseminated intravascular coagulation (p=0,007 ; OR=11,854), average duration of oliguria (p=0,001; ORa=3,025) , Failure stage of RIFLE criteria while admitted (p=0,009; ORa=2,09) and length of ICU stay (p=0,042 ; ORa=1,118). Renal outcome was favorable, with a complete renal function recovery for 72 patients (75%). Only four patients (4%) developed chronic renal failure. Mortality rate was 13%. Conclusion PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation in order to prompt management of the underlying risk factors
Introduction: Granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) uncommonly cause Gastrointestinal (GI) involvement. The aim was to describe frequency, diagnosis, treatment, and outcome of GI complication in a series of patients in a single center. Methods: A database that includes 32 patients with GPA and MPA diagnosed was analyzed in order to put out clinical presentation, outcome and therapy.Results: Seven patients with ANCA associated vasculitis presented GI involvement: 3 GPA and 4 MPA. Mean age at onset of the first symptoms of vasculitis was 51 AE 18 years. Sex ratio was 0, 27. At time of diagnosis GI symptoms were present in all patients. 2 patients presented gastrointestinal bleeding, one patient had severe pancreatitis, endoscopy revealed inflammatory colitis in 2 patients and gastroduodenal ulceration in 3 patients. The serious clinical extra intestinal manifestations consisted on: central nervous system involvement in one patient, cardiac involvement (pericarditis and congestive cardiomyopathy) in 3 patients, 3 cases of pulmonary hemorrhage, 3 cases of thrombo-embolic complication and renal involvement in all cases. All patients were treated with pulse methylprednisolone and cyclophosphamide. Plasmapheresis had been started in 3 patients.azathioprine was maintained in 4 patients. To manage the refractory GI bleed, one patient underwent surgery. 2 patients died because of hemorrhage and 2 patients had an end stage renal disease requiring chronic dialysis. Conclusions: GI involvement in GPA and MPA is a rare and serious complication which requires multidisciplinary engagement.
with proteinuria and 56 % diabetic subjects were taking ACE/ARB. 92 % of CKD subjects with hypertension were taking antihypertensive drug with more than half (54%) receiving calcium channel blocker. 25 % of diabetic subject were on metformin and 57 % were receiving statins. Use of calcium-based phosphate binder was 41% in subject with serum phosphate level>4.5 mg/dl. Sodium bicarbonate therapy was seen in less than 55% of the patients, Statin in less than 42% and Vitamin D analogues in less than 13 % of subjects at all stages of CKD.Conclusions: Pills burden in patients with CKD was high. ACE inhibitors are relatively less prescribed than other anti-hypertensives.No conflict of interest
Among the 5 patients with acute tubulointerstitial nephritis, 4 were biopsy-proven, and 1 was presumed based on the clinical history of recent NSAID use.Renal biopsies were performed in six patients, and histopathological diagnoses were pigment cast nephropathy (n=1), acute tubulointerstitial nephritis (n=4), and infection-related GN (n=1). Among the four patients with acute tubulointerstitial nephritis, two had exposures to NSAIDs and native medications, while a clear aetiology could not be identified in the other two. One patient, in addition, had the incidental finding of extramedullary haematopoiesis in the kidney, which was secondary to HIV-related bone marrow fibrosis.The overall mortality rate was 41.4% (5 patients died during hospitalisation, 7 patients died during follow-up). Seven patients remained dialysis-dependent at the time of discharge/death. Conclusions: While we identified a very vast spectrum of AKI, overwhelmingly the most common cause in our hospital population remains sepsis. A significant proportion required renal replacement therapy, and the patients in our cohort suffered a high mortality rate. Limitations include observational study design, referral bias, and small sample size.
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