3.Successful Management of Recurrent Colon Ulcer in Hemodialysis Patient after Conversion to Peritoneal Dialysis.
Ji Young LEE ; In Tae MOON ; Hye Young LEE ; Hang Lak LEE ; Dong Soo HAN
The Korean Journal of Gastroenterology 2015;66(6):350-353
Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis.
Aspirin/therapeutic use
;
Colon/pathology
;
Colonic Diseases/complications/*diagnosis/drug therapy
;
Colonoscopy
;
Drug Therapy, Combination
;
Gastrointestinal Hemorrhage
;
Humans
;
Kidney Failure, Chronic/*complications
;
Male
;
Middle Aged
;
Peritoneal Dialysis
;
Recurrence
;
Ticlopidine/therapeutic use
;
Ulcer/complications/*diagnosis/drug therapy
4.Intestinal Paragonimiasis with Colonic Ulcer and Hematochezia in An Elderly Taiwanese Woman.
Chung Te LIU ; Yen Cheng CHEN ; Tso Hsiao CHEN ; Ursula BARGHOUTH ; Chia Kwung FAN
The Korean Journal of Parasitology 2012;50(4):349-352
A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like eggs were noted. Serum IgG antibody levels showed strong reactivity with P. westermani excretory-secretory antigens by ELISA. Intestinal paragonimiasis was thus diagnosed according to the morphology of the eggs and serologic finding. After treatment with praziquantel, hematochezia resolved. The present case illustrates the extreme manifestations encountered in severe intestinal paragonimiasis.
Aged, 80 and over
;
Animals
;
Anthelmintics/therapeutic use
;
Antibodies, Helminth/blood
;
Antigens, Helminth/immunology
;
Colonic Diseases/complications/drug therapy/*pathology
;
Colonoscopy
;
Enzyme-Linked Immunosorbent Assay
;
Female
;
Gastrointestinal Hemorrhage/complications/drug therapy/*pathology
;
Humans
;
Intestinal Diseases, Parasitic/complications/drug therapy/parasitology/*pathology
;
Kidney Failure, Chronic/complications
;
Paragonimiasis/complications/drug therapy/parasitology/*pathology
;
Paragonimus westermani/*immunology
;
Praziquantel/therapeutic use
;
Taiwan
;
Ulcer/complications/drug therapy/*pathology
5.Eosinophilic Peritonitis in a Patient with Continuous Ambulatory Peritoneal Dialysis (CAPD) .
Se Yong OH ; Hyang KIM ; Jeung Mook KANG ; Sung Ho LIM ; Hyun Duk PARK ; Soo Suk JUNG ; Kyu Beck LEE
The Korean Journal of Internal Medicine 2004;19(2):121-123
Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24, 500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216, 000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. Creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.
Aged, 80 and over
;
Anti-Bacterial Agents/therapeutic use
;
Cefazolin/therapeutic use
;
Ceftazidime/therapeutic use
;
Diabetic Nephropathies/complications
;
Eosinophilia/drug therapy/*etiology
;
Humans
;
Kidney Failure, Chronic/etiology/therapy
;
Male
;
Peritoneal Dialysis, Continuous Ambulatory/*adverse effects
;
Peritonitis/drug therapy/*etiology
6.Acute renal failure following the use of rosiglitazone in a chronic kidney disease patient.
R Abdul GHANI ; S ZAINUDIN ; N A KAMARUDDIN ; N C T KONG
Singapore medical journal 2009;50(1):e32-4
Drug-induced acute interstitial nephritis is a well-recognised and important reversible cause of acute renal failure. Peroxisome-proliferator activated receptor-gamma agonists, such as rosiglitazone, have been proven to be safe in chronic kidney disease patients. We describe a 65-year-old man with long-standing diabetes mellitus and hypertension, presenting with a five-day history of fluid overload and uraemic symptoms. There was no ingestion of analgesics, alternative medicine and other nephrotoxic drugs, the only new prescription being rosiglitazone, which was commenced during his last clinic follow-up two weeks prior to presentation. He required haemodialysis with minimal improvement in renal profile, despite cessation of the offending drug. Renal biopsy revealed findings consistent with acute interstitial nephritis. An episode of upper gastrointestinal bleeding with bleeding duodenal ulcer limited the use of steroids. He was treated with a course of mycophenolate mofetil which showed good gradual response and he remained stable with residual renal impairment.
Acute Kidney Injury
;
chemically induced
;
drug therapy
;
Aged
;
Humans
;
Hypoglycemic Agents
;
adverse effects
;
Immunosuppressive Agents
;
therapeutic use
;
Kidney Failure, Chronic
;
complications
;
Male
;
Mycophenolic Acid
;
analogs & derivatives
;
therapeutic use
;
Renal Dialysis
;
Thiazolidinediones
;
adverse effects
7.A case of pancytopenia secondary to low-dose pulse methotrexate therapy in a patient with rheumatoid arthritis and renal insufficiency.
Geun Tae PARK ; Dae Won JEON ; Kwang Ho ROH ; Hee Sig MUN ; Chang Hwa LEE ; Chan Hyun PARK ; Kyeng Won KANG ; Sang Mok KIM ; Jong Myeng KANG ; Han Chul PARK
The Korean Journal of Internal Medicine 1999;14(1):85-87
Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm3 and platelet count of 64000/mm3. The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor (G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particularly impaired renal function, should be mandatory for all patients who are receiving MTX therapy.
Aged
;
Antirheumatic Agents/adverse effects*
;
Antirheumatic Agents/administration & dosage
;
Arthritis, Rheumatoid/drug therapy
;
Arthritis, Rheumatoid/complications
;
Case Report
;
Female
;
Human
;
Kidney Failure, Chronic/complications
;
Methotrexate/adverse effects*
;
Methotrexate/administration & dosage
;
Pancytopenia/chemically induced*
;
Risk Factors
8.Shenshuai Yingyang capsule ameliorates muscle atrophy in rats with chronic renal failure: role of Wnt7a-Akt/mTOR signal pathway.
Ming WANG ; Dongtao WANG ; Yi YIN ; Lu LU ; Ying SHI ; Yanfeng HUANG ; Dexiu CHEN ; Lianbo WEI
Journal of Southern Medical University 2015;35(8):1170-1174
OBJECTIVETo observe the effect of Shenshuai Yingyang Capsule (SSYYJN) in ameliorating muscle atrophy in rats with chronic renal failure (CRF) and explore the role of Wnt7a-Akt/mTOR signal pathway in mediating this effect.
METHODSMale rats were randomly assigned to 5/6 nephrectomy group and sham-operated group, and the former group was further randomly divided into CRF model group, KA group, and SSYYJN group. The size of anterior tibia muscle was examined microscopically with HE staining. Protein synthesis in the soleus muscle was investigated by (14)C-phenylalanine experiment, and the expression of Wnt7a, frizzled-7, phospho-Akt, phospho-mTOR and GAPDH were detected with Western blotting.
RESULTSThe body weight, the wet and dry weight, cross-sectional area, and muscle protein synthesis of the anterior tibia muscles, and expressions of the proteins in the Wnt7a/Akt signaling pathway all increased significantly in SSYYJN and KA groups as compared with those in the model group.
CONCLUSIONSSYYJN can effectively improve muscle atrophy in the rat model of CRF possibly by reversing the reduction in the expressions of Wnt7a/Akt signaling pathway proteins in the skeletal muscles.
Animals ; Capsules ; Drugs, Chinese Herbal ; pharmacology ; Kidney Failure, Chronic ; complications ; Male ; Muscle Proteins ; biosynthesis ; Muscle, Skeletal ; drug effects ; Muscular Atrophy ; drug therapy ; Nephrectomy ; Proto-Oncogene Proteins ; metabolism ; Rats ; Signal Transduction ; TOR Serine-Threonine Kinases ; metabolism ; Wnt Proteins ; metabolism
9.Successful treatment of peritonitis by C. bertholletiae in a chronic kidney failure patient on continuous ambulatory peritoneal dialysis after kidney rejection.
Kanchan BHUTADA ; Suresh S BORKAR ; Deepak K MENDIRATTA ; Vikas R SHENDE
Singapore medical journal 2012;53(5):e106-9
Peritonitis is a common problem in patients undergoing peritoneal dialysis. However, peritonitis due to Cunninghamella (C.) bertholletiae, a fungus of the class Zygomycetes, is rare. We present a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis due to kidney rejection. Direct examination of the patient's peritoneal fluid showed fungal hyphae, and the culture was identified as C. bertholletiae. A cumulative dose of 1,600 mg fluconazole was given to the patient intraperitoneally over a one-week period. When his condition had stabilised, oral antifungal treatment was administered for two weeks. After removal of the Tenckhoff catheter, the patient was discharged with arteriovenous fistulation for haemodialysis. Zygomycosis due to C. bertholletiae is often fatal and non-responsive to systemic antifungal therapy. This case is the first from India with a successful outcome, and highlights the importance of early detection and intervention for successful outcome of peritonitis caused by C. bertholletiae.
Antifungal Agents
;
administration & dosage
;
Cunninghamella
;
isolation & purification
;
Drug Administration Routes
;
Fluconazole
;
administration & dosage
;
Follow-Up Studies
;
Graft Rejection
;
complications
;
Humans
;
Kidney Failure, Chronic
;
complications
;
therapy
;
Kidney Transplantation
;
Male
;
Middle Aged
;
Mucormycosis
;
drug therapy
;
etiology
;
microbiology
;
Peritoneal Dialysis, Continuous Ambulatory
;
adverse effects
;
Peritonitis
;
drug therapy
;
etiology
;
microbiology
10.Erythropoietin does not affect nitric oxide system in rats with chronic renal failure.
Soo Wan KIM ; Jong Un LEE ; Dae Gill KANG ; Kwon JUNG ; Nam Ho KIM ; Soon Pal SUH ; Ki Chul CHOI ; Young Joon KANG
Journal of Korean Medical Science 2000;15(2):183-188
We investigated to see whether an altered role of nitric oxide (NO) system is involved in erythropoietin (EPO)-induced hypertension in chronic renal failure (CRF). Male Sprague-Dawley rats were five-sixths nephrectomized to induce CRF. Six weeks after the operation, EPO or vehicle was injected for another 6 weeks. Plasma and urine nitrite/nitrate (NOx) levels were determined. Expression of NO synthase (NOS) proteins in the aortae and kidneys were also determined. In addition, the isometric tension of isolated aorta in response to acetylcholine and nitroprusside was examined. Blood pressure progressively rose in CRF groups, the degree of which was augmented by EPO treatment. Plasma NOx levels did not differ among the groups, while urine NOx levels were lower in CRF groups. Endothelial NOS expression was lower in the kidney and aorta in CRF rats, which was not further affected by EPO-treatment. The inducible NOS expression in the kidney and aorta was not different among the groups. Acetylcholine and sodium nitroprusside caused dose-dependent relaxations of aortic rings, the degree of which was not altered by EPO-treatment. Taken together, EPO-treatment aggravates hypertension in CRF, but altered role of NO system may not be involved.
Acetylcholine/pharmacology
;
Anemia/metabolism
;
Anemia/etiology
;
Anemia/drug therapy*
;
Animal
;
Aorta, Thoracic/physiology
;
Body Weight
;
Erythropoietin/pharmacology*
;
Hypertension, Renal/metabolism
;
Hypertension, Renal/drug therapy
;
Isometric Contraction/drug effects
;
Kidney/enzymology
;
Kidney Failure, Chronic/metabolism*
;
Kidney Failure, Chronic/complications
;
Male
;
Nitrates/urine
;
Nitrates/blood
;
Nitric Oxide/metabolism*
;
Nitric-Oxide Synthase/metabolism
;
Nitrites/urine
;
Nitrites/blood
;
Nitroprusside/pharmacology
;
Rats
;
Rats, Sprague-Dawley
;
Vasoconstriction/drug effects
;
Vasoconstrictor Agents/pharmacology
;
Vasodilator Agents/pharmacology