Medicine
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Observational Study
High body mass index reduces glomerular filtration rate decline in type II diabetes mellitus patients with stage 3 or 4 chronic kidney disease.
Whether high body mass index (BMI) has an effect on progressive diabetic nephropathy in type II diabetes mellitus (DM) patients with chronic kidney disease (CKD) stage 3 or 4 remains unclear. This prospective study aimed to investigate the relationship between BMI and progression of renal function deterioration in type II DM patients with CKD stage 3 or 4. A total of 105 type II DM patients with CKD stage 3 or 4 participated in this 24-month prospective observational study. ⋯ In the linear regression analysis with the stepwise method, each 1 kg/m increase in BMI led to an increase of 0.32 mL min × 1.73 m in the estimated glomerular filtration rate (95% confidence interval, CI, 0.01-0.62; P = 0.04) during the 24-month study period. Moreover, multivariate Cox regression analysis showed that compared with the obese group, the normal BMI group (hazard ratio = 2.76, 95% CI : 1.27-6; P = 0.01) achieved the primary outcome after adjusting for other factors. In this 24-month prospective observational study, we showed that BMI of ≥25 kg/m was a protective factor for renal function deterioration in type II DM patients with CKD stage 3 or 4.
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To investigate the clinical features of Rhupus syndrome, we retrospectively reviewed the medical records of 56 patients with Rhupus who were hospitalized at the Peking Union Medical College Hospital, Beijing, China, between January 2000 and March 2013. We analyzed the clinical manifestations of Rhupus syndrome and compared these with a control group of 160 randomly selected systemic lupus erythematosus (SLE) patients without coexisting rheumatoid arthritis (RA). In our center, 1.30% (56/4301) of hospitalized SLE patients had Rhupus syndrome. ⋯ Rhupus syndrome is rare in SLE patients. Most Rhupus patients had RA onset and a distinctive clinical profile characterized by more severe RA-associated and mild SLE-associated damage. Specific autoantibodies and imaging findings could be helpful for making accurate Rhupus diagnoses.
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Review Case Reports
Crohn's disease successfully treated with infliximab in a patient receiving hemodialysis: case report and review of the literature.
There is limited information in the use of antitumor necrosis factor α, infliximab, in patients on hemodialysis. In Crohn's disease (CD), only 3 cases are reported. A 76-year-old man on hemodialysis for renal failure caused by immunoglobulin A nephropathy developed diarrhea and abdominal pains. ⋯ Adverse reactions were not observed. Infliximab was effective and safe in a patient with CD on hemodialysis. Our case has added additional literature in accordance with previous reports supporting infliximab as effective and safe in patients on hemodialysis.
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Review Case Reports
Neurological manifestation of recreational fatal and near-fatal diethylene glycol poisonings: case series and review of literature.
Diethylene glycol is a common industrial solvent which is responsible for accidental and epidemic poisoning as early as the 1930s. Due to the unavailability and unaffordability of ethanol, people in Qatar among the low income group are consuming household chemicals, some of which contain diethylene glycol, for recreational purposes. The history of ingestion is usually not volunteered and the initial clinical presentation is usually nonspecific, making it difficult to diagnose from the clinical presentation. ⋯ The typical clinical pattern of evolution of the poisoning in the absence of cost-effective ways to detect it in the serum can help clinicians in making the diagnosis. Neurological manifestations may include encephalopathy and multiple cranial and peripheral neuropathies with subsequent brain atrophy. Public awareness of the danger of such recreational use should be raised.
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Case Reports
High phenobarbital clearance during continuous renal replacement therapy: a case report and pharmacokinetic analysis.
Phenobarbital is an old antiepileptic drug used in severe epilepsy. Despite this, little is written about the need for dose adjustments in renal replacement therapy. Most sources recommend a moderately increased dose guided by therapeutic drug monitoring. ⋯ Therapeutic drug monitoring was performed in plasma and dialysate. Calculations revealed that phenobarbital was almost freely dialyzed. Correct dosing of drugs in patients on renal replacement therapy may need a multidisciplinary approach and guidance by therapeutic drug monitoring.