American journal of nephrology
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Case Reports
Acute progressive and extensive metastatic calcifications in a nephrotic patient following chronic hemodialysis.
We report on a 46-year-old female patient with a 5-year history of refractory nephrotic syndrome who rapidly developed extensive metastatic calcifications in lung, bone, blood vessels, skin, uterus and other soft tissues following maintenance hemodialysis. She was admitted for controlling anasarca. On admission, she suffered from severe nephrotic syndrome and chronic renal failure, showing 1.3 g/dl of serum albumin and 4.6 mg/dl of serum creatinine. ⋯ At this time, though the calcium-phosphorous product in serum was almost normal, the free calcium index was confirmed to have been high for 4 weeks. We considered that administration of calcium carbonate and alfacalcidol as well as an influx of free calcium from a dialysate resulted in increased serum ionized calcium which may be unable to be bound to serum protein because of lack of total protein, leading to ectopic deposition of calcium and phosphate. Our findings suggested that intensive care is needed to prevent metastatic calcification when uremic patients with severe nephrosis are treated with bicarbonate hemodialysis.
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Biography Historical Article
Familial hypertension in Morgagni's De Sedibus et Causis Morborum per Anatomen Indagatis.
Morgagni was a contemporary of Malpighi, but unlike the latter he concentrated on macroscopic clinical and anatomic observations. His De Sedibus et Causis Morborum per Anatomen Indagatis consists of 5 books, written as letters to other scientists and members of foreign academies. ⋯ One case history presented, of a patient of Valsalva's who died with edema and a bladder stone, can probably be considered as the first description of familial hypertension. From his clinical and autopsy investigations, Morgagni concluded that the patient died of hereditary bladder stone disease and apoplexy.
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The history of nephrology is a part of culture in general and should be treated not as a hobby or an isolated specialty of medical science, but as closely connected with medical education and everyday clinical practice. In the age of the apotheosis of renal biotechnology, medicine more than ever needs to combine Hippocratic messages with renal technologic achievements, in order both to restore quality of life in patients with renal disease and to bring harmony and balance to individuals impaired in body and soul. ⋯ Hippocratic writings have not lost their nephrologic interest, despite the enormous recent advances in renal technology. Today's practising nephrologist can still learn not only from Hippocratic clinical observations, but also from the prognostic thoughts, the ethical principles, the philosophic concepts and the humane messages of the 'father of clinical nephrology'.
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Comparative Study Clinical Trial Controlled Clinical Trial
Once weekly versus twice weekly subcutaneous administration of recombinant human erythropoietin in haemodialysis patients.
Optimal route and frequency of administration of recombinant human erythropoietin (rHuEPO) have not yet been determined. There is some evidence to suggest that subcutaneous administration of rHuEPO may be more effective than the intravenous route in reversing renal anemia. It is also unclear whether rHuEPO is more effective when given by a large intermittent dose or by more frequent multiple divided doses. ⋯ The average doses of rHuEPO used during the study were 127 +/- 6 and 115 +/- 18 U/kg body weight/week for the once weekly and twice weekly groups, respectively. Subcutaneous administration of low-dose rHuEPO is effective in reversing renal anaemia. Similar responses were obtained with once weekly and twice weekly regimens.
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Two case histories of patients with end-stage renal disease subsequently found to have primary hyperoxaluria are reported. In the setting of renal failure, the diagnosis is both difficult, due to diminished oxalate excretion, and important, because of frequent graft loss due to oxalate deposition after renal transplantation. ⋯ Plasma oxalate levels were normal in one patient and the other patient presented with extensive cystic bone lesions. Primary hyperoxaluria should be considered whenever nephrocalcinosis and/or nephrolithiasis are associated with end-stage renal disease.