Journal of nephrology
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The anion gap (AG) is an important tool in the evaluation of metabolic acidosis. It is affected by many variables including serum albumin and globulin concentrations. HIV patients may have lower serum albumin and higher serum globulin concentrations. We hypothesized that the AG in HIV patients may differ from that of normal controls. ⋯ Our results indicate that the AG is lower in HIV patients and that this decrement may be due to the increase in serum globulin concentrations. Since a high serum AG metabolic acidosis may be masked by a deceitfully normal AG in patients with elevated serum globulin concentrations, calculation of corrected AG should be undertaken to avoid a costly delay in diagnosis and treatment.
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Journal of nephrology · Nov 2007
Review Case ReportsCatastrophic antiphospholipid syndrome: report of 4 cases.
Catastrophic antiphospholipid syndrome (CAPS), described by Asherson in 1992, is a rare form of antiphospholipid syndrome resulting in multiorgan failure with a mortality rate of about 50%. The syndrome occurs in patients with either systemic lupus erythematosus and other rheumatic diseases (systemic sclerosis, rheumatoid arthritis, primary Sjogren syndrome) or alone. Whereas in "classic" antiphospholipid syndrome (APS), medium-large vessels are involved, a diffuse small vessel ischemia and thrombosis (microangiopathic disease) leading to a severe multiorgan dysfunction is predominant in CAPS. "Trigger" factors have been demonstrated in 45% of patients, but in the majority, they remain unknown. ⋯ Disseminated intravascular coagulation occurs in approximately 13% of patients. The present study reports the clinical and serological features of 4 patients affected by this rare form of antiphospholipid syndrome. Nephrologists should be aware of the possibility of this syndrome as a cause of multiorgan failure since prompt recognition is essential for effective treatment.
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Journal of nephrology · Nov 2007
A Mediterranean age-comorbidity prognostic index for survival in dialysis populations.
The most widely used prognostic indices for estimation of survival, including for dialysis patients, were described by Charlson, and an adaptation was proposed by Hemmelgarn for dialysis patients. We present the first age-comorbidity prognostic index (ACPI) designed in a Mediterranean incident dialysis population and examine its concordance with other prognostic indices. ⋯ Although prospective external validation of this new index is required, this index adequately estimates the probability of survival at 3 years. The prognostic power of ACPI is similar to that of the Charlson index; however, relevant differences were found, concerning the weight of factors age, cardiovascular diseases and myocardial dysfunction. In end-stage renal disease we recommend estimating survival by indices established in incident dialysis patients, due to the particular comorbid conditions of this population.