Search

We report the case of a young white male who developed the nephrotic syndrome after being stung by a wasp. A percutaneous renal biopsy was done revealing minimal change glomerulonephritis. The patient was treated with oral prednisone with resolution of proteinuria. Corticosteroids were gradually tapered, the patient did not experience a relapse, and remains in good health with normal renal function. Herein, we also include a review of the literature on wasp bite associated nephrotic syndrome in patients who underwent a renal biopsy., (Copyright 2001 S. Karger AG, Basel)

Background: The incidence of Mycobacterium tuberculosis in hemodialysis (HD) and renal transplant (RT) patients in developing countries is high. With the resurgence of tuberculosis in the US, insights gained in the diagnosis and treatment of this infection in HD and RT patients in developing countries should be valuable to physicians in the West., Methods: A retrospective study of 40 cases of tuberculosis, 24 in HD patients (24/177, 13.6%) and 16 in RT patients (16/109, 14.7%) diagnosed over a period of 21 months in one center., Results: The clinical features, diagnostic procedures, and management dilemmas of this group of patients are described in this report. Diabetes mellitus was the most common associated disease in both groups of patients. Fever, the most common presenting sign, was persistent low grade in 66.6% of HD patients and high intermittent in 56.2% of RT patients. Fever of unknown origin was only seen in RT patients. Pulmonary involvement was most common in both groups, presenting either as infiltrates or effusions. Tuberculous peritonitis was seen only in HD patients (33.3%). Eight HD patients were treated for tuberculosis for variable periods prior to transplantation, 4 of whom had less than 6 months of therapy. None had a recurrence of tuberculosis after transplantation. Because of the known cyclosporin-lowering effect of rifampicin resulting in an increased cost of immunosuppressive therapy, 13 patients were treated successfully with rifampicin-sparing therapy., Conclusion: Tuberculosis should be included in the differential diagnosis of fever in HD and RT patients, especially if fever is of unknown origin in the RT patient. M. tuberculosis in the renal transplant patient can present with high intermittent fever. Partial treatment of tuberculosis is sufficient prior to renal transplantation but treatment should be continued to completion after transplantation. If the cost of immunosuppressive therapy is prohibitive because of rifampicin, rifampicin-sparing antituberculosis therapy can be successfully employed in RT patients., (Copyright 2000 S. Karger AG, Basel)

This study examines whether there is a relationship between aluminum overload and the accumulation of lipofuscin products (aging pigments) and lipid peroxides in red blood cells (RBC) of hemodialyzed patients. Lipid peroxides levels were assessed by the thiobarbituric acid reactivity; lipofuscin products were assessed by determining fluorescence in the lipid extracts at excitation 360 nm and emission 440 nm. Aluminum was measured by atomic absorption spectrophotometry. Controls were age-matched normal volunteers. Data show that there was a significant increase in the lipid peroxides and lipofuscin products in hemodialyzed patients compared with controls even after normalization with hemoglobin or phospholipids in RBC. Further, the increase in the lipid peroxides and lipofuscin products significantly correlated with the levels of aluminum accumulation in RBC of hemodialyzed patients. This study suggests that aluminum overload has a role in increased membrane peroxidation, which in turn can cause reduced RBC life span and contribute to anemia in chronic renal failure patients.

To study aluminum-related bone disease, bone biopsies and serum biochemical measurements were done in 97 patients on maintenance dialysis and in 100 patients with mild to moderate renal failure. Bone histology, histochemical staining for aluminum and determination of bone aluminum content were done. Stainable bone aluminum was found in 50% of dialyzed patients and in 5% of nondialyzed patients. The finding of stainable bone aluminum in dialyzed patients was associated with high morbidity and mortality; it was not only seen in most patients with low turnover osteomalacia, but also in 47% of patients with mixed uremic osteodystrophy and in 1 patient with predominant hyperparathyroid bone disease. Patients with stainable aluminum had lower bone mass and decreased activity of bone-forming and -resorbing cells. Cumulative doses of aluminum-containing phosphate binders were a major risk factor. Aluminum in drinking water represents an additional risk factor. Neither serum biochemical tests nor single infusion of deferoxamine could be employed as diagnostic tools. Bone biopsies were the only means for diagnosis.

Excessive aluminum accumulation in bone is associated with abnormalities in bone formation and mineralization in man and animals. The factors that influence deposition of aluminum in bone are not well understood. In this study the influence of 1,25-vitamin D on bone aluminum accumulation was evaluated in aluminum-loaded parathyroidectomized and nonparathyroidectomized rats with renal insufficiency. All groups of aluminum-loaded rats receiving 1,25-vitamin D had less bone aluminum accumulation. This effect was not influenced by the presence of absence of parathyroid hormone. All rats administered 1,25-vitamin D had elevated serum calcium and depressed serum phosphorus levels and lower body weight compared to controls. The results ascribe a potential role for 1,25-vitamin D in the prevention of aluminum accumulation.