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https://www.readbyqxmd.com/read/29159010/multiple-myeloma-presenting-as-acute-renal-failure-in-the-absence-of-other-characteristic-features
#1
Zachary N Gastelum, Diana M Biggs, Aaron Scott
This case report describes a 54-year-old, asymptomatic man who presented with hyperkalemia on routine lab testing who was later found to have acute renal failure, unresponsive to fluid resuscitation, with minimal improvement after hemodialysis. After a comprehensive evaluation ruled out common causes of acute renal failure, the patient underwent testing with a bone survey, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunoelectrophoresis for suspected plasma cell dyscrasia and received plasmapheresis for hyperviscosity syndrome and nephrotoxicity, which resulted in improved renal function...
September 20, 2017: Curēus
https://www.readbyqxmd.com/read/29158928/discontinuation-of-hemodialysis-in-a-patient-with-anti-gbm-disease-by-the-treatment-with-corticosteroids-and-plasmapheresis-despite-several-predictors-for-dialysis-dependence
#2
Yoshihide Fujigaki, Chikayuki Morimoto, Risa Iino, Kei Taniguchi, Yosuke Kawamorita, Shinichiro Asakawa, Daigo Toyoki, Shinako Miyano, Wataru Fujii, Tatsuru Ota, Shigeru Shibata, Shunya Uchida
A 26-year-old man highly suspected of having antiglomerular basement membrane (GBM) disease was treated with corticosteroid pulse therapy 9 days after initial infection-like symptoms with high procalcitonin value. The patient required hemodialysis the next day of the treatment due to oliguria. In addition to corticosteroid therapy, plasmapheresis was introduced and the patient could discontinue hemodialysis 43 days after the treatment. Kidney biopsy after initiation of hemodialysis confirmed anti-GBM disease with 86...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/29156018/risk-factors-of-myasthenic-crisis-after-thymectomy-for-thymoma-patients-with-myasthenia-gravis
#3
Liang Xue, Lin Wang, Jihong Dong, Yunfeng Yuan, Hong Fan, Yi Zhang, Qun Wang, Jianyong Ding
OBJECTIVES: Total thymectomy should be performed on thymoma patients with myasthenia gravis. The aim of the present study was to investigate the risk factors of postoperative myasthenic crisis (POMC) occurrence in these patients. METHODS: The clinical records of 127 thymoma patients with myasthenia gravis (68 men, 59 women; median age, 50 years) who underwent total thymectomy at our institution from 2005 to 2014 were retrospectively reviewed. The following factors were analysed in relation to POMC: gender, age, duration of symptoms, bulbar symptoms, smoking history, history of myasthenic crisis, comorbidities, perioperative pyridostigmine and prednisolone therapy, spirometric and blood gas parameters, Osserman stage, operation approach, major complications, World Health Organization (WHO) histologic classification, Masaoka stage and use of immunoglobulins or plasmapheresis...
October 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29155846/soluble-cd40-ligand-directly-alters-glomerular-permeability-and-may-act-as-a-circulating-permeability-factor-in-fsgs
#4
Sophie Doublier, Cristina Zennaro, Luca Musante, Tiziana Spatola, Giovanni Candiano, Maurizio Bruschi, Luca Besso, Massimo Cedrino, Michele Carraro, Gian Marco Ghiggeri, Giovanni Camussi, Enrico Lupia
CD40/CD40 ligand (CD40L) dyad, a co-stimulatory bi-molecular complex involved in the adaptive immune response, has also potent pro-inflammatory actions in haematopoietic and non-haematopoietic cells. We describe here a novel role for soluble CD40L (sCD40L) as modifier of glomerular permselectivity directly acting on glomerular epithelial cells (GECs). We found that stimulation of CD40, constitutively expressed on GEC cell membrane, by the sCD40L rapidly induced redistribution and loss of nephrin in GECs, and increased albumin permeability in isolated rat glomeruli...
2017: PloS One
https://www.readbyqxmd.com/read/29148005/microsurgery-for-wrist-arteriovenous-fistula-creation-in-children-a-retrospective-cohort-study
#5
Afram Akturk, Roel Bakx, Michiel J S Oosterveld, Jim C H Wilde, Mirza M Idu
INTRODUCTION: Creating functional arteriovenous fistulae (AVF) at the wrist is challenging in paediatric patients because of the small calibre of the blood vessels. METHODS: We report our experience with AVF surgery in children younger than 15 years of age using microsurgical techniques. Twenty-five patients underwent AVF surgery between 2003 and 2015 (20 for haemodialysis, 4 for plasmapheresis and 1 for parenteral nutrition). Median (range) age was 9 (2-15) years and median weight was 24 (8-61) kg...
November 13, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29142382/capillary-leak-syndrome-following-snakebite-envenomation
#6
REVIEW
V Udayabhaskaran, E T Arun Thomas, Bhagya Shaji
Capillary leak syndrome is a unique complication that follows Russell's viper envenomation. This syndrome has a very high fatality rate and is characterized by parotid swelling, chemosis, periorbital edema, hypotension, albuminuria, hypoalbuminemia, and hemoconcentration. This syndrome is frequently recognized from the southern parts of India, especially from the state of Kerala. It has been postulated that a vascular apoptosis inducing component of Russell's viper venom that is not neutralized by the commercially available anti-snake venom (ASV) is responsible for this complication as it occurs even after adequate doses of ASV administration in most cases...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29136724/-expert-consensus-for-the-diagnosis-and-treatment-of-patients-with-renal-impairment-of-multiple-myeloma
#7
(no author information available yet)
Renal impairment (RI) is a common complication of multiple myeloma (MM), which is presented as chronic kidney disease (CKD) or acute kidney injury (AKI). The typical pathological feature is cast nephropathy. Presently international system staging (ISS) is used in evaluating MM. Although the classic Durie-Salmon staging system could be still used in clinical practice, it may miss out some patients with renal impairment. For evaluations of RI in MM patients with CKD, it's recommended to assess the estimated glomerular filtration rate (eGFR) by creatinine based formula CKD-epidemiology collaboration (EPI) or modification of diet in renal disease(MDRD) and to stage the renal injuries according to 2013 Kidney Disease Improving Global Outcomes (KDIGO) CKD guidelines...
November 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29135404/-bilateral-total-lung-lavage-in-a-patient-with-pulmonary-alveolar-proteinosis
#8
Müge Erbay, Yılmaz Bülbül, Funda Öztuna, Mehmet Kılıç, Neslihan Özçelik, Şafak Ersöz
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant composed of proteins and lipids. Three main categories of PAP have been defined depending on the aetiology: primer/idiopathic, neonatal/congenital, secondary and exogenous/environmental exposure. Radiologically diffuse ground glass opacities, interlobular and intralobular septal thickening is seen. Although open lung biopsy is accepted as the gold standard in diagnosis, it can be diagnosed by showing bronchoalveolar lavage (BAL) fluid with a milky appearance and periodic acid-schiff (PAS) positive globules in biopsy with clinical and radiological findings...
September 2017: Tüberküloz Ve Toraks
https://www.readbyqxmd.com/read/29132419/success-of-anti-cd20-monoclonal-antibody-treatment-for-severe-autoimmune-hemolytic-anemia-caused-by-warm-reactive-immunoglobulin-a-immunoglobulin-g-and-immunoglobulin-m-autoantibodies-in-a-child-a-case-report
#9
Houda Ajmi, Sameh Mabrouk, Saida Hassayoun, Haifa Regaieg, Minyar Tfifha, Chemli Jalel, Hadef Skouri, Noura Zouari, Saoussan Abroug
BACKGROUND: Autoimmune hemolytic anemia is rare in children. First-line therapies for this disease consist of corticosteroids and intravenously administered immunoglobulin that are effective in most patients. However, a small proportion of cases (5 to 10%) is refractory to these therapies and may represent a medical emergency, especially when hemolysis is due to warm immunoglobulin M. Recently, reports of the use of rituximab in adult autoimmune diseases have shown promising results. In children, there are few studies on the use of rituximab in the treatment for autoimmune hemolytic anemia, especially on its long-term efficacy and adverse effects...
November 14, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29124323/-goodpasture-syndrome-ocular-manifestation-in-a-young-man
#10
C Lommatzsch, A Lommatzsch, C Heinz, A Heiligenhaus
Goodpasture syndrome (GS) is a rare organ-specific autoimmune disease that may consist of glomerulonephritis and pulmonary hemorrhage. Only few case reports have been published on ocular symptoms in the context of GS. This is a case report of a 22-year-old male with GS who was referred to our practice because of visual disturbances. The anamnesis revealed pulmonary hemorrhage, acute renal failure and nephrotic syndrome, which was treated by immunosuppressive therapy with additional plasmapheresis. Ophthalmoscopically, bilateral cotton wool spots were found along the vessels and bilateral retinal hemorrhages predominantly at the posterior pole...
November 9, 2017: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
https://www.readbyqxmd.com/read/29123489/plasmapheresis-responsive-rapid-onset-dementia-with-predominantly-frontal-dysfunction-in-the-context-of-hashimoto-s-encephalopathy
#11
Dominique Endres, Magnus S Vry, Petra Dykierek, Anne N Riering, Eva Lüngen, Oliver Stich, Rick Dersch, Nils Venhoff, Daniel Erny, Irina Mader, Philipp T Meyer, Ludger Tebartz van Elst
Background: Hashimoto's encephalopathy (HE) is a rare immunological neuropsychiatric disorder characterized by increased antithyroid antibodies and mixed neurological and psychiatric symptoms. HE has been previously discussed as a differential diagnosis for rapid progressive dementia. However, most of these patients suffered from additional neurological symptoms, like ataxia or seizures. Case presentation: Here, we present the case of a 59-year-old female patient suffering rapid onset dementia with salient frontal executive dysfunction...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29110799/acute-postoperative-management-after-lung-transplantation
#12
REVIEW
Christopher Potestio, Desmond Jordan, Bessie Kachulis
Despite many advances in the field of lung transplantation, lung transplant recipients have the lowest median survival of any solid organ transplant population. Complications such as reperfusion injury, graft rejection, infection, and anastomotic breakdown increase morbidity and mortality during the immediate postoperative period. Ventilator management with lung protective strategies can not only minimize ventilator time and mitigate the risk of ventilator-associated pneumonia, but it may also decrease the risk of primary graft dysfunction and graft failure...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29109928/ventriculoperitoneal-shunt-associated-vancomycin-resistant-meningitis-complicating-a-patient-undergoing-plasmapheresis-for-presumed-systemic-lupus-erythematosus-associated-transverse-myelitis
#13
Adam John Covach, William Nicholas Rose
Objectives  We report a patient who had a working diagnosis of transverse myelitis secondary to a lupus exacerbation. As his clinical course evolved, continued vigilance clarified that he was in fact suffering from a nosocomial infection caused by vancomycin-resistant Enterococcus (VRE). Methods  We performed a retrospective review of the patient's medical record. Results  Despite radiographic improvement, he did not improve clinically following immunosuppressive therapy including plasma exchange. Once meningitis was diagnosed and treated, he improved rapidly...
October 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/29107213/current-and-future-treatment-options-for-pemphigus-is-it-time-to-move-towards-more-effective-treatments
#14
REVIEW
Soheil Tavakolpour
Systemic administration of corticosteroid (CS) remains the standard gold treatment for pemphigus. However, because of several long-term adverse effects, steroid-sparing agents are usually prescribed in combination with CSs. Despite the high number of available studies, the choice of best drugs to treat pemphigus remains controversial. Therapeutic approaches for pemphigus can be divided into traditional treatment and emerging ones. Personalized medicine, which aims to increase the efficacy as well as reduce adverse effects of treatments, could be considered as the future option...
December 2017: International Immunopharmacology
https://www.readbyqxmd.com/read/29105485/thrombotic-thrombocytopenic-purpura-presenting-as-a-severe-peripartum-cardiogenic-shock-role-of-myocardial-biopsy-and-assist-device-for-diagnosis-and-resuscitation
#15
Sébastien Champion, Dominique Belcour, Bernard Alex Gaüzère
We describe the case of a peripartum thrombotic thrombocytopenic purpura with fulminant cardiogenic shock treated with extracorporeal life support. Thrombotic thrombocytopenic purpura should be considered in the case of thrombotic microangiopathy with several or severe organ involvement and needs emergent treatment with plasmapheresis (with or without rituximab). In the case of cardiac involvement, aggressive treatment should be considered given the high mortality and the potential complete recovery.
November 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29103429/immunotherapeutics-in-pediatric-autoimmune-central-nervous-system-disease-agents-and-mechanisms
#16
Margherita Nosadini, Stefano Sartori, Suvasini Sharma, Russell C Dale
Beyond the major advances produced by careful clinical-radiological phenotyping and biomarker development in autoimmune central nervous system disorders, a comprehensive knowledge of the range of available immune therapies and a deeper understanding of their action should benefit therapeutic decision-making. This review discusses the agents used in neuroimmunology and their mechanisms of action. First-line treatments typically include corticosteroids, intravenous immunoglobulin, and plasmapheresis, while for severe disease second-line "induction" agents such as rituximab or cyclophosphamide are used...
August 2017: Seminars in Pediatric Neurology
https://www.readbyqxmd.com/read/29098140/mpgn-and-mixed-cryoglobulinemia-in-a-patient-with-hepatitis-c-new-treatment-implications-and-renal-outcomes
#17
Shannon B Palombo, Eric C Wendel, Laura R Kidd, Farshid Yazdi, Mihran V Naljayan
. INTRODUCTION: The association of hepatitis C virus (HCV), cryoglobulinemia, and membranoproliferative glomerulonephritis (MPGN) is well known. Treatment of underlying HCV infection has greatly improved in recent years with the introduction of direct-acting antivirals (DAA), which have demonstrated curative sustained viral response (SVR) rates for select viral genotypes with the added benefit of less drug side effects. However, a mainstay of newer DAAs is sofosbuvir, which is contraindicated in patients with severe renal impairment...
2017: Clin Nephrol Case Stud
https://www.readbyqxmd.com/read/29096868/impact-of-double-filtration-plasmapheresis-on-adhesion-molecules-levels-in-patients-with-stable-coronary-heart-disease-after-coronary-stenting
#18
Valerii V Tishko, Alexey A Sokolov, Andrei N Belskih, Andrei M Ivanov, Marina E Meshkova, Tatyana S Skorinova
OBJECTIVE AND METHODS: Endothelial dysfunction and inflammatory reaction at the site of damage plays a key role in the formation of neointimal hyperplasia, and in the progression of atherosclerosis. The initiating role in these processes is assigned to adhesion molecules. We studied the dynamics of the level of adhesion molecules soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), soluble form of the molecule platelet adhesion and endothelial type-1 (sPECAM-1), sL-, sP-, sE-selectins during double filtration plasmapheresis (DFPP) with use of plasma fractionators (PF) Cascadeflo EC-50W and EC-40W (Asahi Kasei Medical Co...
November 2017: Atherosclerosis. Supplements
https://www.readbyqxmd.com/read/29082890/acute-pancreatitis-after-coronary-artery-bypass-surgery-treated-by-plasmapheresis
#19
Emine Şeyma Denli Yalvaç, Mustafa Aldağ, Cemal Kocaaslan, Ebubekir Şenateş, Ebuzer Aydın
Acute pancreatitis (AP) is a common disorder and an important cause of morbidity and mortality. There are different causes of AP, including gallstones and excessive alcohol consumption. AP after coronary artery bypass grafting (CABG) surgery is seen less frequently but it is associated with a high mortality rate due to its atypical and misleading symptoms. Supportive treatment, pain management, and treatment of complications are used in the treatment of AP. The treatment of hypertriglyceridemia-induced pancreatitis is plasmapheresis, which is an extracorporeal separation of blood components to assist in the removal of inflammatory mediators...
October 30, 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
https://www.readbyqxmd.com/read/29062252/plasmapheresis-in-a-child-with-cold-antibody-autoimmune-hemolytic-anemia-case-report
#20
Zeynep Canan Özdemir, Özcan Bör, Ener Çağrı Dinleyici, Eylem Kıral
Autoimmune hemolytic anemia is a picture of hemolysis which is caused by autoantibodies against red blood cell surface antigens. It is classified as primary, secondary or warm and cold autoimmune hemolytic anemia according to the temperature at which antibodies react. It is usually an acute and self-limiting condition. Here, we present a three-year-old male patient who presented with malaise, paleness, and dark-colored urine. His hemoglobin level was 5.8 g/dL, and increased indirect bilirubin and lactate dehydrogenase levels and decreased haptoglobulin and reticulocyte levels were noted...
September 2017: Türk Pediatri Arşivi
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