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Pneumocystis carinii
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
Peter D. Walzer, C. Kurtis Kim, Melanie T. Cushion
Pentamidine has considerable toxicity, with about 50% of non-AIDS patients experiencing adverse effects. Local reactions (pain, swelling, sterile abscess) frequently occur at the site of intramuscular injection. A variety of systemic reactions (dizziness, flushing, cardiac arrhythmias) have been reported with intramuscular and intravenous administration. Perhaps the most notable of these reactions is hypotension, which may persist for several hours and require vigorous supportive therapy. Nephrotoxicity (azotemia) is frequent but usually reversible in the absence of other drugs or conditions that impair renal function. Alterations in glucose metabolism are also quite prominent (434-436). Hypoglycemia, sometimes associated with elevated insulin levels, may occur during or following the completion of therapy and appears to be enhanced by the presence of renal insufficiency. The manifestations of hypoglycemia vary in severity from an asymptomatic laboratory value to a life-threatening condition. Hyperglycemia, sometimes progressing to frank diabetes mellitus and requiring insulin therapy, is usually a later event. Abnormal liver function tests, hypocalcemia, and a variety of other adverse reactions to pentamidine have also been reported (437-440).
The abdomen
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
The excretory function of the kidney regulates water and electrolyte secretion to maintain blood volume, blood pressure and plasma electrolyte composition. A fall in perfusion pressure of the kidney results in homeostatic activation of the renin–angiotensin–aldosterone system, resulting in peripheral vasoconstriction, thirst and sodium retention as measures to raise systemic blood pressure. Renal artery stenosis can mimic hypotension and lead to maladaptive, renin-driven systemic hypertension. Water secretion is regulated by sensing of the tonicity of plasma in the hypothalamus and by baroreceptors. An increase in tonicity of the plasma leads to a release of vasopressin from the posterior pituitary; this stimulates insertion of the protein aquaporin into the walls of the collecting ducts in the distal nephron, leading to water reabsorption. The most common electrolyte disturbances in individuals with chronic kidney disease are hyperkalaemia and metabolic acidosis. Uraemia (known as azotaemia in the USA) is the term applied to the physiological abnormalities that arise due to failure of excretion of a variety of metabolic waste products by the kidney.
Noninfectious Pulmonary Manifestations of Renal Disease In Children
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Stephen T. Lawless, H. Jorge Baluarte
The presence of renal failure is associated with a defect in gas transfer due to decreased diffusing capacity across the alveolar capillary membrane. Even more overt respiratory symptoms or radiographic findings can occur1 and will increase in severity as azotemia worsens. The radiographic appearance of pulmonary edema in renal failure assumes a classic “bat’s wing” or “butterfly” pattern also called uremic pneumonia. It is described as bilaterally symmetric alveolar infiltrates in the inner two thirds of the lung fields with sparing of the apex and periphery. This represents a fibrinous pleuritis with protein rich edema and perihilar infiltrates.2
Hyperkalemia in chronic peritoneal dialysis patients
Published in Renal Failure, 2022
Andrew B. Elliott, Karim M. M. Soliman, Michael E. Ullian
We found that serum samples with higher [K+]s also contained higher creatinine concentrations and urea nitrogen concentrations. Similar to our findings were those from Liu et al., who observed a positive correlation between azotemia (creatinine and urea nitrogen levels) and [K+]s [17]. It is possible that noncompliance with PD therapy, which would be reflected by more azotemia, caused hyperkalemia. It is also possible that larger muscle mass or greater protein intake contributed to hyperkalemia. It has been demonstrated that skeletal muscle content of potassium is greater in PD patients than in control patients with normal renal function [21]. A carefully performed metabolic study in 8 chronic PD patients demonstrated that increasing daily dietary protein intake from 0.98 to 1.44 g/kg resulted in positive nitrogen balance and positive potassium balance [22]. We did not find that hyperkalemia-only patients were younger than hypokalemia-only patients, with youth a putative marker of larger muscle mass.
Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study
Published in Renal Failure, 2021
Rodrigo Bezerra, Flávio Teles, Polyana Bezerra Mendonca, Tedla Damte, Andrew Likaka, Edyniesky Ferrer-Miranda, Jones Oliveira de Albuquerque, José Luiz de Lima Filho
Dialysis indications were azotemia with uremic symptoms (usually with urea >150 mg/dL), oliguria refractory to diuretics, hyperkalemia refractory to drug treatment (K+ > 6.0 mEq/L), hypervolemia and metabolic acidosis (pH < 7.20 and serum bicarbonate < 16 mEq/L in arterial blood). Dialysis was interrupted in situations of severe hemodynamic instability after the beginning of the procedure. Prolonged hemodialysis was defined as hemodialysis sessions with a blood flow rate of 200 mL/min and a dialysate flow rate of 300 mL/min, with duration ranging from 5 to 12 h, and was indicated in all patients who developed hypotension refractory to volume expansion requiring the use of vasoactive drugs. Short hemodialysis was defined as 2- to 4-h sessions with blood flow rates between 300–400 mL/min and dialysate flow rates of 500–800 mL/min. High-flow dialyzers with a surface area of 1.8 m2 were used. The sodium concentration, temperature, and ultrafiltration volume were determined according to the nephrologist’s criteria. In patients who did not have contraindications for anticoagulation, unfractionated bolus heparin was used at a dose of 75 U/kg body weight every 3 h.
Malignancy-associated hemophagocytic lymphohistiocytosis in children: a 10-year experience of a single pediatric hematology center
Published in Hematology, 2020
Zhizhuo Huang, Yueping Jia, Yingxi Zuo, Jun Wu, Aidong Lu, Leping Zhang
All patients had persistent fever at the time of diagnosis with M-HLH. The clinical symptoms included hepatomegaly (89%), splenomegaly (67%) and CNS symptoms (56%). The common laboratory abnormalities were neutropenia (70%), anemia (96%), thrombocytopenia (89%), hypofibrinogenemia (63%), hypertriglyceridemia (56%), hyperferritinemia (88%, 23/26) and hemophagocytosis in BM (81%). About 70% of our patients had liver function damage (elevated transaminase and bilirubin), 96% had elevated LDH, and 44% had hypoalbuminemia. Almost 30% of the patients showed kidney function damage, such as azotemia or hyperuricemia. All patients who underwent the tests showed low NK cell function and elevated soluble IL-2 receptor-α chain (sCD25). Twelve patients carried multiple chromosomal abnormalities of BM. Nine patients underwent genetic screening for primary HLH. We recorded three heterozygous mutations in STXBP2 (c. 1759T > C/p.F587L), LYST (c. 10940 + 57 A > G) and IRF7 (c. 1235 A > G/p.Q412R) genes in three patients (No. 7, 10, 15)respectively. The details are listed in Tables 2 and 3.