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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jabbar A, Qureshi R, Nasir K, Dhrolia M, Ahmad A. Transudative and Exudative Pleural Effusion in Chronic Kidney Disease Patients: A Prospective Single-Center Study. Cureus 2021; 13:e18649. [PMID: 34786244 PMCID: PMC8578877 DOI: 10.7759/cureus.18649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of the study is to assess the incidence of pleural effusion and to assess its etiology in admitted chronic kidney disease patients who were admitted secondary to various causes, i.e., fluid overload, sepsis, etc. Material and methods A prospective cross-sectional observational study was conducted at the Department of Nephrology, The Kidney Centre Postgraduate Training Institute, Karachi. A total of 789 patients were admitted between August 2020-February 2021. This study comprised 280 adult chronic kidney disease (chronic kidney disease and end-stage renal disease patients who were on dialysis) patients having pleural effusion (either unilateral or bilateral) secondary to various causes. Results Among 280 patients, the mean age was 55 years with 158 (56.4%) males and 122 (43.6%) females, diabetes (76%) was present in most of the patients along with hypertension (86.1%), and most of the patients were of stage IV and V. Transudative pleural effusion was present in 212 (75.7%) patients secondary to fluid overload and heart failure was the commonest cause while 68 (24.3%) patients had exudative pleural effusion with tuberculosis being the commonest etiology, 44 (15.7%) patients needed intervention while 236 (84.3%) were treated medically. The data was entered and analyzed on SPSS version 21 (IBM Corp, Armonk, USA). The cleaning and coding of data were done before analysis. Continuous variables were expressed in mean ± standard deviation, while the frequencies with percentages were obtained for categorical variables. The Chi-square test was applied to see the association between variables. A p-value of ≤ 0.05 was considered significant. Conclusion Clarification of the cause of pleural effusion is essential. Early diagnosis and prompt treatment like thoracocentesis or in the case of patients on hemodialysis, adequate dialysis may be necessary.
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Affiliation(s)
- Asfia Jabbar
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Ruqaya Qureshi
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Kiran Nasir
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Murtaza Dhrolia
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
| | - Aasim Ahmad
- Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK
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Shaik L, Thotamgari SR, Kowtha P, Ranjha S, Shah RN, Kaur P, Subramani R, Katta RR, Kalaiger AM, Singh R. A Spectrum of Pulmonary Complications Occurring in End-Stage Renal Disease Patients on Maintenance Hemodialysis. Cureus 2021; 13:e15426. [PMID: 34249571 PMCID: PMC8254517 DOI: 10.7759/cureus.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the trends of end-stage renal disease (ESRD) in patients undergoing maintenance hemodialysis (MHD) and find the correlation with effects on the pulmonary system in such patients. Methodology A multicentric prospective study was conducted in the city of Solapur, India. Data were collected from 250 patients through interpersonal interrogation using a questionnaire to capture basic demographic details, the history of ESRD, and relevant respiratory symptoms like breathlessness, cough, fever, etc. related to their disease. Symptoms that are likely associated with the pulmonary system were analyzed and referred to the pulmonology department. Appropriate diagnoses were made using relevant diagnostic tools like X-rays and sputum studies. The association between various disease attributes and pulmonary diagnoses was analyzed using the chi-square (χ2) test, with a p-value of value less than or equal to 0.05 considered statistically significant. Various socio-demographic variables, existing comorbidities, occupation-related risk factors, smoking history, past or current history of any respiratory conditions, the association between the causes of ESRD, time since the first dialysis and sociodemographic factors, and frequency of pulmonary complications were the other covariates in the study. Results Our study reports that 31.6% of our patients had significant impairment in their functioning due to respiratory complaints. The prevalence of respiratory complications was 27.2%. Major contributors were pleural effusion (33.8), pneumonia (25), pulmonary edema (20.58), pleuritis (11.76), collapse (8.8), tuberculosis (5.8), fibrosis (4.4), pericardial effusion (4.4), calcification (2.9), and hydrothorax (1.47). We report one case of Urinothorax as a rare cause of hydrothorax in such patients. Overall, our analysis found a significant association between non-reporting of respiratory complaints and acute admissions to the intensive care unit (ICU) with a respiratory cause at p-value 0.0076 with a greater predilection toward the rural populations. Conclusion Our study results highlight the prevalence of pulmonary complications in ESRD patients. The occurrence of pulmonary complications, irrespective of the presence of symptoms and a greater association between non-reporting of respiratory symptoms and acute admissions to the ICU, is a hallmark to consider the importance of history and clinical vigilance during patient visits.
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Affiliation(s)
| | - Sahith Reddy Thotamgari
- Research (Cardiovascular Diseases), Mayo Clinic, Rochester, USA.,Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | | | - Rutul N Shah
- Internal Medicine, M. P. Shah Government Medical College, Jamnagar, IND
| | - Parneet Kaur
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Department of Health and Family Welfare, Government of Punjab, Chandigarh, IND.,Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Rashmi Subramani
- Internal Medicine: Pulmonology, Saveetha Medical College and Hospital, Chennai, IND.,Contact Tracer Specialist, Larkin Community Hospital, Florida, USA
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Chuang MC, Juan YH, Lee KF, Hsieh MJ. Tracheobronchial calcification in a dialysis patient with metastatic pulmonary calcification. QJM 2021; 114:39-41. [PMID: 32339237 DOI: 10.1093/qjmed/hcaa147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/10/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- M-C Chuang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, No. 6, West Sec., Chiapu Road, Putzu City, Chiayi 61363, Taiwan
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan
| | - Y-H Juan
- Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, Institute for Radiological Research, Chang-Gung University, Linkou, No.5, Fusing St., Gueishan Dist., Taoyuan City 33305, Taiwan
| | - K-F Lee
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan
- Department of Pathology, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, No. 6, West Sec., Chiapu Road, Putzu City, Chiayi 61363, Taiwan
| | - M-J Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, No. 6, West Sec., Chiapu Road, Putzu City, Chiayi 61363, Taiwan
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33302, Taiwan
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de Almeida CP, Ponce D, Balbi AL. Effect of hemodialysis on respiratory mechanics in acute kidney injury patients. Hemodial Int 2018; 23:101-105. [PMID: 30289188 DOI: 10.1111/hdi.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hemodialysis (HD) is one treatment for acute kidney injury (AKI) patients. Studies have shown that this dialysis modality may lead to changes in pulmonary function with an impact on prognosis. The aim of our study was to evaluate changes in respiratory mechanics and oxygenation of AKI patients admitted to an intensive care unit who were undergoing intermittent mechanical ventilation (IMV) and daily HD. METHODS This prospective cohort study evaluated 94 AKI patients and 234 HD sessions. Pulmonary static compliance (Pcs), resistance (Rsr), and arterial partial pressure of oxygen and the fraction of inspired oxygen (PaO2 /FiO2 ) ratio were assessed during the initial three-day period of daily HD therapy. FINDINGS Psc increased progressively during HD sessions, from 39.4 ± 21.4 mL/cm H2 O prior to the initial dialysis to 55.5 ± 25.2 at the end of the last dialysis during the study period (P = 0.04). Similarly, Rsr and PaO2 /FiO2 ratio also improved, from 11.1 ± 6.3 cm H2 O/L/s prior to the initial dialysis to 8.8 ± 4.2 at the end of the last dialysis (P =0.0027) and from 228 ± 85 prior to the initial dialysis to 312.1 ± 111.5, P < 0.001, to the end of the last dialysis, respectively. CONCLUSION This study showed that AKI patients undergoing IMV and daily HD improve their respiratory mechanics and oxygenation.
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Affiliation(s)
| | - Daniela Ponce
- UNESP, Botucatu School of Medicine, Universidade Estadual Paulista, Brazil.,USP, Dentistry College of Bauru, Course of Medicine, Bauru, Sao Paulo State, Brazil
| | - André Luís Balbi
- UNESP, Botucatu School of Medicine, Universidade Estadual Paulista, Brazil
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Effect of peritoneal dialysis vs. haemodialysis on respiratory mechanics in acute kidney injury patients. Clin Exp Nephrol 2018; 22:1420-1426. [PMID: 29948446 DOI: 10.1007/s10157-018-1598-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) and hemodialysis (HD) are options for the treatment of acute kidney injury (AKI) patients. The aim of this study was to compare the effects of PD and daily HD on respiratory mechanics of AKI patients undergoing invasive mechanical ventilation (IMV). METHODS A prospective cohort study evaluated 154 patients, 37 on continuous PD and 94 on HD. Respiratory mechanics parameters such as pulmonary static compliance (Psc) and resistance of the respiratory system (Rsr) and oxygenation index (OI) were assessed for 3 days. Patients were evaluated at moments 1, 2 and 3 (pre- and post-dialysis). RESULTS The initial clinical parameters were similar in the two groups, except the age that was higher in continuous PD group (70.8 ± 11.6 vs. 60 ± 15.8; p < 0.0001). In both groups, Psc increased significantly, with no difference between the two groups-pre-dialysis (continuous PD 40 ± 17.4, 42.8 ± 17.2, 48 ± 19; HD 39.1 ± 21.3, 39. 5 ± 18.9, 45.2 ± 21) and post-dialysis (continuous PD 42.8 ± 7.2, 48 ± 19, 57.1 ± 18.3; HD 42 ± 19, 45 ± 18.5, 56 ± 24.8). Rsr remained stable among patients on continuous PD (pre-dialysis 10.4 ± 5.1, 13.3 ± 7.7, 13.5 ± 10.3, post-dialysis 13.3 ± 7.7, 13.5 ± 10.3, 11.1 ± 5.9) and decreased among HD patients (pre-dialysis 10.4 ± 5.1, 10.4 ± 5.1, 10.4 ± 5, 1, post-dialysis 10.5 ± 6.8, 10 ± 4.9, 8.9 ± 4.2). There was difference in Rsr between the two groups at the post-dialysis moments 1 and 2 (p = 0.03). OI increased in both groups (continuous PD 260.7 ± 119, 252.7 ± 87.1, 287.3 ± 88.4; HD 228 ± 85, 257 ± 84, 312.1 ± 111.5, p > 0.05), although there was no difference between them. CONCLUSION AKI patients undergoing IMV and HD or PD had improvement in the mechanical ventilation and oxygenation, with no difference between the two groups.
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Dilorenzo G, Telegrafo M, Marano G, De Ceglie M, Stabile Ianora AA, Angelelli G, Moschetta M. Uremic lung: The "calcified cauliflower" sign in the end stage renal disease. Respir Med Case Rep 2016; 19:159-161. [PMID: 27766197 PMCID: PMC5065642 DOI: 10.1016/j.rmcr.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 12/04/2022] Open
Abstract
Metastatic pulmonary calcification (MPC) is a rare pathological condition consisting of lung calcium salt deposits which commonly occurs in patients affected by chronic kidney disease probably for some abnormalities in calcium and phosphate metabolism. CT represents the technique of choice for detecting MPC findings including ground glass opacities and partially calcified nodules or consolidations. We present a case of MCP in a patient affected by hepato-renal autosomic-dominant polycystic disease; chest CT revealed extensive lobar-segmental parenchymal calcification with a peculiar cauliflower shape which we called “calcified cauliflower” sign. The “calcified cauliflower” sign can be reported as a new CT pattern of uremic lung that needs to be identified for a correct diagnosis and patient management.
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Affiliation(s)
- Giuseppe Dilorenzo
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele Telegrafo
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Marano
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele De Ceglie
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Amato Antonio Stabile Ianora
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Angelelli
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marco Moschetta
- DETO, Department of Emergency and Organ Transplantations, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Khalil MAM, Rabbani MS, Chima NR, Tan J, Khalil MAU, Rehman ZU. Recurrent Brachiocephalic Vein Stenosis as a Cause for Persistent Left-sided Transudative Pleural Effusion in a Hemodialysis Patient. Ann Vasc Surg 2016; 35:208.e9-208.e13. [PMID: 27263809 DOI: 10.1016/j.avsg.2016.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/23/2015] [Accepted: 01/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Effusion is common in dialysis patients. The most common causes include fluid overload due to renal failure and nonrenal causes like congestive heart failure and infection. We here report a case of left side transudative effusion due to brachiocephalic venous stenosis. METHODS A 34-year-old female who had chronic kidney disease V during transplant work-up was found to be having left arm swelling and left transudative effusion. Work-up for transudative effusion did not show any cardiac cause or liver problem. Her dialysis duration was optimized from 2 times a week to 3 times a week for 4 hr and her dry weight was adjusted. Despite adequate dialysis for 1 month, effusion on the left side persisted. She had a previous venoplasty for a stenosis in brachiocephalic vein but restenosis occurred again. RESULTS Brachiocephalic vein stenting was performed which successfully lead to resolution of left arm swelling and left effusion. She was later on successfully transplanted. CONCLUSIONS Brachiocephalic stenosis can cause ipsilateral transudative effusion. Venoplasty and stenting of the brachiocephalic vein lead to complete resolution of effusion.
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Affiliation(s)
| | - Muhammad Sharoz Rabbani
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Noor Rehman Chima
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jackson Tan
- Department of Nephrology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | - Zia Ur Rehman
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Almeida CP, Ponce D, de Marchi AC, Balbi AL. Effect of peritoneal dialysis on respiratory mechanics in acute kidney injury patients. Perit Dial Int 2015; 34:544-9. [PMID: 25074997 DOI: 10.3747/pdi.2013.00092] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Cibele Puato Almeida
- Internal Medicine, Botucatu School of Medicine - UNESP Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil
| | - Daniela Ponce
- Internal Medicine, Botucatu School of Medicine - UNESP Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil
| | - Ana Carolina de Marchi
- Internal Medicine, Botucatu School of Medicine - UNESP Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil
| | - Andre Luis Balbi
- Internal Medicine, Botucatu School of Medicine - UNESP Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil
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Roumelioti ME, Brown LK, Unruh ML. The Relationship Between Volume Overload in End-Stage Renal Disease and Obstructive Sleep Apnea. Semin Dial 2015; 28:508-13. [PMID: 25940851 DOI: 10.1111/sdi.12389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea (OSA) is common, underdiagnosed, and undertreated among patients with end-stage renal disease (ESRD). As in all cases, pathogenesis of OSA is related to repeated upper airway (UA) occlusion or narrowing, but in ESRD, additional contributory factors likely include uremic destabilization of central respiratory control and anatomic changes in the UA related to fluid status. Pulmonary congestion is common in acute and chronic kidney failure and is a consequence of cardiomyopathy and fluid overload, two potentially reversible risk factors. Emerging evidence suggests that volume overload also reduces the UA caliber. The diminution in UA area as well as destabilization of ventilatory control in ESRD have been postulated as causes of increased OSA prevalence and severity in these patients, and creates a vicious cycle wherein OSA exacerbates fluid overload disorders such as in congestive heart failure (CHF) and ESRD, which then further worsen OSA. Dialysis modalities may differ in their effects on volume status, the accumulation of uremic toxins, and acid-base status, and as a consequence, on the emergence and severity of OSA. Given the contribution of excess fluid to both the severity of nocturnal hypoxia and UA narrowing, establishing and maintaining dry weight is of particular importance when managing OSA in ESRD. Clinical trials to determine the extent to which more aggressive fluid removal in ESRD patients may alleviate OSA are needed.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Lee K Brown
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, and the Program in Sleep Medicine, University of New Mexico Health Sciences Centre, Albuquerque, New Mexico
| | - Mark L Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Upponi S, Butler AJ, Watson CJE, Shaw AS. Encapsulating peritoneal sclerosis--correlation of radiological findings at CT with underlying pathogenesis. Clin Radiol 2013; 69:103-9. [PMID: 24209872 DOI: 10.1016/j.crad.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 12/11/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare entity most commonly associated with peritoneal dialysis (PD). Several imaging features at computed tomography (CT) are common to many diseases; however, appreciation of the features unique to this condition interpreted with the appropriate clinical findings is crucial to diagnosis.
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Affiliation(s)
- S Upponi
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A J Butler
- Academic Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - C J E Watson
- Academic Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - A S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
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Afonso A, Beilin Y. Respiratory arrest in patients undergoing arteriovenous graft placement with supraclavicular brachial plexus block: a case series. J Clin Anesth 2013; 25:321-3. [PMID: 23830847 DOI: 10.1016/j.jclinane.2012.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/05/2012] [Accepted: 11/18/2012] [Indexed: 10/26/2022]
Abstract
Supraclavicular brachial plexus block is commonly used for upper extremity surgery. Respiratory arrest in three patients with end-stage renal disease after ultrasound-guided supraclavicular brachial plexus block for creation of an arteriovenous graft over a 6-month period is presented. Patients with renal failure may represent a group at particular risk for respiratory failure following supraclavicular brachial plexus block.
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Affiliation(s)
- Anoushka Afonso
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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Le Boedec K, Heng HG, Snyder PW, Pressler BM. Pulmonary abnormalities in dogs with renal azotemia. J Vet Intern Med 2012; 26:1099-106. [PMID: 22748163 DOI: 10.1111/j.1939-1676.2012.00964.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/13/2012] [Accepted: 05/22/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Clinical signs associated with respiratory tract disease are regularly encountered in people with kidney failure, and have been anecdotally reported in dogs. OBJECTIVES To compare clinical signs indicative of pulmonary disease, clinicopathologic findings, radiographic abnormalities, and histologic findings in dogs with acute kidney injury (AKI) or International Renal Interest Society Stage 3 or 4 chronic kidney disease (CKD) to nonazotemic dogs. To determine associations between abnormalities indicative of pulmonary disease and outcome in azotemic dogs. ANIMALS One hundred sixty-seven pet dogs (54 AKI dogs, 50 CKD dogs, 63 nonazotemic control dogs diagnosed with intracranial disease). METHODS Retrospective cohort study comparing signalment, clinical signs, clinicopathologic variables, prevalence, and severity of pulmonary radiographic patterns, histopathologic findings, and survival times in AKI, CKD, and control dogs. RESULTS Clinical signs of pulmonary disease were significantly more common in AKI dogs. Prevalence of an alveolar lung pattern was greater in AKI and CKD dogs. Alveolar mineralization was the most common pulmonary histologic lesion in AKI dogs (6 of 8 dogs), with concurrent alveolar concretions or mineralization of pulmonary vessels or bronchioles noted in 1 dog each; mineralization of lung tissues was not noted in control dogs. Neither clinical signs nor presence of an alveolar pattern were associated with likelihood of survival to discharge or median number of days from discharge until death. CONCLUSIONS AND CLINICAL IMPORTANCE Abnormalities indicative of pulmonary disease are more common in azotemic dogs than in control dogs; however, prognosis is not associated with presence of clinical or radiographic pulmonary dysfunction.
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Affiliation(s)
- K Le Boedec
- Department of Clinical Sciences, National Veterinary School of Toulouse, Toulouse, France
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14
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Abstract
To manage patients with diseases of the lungs and the kidneys, one must first understand the relationship between respiratory and renal function. In treating acute renal failure (ARF), the clinician often must contend with respiratory manifestations of volume overload and metabolic acidosis. Mechanical ventilation in patients with renal failure (RF) can be challenging, particularly with lung protective ventilation and weaning. Patients with chronic renal failure (CRF) experience several respiratory complications. Hypoxaemia during dialysis is now understood to be a predictable effect of the loss of CO(2) into the dialysate. Critical illness of any primary cause predisposes patients not only to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) but also to the development of ARF. Meanwhile, the potential for ventilator-induced renal injury has increasingly become the subject of active investigation.
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Affiliation(s)
- Nelson L Turcios
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
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15
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Bertolini L, Vaglio A, Bignardi L, Buzio C, De Filippo M, Palmisano A, Mercati K, Zompatori M, Maggiore U. Subclinical interstitial lung abnormalities in stable renal allograft recipients in the era of modern immunosuppression. Transplant Proc 2012; 43:2617-23. [PMID: 21911134 DOI: 10.1016/j.transproceed.2011.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 05/13/2011] [Accepted: 06/03/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Interstitial lung abnormalities have been detected in up to 24% of kidney transplant patients receiving traditional immunosuppressive therapies (eg, cyclosporine, azathioprine); they usually occur early after transplantation and tend to resolve over time. Newer immunosuppressants such as mycophenolic acid and, particularly, mammalian target of rapamycin (mTOR) inhibitors (eg, sirolimus) may cause significant lung toxicity. However, the prevalence and severity of interstitial lung lesions in long-term, stable kidney transplant patients receiving either traditional or newer immunosuppressants is not known. METHODS We conducted a prospective, cross-sectional study examining high-resolution lung computed tomography (CT) scans in 63 stable kidney transplant recipients whose immunosuppressive therapy had remained unchanged for over 24 months. We compared CT findings of patients taking newer (mycophenolic acid and mTOR inhibitors) and traditional (calcineurin inhibitors and azathioprine) immunosuppressive drugs. RESULTS Interstitial lung alterations were observed in only 3/63 patients (4.8%); the prevalence was 11.5% (3/26) versus 0% (0/37) among the newer versus traditional immunosuppressive therapy groups, respectively (P = .065). The CT patterns were usual interstitial pneumonia and nonspecific interstitial pneumonia-like. The median time between transplant and CT was 49 months in the three patients with CT alterations and 95 months in the remaining 23 patients on newer immunosuppressants. It was 75 months for all patients on newer immunosuppressive drugs and 133 months for those on traditional therapies (P = .0015). A follow-up CT, performed in 2/3 patients with interstitial abnormalities, showed that the lesions were stable in one, while they had disappeared in the other. CONCLUSIONS Interstitial lung abnormalities are infrequent and mild in stable kidney transplant patients treated with newer as well as traditional immunosuppressive drugs. As such abnormalities were detected in patients screened earlier after transplantation, the time since transplantation rather than the drug type is probably the major determinant.
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Affiliation(s)
- L Bertolini
- Department of Radiology, Nephrology and Health Science, University Hospital of Parma, Parma, Italy.
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[Calcified pleural metastasis secondary to secondary hyperparathyroidism]. Arch Bronconeumol 2011; 47:576. [PMID: 21996160 DOI: 10.1016/j.arbres.2011.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/07/2011] [Accepted: 07/09/2011] [Indexed: 10/16/2022]
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Doğan E, Kahraman H, Sayarlıoğlu H. Thoracic Multidedector CT Findings in
Hemodialysis Patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2011. [DOI: 10.29333/ejgm/82690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nagai M, Hirayama K, Ohishi T, Shimohata H, Ohkusu K, Kobayashi M. Pleuritis caused by Campylobacter jejuni subspecies jejuni in a patient undergoing long-term hemodialysis. Intern Med 2010; 49:2481-6. [PMID: 21088354 DOI: 10.2169/internalmedicine.49.3926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 73-year-old female hemodialysis patient experienced fever, shortness of breath on effort, and chest discomfort. A decrease in breath sounds in the right lung field, leukocytosis, elevated CRP level, and a right massive pleural effusion were observed. The patient was diagnosed with bacterial pleuritis based on leukocyte-predominant exudative pleural effusion, and treated with ceftriaxone. Her symptoms, however, were not improved, so thoracic drainage was attempted. Campylobacter species were isolated from cultured pleural fluid samples, and Campylobacter jejuni subspecies jejuni was detected on the multiplex PCR assay. The antibiotic was therefore changed to minocycline following pazufloxacin, and her symptoms were improved.
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Affiliation(s)
- Miho Nagai
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami, Japan.
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Lacativa PGS, Franco FM, Pimentel JR, Patrício Filho PJDM, Gonçalves MDDC, Farias MLF. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism. SAO PAULO MED J 2009; 127:71-7. [PMID: 19597681 PMCID: PMC10964801 DOI: 10.1590/s1516-31802009000200004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 01/22/2009] [Accepted: 03/17/2009] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Patients with end stage renal disease (ESRD) and secondary hyperparathyroidism (HPT2) are prone to develop heterotopic calcifications and severe bone disease. Determination of the sites most commonly affected would decrease costs and patients' exposure to X-ray radiation. The aim here was to determine which skeletal sites produce most radiographic findings, in order to evaluate hemodialysis patients with HPT2, and to describe the most prevalent radiographic findings. DESIGN AND SETTING This study was cross-sectional, conducted in one center, the Hospital Universitário Clementino Fraga Filho (HUCFF), in Rio de Janeiro, Brazil. METHODS Whole-body radiographs were obtained from 73 chronic hemodialysis patients with indications for parathyroidectomy due to severe HPT2. The regions studied were the skull, hands, wrists, clavicles, thoracic and lumbar column, long bones and pelvis. All the radiographs were analyzed by the same two radiologists, with great experience in bone disease interpretation. RESULTS The most common abnormality was subperiosteal bone resorption, mostly at the phalanges and distal clavicles (94% of patients, each). 'Rugger jersey spine' sign was found in 27%. Pathological fractures and deformities were seen in 27% and 33%, respectively. Calcifications were presented in 80%, mostly at the forearm fistula (42%), abdominal aorta and lower limb arteries (35% each). Brown tumors were present in 37% of the patients, mostly on the face and lower limbs (9% each). CONCLUSION The greatest prevalence of bone findings were found on radiographs of the hands, wrists, lateral view of the thoracic and lumbar columns and femurs. The most prevalent findings were bone resorption and ectopic calcifications.
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Affiliation(s)
- Paulo Gustavo Sampaio Lacativa
- Endocrinology Service, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Salim S, Ganeshram P, Patel AD, Kumar AA, Vemuri D, Jeyachandran V, Rajamanickam D, Shantha GPS. Unilateral hemothorax in a 46 year old South Indian male due to a giant arteriovenous hemodialysis fistula: a case report. CASES JOURNAL 2008; 1:225. [PMID: 18840271 PMCID: PMC2567296 DOI: 10.1186/1757-1626-1-225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 10/07/2008] [Indexed: 12/13/2022]
Abstract
In a patient undergoing regular hemodialysis through an arteriovenous fistula access, pleural effusion is a known long term complication. However, a unilateral hemothorax is relatively uncommon. Here we report a 46 year old male, end-stage renal disease patient, on maintenance hemodialysis, who presented with a giant brachiocephalic AV fistula in his left arm and progressive breathlessness. Radiological imaging revealed a left sided pleural effusion. Ultrasound guided aspiration revealed a hemorrhagic pleural fluid. A Doppler study of the fistula revealed a high velocity blood flow through the fistula, thereby establishing the cause of the unilateral hemothorax. Ligation of the fistula resulted in complete resolution of the hemothorax. The other possible causes for hemothorax in a dialysis patient are also discussed in this case report.
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Affiliation(s)
- Shihas Salim
- Department of General Medicine, Sri Ramachandra University, Chennai, India.
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Fatal Acinetobacter baumanii Pneumonia Diagnosed at Autopsy in a Patient with End-Stage Renal Disease. AJSP-REVIEWS AND REPORTS 2007. [DOI: 10.1097/pcr.0b013e31805d0b6e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bakirci T, Sasak G, Ozturk S, Akcay S, Sezer S, Haberal M. Pleural Effusion in Long-Term Hemodialysis Patients. Transplant Proc 2007; 39:889-91. [PMID: 17524841 DOI: 10.1016/j.transproceed.2007.02.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As a consequence of the expanded use of long-term hemodialysis and extended life spans, complications of chronic renal failure are encountered with an increased frequency among uremic patients. Such patients may develop many thoracic and extrathoracic problems--most frequently uremic pleuritis and pericarditis, uremic pneumonia, infection, and metastatic pulmonary calcification. We retrospectively analyzed the medical records of 257 patients who had received long-term hemodialysis between 1990 and 2006 to better understand the incidence, causes, and clinical features of pleural effusions in this population. The incidence of pleural effusion in hospitalized patients receiving long-term hemodialysis was 20.2% (n=52; mean age, 55.83 +/- 16.56 years; male-to-female ratio, approximately 3:2). Pleural effusion resulted from hypervolemia in 61.5% and was bilateral in 68.8% of patients. Unilateral effusion was present in 25 of 52 (48%) patients. The most frequent causes of unilateral effusion were hypervolemia (n=9) and parapneumonic effusion (n=5). Thoracenteses were performed in 14 of the 52 patients in the study group. Of thoracenteses performed, 64.3% of the patients had transudative pleural effusion and 35.7% had exudative effusion. Transudative pleural effusion resulted from hypervolemia in 66.7% and heart failure in 22.2%. Of the patients with transudative effusion, 85.7% were bilateral. The most frequent cause of exudative pleural effusion was uremic pleuritis, which occurred in 40% of the patients. The most common symptom was dyspnea, which occurred in 53.8% of patients. In conclusion, pleural effusions are common in patients receiving chronic hemodialysis. Thoracentesis may be performed in patients with unilateral pleural effusion. Since hypervolemia was the most common cause of pleural effusion, this complication should not be considered an obstacle in renal transplant recipients.
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Affiliation(s)
- T Bakirci
- Baskent University, Faculty of Medicine, Department of Pulmonary Diseases, Ankara, Turkey
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Ramamoorthy SK, Marangolo M, Durrant E, Akima S, Gottlieb DJ. T-cell receptor gamma and delta junctional gene rearrangements as diagnostic and prognostic biomarker for T-cell acute lymphoblastic leukemia. Leuk Lymphoma 2006; 47:747-50. [PMID: 16690535 DOI: 10.1080/10428190500399193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Affiliation(s)
- Bertrand L Jaber
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
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Abstract
BACKGROUND Infection is the second-leading cause of death among patients with end-stage renal disease (ESRD). This is due in part to advanced age, comorbid conditions, and immune dysfunction observed in uremic states. Although one may hypothesize that pulmonary infectious mortality is higher among patients with ESRD compared with the general population (GP), no such data are currently available. METHODS We compared annual pulmonary infectious mortality rates among patients with ESRD to those in the GP. The data were abstracted from the United States Renal Data System and the National Center for Health Statistics, respectively, and were stratified by age, gender, race, and presence or absence of diabetes mellitus (DM). In the GP, primary and multiple cause-of-death analyses were performed to account for potential limitations of the data sources. RESULTS Overall, pulmonary infectious mortality rate was 14-fold to 16-fold higher in dialysis patients and approximately twofold higher in renal transplant recipients compared with the GP. After stratification for age, differences between groups decreased but retained their magnitude. CONCLUSION Patients with ESRD treated with dialysis have higher pulmonary infectious mortality rates compared with the GP, even after stratification for age, race, and DM. Consequently, this patient population must be considered at high risk for the development of lethal pulmonary infections.
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Affiliation(s)
- M J Sarnak
- Division of Nephrology, Department of Medicine, Tupper Research Institute, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
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Abstract
Approximately 20% of the 100,000 patients in the United States currently undergoing dialysis therapy for end-stage renal disease use the technique of peritoneal dialysis. We present a patient on peritoneal dialysis who developed a large posterior mediastinal mass, which on surgical exploration was found to be a paraesophageal hernia sac filled with omentum and dialysis fluid. We use this case as an introduction to review the thoracic complications of peritoneal dialysis.
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Affiliation(s)
- G C Hughes
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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