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Shah K, Wong J, Mac K, Lau NS, Wong VM, Makris A. Adrenal insufficiency in hemodialysis patients-An under-recognized problem: A case series. Hemodial Int 2024; 28:229-232. [PMID: 38326988 DOI: 10.1111/hdi.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
Adrenal insufficiency is an uncommon disorder and presents with non-specific symptoms. Identifying adrenal insufficiency in patients with chronic kidney disease requiring dialysis is increasingly difficult as there is a significant overlap of the signs and symptoms of adrenal insufficiency with those seen in chronic kidney failure. We highlight this diagnostic uncertainty in a case series of three patients with chronic kidney disease requiring hemodialysis as renal replacement therapy from a single center identified as hypoadrenal. Steroid replacement improved symptoms and hemodynamic parameters. Increased vigilance for adrenal insufficiency in dialysis patients is necessary. It is likely under recognized in hemodialysis patients given their multi-morbidity.
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Affiliation(s)
- Krupa Shah
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Jeffrey Wong
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Kathy Mac
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Namson S Lau
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South West Sydney Clinical School, University of NSW, Sydney, Australia
| | - Vincent M Wong
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South West Sydney Clinical School, University of NSW, Sydney, Australia
| | - Angela Makris
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South West Sydney Clinical School, University of NSW, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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Ibrahim NFA, Sabani N, Johari S, Manaf AA, Wahab AA, Zakaria Z, Noor AM. A Comprehensive Review of the Recent Developments in Wearable Sweat-Sensing Devices. SENSORS (BASEL, SWITZERLAND) 2022; 22:7670. [PMID: 36236769 PMCID: PMC9573257 DOI: 10.3390/s22197670] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Sweat analysis offers non-invasive real-time on-body measurement for wearable sensors. However, there are still gaps in current developed sweat-sensing devices (SSDs) regarding the concerns of mixing fresh and old sweat and real-time measurement, which are the requirements to ensure accurate the measurement of wearable devices. This review paper discusses these limitations by aiding model designs, features, performance, and the device operation for exploring the SSDs used in different sweat collection tools, focusing on continuous and non-continuous flow sweat analysis. In addition, the paper also comprehensively presents various sweat biomarkers that have been explored by earlier works in order to broaden the use of non-invasive sweat samples in healthcare and related applications. This work also discusses the target analyte's response mechanism for different sweat compositions, categories of sweat collection devices, and recent advances in SSDs regarding optimal design, functionality, and performance.
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Affiliation(s)
- Nur Fatin Adini Ibrahim
- Faculty of Electronic Engineering & Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
| | - Norhayati Sabani
- Faculty of Electronic Engineering & Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
- Center of Excellance Micro System Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
| | - Shazlina Johari
- Faculty of Electronic Engineering & Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
- Center of Excellance Micro System Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
| | - Asrulnizam Abd Manaf
- Collaborative Microelectronic Design Excellence Centre, Universiti Sains Malaysia, Gelugor 11800, Malaysia
| | - Asnida Abdul Wahab
- Department of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, Johor Bahru 81310, Malaysia
| | - Zulkarnay Zakaria
- Faculty of Electronic Engineering & Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
- Sports Engineering Research Center, Universiti Malaysia Perlis, Arau 02600, Malaysia
| | - Anas Mohd Noor
- Faculty of Electronic Engineering & Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
- Center of Excellance Micro System Technology, Universiti Malaysia Perlis, Arau 02600, Malaysia
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Ismaeel H, Tariq S, Akram Z. End-Stage Renal Disease in a Patient With Schmidt’s Syndrome: A Case Report. Cureus 2022; 14:e27342. [PMID: 36046305 PMCID: PMC9416904 DOI: 10.7759/cureus.27342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Schmidt's syndrome constitutes Addison's disease in conjunction with autoimmune hypothyroidism or type 1 diabetes mellitus. It has misleading symptomology and an unclear order of presentation of symptoms. This often results in missed and late diagnosis. Chronic kidney disease is a rarely reported phenomenon in Schmidt’s syndrome. Multiple factors may have the potential to cause renal failure, such as Addison's disease and/or hypothyroidism, the understanding of which is still evolving. A 45-year-old gentleman who is a known case of Schmidt's syndrome presented to us with fatigue, anorexia, and weight gain. Further evaluation revealed a picture of chronic kidney disease. We would like to alert fellow peers of this potential complication and the importance of screening as well as timely diagnosis.
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Gusev E, Solomatina L, Zhuravleva Y, Sarapultsev A. The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation. Int J Mol Sci 2021; 22:ijms222111453. [PMID: 34768884 PMCID: PMC8584056 DOI: 10.3390/ijms222111453] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease can progress to end-stage chronic renal disease (ESRD), which requires the use of replacement therapy (dialysis or kidney transplant) in life-threatening conditions. In ESRD, irreversible changes in the kidneys are associated with systemic changes of proinflammatory nature and dysfunctions of internal organs, skeletal muscles, and integumentary tissues. The common components of ESRD pathogenesis, regardless of the initial nosology, are (1) local (in the kidneys) and systemic chronic low-grade inflammation (ChLGI) as a risk factor for diabetic kidney disease and its progression to ESRD, (2) inflammation of the classical type characteristic of primary and secondary autoimmune glomerulonephritis and infectious recurrent pyelonephritis, as well as immune reactions in kidney allograft rejection, and (3) chronic systemic inflammation (ChSI), pathogenetically characterized by latent microcirculatory disorders and manifestations of paracoagulation. The development of ChSI is closely associated with programmed hemodialysis in ESRD, as well as with the systemic autoimmune process. Consideration of ESRD pathogenesis from the standpoint of the theory of general pathological processes opens up the scope not only for particular but also for universal approaches to conducting pathogenetic therapies and diagnosing and predicting systemic complications in severe nephropathies.
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Saygili S, Canpolat N, Sever L, Caliskan S, Atayar E, Ozaltin F. Persistent hypoglycemic attacks during hemodialysis sessions in an infant with congenital nephrotic syndrome: Answers. Pediatr Nephrol 2019; 34:77-79. [PMID: 29959533 DOI: 10.1007/s00467-018-3982-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Seha Saygili
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Fatih, 34098, Istanbul, Turkey.
| | - Nur Canpolat
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Fatih, 34098, Istanbul, Turkey
| | - Lale Sever
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Fatih, 34098, Istanbul, Turkey
| | - Salim Caliskan
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Fatih, 34098, Istanbul, Turkey
| | - Emine Atayar
- Nephrogenetics Laboratory, Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Fatih Ozaltin
- Nephrogenetics Laboratory, Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.,Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.,Hacettepe University Center for Biobanking and Genomics, Ankara, Turkey
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Markova A, Lester J, Wang J, Robinson-Bostom L. Diagnosis of common dermopathies in dialysis patients: a review and update. Semin Dial 2013; 25:408-18. [PMID: 22809004 DOI: 10.1111/j.1525-139x.2012.01109.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cutaneous abnormalities in patients with end-stage renal disease (ESRD) receiving hemodialysis or peritoneal dialysis may demonstrate signs of their underlying condition or reveal associated disease entities. While a thorough examination of the scalp, skin, mucosa, and nails is integral to establishing a diagnosis, certain conditions will resolve only with dialysis or improvement of their renal disease and others may not require or respond to treatment. Half and half nails, pruritus, xerosis, and cutaneous hyperpigmentation are common manifestations in ESRD. With hemodialysis, uremic frost is no longer prevalent in ESRD patients and ecchymoses have decreased in incidence. Acquired perforating dermatoses are seen in over one-tenth of hemodialysis patients. Metastatic calcinosis cutis and calciphylaxis are both rarely reported, although the latter is seen almost exclusively in the setting of hemodialysis. Diagnosis of nephrogenic systemic fibrosis has historically been challenging; as such, new diagnostic criteria have been proposed. Blood porphyrin profiles are needed to differentiate between porphyria cutanea tarda and pseudoporphyria. We will review and provide an update on the aforementioned common cutaneous manifestations of ESRD in patients receiving dialysis.
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Affiliation(s)
- Alina Markova
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
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