Amiodarone is an antiarrhythmic drug, in use from the 1960s, which acts on potassium transport in myocytes, causing a lengthening of the action potential and refractory period. Even though it is ...broadly prescribed, its use is limited by a relatively high occurrence of adverse reactions such as lung, thyroid or hepatic disease, skin changes and so on. The authors report a case of a female patient who was admitted due to chest pain. Due to the bluish skin pigmentation, other causes of amiodarone toxicity were investigated, and hyperthyroidism was detected. After amiodarone discontinuation and specific therapy, thyroid function returned to normal.
Blue pigmentation of facial skin is an uncommon adverse effect of chronic amiodarone therapy that occurs in less than 3% of patients.When a patient is on chronic amiodarone therapy, signs of toxicity, such as hyperthyroidism, lung injury or hepatic disease, should be investigated.Regular liver and thyroid function tests and chest x-rays should be carried out on follow-up after initiation of amiodarone.
Abstract Background and Aims Minimal change disease (MCD) in adults is one of the causes of nephrotic syndrome. Recently, anti-nephrin antibodies localized in glomerular podocytes have been described ...in a certain subset of patients with MCD, supporting the autoimmune etiology of the disease. Method A 79-year-old man with arterial hypertension, hypothirosis and mild dementia presented with new-onset nephrotic syndrome. Peripheral and periocular edema, hypoalbuminemia (serum albumin 17 g/l), proteinuria 15 g/day and hypercholesterolemia (serum cholesterol 6.7 mmol/l) were noted. Blood pressure was 133/85 mmHg. Creatinine was 165 mcmol/l on admission and increased to 361 mcmol/l in the following days. Immunologic tests were negative, including antibodies against phospholipase A2-receptor (anti-PLA2R) and thrombospondin-7A (anti-THSD7A). Anti-HBc was positive, HBV DNA was below 15 IU/ml. Liver tests and abdominal ultrasound were normal, with no signs of liver disease. Results Renal biopsy revealed 18 glomeruli with global sclerosis of one glomerulus (1/18) and 5% interstitial fibrosis. Tubular damage was noted, which could be attributed to severe proteinuria. Immunofluorescence showed discrete IgG podocyte deposits with a uniform kappa/lambda distribution and a high probability of idiopathic minimal change disease due to anti-nephrin antibodies. Electron microscopy showed diffuse effacement of the podocyte foot processes without deposits. The serum taken after the biopsy and before the start of immunosuppressive therapy was positive for anti-nephrin antibodies. Due to a possible pharmacokinetic interaction with tenofovir, which the patient was receiving because of his anti-HBc positivity, we decided not to use cyclosporine. In addition to standard therapy with angiotensin convertase inhibitors, calcium channel blockers and furosemide, the patient was treated with low-dose oral glucocorticoids and mycophenolic acid. In addition, he received rituximab. After a few weeks, the oral glucocorticoids and mycophenolic acid were discontinued. The nephrotic syndrome regressed completely and renal function improved. Conclusion Anti-nephrin antibodies have contributed to a subgroup of patients with MCD, they can be found in a renal biopsy and are also detected in the serum of these patients. Targeted anti-B-cell therapy should be introduced to improve the prognosis of patients.
Low (<0.9) and high (>1.4) ankle brachial index (ABI) is associated with a higher cardiovascular (CV) mortality in the general and hemodialysis (HD) population. The aim of our study was to determine ...the impact of ABI on long‐term survival of 52 non‐diabetic HD patients. The ABI was determined using an automated, non‐invasive waveform analysis device. Patients were divided into three groups: low (<0.9), normal (0.9–1.4) and high (>1.4) ABI. Patients were observed from the date of ABI measurement until their death or ten years. Survival analysis showed higher risk for CV death in HD patients with high ABI compared to normal ABI (log rank test P < 0.027). In Cox regression model adjusted for arterial hypertension, smoking, serum cholesterol and triglycerides, high ABI (P < 0.049) remained a predictor of mortality. The results indicate an association between ABI and long‐term survival of non‐diabetic HD patients and only high ABI was associated with higher CV mortality.
Atherosclerosis is a leading cause of morbidity and mortality in hemodialysis (HD) patients. Low (<0.90) and high (>1.40) ankle‐brachial index (ABI) is known as a non‐invasive diagnostic marker for ...generalized atherosclerosis associated with higher cardiovascular (CV) mortality in the general population. Less is known about associations between ABI and CV mortality in HD patients. The aim of our study was to determine the impact of the ABI on CV mortality in nondiabetic HD patients. Fifty‐two nondiabetic HD patients (mean age 59 years, range 22 – 76 years) were enrolled in our study. Twenty‐three (44%) were women and 29 (56%) men. The ABI was determined using an automated, non‐invasive, waveform analysis device. All patients were divided according to the ABI into three groups: low ABI (<0.9), normal ABI (0.9–1.4) and high ABI (>1.4). The presence of arterial hypertension and smoking was established. Serum cholesterol (HDL and LDL) and triglycerides were measured by routine laboratory methods. Survival rates were analyzed using Kaplan–Meier survival curves. The Cox regression model was used to assess the influence of the ABI on CV outcomes. The model was adjusted for age, arterial hypertension, smoking, cholesterol and triglycerides. Mean ABI value was 1.2 ± 0.3 (range 0.2–2.2). Patients were observed from the date of the ABI measurement until their death or maximally up to 1620 days. Kaplan–Meier survival analysis showed that the risk for CV death was higher for HD patients with low and high ABI compared to normal ABI (log rank test: P < 0.006; P < 0.0001). In the adjusted Cox multivariable regression model low and high ABI (P < 0.011; P < 0.003) remained predictors of mortality in our patients. The results indicate a U‐shaped association between the ABI and CV mortality in nondiabetic HD patients and showed that low and high ABI were directly associated with higher mortality of our patients.
Abstract
BACKGROUND AND AIMS
Inflammation is an important process in the pathogenesis of atherosclerosis, and chronic kidney disease (CKD) is recognized as a proinflammatory state. Interleukin-6 ...(IL-6) is associated with cardiovascular events and also predicts mortality in individuals with CKD patients.
The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters and represents a non-invasive measure of coronary perfusion. In a non-dialysis CKD population, we previously reported about the prognostic value of SEVR for cardiovascular outcome in these patients.
The aim of this study was to investigate the association between inflammatory markers IL-6, tumour necrosis factor-α (TNF-α), high-sensitive C-reactive protein (hsCRP) and SEVR in CKD patients undergoing maintenance hemodialysis (HD).
METHOD
In a cross-sectional study, we enrolled only HD patients. SEVR was assessed using a generalized transfer function applied to the radial artery pressure wave form (Sphygmocor, Atcor Medical, Sydney, Australia). Plasma IL-6, TNF-α and hsCRP were measured by an enzyme-linked immunosorbent assay.
RESULTS
A total of 40 HD patients (mean age 65.2 ± 11.8 years, 72.5% male) were included. Other descriptive parameters are presented in Table 1. A statistically significant correlation was found between SEVR and IL-6 (r = 0.379; P = 0.016), but not between SEVR and TNF-α (P = 0.195), nor between SEVR and hsCRP (P = 0.686).
In a multivariate adjusted model with SEVR as dependent variable and IL-6, TNF-α and hsCRP as independent variables we found a statistically significant association only between SEVR and IL-6 (β = 0.393; P = 0.017).
CONCLUSION
This study suggests an association between IL-6 and SEVR in HD patients.
Abstract
Background and Aims
Use of cytokine adsorbents has been proposed as a novel therapeutic approach in sepsis management. Our aim was to evaluate laboratory markers, clinical parameters and ...SOFA (Sequential Organ Failure Assessment) score in patients who were treated with cytokine adsorbing membrane (CytoSorb®, CytoSorbents Corp. New Jersey, USA) and continuous veno-venous haemodialysis.
Method
We included adult patients with septic shock and acute renal failure. We retrospectively collected laboratory results (leukocytes, thrombocytes, C-reactive protein, procalcitonin, lactate, urea, creatinine, bilirubin, PaO2), clinical parameters (mean arterial pressure (MAP), FiO2, residual diuresis), SOFA score and vasopressor use at the beginning and at the end of the procedure.
Results
We included 69 patients, 51 men, aged 56.6 ± 15 years. 51 patients had 1 procedure, 14 patients had 2 procedures, 3 patients had 3 procedures and 1 patient had 4 procedures. Median time from admission to initiation of procedure was 47 hours, median treatment time was 23.6 hours.
We discovered significant improvement in procalcitonin (35.36 ± 37.33 ng/mL vs. 24.25 ± 31.18 ng/mL; p<0.001), creatinine (345.06 ± 174.65 μmol/L vs. 233.11 ± 108.82 μmol/L; p<0.0001), SOFA score (14.20 ± 2.64 vs. 12.69 ± 3.52; p<0.001) and FiO2 (48.17 ± 21.17 % vs. 44.63 ± 21.45 %; p=0.020).
Patients with more than 1 procedure showed statistically significant reduction in lactate level (5.40 ± 4.74 mmol/L vs. 2.46 ± 1.74 mmol/L; p=0.010) and vasopressin dose (1.26 ± 1.61 vs. 0.88 ± 3.2 IU/h; p=0.022).
Conclusion
We observed potential beneficial effect of adsorptive membrane use in septic patients. According to our results two or more procedures were associated with improved laboratory markers and lower vasopressor requirement.
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