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Biomedical subjects

O Soffer

Publications and source records attributed to O Soffer.

9 recordsLinked to original sources

Pulmonary embolism in end stage renal disease.

Clinically significant pulmonary embolism is considered to be rare in patients with end stage renal disease. Two cases with long standing renal disease on dialysis, are reported where pulmonary embolism contributed significantly to morbidity and mortality. One patient had hypotension during dialysis. The differential diagnosis of sustained hypotension during dialysis or in the ICU should include pulmonary embolism. Establishing the diagnosis may require pulmonary angiography.

Diagnosis, Differential

Protein S and C antigen levels in proteinuric patients: dependence on type of glomerular pathology.

The cause of the thrombotic tendency in nephrotic patients is unknown. Recent reports of thrombotic complications in patients with deficiencies of protein C or protein S (natural inhibitors of coagulation) have raised the possibility that decreased levels of these proteins may play a role in the hypercoagulable state of nephrotic patients. We measured the levels of protein C, total protein S, and free protein S antigens in 42 patients (21 nephrotic and 21 non-nephrotic) with one of four types of glomerular pathology: diabetic nephropathy (DM), focal glomerular sclerosis (FGS), membranous glomerulonephritis (MGN), and chronic renal failure due to hypertension (CRF). Protein C and total protein S antigen levels were significantly higher in FGS and MGN than they were in DM or CRF. Free protein S levels were lower in DM than they were in MGN. Protein C, total protein S, and free protein S levels did not significantly correlate with either serum albumin or degree of proteinuria. The mean levels of the three proteins did not differ between nephrotic and non-nephrotic patients. Free protein S and protein C were, however, significantly correlated (P less than .005 and P less than .002, respectively) with the type of glomerular pathology, independent of differences in age, sex, serum albumin, or degree of proteinuria. These data suggest that abnormalities of free protein S and protein C are related to the nature of the underlying renal disease, rather than to the degree of proteinuria.

Glycoproteins

Acquired renal cystic disease in end-stage renal disease: an autopsy study of 155 cases.

Autopsy reports on 155 successive end-stage renal disease (ESRD) patients and 147 control patients without ESRD, matched for age, race and gender, were collected. Cystic transformation of the kidneys was noted in 58% of the ESRD patients and 13.6% of the control patients. There were 25 ESRD patients with renal adenoma and 3 with renal cell carcinoma. The single best predictor of cystic transformation or tumorous degeneration was patient's age. A statistically significant association between cystic transformation and gender, as well as the cause of ESRD, was also found. In contrast to previous reports we were unable to document a strong association between the incidence of either cystic transformation or tumorous degeneration with the duration of dialysis, nor did these two parameters correlate with mode of dialysis. We suggest that cystic transformation of the kidneys in ESRD is related to age and renal failure per se, is not strongly associated with duration of dialysis and is independent of mode of dialysis. Concomitant tumorous degeneration was frequent, but this was usually an incidental autopsy finding. Renal malignancy was uncommon and metastases were absent.

Adenoma

Light chain cast nephropathy and acute renal failure associated with rifampin therapy. Renal disease akin to myeloma kidney.

Acute renal failure developed in a patient with a normal serum creatinine level, after treatment with rifampin was begun for tuberculosis. Renal biopsy revealed an obstructive nephropathy due to tubular casts. Immunoperoxidase and immunofluorescence studies demonstrated the presence of heterogeneous light chains within these casts. This unique drug-induced renal disease is discussed with reference to the literature and to possible analogies with myeloma kidney.

Acute Kidney Injury

Intraoperative hemodialysis during cardiopulmonary bypass in chronic renal failure.

This report describes the features and the course of a patient on maintenance hemodialysis in whom infective endocarditis of the aortic valve ensued. The subsequent development of intractable congestive heart failure necessitated aortic valve replacement. Use of intraoperative hemodialysis, facilitating the intraoperative and postoperative management of the patient, is described. Following valve replacement the patient did well with no evidence of congestive heart failure.

Aortic Valve

Thyroid function in hemodialysis.

The relevance of the biochemical evidence of hypothyroidism in patients on regular hemodialysis is debatable. Several indexes of thyroid function were assessed in 46 patients undergoing chronic hemodialysis for 2 to 45 months. Low serum levels of thyroxine were found in 69.5% of the patients studied and of triiodothyronine (T3) in 46.5%. Low values of T3-Sephadex binding were noted in 17.3%, of free thyroxine index (FTI) in 26.3% and of radioiodine uptake in 19.3% of the patients; 13.0% had high levels of thyroid-stimulating hormone (TSH). The overall incidence of hypothyroidism, based on FTI and TSH, was 34.8%. We concluded that the diagnosis of hypothyroidism should be based on FTI and TSH levels, and that chronically hemodialyzed patients tend to exhibit biochemical rather than clinical hypothyroidism.

Adolescent

Acute human immunodeficiency virus infection temporally associated with rhabdomyolysis, acute renal failure, and nephrosis.

A previously healthy 29-year-old homosexual man presented with a 4-day history of fever, malaise, sore throat, and bleeding gums. Rhabdomyolysis, acute renal failure, and nephrotic range proteinuria were also present. The patient was found to have acute human immunodeficiency virus (HIV) infection confirmed by the presence of HIV antigen in his serum and subsequent evolution of an HIV antibody profile typical of acute seroconversion. A kidney biopsy revealed acute tubular necrosis and mesangioproliferative glomerulonephritis, with tubuloreticular inclusions. In the presence of otherwise unexplained acute renal failure, rhabdomyolysis, or new onset nephrotic syndrome, acute HIV infection should be considered in the differential diagnosis.

Acute Disease

CT findings in complications of acquired renal cystic disease.

A 42-year-old man with end-stage renal disease developed acquired renal cystic disease. The left kidney underwent tumorous degeneration necessitating nephrectomy. Eight months later acute hemorrhagic renal cyst rupture culminated in right nephrectomy.

Adult