Biomedical subjects
Publications and source records attributed to P Finocchiaro.
A forty-nine year old man was admitted to the Renal Unit of our Hospital because of renal failure, loin pain, low grade fever and loss of weight. It was done a complete work-up. The ultrasound and the computed tomography of the abdomen were very helpful to get the right diagnosis.
With few exceptions renal volume is markedly reduced in patients with end-stage renal disease, a phenomenon which is almost always accompanied by a progressive loss of renal compliance secondary to renal structure fibrosis. We have observed a remarkable renal compliance during an episode of acute pyelonephritis in a patient on long-term dialysis.
The relationship between hyperhomocysteinemia and cardiovascular damage is well known, whereas the role of this alteration in renal disease progression has been scarcely studied. Experimental studies demonstrated that exposure to high levels of homocysteinemia causes glomerular and interstitial damage which is remarcably proportional to the serum concentration of this aminoacid. Until now the renal effects of hyperhomocysteinemia in man has been investigated only in observational studies. The Hoorn study, a prospective study in a Dutch population, showed that the plasma homocysteine is a strong predictor of proteinuria in diabetic and non diabetic subjects. Findings in this study were recently confirmed in a cohort study in 7500 Japanese because plasma homocysteine predicted the onset of renal failure in this population. NO-dependent endothelial dysfunction triggered by homocysteine via reduction of the activity of the enzyme that metabolizes Asimmetric Dymethilarginine (dmethylarginine dymethilaminohydrolase) is a likely mechanism whereby hyperomocysteinemia causes cardiovascular and renal damage as well.
This is a clinical case of a patient suspected to have a lymphoma. Later on, other diagnostic procedures and particularly a neck ultrasound, revealed an idiopathic hyperparathyroidism.