1
40
3
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Text
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URL Address
<a href="http://doi.org/10.15171/jnp.2017.09" target="_blank" rel="noreferrer noopener">http://doi.org/10.15171/jnp.2017.09</a>
Pages
53–57
Issue
2
Volume
6
Dublin Core
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Title
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Infection associated acute interstitial nephritis; a case report.
Publisher
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Journal of nephropathology
Date
A point or period of time associated with an event in the lifecycle of the resource
2017
2017-03
Subject
The topic of the resource
Acute interstitial nephritis; Dental abscess; Drug induced AIN; Infection associated AIN
Creator
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Raina Rupesh; Ale Shirisha; Chaturvedi Tushar; Fraley Luke; Novak Robert; Tanphaichitr Natthavat
Description
An account of the resource
BACKGROUND: Acute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with a variety of infections, drugs, and sometimes with unknown causes. It is a common cause of acute kidney injury (AKI) and subsequent renal impairment, which often times is under-diagnosed. Infection-associated AIN occurs as a consequence of many systemic bacterial, viral, and parasitic infec-tions; however, its incidence has decreased significantly after the advent of antimicrobials. Infection-associated AIN presents with both oliguric or non-oliguric renal insufficiency, without the classical clinical triad of AIN (fever, rash, and arthralgia). In this scenario the renal function is usually reversible after the infection is treated. In most cases, patients with acute renal failure present with extra-renal manifestations typically detected in underlying infections. Renal biopsy serves as the most definitive test for both the diagnosis and prognosis of AIN. CASE PRESENTATION: In this paper, we will address one such case of biopsy-proven AIN. In this case, the patient presented with severe AKI induced by anaerobic streptococcus, leading to a periodontal abscess, which was successfully treated with corticosteroids and requiring renal replacement therapy (RRT). CONCLUSIONS: AIN should be considered in the differential for unexplained AKI. Initial management should include conservative therapy by withdrawing any suspected causative agent. Renal biopsy is needed for confirmation in cases where kidney function fails to improve within 5-7 days on conservative therapy. Risk of immunosuppression is very important to consider when giving steroids in patients with infection induced AIN, and steroids may have to be delayed until the active infection is completely controlled.
Identifier
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<a href="http://doi.org/10.15171/jnp.2017.09" target="_blank" rel="noreferrer noopener">10.15171/jnp.2017.09</a>
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Information about rights held in and over the resource
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2017
Acute interstitial nephritis
Ale Shirisha
Chaturvedi Tushar
Dental abscess
Department of Internal Medicine
Drug induced AIN
Fraley Luke
Infection associated AIN
Journal of nephropathology
NEOMED College of Medicine
Novak Robert
Raina Rupesh
Tanphaichitr Natthavat
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1186/s12882-018-0812-x" target="_blank" rel="noreferrer noopener">http://doi.org/10.1186/s12882-018-0812-x</a>
Pages
9–9
Issue
1
Volume
19
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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The use of eculizumab in gemcitabine induced thrombotic microangiopathy.
Publisher
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BMC nephrology
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
2018-01
Subject
The topic of the resource
*Gemcitabine; *Hemolytic uremic syndrome; *Pancreatic cancer; *Renal failure; *Thrombotic microangiopathy; Antibodies; Antimetabolites; Antineoplastic – Adverse Effects; Antineoplastic/*adverse effects; Deoxycytidine; Deoxycytidine – Adverse Effects; Deoxycytidine/adverse effects/*analogs & derivatives; Female; Humanized/*therapeutic use; Humans; Middle Age; Middle Aged; Monoclonal; Monoclonal – Therapeutic Use; Scales; Thrombocytopenia – Chemically Induced; Thrombocytopenia – Diagnosis; Thrombocytopenia – Drug Therapy; Thrombotic Microangiopathies/*chemically induced/diagnosis/*drug therapy
Creator
An entity primarily responsible for making the resource
Krishnappa Vinod; Gupta Mohit; Shah Haikoo; Das Abhijit; Tanphaichitr Natthavat; Novak Robert; Raina Rupesh
Description
An account of the resource
BACKGROUND: Thrombotic microangiopathy (TMA) secondary to gemcitabine therapy (GiTMA) is a very rare pathology that carries a poor prognosis, with nearly half of the cases progressing to end stage renal disease. GiTMA is most commonly associated with adenocarcinomas, most notably pancreatic cancers. The mainstay of management is withdrawal of the offending drug and supportive care. Plasmapheresis has a limited role and hemodialysis may help in the management of fluid overload secondary to renal failure. Furthermore, a C5 inhibitor, eculizumab, has been successfully used in the treatment of GiTMA. CASE PRESENTATION: A 64-year-old Caucasian female with history of pancreatic adenocarcinoma on gemcitabine chemotherapy presented with signs and symptoms of fluid overload and was found to have abnormal kidney function. Her BP was 195/110 mmHg, serum creatinine 4.48 mg/dl, hemoglobin 8.2 g/dl, platelets 53 x 10(3)/cmm, lactate dehydrogenase 540 IU/L, and was found to have schistocytes on blood film. A diagnosis of TMA secondary to gemcitabine therapy was suspected. Hemodialysis for volume overload and daily plasmapheresis were initiated. After six days of plasmapheresis, renal function did not improve. Further work up revealed ADAMTS 13 activity \textgreater15%, low C3, and stool culture and Shiga-toxin PCR were negative. Renal biopsy was consistent with TMA. Gemcitabine was discontinued, but renal function failed to improve and eculizumab therapy was considered due to suspicion of aHUS. Serum creatinine \textgreater2.26 mg/dl and a platelet count of \textgreater/= 30 x 10(9)/L is highly suggestive of aHUS, while TTP is more likely when creatinine is \textless2.26 mg/dl and platelet count of \textless30 x 10(9)/L. She received intravenous eculizumab for eight months, which resulted in significant improvement of renal function. Other markers of hemolysis, namely LDH and bilirubin, also rapidly improved following eculizumab therapy. Plasmapheresis and hemodialysis were discontinued after two and eight weeks of initiation respectively. CONCLUSION: Chemotherapy induced TMA is very rare and requires a high index of clinical suspicion for timely diagnosis. Discontinuation of the offending drug and supportive care is the main stay of treatment; however, eculizumab has been shown to be beneficial in GiTMA. Further research is required to validate this approach.
Identifier
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<a href="http://doi.org/10.1186/s12882-018-0812-x" target="_blank" rel="noreferrer noopener">10.1186/s12882-018-0812-x</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Gemcitabine
*Hemolytic uremic syndrome
*Pancreatic cancer
*Renal failure
*Thrombotic microangiopathy
2018
Antibodies
Antimetabolites
Antineoplastic – Adverse Effects
Antineoplastic/*adverse effects
BMC nephrology
Das Abhijit
Deoxycytidine
Deoxycytidine – Adverse Effects
Deoxycytidine/adverse effects/*analogs & derivatives
Department of Internal Medicine
Female
Gupta Mohit
Humanized/*therapeutic use
Humans
Krishnappa Vinod
Middle Age
Middle Aged
Monoclonal
Monoclonal – Therapeutic Use
NEOMED College of Graduate Studies Student
NEOMED College of Medicine
Novak Robert
Raina Rupesh
Scales
Shah Haikoo
Tanphaichitr Natthavat
Thrombocytopenia – Chemically Induced
Thrombocytopenia – Diagnosis
Thrombocytopenia – Drug Therapy
Thrombotic Microangiopathies/*chemically induced/diagnosis/*drug therapy
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1097/01.mjt.0000174345.59177.9b" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/01.mjt.0000174345.59177.9b</a>
Pages
18–23
Issue
1
Volume
13
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Screening for nephropathy and antiangiotensin use among diabetic patients in an academic community medical center.
Publisher
An entity responsible for making the resource available
American Journal of Therapeutics
Date
A point or period of time associated with an event in the lifecycle of the resource
2006
2006-02
Subject
The topic of the resource
*Guideline Adherence; Academic Medical Centers; Age Factors; Aged; Angiotensin II Type 1 Receptor Blockers/*administration & dosage/therapeutic use; Angiotensin-Converting Enzyme Inhibitors/*administration & dosage/therapeutic use; Coronary Artery Disease/diagnosis; Diabetes Mellitus; Diabetic Nephropathies/*diagnosis/epidemiology/etiology; Drug Utilization; Female; Humans; Hypertension/diagnosis/drug therapy; Male; Middle Aged; Practice Guidelines as Topic; Proteinuria/diagnosis; Retrospective Studies; Type 1/complications/drug therapy; Type 2/complications/drug therapy
Creator
An entity primarily responsible for making the resource
Frazee Lawrence A; Samandari Seyhoon; Tanphaichitr Natthavat; Bourguet Claire C; Pfister Eugene W
Description
An account of the resource
The American Diabetes Association recommends routine screening for albuminuria to detect early nephropathy in all patients with diabetes mellitus. If nephropathy is identified, treatment with an antiangiotensin agent decreases progression and improves renal outcomes. Concordance with guidelines for nephropathy screening and antiangiotensin therapy among diabetic patients in a primary care setting of an academic community medical center was evaluated. Medical charts of adult patients with diabetes mellitus from February 2000 through January 2003 were retrospectively reviewed. In part 1 of the study, whether patients were screened for nephropathy at least once was recorded. In part 2 of the study, antiangiotensin prescribing was assessed in all patients and in subgroups stratified by screening. In both parts of the study, patient characteristics and comorbidities were assessed using multivariate analysis to determine their impact on the odds that a patient was screened and that antiangiotensin therapy was prescribed. Among the 329 patients included, 182 patients (55.3%) were screened for nephropathy. Patients who were screened were younger (OR=0.83 for 10-year increase, 95% CI: 0.69-0.99), less likely to have congestive heart failure (OR=0.42, 95% CI: 0.20-0.90), and more likely to be cared for by a resident physician directly supervised by an attending physician (OR=3.03; 95% CI: 1.82-5.03). A total of 215 patients (65.3%) were prescribed antiangiotensin therapy. Hypertension was a predictor of antiangiotensin therapy among all patients who were screened (OR=10.34, 95% CI: 4.45-24.01), those who were screened and negative (OR=15.46, 95% CI: 5.56-42.98), and those who were not screened (OR=10.79, 95% CI: 4.39-26.52). Among patients screened for nephropathy, coronary artery disease (OR=3.01, 95% CI: 1.05-8.63), and the presence of proteinuria (OR=4.26, 95% CI: 1.61-11.24) were predictors of antiangiotensin use. This study found that the likelihood of screening for nephropathy among diabetic patients was inversely associated with a diagnosis of congestive heart failure and increasing age. Conversely, care by a resident physician directly supervised by an attending physician increased the odds that patients would be screened. A diagnosis of hypertension and the presence of albuminuria were each associated with increased use of an antiangiotensin agent.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1097/01.mjt.0000174345.59177.9b" target="_blank" rel="noreferrer noopener">10.1097/01.mjt.0000174345.59177.9b</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Guideline Adherence
2006
Academic Medical Centers
Age Factors
Aged
American journal of therapeutics
Angiotensin II Type 1 Receptor Blockers/*administration & dosage/therapeutic use
Angiotensin-Converting Enzyme Inhibitors/*administration & dosage/therapeutic use
Bourguet Claire C
Coronary Artery Disease/diagnosis
Department of Internal Medicine
Diabetes Mellitus
Diabetic Nephropathies/*diagnosis/epidemiology/etiology
Drug Utilization
Female
Frazee Lawrence A
Humans
Hypertension/diagnosis/drug therapy
Male
Middle Aged
NEOMED College of Medicine
Pfister Eugene W
Practice Guidelines as Topic
Proteinuria/diagnosis
Retrospective Studies
Samandari Seyhoon
Tanphaichitr Natthavat
Type 1/complications/drug therapy
Type 2/complications/drug therapy