Rare Surgical Lung Biopsy Findings of Metastatic Pulmonary Calcification Associated with Chronic Renal Failure

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S37-S38
Author(s):  
N Ronen ◽  
Y Sheinin
Keyword(s):  
Lung Disease ◽  
Interstitial Fibrosis ◽  
Wedge Resection ◽  
Lung Parenchyma ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Pulmonary Calcification ◽  
Stage Renal Disease ◽  
End Stage ◽  
Metastatic Pulmonary Calcification

Abstract Introduction/Objective Metastatic pulmonary calcification is a metabolic lung disease characterized by depositions of calcium in lung parenchyma. Depositions of calcium salts are usually caused by hypercalcemia and are associated with end-stage renal disease, primary and secondary hyperparathyroidism, and hemodialysis. It is mostly asymptomatic and clinically silent but can lead to life-threatening respiratory failure. Methods We present a case of a 53-year-old woman, with a failed renal transplant and on hemodialysis, admitted with cough and shortness of breath. Computed tomography showed extensive diffuse bilateral groundglass and nodular opacities. Bronchoscopy was unremarkable. BAL results were negative for infection. The initial differential diagnosis included pneumonitis, interstitial lung disease, and chronic obstructive pulmonary disease. VATS lung wedge resection was performed. Results Microscopically there were numerous interstitial, peribronchial and perivascular calcifications highlighted by Van Kossa stain. Calcifications were associated with a marked interstitial fibrosis confirmed by trichrome stain. There was no evidence of significant acute and chronic inflammation, granulomas, fibroblastic foci and vasculitis. Conclusion Metastatic pulmonary calcification is found in 60–80% of autopsies of patients undergoing dialysis treatment. It is rarely diagnosed during their lifetime, because patients are usually asymptomatic, or the imaging findings are negative. The diagnosis of metastatic pulmonary calcification in our patient prompt further evaluation for repeat kidney transplant and the patient is being considered for parathyroidectomy for her tertiary hyperparathyroidism.

scholarly journals Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review

2016 ◽  
Vol 35 (1) ◽  
pp. 173-183 ◽  
Author(s):  
Veerawat Phongtankuel ◽  
Lauren Meador ◽  
Ronald D. Adelman ◽  
Jordan Roberts ◽  
Charles R. Henderson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
English Language ◽  
Chronic Obstructive ◽  
Positive Outcomes ◽  
Spiritual Support ◽  
Obstructive Pulmonary Disease ◽  
Study Selection ◽  
Stage Renal Disease ◽  
End Stage

Background: Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it is unclear what is being implemented and who is delivering these interventions. Objectives: To (1) describe the delivery of multicomponent palliative care interventions, (2) characterize the disciplines delivering care, (3) identify the components being implemented, and (4) analyze whether the number of disciplines or components being implemented are associated with positive outcomes. Design: Systematic review. Study Selection: English-language articles analyzing multicomponent palliative care interventions. Outcomes Measured: Delivery of palliative interventions by discipline, components of palliative care implemented, and number of positive outcomes (eg, pain, quality of life). Results: Our search strategy yielded 71 articles, which detailed 64 unique multicomponent palliative care interventions. Nurses (n = 64, 88%) were most often involved in delivering care, followed by physicians (n = 43, 67%), social workers (n = 33, 52%), and chaplains (n = 19, 30%). The most common palliative care components patients received were symptom management (n = 56, 88%), psychological support/counseling (n = 52, 81%), and disease education (n = 48, 75%). Statistical analysis did not uncover an association between number of disciplines or components and positive outcomes. Conclusions: While there has been growth in multicomponent palliative care interventions over the past 3 decades, important aspects require additional study such as better inclusion of key groups (eg, chronic obstructive pulmonary disease, end-stage renal disease, minorities, older adults); incorporating core components of palliative care (eg, interdisciplinary team, integrating caregivers, providing spiritual support); and developing ways to evaluate the effectiveness of interventions that can be readily replicated and disseminated.

scholarly journals Hybrid dialysis: a promising strategy to reduce hospital access during the SARS-CoV-2 pandemic

2020 ◽  
Vol 13 (10) ◽  
pp. e236411
Author(s):  
Giacomo Mori ◽  
Gaetano Alfano ◽  
Francesco Fontana ◽  
Riccardo Magistroni
Keyword(s):  
Peritoneal Dialysis ◽  
Venous Catheter ◽  
Chronic Obstructive ◽  
Central Venous Catheter Placement ◽  
Obstructive Pulmonary Disease ◽  
Haemodialysis Session ◽  
Promising Strategy ◽  
Hospital Access ◽  
Stage Renal Disease ◽  
End Stage

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.

Metastatic pulmonary calcification in end stage renal disease

BMJ ◽  
2015 ◽  
Vol 350 (apr09 18) ◽  
pp. h1544-h1544
Author(s):  
C. K. Cheung ◽  
G. Warwick ◽  
J. Barratt
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pulmonary Calcification ◽  
Stage Renal Disease ◽  
End Stage ◽  
Metastatic Pulmonary Calcification

scholarly journals Clinical characteristics of Japanese patients with chronic obstructive pulmonary disease (COPD) with comorbid interstitial lung abnormalities: A cross-sectional study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0239764 ◽  
Author(s):  
Manabu Ono ◽  
Seiichi Kobayashi ◽  
Masakazu Hanagama ◽  
Masatsugu Ishida ◽  
Hikari Sato ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Disease ◽  
Pulmonary Disease ◽  
Clinical Characteristics ◽  
Interstitial Fibrosis ◽  
Japanese Patients ◽  
Chronic Obstructive ◽  
Observational Period ◽  
Obstructive Pulmonary Disease ◽  
Lung Abnormalities

Smoking-related interstitial lung abnormalities are different from specific forms of fibrosing lung disease which might be associated with poor prognoses. Chronic obstructive pulmonary disease with comorbid interstitial lung abnormalities and that with pulmonary fibrosis are considered different diseases; however, they could share a common spectrum. We aimed to evaluate the clinical characteristics of Japanese patients with chronic obstructive pulmonary disease and comorbid interstitial lung abnormalities. In this prospective observational study, we analyzed data from the Ishinomaki COPD Network Registry. We evaluated the clinical characteristics of patients with chronic obstructive pulmonary disease with and without comorbid interstitial lung abnormalities by comparing the annualized rate of chronic obstructive pulmonary disease exacerbations per patient during the observational period. Among 463 patients with chronic obstructive pulmonary disease, 30 (6.5%) developed new interstitial lung abnormalities during the observational period. After 1-to-3 propensity score matching, we found that the annualized rate of chronic obstructive pulmonary disease exacerbations per patient during the observational period was 0.06 and 0.23 per year in the interstitial lung abnormality and control groups, respectively (P = 0.043). Our findings indicate slow progression of interstitial lung abnormality lesions in patients with pre-existing chronic obstructive pulmonary disease. Further, interstitial lung abnormality development did not significantly influence on chronic obstructive pulmonary disease exacerbation. We speculate that post-chronic obstructive pulmonary disease interstitial lung abnormalities might involve smoking-related interstitial fibrosis, which is different from specific forms of fibrosing lung disease associated with poor prognoses.

scholarly journals Clinical Analysis of Chronic Obstructive Lung Disease Complicated with Pulmonary Interstitial Fibrosis

2017 ◽  
Vol 1 (3) ◽  
Author(s):  
Han Lime
Keyword(s):  
Lung Function ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Interstitial Fibrosis ◽  
Chronic Obstructive Lung Disease ◽  
Clinical Analysis ◽  
Chronic Obstructive ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Pulmonary Interstitial Fibrosis

Objective: investigate the clinical characteristics of chronicobstructive lung disease complicated with pulmonary interstitialfibrosis. Method: Choose these 240 patients with chronicobstructive lung disease who were diagnosed and treated in thehospital from 2014 to 2016, and 80 patients were checked withchronic obstructive lung disease complicated with pulmonaryinterstitial fibrosis; these patients were underwent with CTexamination, lung function examination and blood gasexamination. Result: through the CT examination, it indicates thatthe patients with c chronic obstructive lung disease withpulmonary interstitial fibrosis show excessive lung permeabilityand bullae of lung, etc. It has the statistical difference comparedwith these patients with chronic obstructive lung disease (P <0.05). The difference of lung function and blood gas indicatorbetween the two groups is statistically significant, which is ofstatistical significance (P<0.05). Conclusion: The clinicalcharacteristics of chronic obstructive lung disease complicatedwith pulmonary interstitial fibrosis are excessive lung permeabilityand bullae of lung, and the lung function and blood gas indicator ofthese patients are significantly different from those patients'indicator with chronic obstructive pulmonary disease, so it can beregarded as an important way to diagnose patients.

scholarly journals MO677RRT DURING COVID 19 EPIDEMIC. EXPIRIENCE OF ONE CENTER

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Gordana Strazmester Majstorovic ◽  
Violeta Knezevic ◽  
Tijana Azasevac ◽  
Mira Markovic ◽  
Vladimir Veselinov ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Hemodynamic Instability ◽  
Chronic Obstructive ◽  
Intermittent Hemodialysis ◽  
Obstructive Pulmonary Disease ◽  
Volume Load ◽  
Survivor Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Novi Sad

Abstract Background and Aims The incidence of Acute kidney injuri AKI during Covid 19 infection is 3 – 15%, up to 50% for patients (pts) with Acute respiratory distress syndrome ARDS. Method From March till December 2020. Department for hemodialysis in Novi Sad did 184 renal replacement therapy (RRT) procedures (proc) on 65 Covid 19 positive pts. Results There were 73,85% men and 26,15% women (p &lt; 0,01), with average (avs.) age of 65,8 years (SD 9,20). Most of them were admitted directly to the Intensive care unit, 64,62% (p &lt; 0,01). The length of stay in hospital ranged from 2 - 61 days (avs. 15,86; SD 11,19). The most common comorbidities were hypertension (86,1%), diabetes (33,8%), coronary disease (30,8%) and chronic obstructive pulmonary disease (21,5%). Most common indication for RRT was acutisation of chronic kidney disease (CKD) 43,08% (p &lt; 0,01) followed by pre-existing end stage renal disease (ESRD) 29,23% and AKI 27,69%. RRT was started 1 - 31 days after the admittance (avs. 8,51; SD 7,33). 57 intermittent hemodialysis proc (30,98%) were done on 13 pts (14,06%) who were hemodynamicly and respiratory stable. The decision to initiate CRRT was made upon the renal indications, the presence of ARDS or significant volume load. A total of 127 CRRT proc (69,02%) were done on 57 pts (87,5%). The most of them were CVVHDF (74,02%) and the rest CVVHD (25,98%). Most commonly used membrane was oXiris 47,24% (p &lt; 0,001) followed by EMIC2 25,98%, Kit 8 17,32% and ST-150 9,45%. Most CRRT proc (89,76%) were done with heparin as an anticoagulant and 10 proc (7,87%) in 5 pts using citrate. 3 proc (2,36%) in 2 pts were done without using anticoagulant. The procedurès duration had to depend on the number of devices, the number of pts requiring CRRT and the number of available trained medical workers. The average achieved length of proc was 712 min. (11 h and 52 min.) (SD 435,07). Most patients had 1 (49,12%; p&lt; 0,001) or 2 (30,69%) CRRT proc, up to 9 (avs. 2,23; SD 1,95). The average achieved ultrafiltration was 2716,41 ml (SD 1016,82). In 23 pts (40,35%) 26 CRRT proc (20,47%) had to be stopped earlier, because of circuit clotting (9,45%; p &lt; 0,001), deterioration of hemodynamic instability/respiratory insufficiency (7,09%), device malfunction (2.36%) and RRT need for another pts (1,58%). ARDS has developed 42 pts (64,61%). The need for vasoactive support had 41 pts (63,08%). 51 pts (78,46%) requiring RRT died. Conclusion Comparing group of pts who survived with group of those who died, greater number of pts with ESRD was in the first group. In survivor group, RRT was started earlier with greater number and shorter duration of proc. In the group of pts who died, there were more ARDS and vasoactive support need. They had a higher levels of CRP, leukocyte count and the neutrophil to lymphocyte ratio.

scholarly journals The lung microbiome in end-stage Lymphangioleiomyomatosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Julie Ng ◽  
Gustavo Pacheco-Rodriguez ◽  
Lesa Begley ◽  
Yvonne J. Huang ◽  
Sergio Poli ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Failure ◽  
Lung Disease ◽  
Pulmonary Disease ◽  
Respiratory Infections ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cystic Lung ◽  
Lung Microbiome ◽  
End Stage

AbstractLymphangioleiomyomatosis (LAM) is a progressive cystic lung disease with mortality driven primarily by respiratory failure. Patients with LAM frequently have respiratory infections, suggestive of a dysregulated microbiome. Here we demonstrate that end-stage LAM patients have a distinct microbiome signature compared to patients with end-stage chronic obstructive pulmonary disease.

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