scholarly journals Duodenal Villous Atrophy in a TTG-Negative Patient Taking Olmesartan: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Tasha Kulai ◽  
Thomas Arnason ◽  
Donald MacIntosh ◽  
John Igoe
Keyword(s):  
Villous Atrophy ◽  
Kidney Injury ◽  
Intraepithelial Lymphocytes ◽  
Surface Epithelium ◽  
Review Of The Literature ◽  
Angiotensin Ii Receptor ◽  
Angiotensin Ii Receptor Antagonist ◽  
Repeat Endoscopy ◽  
History Of

Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient’s diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.

scholarly journals The vicious cycle: a history of obesity and COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacek Bil ◽  
Olga Możeńska
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Obesity Paradox ◽  
Lifestyle Changes ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
History Of ◽  
Receptor Blockers ◽  
History Of Obesity

AbstractRecently, we face a surge in the fast-forward Coronavirus Disease 2019 (COVID-19) pandemic with nearly 170 million confirmed cases and almost 3.5 million confirmed deaths at the end of May 2021. Obesity, also known as the pandemic of the 21st century, has been evolving as an adverse prognostic marker. Obesity is associated with a higher risk of being SARS-CoV-2-positive (46%), as well as hospitalization (113%) and death (48%) due to COVID-19. It is especially true for subjects with morbid obesity. Also, observational studies suggest that in the case of COVID-19, no favorable “obesity paradox” is observed. Therefore, it is postulated to introduce a new entity, i.e., coronavirus disease-related cardiometabolic syndrome (CIRCS). In theory, it applies to all stages of COVID-19, i.e., prevention, acute proceedings (from COVID-19 diagnosis to resolution or three months), and long-term outcomes. Consequently, lifestyle changes, glycemic control, and regulation of the renin-angiotensin-aldosterone pathway have crucial implications for preventing and managing subjects with COVID-19. Finally, it is crucial to use cardioprotective drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and statins. Nevertheless, there is the need to conduct prospective studies and registries better to evaluate the issue of obesity in COVID-19 patients.

scholarly journals Laparoscopic resection of bilateral perinephric pseudocyst in a pediatric feline patient

2019 ◽  
Vol 5 (1) ◽  
pp. 205511691985064
Author(s):  
Margaret Amparo Placer ◽  
Cindy McManis
Keyword(s):  
Laparoscopic Resection ◽  
Kidney Injury ◽  
Abdominal Distension ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Invasive Approach ◽  
Less Invasive Approach ◽  
History Of ◽  
Grade 3

Case summary A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively. Relevance and novel information Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.

scholarly journals Celiac Disease Diagnosed in an Older Adult Patient with a Complex Neuropsychiatric Involvement: A Case Report and Review of the Literature

2020 ◽  
Vol 10 (7) ◽  
pp. 426
Author(s):  
Emma Falato ◽  
Fioravante Capone ◽  
Federico Ranieri ◽  
Lucia Florio ◽  
Marzia Corbetto ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Case Report ◽  
Older Adult ◽  
Clinical Picture ◽  
Neurological Involvement ◽  
Extraintestinal Manifestations ◽  
Review Of The Literature ◽  
History Of ◽  
Delusional Jealousy

We present a case of celiac disease (CD) diagnosis in a 75-year-old woman with a long-term history of chronic delusional jealousy and a complex neurological involvement. The case describes a very unusual clinical picture, provides some clinical clues, and highlights the importance of being aware of CD extraintestinal manifestations in order to get a timely diagnosis.

scholarly journals A patient with severe rhabdomyolysis and high levels of creatinine kinase had renal functions fully recovered after haemodialysis: a case report

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988810 ◽  
Author(s):  
Shang-Feng Tsai ◽  
Jun-Li Tsai ◽  
Cheng-Hsu Chen
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Predictive Power ◽  
Kidney Injury ◽  
Blood Biomarkers ◽  
History Of ◽  
Very High ◽  
Current Report

Rhabdomyolysis is diagnosed based on the levels of blood biomarkers such as creatine kinase (CK), but the use of CK levels to predict long-term renal function remains controversial. This current report presents a case with a very high CK level with the presentation of acute kidney injury (AKI) who regained full renal function. A 29-year-old man, in a manic mood and presenting with dyspnoea, was admitted to hospital following an episode of ketamine use along with a history of drug abuse. The laboratory analyses identified rhabdomyolysis (CK, 35 266 U/l) and AKI (serum creatinine, 3.96 mg/dl). Despite treatment with intravenous normal saline (4000 ml/day), his CK level reached at least 300 000 U/l. He underwent 13 sessions of haemodialysis and his renal function fully recovered. The final measurements were serum creatinine 1.0 mg/dl and CK 212 U/l. These findings support the view that the predictive power of CK level on AKI is limited, especially regarding long-term renal function. Close follow-up examinations of renal function after haemodialysis are mandatory for patients with rhabdomyolysis.

scholarly journals Long-Term Consequences of Fetal Angiotensin II Receptor Antagonist Exposure

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
K. Wegleiter ◽  
M. Waltner-Romen ◽  
R. Trawoeger ◽  
U. Kiechl-Kohlendorfer ◽  
E. Griesmaier
Keyword(s):  
Angiotensin Ii ◽  
Receptor Antagonist ◽  
Neonatal Period ◽  
Clinical Symptoms ◽  
Angiotensin Ii Receptor ◽  
Angiotensin Ii Receptor Antagonists ◽  
Angiotensin Ii Receptor Antagonist ◽  
Receptor Antagonists

Fetal angiotensin II receptor antagonist exposure is associated with major complications and even death when administered during pregnancy. Neonates frequently require intensive care treatment, and mortality is high. Despite this well-known risk potential, a considerable number of women still receive angiotensin II receptor antagonists during pregnancy to treat arterial hypertension. Although clinical symptoms in the neonatal period are well described, few reports address long-term follow-up after fetal exposure to angiotensin II receptor antagonists. We here report on a patient who was unwittingly exposed to olmesartan medoxomil during pregnancy. After birth, the neonate presented with mild clinical symptoms, mainly affecting the kidneys. However, neurodevelopmental follow-up revealed a delay in motor development with muscular hypotonia and failure to thrive at age 2 years. This case highlights the fact that, despite not causing neurological symptoms in the neonatal period, fetal angiotensin II receptor antagonist exposure during pregnancy might lead to neurodevelopmental impairment in later life.

scholarly journals Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19)

2021 ◽  
pp. CJN.16281020
Author(s):  
Jesús Rivero ◽  
Maribel Merino-López ◽  
Rossana Olmedo ◽  
Rubén Garrido-Roldan ◽  
Bernardo Moguel ◽  
...  
Keyword(s):  
Kidney Biopsy ◽  
Light And Electron Microscopy ◽  
Kidney Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Lower Probability ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Multicenter Observational Study ◽  
History Of ◽  
Histopathologic Findings

Background and objectivesAKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity.Design, setting, participants, & measurementsOur multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables.ResultsA total of 85 patients were included. Median age was 57 (49–66) years, 69% were men, body mass index was 29 (26–35) kg/m2, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2–3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings.ConclusionsA high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.

scholarly journals Olmesartan-Induced Enteropathy: A Case of Recurrent Diarrhoea

2020 ◽  
Author(s):  
Ana Rita Matos ◽  
Elisabete Coelho ◽  
Sofia Caridade
Keyword(s):  
Clinical Presentation ◽  
Villous Atrophy ◽  
Kidney Injury ◽  
Duodenal Mucosa ◽  
Outpatient Basis ◽  
Antibody Testing ◽  
Blood Tests ◽  
History Of ◽  
Biopsy Examination ◽  
Previous Admission

A 77-year-old man with arterial hypertension and dyslipidaemia, treated with olmesartan/hydrochlorothiazide and simvastatin, was admitted with a 3-week history of anorexia, nausea, vomiting, profuse diarrhoea and weight loss. He was dehydrated and blood tests showed acute kidney injury. The aetiological study was inconclusive. The patient had a favourable clinical evolution during hospitalization and was discharged. However, after about 10 days at home, he was re-admitted to hospital with the same clinical presentation. It was noticed that olmesartan had not been prescribed during the previous admission but had been restarted on an outpatient basis. Biopsy examination showed duodenal mucosa with villous atrophy and polymorphic inflammatory infiltrate. Antibody testing for coeliac disease was negative. Based on these facts, it was hypothesized that the patient had olmesartan-induced enteropathy, which was subsequently confirmed.

Methotrexate-Induced Cutaneous Ulcers in a Nonpsoriatic Patient: Case Report and Review of the Literature

2011 ◽  
Vol 15 (5) ◽  
pp. 275-279 ◽  
Author(s):  
Anil Kurian ◽  
Richard Haber
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Marrow ◽  
Complete Healing ◽  
Bone Marrow Suppression ◽  
Review Of The Literature ◽  
Patient Case ◽  
Antimitotic Agent ◽  
Autoimmune Conditions ◽  
History Of

Background: Methotrexate is a mainstay of treatment for autoimmune conditions such as rheumatoid arthritis and psoriasis. Methotrexate has numerous potential side effects and, in rare circumstances, can lead to cutaneous ulceration. Methotrexate can cause skin ulceration, and stopping this medication can lead to complete healing of the ulcerated lesion. Observations: A 67-year-old man with rheumatoid arthritis on long-term methotrexate therapy presented to hospital with ulcers on his hands, elbows, and lower extremities. He had no history of psoriasis. Shortly after admission, the patient was noted to have pancytopenia. A bone marrow biopsy showed a hypocellular marrow. Both the cutaneous ulcers and the hypocellular marrow were thought to be induced by methotrexate. The ulcerated areas were biopsied, and histopathology showed no evidence of vasculitis. After 1 month of rehabilitative skin care, the patient's ulcers healed almost completely and his bone marrow suppression recovered. Conclusion: We report the fifth case of methotrexate-induced cutaneous ulceration in a nonpsoriatic patient and review the literature on this unusual drug reaction. Methotrexate can induce cutaneous ulceration in nonpsoriatic patients and should be considered a potential cause of ulceration in patients treated with this antimitotic agent.

scholarly journals Retroperitoneal Leiomyosarcoma Presenting as Lower Gastrointestinal Bleeding: A Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Dominic G. Ventura ◽  
Shyam J. Thakkar ◽  
Katie Farah
Keyword(s):  
Gastrointestinal Bleeding ◽  
Early Recognition ◽  
Lower Gastrointestinal Bleeding ◽  
Retroperitoneal Mass ◽  
Review Of The Literature ◽  
Rectal Varices ◽  
Term Survival ◽  
History Of ◽  
Hepatic Lesions

We report the first known case of a retroperitoneal leiomyosarcoma that presented with an endoscopically defined source of gastrointestinal bleeding in the colon. A 68-year-old male with a history of diverticulosis, hypertension, and hypercholesterolemia who complained of a 3-month history of abdominal pain, nausea, and intermittent hematochezia presented for evaluation of large volume hematochezia and lightheadedness. Colonoscopy revealed left-sided diverticulosis and rectal varices without stigmata of recent bleed. CT scan showed a 26 × 20 × 13 cm heterogeneous retroperitoneal mass and multiple hypodense hepatic lesions. Liver biopsy revealed leiomyosarcoma. In summary, although surgery is the mainstay of treatment, resectability has not improved significantly. Early recognition and aggressive surgery are keys to long-term survival.

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