Chronic Copper Sulfate Poisoning

Copper, as a salt, is toxic and has the potential to harm multiple organs. Copper intoxication causes intravascular haemolysis followed by liver and kidney failure that can be fatal. We present a case of chronic copper sulfate poisoning in a 66-year-old man with dysphagia to solids and liquids, anaemia, acute kidney injury, liver cytolysis and hypocalcaemia. The patient improved with supportive care, but chronic kidney disease was established. Anamnesis was crucial for the diagnosis, given the non-specific signs and symptoms. The history of chronic exposure to pest treatment with a blue dust cloud made us suspect copper sulfate poisoning.

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Quinine-Induced Thrombotic Microangiopathy (Q-TMA): Frequency, Presenting Features, Outcomes

Blood ◽

10.1182/blood.v128.22.1381.1381 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1381-1381 ◽

Cited By ~ 1

Author(s):

Evaren E Page ◽

Sara K. Vesely ◽

James N. George

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Conflicts Of Interest ◽

Elevated Serum ◽

Kidney Injury ◽

Long Term Outcome ◽

Presenting Symptoms ◽

Immune Mediated ◽

Organ Systems ◽

History Of

Abstract Q-TMA is an acute, severe, immune-mediated, drug-induced disorder. Q-TMA is suspected when symptoms suddenly begin within hours following quinine (Q) exposure. Diagnosis of Q-TMA is established by the history of recurrent acute symptoms following recurrent Q exposures and/or by documentation of Q-dependent antibodies reactive with platelets and/or neutrophils. The Oklahoma TTP-HUS Registry enrolls all patients for whom plasma exchange (PEX) is requested for suspected TTP or HUS. Since 1995, when routine measurement of ADAMTS13 activity began, the Registry has diagnosed 78 patients with acquired TTP (ADAMTS13 <10%). During this time we have also diagnosed 17 patients with Q-TMA; 2 additional patients were diagnosed before 1995. Seventeen of these 19 patients were tested for Q-dependent antibodies; all were positive. Nine patients had a history of recurrent acute symptoms with recurrent Q exposure, including the 2 patients not tested for Q-dependent antibodies. Q exposure was a pill in 18 patients, tonic water in one. Remarkably, 18 patients were women; all 19 patients were white. Common presenting symptoms were fever, chills, nausea and vomiting. No patients had focal neurologic abnormalities. All patients had microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury. Eight patients had elevated serum alanine aminotransferase (231-1345 U/L). Three patients had neutropenia (absolute neutrophil counts, 184-486). Two patients had coagulation abnormalities suggesting disseminated coagulation (DIC). One patient died from complications of the central venous catheter insertion, performed for PEX and dialysis; all other patients recovered normal platelet counts. Three of the 18 surviving patients had end-stage renal disease (2 had kidney transplants). The median estimated glomerular filtration rate (GFR) for the other 15 patients, at 2.7-19.2 years (median, 10.2) after recovery, was 36 ml/min (range, 19-98). Only two patients had normal GFR (≥90 ml/min). Eleven patients had chronic kidney disease, defined by GFR <60 ml/min. Seven of 18 patients have died 4.1-12.7 years (median, 7.8) following recovery at ages 59-87 years. Conclusion. Quinine can cause severe immune-mediated toxicities involving multiple organ systems (Am J Hematol 2016; 91: 461). Q-TMA is an acute disorder causing severe kidney injury and, in some patients, also liver toxicity, neutropenia, and/or DIC. Q-TMA is not rare. During 20 years, we enrolled 17 Q-TMA patients compared to 78 patients with acquired TTP. Chronic kidney disease is a common long-term outcome. Explicit questions are required to discover the association of systemic symptoms with quinine ingestion. Table Table. Disclosures No relevant conflicts of interest to declare.

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Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Journal of Clinical Medicine ◽

10.3390/jcm10225224 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5224

Author(s):

Antonio Mirijello ◽

Pamela Piscitelli ◽

Angela de Matthaeis ◽

Michele Inglese ◽

Maria Maddalena D’Errico ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Strong Predictor ◽

Univariate Analysis ◽

Kidney Injury ◽

Composite Outcome ◽

Glucose Levels ◽

History Of ◽

Clinical Records ◽

The Impact

Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or < 60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95%CI 1.02-2.63, p = 0.040) and age (HR per 5 years 1.22, 95%CI 1.10-1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.

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Midkine as an Early Biomarker of Contrast-induced Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Single-center Prospective Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6634 ◽

2021 ◽

Vol 9 (B) ◽

pp. 983-989

Author(s):

Mohamed Ahmed ◽

Gamal Hamed Ibrahim ◽

Mahmoud Adel ◽

Amira Ismail ◽

Abdallah Almaghraby ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Percutaneous Coronary Intervention ◽

Kidney Disease ◽

Kidney Injury ◽

Coronary Intervention ◽

Left Ventricular Ejection ◽

Percutaneous Coronary ◽

History Of ◽

Early Biomarker

Background: Contrast-induced acute kidney injury (CI-AKI), is an important complication of percutaneous coronary intervention (PCI). We aimed to study the role of serum midkine (MK) as an early biomarker of CI-AKI. Methods: We conducted a prospective observational cohort study. It includes 100 chronic kidney disease (CKD) patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2. All patients were undergoing PCI for ACS. We measured serum midkine before, 2 and 24 hours after PCI. Results: The mean age of the patients was 70.32±3.62 years, 74% males. Twenty-seven patients developed CI-AKI. The CI-AKI group has a history of diabetes mellitus (DM) and/or dyslipidemia, history of diuretics, metformin and/or angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARBs) use. The CI-AKI patients have low left ventricular ejection fraction (LVEF) (EF < 45%) and low Creatinine Clearance (CrCl) before PCI. The CI-AKI received more contrast volume, had a longer duration of PCI and had high Mehran risk score after PCI. Comparison between the two studied groups regarding serum MK showed that there was a statistically significant difference regarding serum MK 2 hours after PCI. Receiver operating characteristic (ROC) curve analysis for serum MK showed that serum MK measured 2 hours after PCI was statistically significant to predict CI-AKI. Conclusion: An early Serum MK after PCI can be used as an early predictor of CI-AKI in ACS patients.

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Detection of SARS-CoV-2 in peritoneal fluid from patients with kidney disease and COVID-19: report of two cases

10.21203/rs.3.rs-79032/v1 ◽

2020 ◽

Author(s):

Margarita Ibarra-Hernandez ◽

María de la Luz Alcantar-Vallín ◽

Rodolfo I. Cabrera-Silva ◽

Karina Sánchez-Reyes ◽

Monserrat Alvarez-Zavala ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Kidney Disease ◽

Peritoneal Fluid ◽

Kidney Injury ◽

Qrt Pcr ◽

Multiple Organs ◽

Progressive Dyspnea ◽

History Of ◽

End Stage ◽

Outpatient Settings

Abstract Background: Coronavirus disease-2019 (COVID-19) has a broad clinical presentation, involving multiple organs besides the respiratory system. Currently, there is little evidence available on the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in peritoneal fluid (PF). In this study, we describe the detection of SARS-CoV-2 in the PF of two patients with COVID 19 and kidney disease.Case presentation: Case 1: A 71-year-old woman with a history of end-stage kidney disease who presented with a 15-day evolution of progressive dyspnea, accompanied by dry cough and fever; IgM antibodies to SARS-CoV-2 were detected on admission. Real-time SARS-CoV-2 polymerase chain reaction (qRT-PCR) in the PF was positive. Three days after admission the patient's respiratory distress improved and she was discharged after 8 days of hospitalization.Case 2: A 78-year-old woman, with type 2 diabetes, hypertension, a 15-day history of polypnea, and a 5-day onset of fever and dyspnea. IgM and IgG antibodies to SARS-CoV-2 were detected on admission, as well as a positive nasopharyngeal qRT-PCR test for SARS-CoV-2. During hospitalization she developed acute kidney injury, requiring peritoneal dialysis, SARS-CoV-2 was confirmed in PF by qRT-PCRConclusions: These two cases highlights the importance of increasing the level of awareness for the presence and possible SARS-CoV-2 transmission through non-respiratory routes, like peritoneal fluid.Emphasis should be given to appropriate preventive strategies for minimizing the risk of transmission of COVID-19 from patients on peritoneal dialysis in both inpatient and outpatient settings.

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Severe hypercalcaemia due to household cleaner ingestion

BMJ Case Reports ◽

10.1136/bcr-2019-231771 ◽

2019 ◽

Vol 12 (10) ◽

pp. e231771

Author(s):

Medha Satyarengga ◽

Kristi D Silver

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Injury ◽

Laboratory Evaluation ◽

Cleaning Product ◽

Hydroxyvitamin D ◽

History Of ◽

Household Cleaning ◽

Severe Hypercalcaemia

We report the case of a 59-year-old man with a history of type 2 diabetes, hypertension and chronic kidney disease who presented with symptomatic severe hypercalcaemia (calcium 15.8 mg/dL) and acute kidney injury. Evaluation revealed that the hypercalcaemia was not mediated by parathyroid hormone (PTH), PTH-related peptide or 1,25-hydroxyvitamin D. Adrenal insufficiency was subsequently diagnosed and was initially thought to be the aetiology of the hypercalcaemia. He was treated with intravenous fluid, pamidronate and started on hydrocortisone with resolution of his hypercalcaemia. Over the next several months, despite adherence to hydrocortisone therapy, the patient continued to have recurrent severe hypercalcaemia requiring hospitalisation. Additional laboratory evaluation showed similar results to the initial evaluation. On further questioning, the patient admitted to routinely ingesting the household cleaning product Comet, which contains a large amount of calcium. Psychiatric assessment confirmed the diagnosis of pica. The patient eventually discontinued ingestion of Comet with resolution of his hypercalcaemia.

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MO390THE RISK FACTORS AND CLINICAL OUTCOMES ASSOCIATED WITH ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0044 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Hormat Rahimzadeh Eshkalak ◽

Hossein Farrokhpour ◽

Sina Kazemian ◽

Maryam Rahbar ◽

Mahnaz Montazeri ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Disease Severity ◽

Kidney Injury ◽

Risk Indicators ◽

Invasive Ventilation ◽

History Of ◽

Male Sex

Abstract Background and Aims Kidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Current evidence on AKI rate in patients hospitalized with COVID-19 and its associated risk factors is limited, especially in Iran. Method In this retrospective cohort study, we enrolled adult patients referred to the Sina hospital, Iran, from 20 February to 14 May 2020, with either a positive PCR test or a highly susceptible chest computed tomography features (CT) consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes (KDIGO) criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge. Results: We evaluated 516 patients with a mean age of 57.6±16.1 years and a male to female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprised of 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multi-organ damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio (OR):11.27), chronic kidney disease (OR: 6.89), history of hypertension (OR:1.69), disease severity (OR; 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge. Conclusion We found that male sex, history of chronic kidney disease, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.

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Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection

Archives of Pediatric Infectious Diseases ◽

10.5812/pedinfect.109915 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Alireza Ghodsi ◽

Elnaz Mahmoudabadi ◽

Sara Ghahremani ◽

Abdolreza Malek

Keyword(s):

Cardiac Involvement ◽

Clinical Signs ◽

Clinical Manifestations ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Signs And Symptoms ◽

Multiple Organs ◽

Clinical Signs And Symptoms ◽

Cardiac Manifestations ◽

Inflammatory Syndrome

Context: Multisystem inflammatory syndrome in children (MIS-C) is an emerging condition after the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, termed COVID-19. This study aimed to describe the cardiac manifestations of children diagnosed with MIS-C. Evidence Acquisition: This narrative review was conducted by searching the PubMed, Scopus, and Google Scholar databases to review MIS-C cardiac manifestations up to September 30, 2020. The demographic features, past medical history, clinical signs and symptoms, cardiac involvement, and the type of COVID-19 diagnosis confirmation were extracted. Results: In many children, MIS-C seems to be a post-infectious complication of the COVID-19 infection. This syndrome affects multiple organs and has various clinical manifestations mimicking Kawasaki disease. Patients frequently present with persistent fever, kidney injury, gastrointestinal (GI) problems, neurologic symptoms, mucosal changes, conjunctivitis, and cardiac involvement. Children with MIS are more likely to present with hypotension, shock, and cardiac dysfunction, rather than coronary artery abnormalities and arrhythmia. Children with MIS need close observation; some need to be hospitalized, and a few may need a Pediatric Intensive Care Unit (PICU) admission. Treatment currently includes anticoagulants, IV immunoglobulin, and anti-inflammatory drugs. Conclusions: As a novel syndrome associated with SARS-CoV-2 infection, MIS-C is potentially lethal. Cardiac manifestations, including coronary and myocardial involvement, are common and should be carefully identified. With prompt diagnosis and proper treatment, most children will survive, but the outcomes of the disease are unknown, so long-term follow-ups are required.

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Chronic kidney disease and acute kidney injury in the COVID-19 Spanish outbreak

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa189 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1353-1361 ◽

Cited By ~ 7

Author(s):

Jose Portolés ◽

María Marques ◽

Paula López-Sánchez ◽

María de Valdenebro ◽

Elena Muñez ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Elevated Serum ◽

Kidney Injury ◽

Hospital Death ◽

Multiple Organs ◽

Kidney Involvement ◽

Cox Proportional Hazard Regression ◽

Novel Coronavirus

Abstract Background Novel coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread, affecting >10 million cases worldwide. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and primarily manifesting as an acute respiratory failure with interstitial and alveolar pneumonia, it can also affect multiple organs. Kidney involvement was underestimated in early reports and its role remains controversial. The aim of this study was to analyse the role of kidney damage in COVID-19 outcome. Methods This is a prospective cohort study of 1603 consecutive patients admitted in a University Reference Hospital in the heart of the European outbreak. Results Median age was 64 years, 40.4% were female, 15.2% presented diabetes mellitus, 35.7% hypertension and 20.3% obesity. On admission, the prevalence of elevated serum creatinine (sCr), proteinuria, leucocyturia and haematuria were 21.0, 37.8, 31.8 and 45.6%, respectively. In total, 43.5% of those with an elevated sCr had previous chronic kidney disease (CKD) and 11.4% of those with normal sCr developed an in-hospital acute kidney injury (AKI); 17 patients needed acute haemodialysis; and 197 patients died during hospitalization. Cox proportional hazard regression confirmed that elevated baseline sCr [hazard ratio (95% confidence interval) 2.40 (1.79–3.22)], previous CKD [1.59 (1.06-2.37)], haematuria [1 + 1.68 (0.92–3.06), 2–3 + 2.69 (1.49–4.87)] and in-hospital AKI [1.50 (0.92–2.44)] were independent risk factors for in-hospital death after adjusting for age, sex and comorbidity. Conclusion The prevalence of acute and chronic kidney disease on admission and in-hospital AKI is higher than previously reported in Wuhan, and is associated with high in-hospital mortality. We should increase our awareness towards kidney involvement and design specific strategies for management of COVID-19 in these patients.

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My Bleeding Nephrons!

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619858126 ◽

2019 ◽

Vol 7 ◽

pp. 232470961985812 ◽

Cited By ~ 1

Author(s):

Jiemin Li ◽

Sandeep Anand Padala ◽

George Hinnant ◽

Anusha Vakiti ◽

Azeem Mohammed

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Iga Nephropathy ◽

Kidney Injury ◽

International Normalized Ratio ◽

Gross Hematuria ◽

Common Risk Factor ◽

Vein Thrombosis ◽

History Of ◽

Uncommon Condition

Anticoagulation-related nephropathy (ARN) is an uncommon diagnosis that should be considered in patients presenting with unexplained acute kidney injury (AKI) and coagulopathy. In this article, we present the case of a 70-year-old male with a history of cirrhosis and portal vein thrombosis on Coumadin who presented to the hospital with gross hematuria. The patient was diagnosed with AKI on chronic kidney disease (CKD) secondary to ARN superimposed on sclerosing IgA nephropathy. ARN, also known as warfarin-associated nephropathy, is an uncommon condition in which AKI from glomerular hemorrhage develops in a patient with an international normalized ratio greater than 3. The most common risk factor for development of ARN is CKD. AKI in our patient unearthed preexisting CKD due to IgA nephropathy as evidenced by the biopsy.

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A Case Report on Mephentermine Induced Psychosis with Acute Liver & Kidney Injury

RECENT ADVANCES IN PATHOLOGY AND LABORATORY MEDICINE ◽

10.24321/2454.8642.202102 ◽

2021 ◽

Vol 07 (1&2) ◽

pp. 4-6

Author(s):

Manjulika Debnath ◽

Keyword(s):

Past History ◽

Kidney Injury ◽

Sudden Onset ◽

Young Population ◽

Kidney Function Tests ◽

Long Term Follow Up ◽

Liver And Kidney ◽

History Of

Background: Mephentermine is a sympathomimetic agent derived from methamphetamine. It is a commonly used drug for the treatment of hypotension during anaesthesia. Its abuse has markedly increased especially in the young population due to its stimulant properties and ability to boost performance in competitive sports or bodybuilding. Very few cases of Mephentermine dependence with or without psychosis have been reported from India and worldwide. Case Description: A 24-year-old male presented with a sudden onset of behavioural abnormalities a few hours following the use of Mephentermine. He was very agitated and restless. On physical examination, tachycardia, elevated BP and bilaterally dilated pupils were found. His symptoms remitted within a few hours of using Injection Haloperidol 10 mg with Lorazepam 4 mg once. He was found to have grossly deranged liver and kidney function tests. There was no past and family history of any psychiatric illness. No past history of any physical illness. Conclusion: No previous report of mephentermine induced psychosis with acute kidney and liver injury has been reported in the literature. Cases such as this may be common among the general public. Long term follow-up is required to know the course and outcome in such unusual cases.

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