Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer

Introduction Cetuximab, an anti-EGFR monoclonal antibody, often cause skin toxicity, most commonly acneiform rash. We present a rare case of glomerulonephritis associated with cetuximab therapy. Case Report A 58-year-old male patient recently completed cetuximab-based chemotherapy for metastatic colorectal adenocarcinoma. He presented with acute renal failure, anasarca edema and nephrotic proteinuria. The amount of protein in the 24-h urine test was over 15.6 grams. Management & Outcome The patient showed a dramatic improvement in renal function shortly after terminated of cetuximab therapy without immunosuppressive therapy. Discussion Therefore, drugs targeting epidermal growth factor receptor (EGFR) monoclonal antibody were thought to trigger nephrotic syndrome by causing glomerular damage. As a result, physicians using EGFR monoclonal inhibitors should be very careful about renal functions and proteinuria in patients.

Nontypical presentation of a common disease: a case report

Background Kawasaki disease is an idiopathic medium-sized vasculitis that occurs primarily in infants and children younger than 5 years of age. Atypical Kawasaki disease applies to patients who do not fulfill the complete criteria of fever of 5 days or more with at least four of five features: bilateral conjunctival injection, changes in the lips and oral cavity, cervical lymphadenopathy, extremity changes, and polymorphous rash. Acute kidney injury is defined as a sudden decline in kidney function within hours, including structural injuries and loss of function. Acute kidney injury is extremely common in hospitalized pediatric patients. However, it is rarely documented in Kawasaki disease. Acute kidney injury is underestimated in Kawasaki disease due to the lack of a clear definition of age-specific normal serum creatinine levels and routine renal functions. This report describes a case who presented with clinical features suggestive of atypical Kawasaki disease and developed acute kidney injury. Case presentation A 2-year-old Saudi girl had a history of high-grade fever for 5 days, moderate dehydration, dry cracked lips, poor appetite, and generalized erythematous rash; therefore, she was diagnosed to have incomplete Kawasaki disease. Laboratory investigations revealed normochromic normocytic anemia, leukocytosis, thrombocytosis, high inflammatory markers, and acute kidney injury stage III. An echocardiogram showed a 4-mm dilatation on the left main coronary artery and a 3-mm dilatation on the right. A renal biopsy was not performed to identify the cause of the injury as it showed improvements after the start of the specific therapy for Kawasaki disease; intravenous immune globulin at a dose of 2 g/kg, aspirin at a high dosage of 80 mg/kg/day, and prednisolone at 2 mg/kg. In addition to the acute kidney injury management, normal saline boluses were followed by furosemide at a 2 mg/kg dose. Her urine output increased, and her renal functions normalized. She was discharged in good condition after 10 days. Conclusions It is valuable to check renal function tests in a confirmed case of Kawasaki disease to reduce the negative consequences of late acute kidney injury discovery. Early detection and intervention make a substantial difference in acute kidney injury management.

PERCUTANEOUS CYSTOLITHOLAPAXY AS AN ALTERNATIVE APPROACH FOR GIANT BLADDER STONES: A CASE SERIES OF PATIENTS WITH SIGNIFICANT COMORBIDITIES

Objective: We reported two giant bladder stones cases, with significant comorbidities and mentally impaired patients, treated with PCCL. Case(s) Presentation: We report two cases of giant cystolithiasis (sized 8.8 cm x 7.2 cm and 7.0 cm x 5.8 cm) in male patients with impaired renal functions and mental illness. We performed PCCL on both patients with cystoscopy-guided bladder puncture and dilation, under spinal anesthesia. Stone fragmentation through transurethral (pneumatic) and percutaneous (suprapubic amplatz ultrasound) lithotriptors was performed simultaneously. Discussion: Stone fragments were evacuated through the nephroscope. These fluoroscopy-free procedures were performed under one hour. The patients were discharged on day three post-operatively without indwelling catheter. Conclusion: We performed PCCL with simultaneous transurethral fragmentation in giant bladder stone cases presenting with impaired renal functions and mental illness. We faced no significant post-operative issue. This technique, or its modified approach, is safe and applicable

Pathophysiological Basis of COVID-19

The World Health Organization (WHO) recognized the coronavirus disease (COVID-19) as a worldwide pandemic caused by a newly discovered coronavirus responsible for Severe Acute Respiratory Syndrome (SARS-Cov2). The virus appeared in Wuhan, China in December 2019 and spread throughout the world, causing several mortality cases particularly in older people and those with chronic diseases. A body of evidence suggests a multi-target of SARS-Cov2, which may act beyond the respiratory system being responsible for other pathological complications, including the gastrointestinal tract, nervous, and the renal functions. The chapter will provide a literature review of the recent data on COVID-19 physiopathology involving in addition to the respiratory dysfunction all the potential physiological functions which could be independently and directly impaired by the SARS-Cov2.

Evaluation of acute and subchronic toxicity of “Tran Chau Nguu Hoang Hoan” in experimental animals

“Tran chau nguu hoang hoan” was prepared from 12 herbal ingredients. So far, the safety of this product, has not been reported yet. Thus, this study aimed to evaluate the acute and subchronic toxicity of “Tran chau nguu hoang hoan” through oral administration in experimental animals. The acute toxicity was determined by the method of Litchfield Wilcoxon in mice at the doses of 2.42 g/kg b.w/day to 6.04 g/kg b.w/day. The subchronic toxicity was evaluated followed the Guideline of WHO and OECD in rats with oral doses of 58.0 mg/kg b.w/day and 174.0 mg/kg b.w/day for 12 consecutive weeks. As a result, in the course of the acute toxicity test, the mice showed no abnormal sign or death. In terms of the subchonic toxicity test, hematological indexes, hepato-renal functions and microscopic images of liver and kidney were unchanged. In conclusion, “Tran chau nguu hoang hoan” does not appear to produce acute and subchronic toxicities in mice and rats.

The study of acute and subchronic toxicities of Da Dai Trang HVD capsules in experimental animals

The purpose of this research is to evaluate the acute and subchronic toxicities of DA DAI TRANG HVD capsules through oral administration in experimental animals. The acute toxicity was determined by the method of Litchfield Wilcoxon in Swiss mice. The subchronic toxicity was evaluated by the recommendation of WHO and OECD in Wistar rats with oral doses of 1.44 g/kg/day (equal to recommended human dose) and 4.32 g/kg/day (3 times as high as recommended human dose) in 4 consecutive weeks. As a result, DA DAI TRANG HVD capsules at the highest dose used for mice (99.9 g materials/kg) did not express acute toxicity in mice. In term of the subchonic toxicity test, DA DAI TRANG HVD had no deleterious effect on hematological parameters, hepato-renal functions, macroscopic and microscopic images of livers and kidneys of rats. In conclusion, DA DAI TRANG HVD capsules did not produce the acute and subchronic toxicities in Swiss mice and Wistar rats.

Clinical profile of acute kidney injury in neonates with perinatal asphyxia

Background: Acute kidney injury (AKI) is one of the most common complication observed in perinatal asphyxia. Early recognition is required for appropriate treatment and improve the outcome.Methods: It is a hospital based retrospective study conducted from august 2019 to December 2019. Total 85 full term neonates with perinatal asphyxia were included in the study. Renal functions were assessed by monitoring urine output, serum creatinine and ultrasonography. Acute kidney injury assessed by pRIFLE criteria and HIE staging is done by modified Sarnat and Sarnat staging. Severity of AKI is correlated with stages of HIE. AKI is managed as per unit protocol.Results: Total 85 perinatal asphyxia neonates were included in the study. Out of total 85 neonates, 25 (29.4%) neonates had evidence of acute kidney injury. Among 25 neonates with acute kidney injury, higher percentage was observed in male neonates which was 14 (56%) against 11 (44%) among female neonates. Predominantly, non oligouric acute kidney injury was observed among acute kidney injury neonates which accounted to 20 neonates (80%) (p-0.258). Serum creatinine between 1.5-2 mg/dl was observed in 18 (21.1%) neonates and 7 (8.2%) neonates had creatinine between 2-3 mg/dl. Sonological abnormality was noted in 2 (2.3%) neonates. Among neonates with non oligouric AKI, 3 (12%) neonates had HIE stage 1, 15 (60%) had HIE-2 and 7 (28%) had HIE-3. However, neonates with non oligouric AKI were higher among HIE 2 when compared to neonates with oligouric renal failure who were higher in HIE 3. No mortality occurred among these neonates.Conclusions: Majority of the neonates with perinatal asphyxia had non oliguric AKI which responded well to conservative treatment. AKI is most commonly seen in HIE stage 2 babies. Since non oligouric renal failure was a predominant finding among asphyxiated neonates, Serum creatinine monitoring remains main stay of diagnosis.