B. Barbosa

Acute Granulomatous Interstitial Nephritis – A Rare Case of Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology with a wide range of clinical presentations. Authors describe the case of a 72-year-old man with severe acute renal injury secondary to granulomatous interstitial nephritis. Despite the suggestive renal biopsy, only the exclusion of other granulomatous diseases enabled the definitive diagnosis of renal sarcoidosis. The patient underwent hemodialysis and therapy with prednisolone 1mg/kg/day. His serum creatinine returned to baseline over the following months, with no evidence of residual injury. Sarcoid interstitial nephritis is usually silent, and there are very few reported cases associated with severe acute renal failure.

In-hospital mortality in centenarians admitted to an internal medicine ward

Introduction.– The increase of centenarians requiring hospitalization is a reality. The main purpose of the study was to analyze the determinants of in-hospital mortality among centenarians admitted to an Internal Medicine ward. Methods.–A cohort of 63patients, 100years of age andolder, admitted to Internal Medicine, from 2008 to 2012, were retrospectively studied. Demographic information, comorbidities, recent admissions (past 90 days), clinical and laboratory data were recorded from each patient. Results.– Of these 63 patients, with a mean age of 101.1 years, 57 (90.5%)werewomen. Themain reasons for admissionwere respiratory infection (68,3%), especially healthcare-associated pneumonia (38.1%), and urinary infection (12.7%). The most commonly identified comorbiditieswere hypertension (58.7%), heart failure (54.0%), atrial fibrillation (33.3%), renal disease (28.6%) and respiratory disease (28.6%). Diabetes was present in 10 patients. The overall mortality was 36.5%, respiratory infections were responsible for most deaths (69.6%). Patients coming from nursing homes had higher mortality (52.9%). 17 patients had at least one hospitalization in the last 90 days, with a mortality of 58.8% (versus 28.26% in patients without recent hospitalizations). 8 patients had pressure ulcers, of which 5 died. 55.6% of patients with renal disease also died. Laboratory tests associated with mortality were: leukocytes, C-reactive protein, creatinine, BUN and lactates. Conclusions.– The leading cause of hospitalization was respiratory infections. Most comorbidities identified were referred to the cardiovascular system, however diabetes percentage was relatively low. Mortality among hospitalized centenarians was very high, particularly in patients in nursing homes and with recent hospitalizations.