Basant Pawar

A prospective study of cutaneous abnormalities in patients with chronic kidney disease

There are diverse ways in which the skin is affected by chronic kidney disease (CKD). Various specific and nonspecific skin abnormalities are observed in patients with CKD. The aim of the study was to document the prevalence of skin diseases that commonly occur in patients with CKD on medical treatment and dialysis. A total of 99 patients with CKD were examined for evidence of skin diseases. Ninety-six had at least one cutaneous abnormality attributable to CKD. The most prevalent finding was xerosis (66.7%), followed by pallor (45.45%), pruritus (43.4%), and cutaneous pigmentation (32.3%). Other cutaneous manifestations included dermatitis (27.27%); Kyrles disease (17.17%); fungal (8.08%), bacterial (11.1%), and viral (5.05%) infections; purpura (10.1%); gynecomastia (4.04%); and yellow skin (5.05%). The common nail changes were half and half nails (36.36%) and onycholysis (13.13%). CKD is associated with various cutaneous abnormalities caused either by the disease or by treatment, the most common being xerosis and pruritus. The dermatologic complications can significantly impair the quality of life in certain individuals; therefore, earlier diagnosis and treatment is important to improve their quality of life.

Thrombotic thrombocytopenic purpura and systemic lupus erythematosus: successful management of a rare presentation.

Thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) very rarely present simultaneously and pose a diagnostic and therapeutic dilemma to the critical care team. Prompt diagnosis and management with plasma exchange and immunosuppression is life-saving. A patient critically ill with TTP and SLE, successfully managed in the acute period of illness with plasma exchange, steroids and mycophenolate mofetil is described.

Acute interstitial nephritis in association with polymyositis

170 J Postgrad Med April 2008 Vol 54 Issue 2 lower lobes of the lungs, especially if it is in contact with the diaphragm, along with primary lung, pleural and diaphragmatic neoplasms as well as metastases and other non-neoplastic causes. A noninvasive imaging modality such as a CT scan with FNAC should establish the correct diagnosis and more invasive procedures like diagnostic pneumoperitoneum and an exploratory thoracotomy should seldom be required.

All that is swollen and red is not infection

Unilateral upper limb extremity swelling and pain are common presentations in clinical practice whose differential diagnoses include cellulitis, abscess, lymphoedema, and venous thrombosis. We report here the case of a renal transplant recipient with an unusual cause of upper extremity swelling and pain. His condition of native radiocephalic, arteriovenous (AV), fistula-related, venous hypertension was misdiagnosed and managed as cellulitis. This case illustrates the importance of an index of suspicion and careful clinical examination for diagnosis and thus, avoid potentially dangerous and distressing symptoms. The patient improved with a surgical AV fistula ligation.

Successful renal transplantation after two separate urinary tract malignancies

A patient who was treated for renal cell carcinoma and transitional cell carcinoma, later presented with end stage renal disease. He was managed with hemodialysis and later underwent successful renal transplantation. There was no evidence of tumor recurrence nearly nine years post-renal transplantation.

A sinister presentation of typhoid fever

Hemolytic uremic syndrome (HUS) is a recognized complication of E. coli O157:H7 and Shigella infection. It has been rarely associated with Salmonella typhi infection and has a high mortality, if the recognition and treatment of this disease is delayed. A fatal outcome of HUS following Salmonella typhi infection is described.

ARCS/AUCS: A rare clinicoradiological presentation

A rare presentation of ARCS (azoospermia, renal anomalies, cervicothoracic spine dysplasia)/AUCS (azospermia, urogenital anomaly, cervicothoracic spine dysplasia) in a patient of end-stage renal disease is described. ARCS/AUCS is analogous to MURCS (Mullerian duct aplasia, renal aplasia, cervicothoracic somite dysplasia) in females.[1,2]

Gastric antral vascular ectasia in a renal transplant patient

Gastric antral vascular ectasia syndrome (GAVE) is an uncommon cause of gastrointestinal bleeding. Pharmacotherapeutic and endoscopic intervention in patients with GAVE is a challenge, especially when surgery is a closed option due to an underlying severe hepatic impairment. The clinical presentation and management of a renal allograft recipient with the GAVE syndrome is described.