David A. Ogden

Cardiac calcification in uremia: A clinical, biochemical and pathologic study☆

Abstract Clinical, electrocardiographic and biochemical data are correlated with pathologic findings in six patients receiving chronic dialysis who demonstrated moderate to severe metastatic calcification of the myocardium at postmortem. Electrocardiographic changes or congestive heart failure were the only clue to metastatic calcification since x-ray signs of osteitis fibrosa or soft tissue metastatic calcification were absent. First degree heart block, the initial electrocardiographic finding in five cases, occurred within thirteen months of death and was subsequently associated with intraventricular conduction defect in four patients. This progressed to complete heart block in two patients. Sudden death occurred in two patients and intractable congestive heart failure was observed in two patients. Calcium deposition and fibrosis of the atrioventricular (A-V) node were seen in four patients with partial or complete heart block. Marked calcium deposition in the interventricular septum was noted in four patients with intraventricular conduction defect. Two patients with congestive heart failure showed moderate to severe metastatic calcification of the ventricular myocardium. One patient who died suddenly showed nearly complete calcific obliteration of the sino-atrial node. Calcium deposition with luminal narrowing of small myocardial vessels was found in all cases. The artery to the A-V node was narrowed in four patients and to the sino-atrial node in one patient. Parathyroid hyperplasia was noted in all patients.

Post-transplantation T cell lymphoblastic lymphoma

Immunosuppressed renal transplant recipients are at increased risk for large cell lymphoma of B cell phenotype. This report describes a case of post-transplantation lymphoma presenting with a mediastinal mass causing superior vena cava syndrome, tracheal obstruction, and pleural effusion. Cytospin preparations of pleural fluid documented high-grade lymphoblastic lymphoma morphology and immature T cell (cortical thymocyte) phenotype: Leu 1-6-positive, Leu 9-positive, Tdt-positive, B-negative, Calla-positive. The occurrence of post-transplantation lymphoma of T cell lineage is inconsistent with the postulated Epstein-Barr virus origin and raises important questions regarding the development of lymphoproliferative disorders in immunosuppressed organ transplant recipients.

Immunosuppressive Therapy and Plasmapheresis in Rapidly Progressive Glomerulonephritis Associated With Bacterial Endocarditis

A 25-year-old male presented with new cardiac murmurs and acute renal insufficiency. Blood cultures grew Streptococcus viridans and appropriate antibiotic therapy was initiated. A renal biopsy revealed diffuse proliferative glomerulonephritis with crescents involving more than 50% of the glomeruli. Treatment with antibiotics, plasmapheresis, and steroids resulted in renal recovery that paralleled reductions in circulating immune complexes. The rationale for this therapeutic approach is discussed, as well as a review of two similar case reports. These experiences suggest a possible role for plasmapheresis and immunosuppressive drugs in patients who develop rapidly progressive glomerulonephritis as a complication of bacterial endocarditis.

Function of the renal homograft in man immediately after transplantation

Abstract Six patients subjected to renal homotransplantation and simultaneous bilateral nephrectomy have been studied to characterize the diuresis observed after transplant and to seek evidence of specific tubular functions in the period immediately after transplantation. A diuresis of 5,825 to 14,855 ml. per 24 hours, lasting less than 72 hours was observed in five of six cases. The magnitude of the diuresis was found to relate directly to initial creatinine clearance. Investigation of urinary composition revealed the diuresis to be osmotic. The ratio of electrolyte osmolal clearance to osmolal clearance exceeded 50 per cent in five of the six patients. Urinary urea constituted a significant but lesser portion of urinary solute. In five of six cases, mean creatinine clearances 6 and 18 hours after the transplant were 65.4 and 66.5 ml. a minute, respectively. The mean para-aminohippurate (PAH) clearance was 247 ml. a minute at 6 hours and 358 ml. a minute at 18 hours in the four patients studied at both times. Activity of specific tubular mechanisms for glucose, sodium and solute-free water reabsorption and for potassium secretion was demonstrated in the first five days following renal homotransplantation.

Continuous Arteriovenous Hemodiariltration: An Aggressive Approach to the Management of Acute Renal Failure

Continuous arteriovenous hemodiafiltration (CAVHD) offers a modified therapeutic approach to the patient with acute renal failure. The system employs a hollow-fiber dialyzer, whose perfusion is dependent on the patients BP. Peritoneal dialysis solution is infused through the dialysate ports in a direction countercurrent to blood flow at a rate of 500 to 1,500 mL/h. Five complex patients with acute renal failure were treated with CAVHD for periods ranging from two to 40 days. Urea clearances approached 37 Lld, and in stable patients, the BUN was maintained at 40 to 60 mg/dL and serum creatinine 1.4 to 4.0 mg/dL. Ultrafiltration up to 1 Llh could be obtained without difficulty. CAVHD is a safe and technically simple procedure that is particularly suitable for hemodynamically unstable patients with ongoing needs for fluid removal.

Exertional Heat Stroke and Acute Renal Failure in a Young Woman

Strenuous exercise leading to heat stroke is known to cause rhabdomyolysis and acute renal failure in men, but there are no reports of this environmental illness in otherwise healthy women. We report the first case of heat and exercise induced acute renal failure in a young nonacclimated adult female following intense exertion in the Grand Canyon. This individual displayed the typical clinical features of exertional heat stroke including hyperpyrexia, CNS disturbance, rhabdomyolysis, oligoanuric acute renal failure, and disseminated intravascular coagulopathy. The pathophysiology is discussed as well as sexual differences in response to heat and exercise. The specific factors that may have predisposed this young woman to heat stroke from exertion are identified.

Hypermagnesemia After Renal Homotransplantation

Abstract The clinical and biochemical features of three patients who developed magnesium intoxication after renal homotransplantation are described. All patients were receiving magnesium-containing...

Massive azathioprine overdose:Case report and review of the literature

Abstract A review of the literature failed to reveal any previous report of accidental or intentional massive overdose with azathioprine. We present the results of a single azathioprine overdose of 7,500 mg in a renal transplant recipient receiving long-term immunosuppressive therapy. The immediate toxic reactions were nausea, vomiting and diarrhea followed by mild leukopenia, mild abnormalities in liver function and improved renal function. An increased sensitivity to the drug, evidenced by a second leukopenic episode, followed resumption of therapy 1 week later.

Urinary solute excretion as an index of renal homograft rejection.

Excerpt Initial technical success is usually achieved in human renal transplantation. Subsequent survival of the homograft and of the patient requires successful control of graft rejection. Early r...

Simultaneous tuberculosis and coccidioidomycosis in end stage renal disease

During a ten year period, tuberculosis and coccidioidomycosis occurred in less than one and three percent respectively of 380 patients who had received dialysis and renal transplants in Southern Arizona. In two patients, who were immunosuppressed by diabetes, renal failure, and inanition, these infections were concurrent and diagnosis was delayed. Because the occurrence of both illnesses in two patients is unlikely by chance alone and because both infections were present when symptoms developed, potentiation of one infection by the other may have occurred.