Leonard L. Vertuno

Hypercalcemia Associated with Silicone-Induced Granulomas

HYPERCALCEMIA occurs in a variety of chronic granulomatous diseases, such as sarcoidosis,1 2 3 4 tuberculosis,5 , 6 and berylliosis.7 Except in sarcoidosis, the mechanism for the hypercalcemia obse...

Pneumocystis carinii pneumonia: a lethal complication of "pulse" methylprednisolone therapy.

A previously healthy, HIV-negative, 67-year-old man developed rapidly progressive glomerulonephritis. Following “pulse” methylprednisolone therapy he developed Pneumocystis carinii pneumonia. This complication should be recognized as a potential hazard of “pulse” steroid therapy.

Systemic lupus erythematosus presenting with hyporeninemic hypoaldosteronism in a 10-year-old girl.

Hyperkalemia has been noted to occur spontaneously in patients with long-standing systemic lupus erythematosus who did not have advanced renal insufficiency. The patients previously described all had relatively normal renin-aldosterone systems, and the hyperkalemia was thus presumed to be secondary to a primary defect in renal tubular potassium secretion. We describe at 10-year-old girl with lupus nephritis, without significant renal insufficiency, who had hyperkalemia from hyporeninemic hypoaldosteronism postulated to be due to vasculitis involving the afferent/efferent arterioles and juxtaglomerular apparatus.

The Role of Splenectomy in Cadaveric Renal Transplantation

We analyzed 50 consecutive cadaver renal transplants to ascertain what benefit, if any, accrued from pretransplantation splenectomy. Because antithymocyte globulin was administered in a random fashion to some patients, its effects were also analyzed. Recipient modification with either modality enhanced graft survival in first transplants when compared to no modification (splenectomy versus no modification 62 versus 27%, p = 0.06; ATG versus modification 75 versus 27%, p = 0.01). The collective experience with splenectomy, its rationale, and its complications are discussed.