Robert O. Berkseth

Immune-Complex Nephritis in Mixed Connective Tissue Disease

Excerpt Mixed connective tissue disease has been recognized as a rheumatic syndrome with features similar to those of systemic lupus erythematosus, progressive systemic sclerosis, and polymyositis,...

Human Granulocytic Ehrlichiosis Presenting with Acute Renal Failure and Mimicking Thrombotic Thrombocytopenic Purpura

We present the case of an elderly female patient presenting with recurrent acute renal failure, fever, altered mental status, abdominal pain, thrombocytopenia and a small number of fragmented red cells on peripheral smear mimicking recurrent thrombotic thrombocytopenic purpura (TTP). Eventually, however, she was diagnosed to have human granulocytic ehrlichiosis (HGE), and after treatment for HGE her clinical and laboratory abnormalities resolved. Ehrlichiosis mimicking TTP, diagnosed at postmortem examination, has been described in a single prior case. As illustrated in this case, there are potential difficulties in diagnosing HGE after plasma exchange, blood transfusion and immunosuppressive therapy. Ehrlichiosis, a potentially curable disease, should be considered in the differential diagnosis of thrombotic microangiopathic disorders.

Sensitivity of Erythrocytes to Oxidant Stress in Uremia

The erythrocytes from 19 chronic hemodialysis patients were examined for Heinz bodies and their sensitivity to oxidant stress. Heinz bodies were found in 63% of patients and an elevated level of oxidized hemoglobin in 36%. When exposed to acetylphenhydrazine oxidant stress, 84% had a normal response and 95% had stable reduced glutathione levels. Ascorbic-acid-induced oxidant stress was tolerated by 84%. The activities of enzymes associated with the hexose monophosphate shunt were examined and found to be intact. This study demonstrates an increased number of Heinz bodies in hemodialysis patients. However, this is not due to an increased sensitivity to oxidant stress. Other mechanisms must be sought to explain the presence of Heinz bodies in these patients.

Adequacy, Benefits, Complications, Dose and Efficacy of Filtration – The Minneapolis Experience

Twenty-four patients were studied in an A-B-A format with 3 months of control hemodialysis, 12 months of hemofiltration, and 3 months return to control hemodialysis. Hemofiltration was performed in th

Dietary Factors in Calcium Nephrolithiasis

■ Objective: To review dietary factors implicated in the pathogenesis of calcium nephrolithiasis and the pathophysiological mechanisms proposed for each. ■ Data sources: Data were obtained from English language articles published between 1950 and 1991 addressing the evaluation and therapy of patients with nephrolithiasis. The articles are indexed in the National Library of Medicines MEDLINE data base. ■ Study selection: Studies selected for inclusion in this review were those that identified and discussed dietary factors in the pathophysiology of calcium nephrolithiasis. ■ Data extraction: References were reviewed by the authors with emphasis on study size, randomization, and statistical analysis. ■ Data synthesis: Renal stone formation is the result of genetic, metabolic, and environmental factors. The most important environmental factors relate to diet. Assessment of dietary sodium, calcium, phosphorus, oxalate, protein, fiber, fluid, and exogenous vitamins is mandatory in the initial evaluation of the patient with renal stones. Instruction to correct identified dietary excesses or deficiencies is the first therapeutic intervention for all patients, including those in whom additional drug therapy is ultimately required. ■ Conclusions: Nutritional intervention is central to the evaluation, therapy, and long-term monitoring of the patient with calcium nephrolithiasis.