Sara Leitão

Acute kidney injury in an internal medicine ward in a Portuguese quaternary hospital

BACKGROUND The term acute kidney injury (AKI) was proposed to reflect the wide spectrum of traditional acute renal failure. RIFLE classification stratifies AKI into three classes of severity and two classes of outcome. AKIN classification proposes an improvement regarding RIFLE in the stratification of AKI, while recently published KDIGO guidelines comprise characteristics of both RIFLE and AKIN. There are no published studies on the utility and measure of agreement between classifications in patients admitted to internal medicine wards. METHODS Prospective study undertaken in two internal medicine wards in a Portuguese hospital. Patients admitted for a minimum of 72 h, with a diagnosis of AKI or acute-on-chronic kidney disease at admission or during hospitalisation, were included. RIFLE, AKIN and KDIGO criteria were applied for identification of AKI and stratification into risk groups. RESULTS Sixty-nine patients were included, with a mean age of 79.7±10.0 years and mean GFR of 21.7±8.8 mL/min/1.73 m2. Hypovolaemia due to dehydration was the main cause of AKI (53.6%) and, thereby, RIFLE classification identified a higher number of patients as having AKI, compared to AKIN (94.2% vs. 84.1%). Most patients (69.6%) recovered to their baseline renal function, however fifteen patients (21.7%) died, 53.3% presenting more severe kidney disease. CONCLUSIONS Our results demonstrate good concordance and correlation between RIFLE, AKIN and KDIGO criteria for the diagnosis of AKI (p<0.001 at initial and final assessment). The authors support the need for further improvement of the classification, ultimately through the use of new biomarkers capable of earlier identification of patients at risk.

Sclerosing Mesenteritis and Disturbance of Glucose Metabolism: A New Relationship? A Case Series

Case series Patient: Male, 51 • Male, 70 • Male, 63 • Male, 67 • Female, 76 Final Diagnosis: Sclerosing mesenteritis Symptoms: Abdominal pain Medication: — Clinical Procedure: Colcicine Specialty: Metabolic Disorders and Diabetics Objective: Rare co-existance of disease or pathology Background: Sclerosing mesenteritis is an idiopathic inflammatory and fibrotic disease that affects the mesentery. It is a rare disease, with the total number of reported cases in the literature ranging from 122 to 300. It mainly affects men in the sixth decade of life, and its etiology remains unknown. Clinical presentation is variable, but it is frequently asymptomatic. Diagnosis is often made by computed tomography (CT) scan, although biopsy may be needed for confirmation. An association between other diseases (e.g., neoplasms) and sclerosing mesenteritis has been described, but the relationship between the latter and glucose changes is not disclosed in the currently available literature. Case Report: Five cases of sclerosing mesenteritis and glucose metabolism disorders (impaired fasting glucose and type 2 diabetes mellitus) were retrospectively collected and analyzed. The mean age was 65±9.3 years, 80% were male, and all patients were white. Three patients were asymptomatic and the other 2 (40%) had non-specific chronic abdominal pain. Blood tests revealed normal inflammatory parameters (mean HbA1c was 6.4% and fasting blood glucose was 140 mg/dL). The diagnosis was made by abdominal CT scan. The 2 symptomatic patients underwent therapy with colchicine 1 mg/day, with clinical improvement. During the mean 43-month follow-up period, there was no symptomatic progression, thereby maintaining the usual benign course of this condition. Conclusions: Sclerosing mesenteritis has only been described in small series and isolated cases, but its diagnosis is becoming more common due to greater access to diagnostic methods and higher awareness of the disease in the medical community. Furthermore, despite the small sample size, we describe a possible association between glucose metabolism impairment and sclerosing mesenteritis.

Tuberculose miliar e febre Q em doente imunocompetente

Resumo A tuberculose miliar e a forma de doenca progressiva resultante da disseminacao hematogenea macica do Mycobacterium tuberculosis (MT). Afecta imunodeprimidos e idosos e tem manifestacoes clinicas insidiosas e inespecificas. O caso clinico descrito refere-se a um homem adulto, sem imunodeficiencia, com infeccao simultânea por Coxiella burnetti e MT. A raridade desta associacao e a sua forma de apresentacao sublinham a necessidade de alto grau de suspeicao clinica para a formulacao dos diagnosticos, sendo este o segundo caso descrito na literatura.