scholarly journals Chlorhexidine – a commonly used but often neglected culprit of dialysis associated anaphylactic reactions (case report)

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Jia Neng TAN ◽  
Yi ◽  
Sabrina HAROON ◽  
Titus LAU
Keyword(s):  
Dialysis Patient ◽  
Kidney Injury ◽  
Healthcare Setting ◽  
Dialysis Treatment ◽  
Case Presentation ◽  
Fluid Removal ◽  
Life Saving ◽  
End Stage ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Abstract Background Hemodialysis-associated anaphylactic reactions are rare and frequently complex in nature due to the sheer number of possible culprit agents. Unfortunately, dialysis is often unavoidable or strictly essential for life-saving solute clearance or fluid removal in patients with end stage kidney failure and those with severe acute kidney injury. It is of utmost importance that the culprit agent is identified and avoided to allow continuation of dialysis treatment as needed. Case presentation We present 2 cases of hemodialysis-associated anaphylactic reactions. These patients developed anaphylactic reactions peri-dialysis and were initially suspected to have dialyser reactions. They were investigated in a controlled healthcare setting and possible culprit agents were systemically identified and eliminated. They both underwent allergy testing and were diagnosed with chlorhexidine allergy. Of note, Case 1 was an incident dialysis patient at the time of presentation and Case 2 was a prevalent dialysis patient. This suggests that the time from initial sensitization to reaction may not always be helpful in determining if a particular agent is the culprit of an anaphylactic reaction. In both cases, the patients were dialysed through a tunnelled dialysis catheter. We postulate that the presence of an exit site, which represents a compromise to the integrity of the skin’s epidermal barrier, may have a significant role in the development of these reactions. As chlorhexidine is a widely used disinfectant in hemodialysis, it is imperative that we consider it as a possible culprit agent when these reactions arise. To our knowledge, there are no other reported cases of anaphylaxis secondary to chlorhexidine use in dialysis patients other than a previous report in 2017. Our report also highlights the possibility of these reactions occurring more frequently in patients with damaged epidermal barriers and in patients exposed to higher environmental concentrations of chlorhexidine. These are novel concepts that can be explored with further research. Conclusion Chlorhexidine associated anaphylactic reactions can occur in the peri-dialysis setting and a high index of suspicion is paramount to diagnosis.

scholarly journals Premature atherosclerosis and acute coronary syndrome in a child with end-stage renal disease

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Tülay Becerir ◽  
Münevver Yılmaz ◽  
İlknur Girişgen ◽  
Neslihan Yılmaz ◽  
Dolunay Gürses ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Left Coronary Artery ◽  
Premature Atherosclerosis ◽  
Case Presentation ◽  
Coronary Syndrome ◽  
Life Saving ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Although acute coronary syndrome is rare in children, it is the most important cause of mortality in children with end-stage renal disease. Case presentation Here, a 16-year-old pediatric patient, who has been on dialysis since the age of 3, and who was diagnosed with acute coronary syndrome and placed an emergency percutaneous transcatheter stent in the left anterior descending branch of the left coronary artery is presented. It is important that the present patient does not have any electrocardiography findings in favor of cardiovascular disease and that he cannot fully explain the complaint of chest pain due to his mental retardation. Conclusions Early detection of acute coronary syndrome is life-saving, especially in children with chronic kidney disease.

scholarly journals Alport's Syndrome in Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Suchita Mehta ◽  
Chadi Saifan ◽  
Marie Abdellah ◽  
Rita Choueiry ◽  
Rabih Nasr ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Adverse Outcomes ◽  
Rapid Progression ◽  
Alport's Syndrome ◽  
Case Presentation ◽  
Alport’S Syndrome ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
In Pregnancy

Background. Alport's syndrome is an X-linked hereditary disorder affecting the glomerular basement membrane associated with ocular and hearing defects. In women, the disease is much less severe compared to that in men. However, women with Alport's syndrome can have an accelerated form of their disease during pregnancy with worsening of kidney function and can also develop preeclampsia. There are only four described cases of Alport's syndrome in pregnancy.Case Presentation. 20-year-old woman with a history of Alport's syndrome, which during pregnancy worsened resulting in hypertension, proteinuria, and acute kidney injury. Fortunately, there was complete resolution of the proteinuria and kidney injury with delivery, and the patient did not require any renal replacement therapy.Conclusion. One of the four reported cases had an accelerated form of the disease during pregnancy with rapid progression of kidney injury and end-stage renal disease. There are no definite guidelines to monitor these patients during pregnancy. Further studies are required to understand the exact pathophysiology of kidney damage that occurs in pregnant women with Alport's syndrome. This may give us some insight into the prognostic predictors, so that we can monitor these women more thoroughly and prevent adverse outcomes.

scholarly journals Evaluation of Hypervolemia in Children

2020 ◽  
Author(s):  
Matjaž Kopač
Keyword(s):  
Kidney Injury ◽  
Critically Ill Children ◽  
Fluid Restriction ◽  
Circulating Blood Volume ◽  
Fluid Removal ◽  
Nutrition Management ◽  
Effective Circulating Blood Volume ◽  
Total Body ◽  
Stage Renal Disease ◽  
End Stage

AbstractHypervolemia is a condition with an excess of total body water and when sodium (Na) intake exceeds output. It can have different causes, such as hypervolemic hyponatremia (often associated with decreased, effective circulating blood volume), hypervolemia associated with metabolic alkalosis, and end-stage renal disease. The degree of hypervolemia in critically ill children is a risk factor for mortality, regardless of disease severity. A child (under 18 years of age) with hypervolemia requires fluid removal and fluid restriction. Diuretics are able to increase or maintain urine output and thus improve fluid and nutrition management, but their benefit in preventing or treating acute kidney injury is questionable.

scholarly journals Pediatric Cecal Volvulus: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Chukwubuike Emeka ◽  
Chukwubuike Emeka
Keyword(s):  
Intestinal Obstruction ◽  
Rare Case ◽  
Clinical Presentation ◽  
Chromosomal Abnormalities ◽  
Cecal Volvulus ◽  
Predisposing Factor ◽  
Case Presentation ◽  
Mobile Cecum ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Introduction: Cecal volvulus (CV) is rare cause of intestinal obstruction especially in children. There is no established protocol for the treatment of CV due to its rarity. Case Presentation: We present a rare case of CV in a 9-year-old girl. Discussion: The spectrum of intestinal malrotation may give rise to a mobile cecum that may result to CV. Constipation could be a predisposing factor. The clinical presentation which may include abdominal pain, distension, constipation and vomiting depends on the time of presentation. There may be associations with chromosomal abnormalities. Conclusion: Although CV is a rare cause of intestinal obstruction, awareness and high index of suspicion is needed by clinician for early diagnosis and treatment.

scholarly journals Case Report: Delayed Post-partum Preeclampsia in rural Ecuador

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Miguel Obregón ◽  
Carolina Betancourt ◽  
David Gaus
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Magnesium Sulfate ◽  
Post Partum ◽  
Hypertensive Urgency ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Peripartum Period ◽  
High Index Of Suspicion ◽  
Time Of Presentation

Background: Delayed, Post-partum preeclampsia is an unusual presentation of preeclampsia.  Delay in diagnosis at the time of presentation could result in progression to eclampsia.  Consideration should be given to routine post-partum checkup at 3-4 weeks rather than 6 weeks in countries where home birthing is still common. Case Presentation: We report a case of delayed, post-partum preeclampsia in a mother 4 weeks post-partum who presented to our emergency department with headache and abdominal pain. Hypertensive urgency was diagnosed.  Subsequently, a 24 hour urine indicated significant proteinuria, and delayed postpartum preeclampsia was established.  Her blood pressure normalized and adequate diuresis was maintained.  Magnesium Sulfate was not initiated. Conclusion: A high index of suspicion for preeclampsia is required in hypertension in the peripartum period.  This is also true up to one month post partum.  When should magnesium sulfate be discontinued in these patients who have adequate diuresis and normal blood presssures, the signs normally used in the immediate post-partum period that the preeclampsia has resolved?

scholarly journals Rare crystalline nephropathy leading to acute graft dysfunction: a case report

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sahil Bagai ◽  
Dinesh Khullar ◽  
Bhavna Bansal
Keyword(s):  
Correct Diagnosis ◽  
Kidney Injury ◽  
Graft Dysfunction ◽  
Case Presentation ◽  
Therapeutic Implications ◽  
High Index Of Suspicion ◽  
Indian Male ◽  
Aprt Deficiency ◽  
Genetic Form ◽  
Acute Graft

Abstract Background Adenine phosphoribosyl transferase (APRT) deficiency is a rare genetic form of kidney stones and/or kidney failure characterized by intratubular precipitation of 2,8 dihydroxyadenine crystals. Early diagnosis and prompt management can completely reverse the kidney injury. Case presentation 44 year old Indian male, renal transplant recipient got admitted with acute graft dysfunction. Graft biopsy showed light brown refractile intratubular crystals with surrounding giant cell reaction, consistent with APRT deficiency. Patient improved after receiving allopurinol and hydration. Conclusion APRT forms a reversible cause of crystalline nephropathy. High index of suspicion is required for the correct diagnosis as timely diagnosis has therapeutic implications.

Rare giant inguinal hernia causing end-stage dialysis-dependent renal failure

2020 ◽  
Vol 13 (4) ◽  
pp. e233140
Author(s):  
Jacob Levi ◽  
Karl Chopra ◽  
Mubashar Hussain ◽  
Shafiul Chowdhury
Keyword(s):  
Inguinal Hernia ◽  
Mesh Repair ◽  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Past Medical History ◽  
Bladder Hernia ◽  
Open Mesh Repair ◽  
Catheter Tip ◽  
End Stage ◽  
Open Mesh

A 72-year-old man presented with urinary retention, weight loss, haematuria and severe acute kidney injury. He had never before been admitted to hospital and his past medical history included only an inguinal hernia. On examination, he appeared uraemic and had a right-sided painful hernia. A three-way catheter was inserted, bladder washouts performed and irrigation started. An ultrasound showed severe bilateral hydronephrosis and a ‘thickened bladder’ and this was thought to be obstructive uropathy secondary to bladder cancer. Twenty-four hours later his hernia doubled in diameter, became incarcerated and a CT of the abdomen and pelvis showed an inguinal hernia of both bladder and bowel, with the catheter tip inside the bladder hernia. He was taken to theatres and an open mesh repair was performed with a rigid cystoscopy to assist in locating and reducing the bladder. He required intensive care and dialysis postoperatively and remains on regular dialysis following discharge.

scholarly journals Delayed bowel perforation after instilling over warmed peritoneal dialysate

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueli Lai ◽  
Mingming Nie ◽  
Xiaodong Xu ◽  
Yuanjie Chen ◽  
Zhiyong Guo
Keyword(s):  
Peritoneal Dialysis ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Dialysis Patient ◽  
Case Presentation ◽  
Abdominal Organs ◽  
Home Based ◽  
Dialysis Solution ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

scholarly journals Zebrafish as a New Tool in Heart Preservation Research

2021 ◽  
Vol 8 (4) ◽  
pp. 39
Author(s):  
Luciana Da Silveira Cavalcante ◽  
Shannon N. Tessier
Keyword(s):  
New Technologies ◽  
Ex Vivo ◽  
Machine Perfusion ◽  
Life Saving ◽  
First Choice ◽  
Heart Preservation ◽  
End Stage Heart Failure ◽  
Ischemia Tolerance ◽  
The 1960S ◽  
End Stage

Heart transplantation became a reality at the end of the 1960s as a life-saving option for patients with end-stage heart failure. Static cold storage (SCS) at 4–6 °C has remained the standard for heart preservation for decades. However, SCS only allows for short-term storage that precludes optimal matching programs, requires emergency surgeries, and results in the unnecessary discard of organs. Among the alternatives seeking to extend ex vivo lifespan and mitigate the shortage of organs are sub-zero or machine perfusion modalities. Sub-zero approaches aim to prolong cold ischemia tolerance by deepening metabolic stasis, while machine perfusion aims to support metabolism through the continuous delivery of oxygen and nutrients. Each of these approaches hold promise; however, complex barriers must be overcome before their potential can be fully realized. We suggest that one barrier facing all experimental efforts to extend ex vivo lifespan are limited research tools. Mammalian models are usually the first choice due to translational aspects, yet experimentation can be restricted by expertise, time, and resources. Instead, there are instances when smaller vertebrate models, like the zebrafish, could fill critical experimental gaps in the field. Taken together, this review provides a summary of the current gold standard for heart preservation as well as new technologies in ex vivo lifespan extension. Furthermore, we describe how existing tools in zebrafish research, including isolated organ, cell specific and functional assays, as well as molecular tools, could complement and elevate heart preservation research.

scholarly journals SARS-CoV-2 infection in an infant with non-respiratory manifestations: a case report

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Muhammad Adel ◽  
Ahmed Magdy
Keyword(s):  
Computed Tomography ◽  
Aplastic Anemia ◽  
Rt Pcr ◽  
Positive Real ◽  
Case Presentation ◽  
Chest Computed Tomography ◽  
High Incidence ◽  
Laboratory Investigations ◽  
High Index Of Suspicion ◽  
Specific Symptoms

Abstract Background Coronavirus disease (COVID-19) presents in children usually with less severe manifestations than in adults. Although fever and cough were reported as the most common symptoms, children can have non-specific symptoms. We describe an infant with aplastic anemia as the main manifestation. Case presentation We describe a case of SARS-CoV-2 infection in an infant without any respiratory symptoms or signs while manifesting principally with pallor and purpura. Pancytopenia with reticulocytopenia was the predominant feature in the initial laboratory investigations, pointing to aplastic anemia. Chest computed tomography surprisingly showed typical findings suggestive of SARS-CoV-2 infection. Infection was later confirmed by positive real-time reverse transcription polymerase chain reaction assay (RT-PCR) for SARS-CoV-2. Conclusions Infants with COVID-19 can have non-specific manifestations and a high index of suspicion should be kept in mind especially in regions with a high incidence of the disease. Chest computed tomography (CT) and testing for SARS-CoV-2 infection by RT-PCR may be considered even in the absence of respiratory manifestations.

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