ABSTRACT: There is an increasing recognition of the association between chronic hepatitis C virus infection and glomerular diseases.
Renal complications may be the presenting manifestation of hepatitis C virus infection. Patients may present with signs and
symptoms of cryoglobulinemic systemic vasculitis, proteinuria, microscopic hematuria, acute renal failure, or nephrotic syndrome.
The pathogenesis of hepatitis C virus associated with renal disease remains incompletely understood; however, deposition of
circulating immune complexes in the subendothelial space and mesangium in the glomeruli seems to play a major role. The most
common renal pathology associated with hepatitis C virus infection is type I membranoproliferative glomerulonephritis with
or without cryoglobulinemia. In patents who do not have significant renal impairment, combination therapy with interferon
alfa (IFN-α) and ribavirin seems to be the treatment of choice, although the experience with this combination is quite limited
in patients with renal involvement. A prolonged course of high-dose IFN-α has been most commonly used for these patients with
significant success, but relapse of hepatitis C viremia and renal disease after discontinuation of therapy have frequently
Current Gastroenterology Reports 04/2012; 3(1):79-83.
ABSTRACT: There is an increasing recognition of the association between chronic hepatitis C virus (HCV) infection and glomerular diseases.
Renal complications may be the presenting manifestation of HCV infection. Patients may present with systemic vasculitis secondary
to cryoglobulinemia, or they may present with proteinuria, microscopic hematuria, acute renal failure, or nephrotic syndrome.
The pathogenesis of HCV-associated renal disease remains incompletely understood; however, deposition of HCV-containing circulating
immune complexes in the glomeruli (ie, subendothelial space and mesangium) seems to play an important role. The most common
renal pathology associated with HCV infection is type I membranoproliferative glomerulonephritis with or without cryoglobulinemia.
In patients who do not have significant renal impairment, combination therapy with interferon-á and ribavirin is the treatment
of choice. The experience with this combination therapy is quite limited in patients with renal impairment. Prolonged courses
of high-dose interferon-á therapy have been successfully used for these patients; however, relapse of HCV viremia and recurrence
of renal disease is common after discontinuation of therapy.
Current Hepatitis Reports 04/2012; 1(1):23-29.
Clinical and Experimental Nephrology 07/2009; 13(6):677-8. · 1.37 Impact Factor
ABSTRACT: A 54-year-old male with chronic osteomyelitis presented with new-onset hypercalcemia. Extensive initial evaluation did not reveal the underlying cause of his hypercalcemia. Subsequent biopsies revealed squamous cell carcinoma transformation consistent with Marjolin's ulcer. Timely surgery had been shown to be effective in achieving remission in patients with Marjolin's ulcers, even in the presence of hypercalcemia. Therefore, we recommend that patients with chronic wounds and new-onset or otherwise unexplained hypercalcemia should be evaluated for development of Marjolin's ulcers.
Military medicine 04/2009; 174(3):308-10. · 0.92 Impact Factor
ABSTRACT: A hallmark of the clinical syndrome of thrombotic thrombocytopenic purpura (TTP) is evidence of microangiopathic hemolytic anemia. The presence of schistocytes on the peripheral blood smear, elevated plasma lactic dehydrogenase, and decreased haptoglobin concentration are used as evidence of microangiopathic hemolytic anemia to make a diagnosis of TTP. This report describes a case of recurrence of TTP in the absence of schistocytes in the peripheral blood smear during the recurrent episode. Although careful attention should be paid to microscopic examination of a blood smear in any patient presenting with acute renal failure and thrombocytopenia, this case emphasizes the need to consider TTP-hemolytic uremic syndrome in the differential diagnosis, even in the absence of peripheral schistocytosis.
Southern Medical Journal 04/2005; 98(3):392-5. · 0.83 Impact Factor
ABSTRACT: Nephrogenic fibrosing dermopathy (NFD) is a rare clinical entity affecting patients with renal failure, often on chronic dialysis or after transplantation. The patient profile at risk for this debilitating condition is undefined. Lack of awareness of the condition has hampered epidemiologic work in identifying the etiology. We present four chronic hemodialysis (HD) patients who developed this disease. The patients' ages ranged from 26 to 75 years, and they had received HD from between 20 months and 10 years before the diagnosis of NFD. Two patients had a history of renal transplantation. All patients had progressive thickening and woody induration of the skin associated with contractures, leading to difficult ambulation, and permanent disability within weeks of the diagnosis. In one case, the diaphragm, psoas muscle, and pericardium were involved. The latter is likely the first report of pericardial involvement of NFD. In all four patients, the skin findings were restricted to the extremities, sparing the trunk and face. Skin biopsy findings included thickened dermis with particularly thickened collagen bundles, fibroblast proliferation, minimal mucin deposition, and nearly absent inflammation. The pathologic findings were distinct from scleromyxedema and scleroderma. We found no laboratory evidence of autoimmune disease or thyroid dysfunction to account for alternate etiologies. CD34-positive cells were documented in the skin biopsies as well as in the diaphragm, psoas muscle, and pericardial tissue of the concerned case. NFD is a novel fibrosing disorder of progressively debilitating nature which needs further clinical characterization and recognition to guide investigation of its pathogenesis.
Hemodialysis International 11/2004; 8(4):404-8. · 1.54 Impact Factor
ABSTRACT: Management of tunneled, cuffed, central venous catheters in hemodialysis (HD) patients with bacteremia remains a challenge. Attempts to salvage the catheter with systemic antibiotics alone have been associated with increased risk of metastatic infectious complications.
Retrospective case series of patients with infectious complications in a chronic dialysis unit, affiliated with a tertiary care university hospital.
Between 1996 and 1999, when we treated HD catheter-associated bacteremia with systemic antibiotics alone, we encountered a clustering of 8 cases of paraspinal/vertebral infections in a population of 162 patients. After changing our protocol, i.e., routine catheter exchange over a guide wire at approximately 48 h, while on systemic antibiotic therapy, we did not encounter any new cases of paraspinal/vertebral infections over a 15-month period.
Our experience suggests that routine exchange of tunneled, cuffed catheters over a guide wire in HD patients presenting with bacteremia may significantly reduce serious infectious complications, e.g., epidural abscess/vertebral osteomyelitis.
American Journal of Nephrology 23(4):202-7. · 2.54 Impact Factor