Despite improvements in overall prognosis in lupus nephritis, 10%-30% of patients with proliferative renal involvement progress to end stage renal disease, according to the severity of the disease and associated socio...Despite improvements in overall prognosis in lupus nephritis, 10%-30% of patients with proliferative renal involvement progress to end stage renal disease, according to the severity of the disease and associated socioeconomic factors. Kidney transplantation has been recognized as the most appropriate treatment for those patients, but several issues remain after renal function restoration in a lupus recipient. Among these are the fear of lupus nephritis recurrence in the graft,the choice of immunosuppressive therapy in cases of recurrent lupus for a patient who has already received a toxic and prolonged immunosuppressive course, and finally, the management of comorbidities to reduce associated morbidities in the long term. All the above topics are examined in this review, with the hope of providing a clear picture of data as illustrated in the current literature.展开更多
BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report o...BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)patient.CASE SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial scan.Upon arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 h.Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2.COVID-19 lung involvement was mild and was resolved without specific treatment.Myocardial injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per os.CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable patients.Morbidity and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than thos...BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable patients.Morbidity and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than those in the general population,but vary across continents and countries in Europe.AIM To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece.METHODS We correlated clinical,laboratory,and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic.The diagnosis was confirmed by real-time polymerase chain reaction.Outcome was determined as survivors vs non-survivors and“progressors”(those requiring oxygen supplementation because of COVID-19 pneumonia worsening)vs“non-progressors”.RESULTS We studied 32 patients(17 males),with a median age of 75.5(IQR:58.5-82)years old.Of those,12 were diagnosed upon screening and 20 with related symptoms.According to the World Health Organization(WHO)score,the severity on admission was mild disease in 16,moderate in 13,and severe in 3 cases.Chest computed tomography(CT)showed 1-10%infiltrates in 24 patients.Thirteen“progressors”were recorded among included patients.The case fatality rate was 5/32(15.6%).Three deaths occurred among“progressors”and two in“non-progressors”,irrespective of co-morbidities and gender.Predictors of mortality on admission included frailty index,chest CT findings,WHO severity score,and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin.Predictors of becoming a“progressor”included increasing number of neutrophils and neutrophils/lymphocytes ratio.CONCLUSION Patients on MHD seem to be at higher risk of COVID-19 mortality,distinct from the general population.Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.展开更多
文摘Despite improvements in overall prognosis in lupus nephritis, 10%-30% of patients with proliferative renal involvement progress to end stage renal disease, according to the severity of the disease and associated socioeconomic factors. Kidney transplantation has been recognized as the most appropriate treatment for those patients, but several issues remain after renal function restoration in a lupus recipient. Among these are the fear of lupus nephritis recurrence in the graft,the choice of immunosuppressive therapy in cases of recurrent lupus for a patient who has already received a toxic and prolonged immunosuppressive course, and finally, the management of comorbidities to reduce associated morbidities in the long term. All the above topics are examined in this review, with the hope of providing a clear picture of data as illustrated in the current literature.
文摘BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)patient.CASE SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial scan.Upon arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 h.Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2.COVID-19 lung involvement was mild and was resolved without specific treatment.Myocardial injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per os.CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable patients.Morbidity and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than those in the general population,but vary across continents and countries in Europe.AIM To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece.METHODS We correlated clinical,laboratory,and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic.The diagnosis was confirmed by real-time polymerase chain reaction.Outcome was determined as survivors vs non-survivors and“progressors”(those requiring oxygen supplementation because of COVID-19 pneumonia worsening)vs“non-progressors”.RESULTS We studied 32 patients(17 males),with a median age of 75.5(IQR:58.5-82)years old.Of those,12 were diagnosed upon screening and 20 with related symptoms.According to the World Health Organization(WHO)score,the severity on admission was mild disease in 16,moderate in 13,and severe in 3 cases.Chest computed tomography(CT)showed 1-10%infiltrates in 24 patients.Thirteen“progressors”were recorded among included patients.The case fatality rate was 5/32(15.6%).Three deaths occurred among“progressors”and two in“non-progressors”,irrespective of co-morbidities and gender.Predictors of mortality on admission included frailty index,chest CT findings,WHO severity score,and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin.Predictors of becoming a“progressor”included increasing number of neutrophils and neutrophils/lymphocytes ratio.CONCLUSION Patients on MHD seem to be at higher risk of COVID-19 mortality,distinct from the general population.Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.
