Aims: Catheter-related infection, which is one of the major side effects of the use of dialysis catheters, leads to increases in hospitalization, morbidity and mortality. Antibiotic lock is an option for reducing the ...Aims: Catheter-related infection, which is one of the major side effects of the use of dialysis catheters, leads to increases in hospitalization, morbidity and mortality. Antibiotic lock is an option for reducing the incidence of these infections, but there are concerns regarding antibiotic resistance. A prior study demonstrated that Taurolock (a taurolidine lock) may reduce the rate of catheter-related infection. Methods and Material: This investigation was a prospective before-and-after study. During period one, patients continued to use a heparin lock (5000 units/ml) for 6 months. During period two, they were shifted to Taurolock (a solution of 1.35% taurolidine, 4% citrate, and 500 units/ml of heparin) for 6 months. The primary outcome was the incidence of tunneled catheter-related infection and/or catheter exchange, and the secondary outcomes were the effects of Taurolock on catheter flow rate, dialysis adequacy, and catheter malfunction rate. Results: A total of 49 patients were included in this study. During period one, the primary outcome occurred 17 times, with an incidence rate of 86.8 per 100 patient-years;during period two, the primary outcome occurred 7 times, with an incidence rate of 32.6 per 100 patient-years (incidence rate ratio: 2.65, 95% confidence interval (CI): 1.05 - 7.6, P = 0.023). There was no significant difference between the two periods with respect to mean catheter blood flow rate (P = 0.29). During period one, thrombolytic therapy (TPA) lock was indicated on 19 occasions, with an incidence rate of 97 per 100 patient-years;during period two, TPA lock was indicated on 53 occasions, with an incidence rate of 247.5 per 100 patient-years (incidence rate ratio: 0.3, 95% CI: 0.21 - 0.67, P = 0.0003). Conclusions: We demonstrated that Taurolock usage is safe and effective for the prevention of dialysis catheter-related infection and/or catheter exchange.展开更多
Multiple myeloma is a malignant plasma cell disorder that affects the kidney with various clinical presentations. The most common renal manifestation of multiple myeloma is myeloma cast nephropathy. We are describing ...Multiple myeloma is a malignant plasma cell disorder that affects the kidney with various clinical presentations. The most common renal manifestation of multiple myeloma is myeloma cast nephropathy. We are describing a young patient with multiple myeloma presented with back pain, anemia and renal impairment. The renal biopsy showed a myeloma cast nephropathy. She was treated with myeloma chemotherapy, high cut-off hemodialysis and autologous hematopoietic stem cell transplantation with good outcome. We report this rare case of multiple myeloma presented with myeloma cast nephropathy (MCN) in a young patient to describe the evidence of light chain removal strategies including plasmapheresis and high cut-off hemodialysis for the management of myeloma cast nephropathy.展开更多
Coronavirus disease 2019 has spread across the world and has been classified as a pandemic.It has overwhelmed the healthcare systems.Specifically,it has overstretched the intensive care units and renal replacement the...Coronavirus disease 2019 has spread across the world and has been classified as a pandemic.It has overwhelmed the healthcare systems.Specifically,it has overstretched the intensive care units and renal replacement therapy services in many countries.In this paper,we discuss the reconfiguration of nephrology services in the State of Qatar during the current pandemic.We highlight the key strategies that have been implemented to ensure that renal replacement therapy capacity is not constrained in either the intensive care or ambulatory setting.Some innovative approaches for the safe delivery of ambulatory care to dialysis and kidney transplant patients are also discussed.展开更多
Background: Encapsulating peritoneal sclerosis is a rare but life-threatening condition in peritoneal dialysis. It is associated with extensive thickening and fibrosis of the peritoneum resulting in recurrent small bo...Background: Encapsulating peritoneal sclerosis is a rare but life-threatening condition in peritoneal dialysis. It is associated with extensive thickening and fibrosis of the peritoneum resulting in recurrent small bowel obstructions and malnutrition. Herein we present case series of encapsulating peritoneal sclerosis diagnosed and treated in a large center of peritoneal dialysis in the State of Qatar followed by literature review to increase the awareness of physicians to it. Case Presentation: The data were collected retrospectively from 180 peritoneal dialysis patients at Hamad General Hospital, Doha, Qatar, between 2008 and 2016. The diagnosis of encapsulating peritoneal sclerosis was based on clinical and radiological features. Seven patients (3.8%) were diagnosed with encapsulating peritoneal sclerosis. The mean age of the patients was 49 years (range, 23 to 65 years). The mean duration of peritoneal dialysis was 6 years (range, 3 to 7 years). The mean peritonitis episodes were 1.8 (range 1 to 4 episodes). Five patients were diagnosed with encapsulating peritoneal sclerosis after stopping peritoneal dialysis, and two patients diagnosed while they were on peritoneal dialysis treatment. Five patients are still alive and were treated with oral prednisolone and tamoxifen. Two patients underwent adhesiolysis surgery, one of them died due to recurrent sepsis and malnutrition. Another patient died because of cardiac arrest during hemodialysis. The overall mortality rate was 28.5% in our series. Conclusions: Encapsulating peritoneal sclerosis is a rare and life-threatening peritoneal disease in chronic peritoneal dialysis patients. It requires high index of suspicion for early diagnosis and treatment.展开更多
<strong>Background:</strong> A highly contagious virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a pandemic globally. HIV medications were one of the suggested treatmen...<strong>Background:</strong> A highly contagious virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a pandemic globally. HIV medications were one of the suggested treatments for Coronavirus disease 2019 (COVID-19). Here, we report an unusual adverse drug reaction with darunavir in a SARS-CoV-2-infected patient. <strong>Case Presentation:</strong> This is a case presentation of a 53-year-old male with no past medical history who was diagnosed with COVID-19. One week after initiating treatment, the patient developed acute kidney injury, and his serum creatinine increased significantly. <strong>Conclusion:</strong> As there was no clear justification for renal impairment such as a prerenal or postrenal cause, acute kidney injury, possibly crystal-induced nephropathy, was considered an adverse drug reaction from darunavir.展开更多
文摘Aims: Catheter-related infection, which is one of the major side effects of the use of dialysis catheters, leads to increases in hospitalization, morbidity and mortality. Antibiotic lock is an option for reducing the incidence of these infections, but there are concerns regarding antibiotic resistance. A prior study demonstrated that Taurolock (a taurolidine lock) may reduce the rate of catheter-related infection. Methods and Material: This investigation was a prospective before-and-after study. During period one, patients continued to use a heparin lock (5000 units/ml) for 6 months. During period two, they were shifted to Taurolock (a solution of 1.35% taurolidine, 4% citrate, and 500 units/ml of heparin) for 6 months. The primary outcome was the incidence of tunneled catheter-related infection and/or catheter exchange, and the secondary outcomes were the effects of Taurolock on catheter flow rate, dialysis adequacy, and catheter malfunction rate. Results: A total of 49 patients were included in this study. During period one, the primary outcome occurred 17 times, with an incidence rate of 86.8 per 100 patient-years;during period two, the primary outcome occurred 7 times, with an incidence rate of 32.6 per 100 patient-years (incidence rate ratio: 2.65, 95% confidence interval (CI): 1.05 - 7.6, P = 0.023). There was no significant difference between the two periods with respect to mean catheter blood flow rate (P = 0.29). During period one, thrombolytic therapy (TPA) lock was indicated on 19 occasions, with an incidence rate of 97 per 100 patient-years;during period two, TPA lock was indicated on 53 occasions, with an incidence rate of 247.5 per 100 patient-years (incidence rate ratio: 0.3, 95% CI: 0.21 - 0.67, P = 0.0003). Conclusions: We demonstrated that Taurolock usage is safe and effective for the prevention of dialysis catheter-related infection and/or catheter exchange.
文摘Multiple myeloma is a malignant plasma cell disorder that affects the kidney with various clinical presentations. The most common renal manifestation of multiple myeloma is myeloma cast nephropathy. We are describing a young patient with multiple myeloma presented with back pain, anemia and renal impairment. The renal biopsy showed a myeloma cast nephropathy. She was treated with myeloma chemotherapy, high cut-off hemodialysis and autologous hematopoietic stem cell transplantation with good outcome. We report this rare case of multiple myeloma presented with myeloma cast nephropathy (MCN) in a young patient to describe the evidence of light chain removal strategies including plasmapheresis and high cut-off hemodialysis for the management of myeloma cast nephropathy.
基金We thank Dham T,Abdulla A,Joseph J,Joseph S,and all the Hamad Medical Corporation staff for their excellence in patient care in these extremely difficult times.We also thank Hamza Asim for his assistance with computer graphics.
文摘Coronavirus disease 2019 has spread across the world and has been classified as a pandemic.It has overwhelmed the healthcare systems.Specifically,it has overstretched the intensive care units and renal replacement therapy services in many countries.In this paper,we discuss the reconfiguration of nephrology services in the State of Qatar during the current pandemic.We highlight the key strategies that have been implemented to ensure that renal replacement therapy capacity is not constrained in either the intensive care or ambulatory setting.Some innovative approaches for the safe delivery of ambulatory care to dialysis and kidney transplant patients are also discussed.
文摘Background: Encapsulating peritoneal sclerosis is a rare but life-threatening condition in peritoneal dialysis. It is associated with extensive thickening and fibrosis of the peritoneum resulting in recurrent small bowel obstructions and malnutrition. Herein we present case series of encapsulating peritoneal sclerosis diagnosed and treated in a large center of peritoneal dialysis in the State of Qatar followed by literature review to increase the awareness of physicians to it. Case Presentation: The data were collected retrospectively from 180 peritoneal dialysis patients at Hamad General Hospital, Doha, Qatar, between 2008 and 2016. The diagnosis of encapsulating peritoneal sclerosis was based on clinical and radiological features. Seven patients (3.8%) were diagnosed with encapsulating peritoneal sclerosis. The mean age of the patients was 49 years (range, 23 to 65 years). The mean duration of peritoneal dialysis was 6 years (range, 3 to 7 years). The mean peritonitis episodes were 1.8 (range 1 to 4 episodes). Five patients were diagnosed with encapsulating peritoneal sclerosis after stopping peritoneal dialysis, and two patients diagnosed while they were on peritoneal dialysis treatment. Five patients are still alive and were treated with oral prednisolone and tamoxifen. Two patients underwent adhesiolysis surgery, one of them died due to recurrent sepsis and malnutrition. Another patient died because of cardiac arrest during hemodialysis. The overall mortality rate was 28.5% in our series. Conclusions: Encapsulating peritoneal sclerosis is a rare and life-threatening peritoneal disease in chronic peritoneal dialysis patients. It requires high index of suspicion for early diagnosis and treatment.
文摘<strong>Background:</strong> A highly contagious virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a pandemic globally. HIV medications were one of the suggested treatments for Coronavirus disease 2019 (COVID-19). Here, we report an unusual adverse drug reaction with darunavir in a SARS-CoV-2-infected patient. <strong>Case Presentation:</strong> This is a case presentation of a 53-year-old male with no past medical history who was diagnosed with COVID-19. One week after initiating treatment, the patient developed acute kidney injury, and his serum creatinine increased significantly. <strong>Conclusion:</strong> As there was no clear justification for renal impairment such as a prerenal or postrenal cause, acute kidney injury, possibly crystal-induced nephropathy, was considered an adverse drug reaction from darunavir.
