Case studies renal failure

Renal Effects. Case studies were located regarding renal effects in humans after oral exposure to chromium(VI) compounds. Acute renal failure, characterized by proteinuria, hematuria, followed by anuria, developed in a chrome plating worker who had accidentally swallowed an unreported volume of a plating fluid containing 300 g chromium trioxide/L. He was treated by hemodialysis (Fristedt et al. 

Renal Effects. Hemorrhage of the medullary layer of the kidneys was observed in an early report of three fatal cases of acute oral poisoning with endosulfan (Terziev et al. 1974). More recent studies have reported acute renal failure after ingestion of endosulfan as a major contributing cause of death in two individuals in both cases, postmortem examination showed extensive tubular necrosis (Blanco-Coronado et al. 1992 Lo et al. 1995). Neither case discussed the possible mechanism of endosulfan-induced acute renal failure, but in one case, the authors of the report indicate that the renal lesions may relate to sepsis and shock (Blanco-Coronado et al. 1992). Ingested doses were not determined in any of these cases, and it is not totally clear that the effects observed at autopsy were a direct result of endosulfan exposure, although based on results from acute animal studies, it seems likely. 

Some case studies suggest that dermal exposure to the vapor of diesel fuel may also result in absorption via the skin. The studies identify one individual with only vapor exposure and two others with vapor and/or direct dermal contact with diesel fuel individuals developed acute renal failure or renal necrosis (Barrientos et al. 1977 Crisp et al. 1979 Reidenberg et al. 1964). Also, dermal exposures to marine diesel fuel and JP-5 in mice induced renal damage (Basely et al. 1982). No studies were located that directly tested dermal absorption of fuel oil vapor. 

Abdominal cramps, vomiting, and diarrhea occurred in a truck driver who was exposed to diesel fuel vapor for 10 days while driving a truck with a leaking fuel injector. Acute renal failure was also observed. One case study describes eye irritation in two individuals exposed to JP-5 fuel (kerosene) for approximately 1 hour while flying an airplane. Coordination and concentration difficulties were noted, as were headache, apparent intoxication, and anorexia. Inhalation of 140mg/m deodorized kerosene by six volunteers caused olfactory fatigue in three subjects and a taste sensation in... 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

Renal failure was reported in one case study of a human exposed by acute inhalation to barium (Shankle and Keane 1988). Case studies of humans developing renal failure, renal insufficiency, and renal degeneration following acute oral barium poisoning have been reported (Gould et al. 1973 ... 

NSAIDs inhibit prostaglandin synthesis, and in so doing can reduce GFR in susceptible patients, including those with cirrhosis. A number of renal complications can occur, including acute renal failure. All NSAIDs have been associated with nephrotoxicity. There is a small amount of data suggesting that renal effects are less likely to occur with sulindac, but studies relate to short-term therapy only, and there have been case reports of acute renal failure developing in high-risk patients [4,27,35]. 

Disposition in the Body. Rapidly but incompletely absorbed after oral administration bioavailability about 65%. Up to 90% of an intravenous dose is excreted in the urine, mainly as unchanged drug with up to 14% of the dose as a glucuronide conjugate. 2-Amino-4-chloro-5-sulphamoylanthranilicacid has been reported as a metabolite in several studies, but in other cases it has not been detected and it has been suggested that it is an analytical artefact produced during acid extraction procedures. In normal subjects, about 6 to 18% of a dose is eliminated in the faeces after intravenous administration this may be increased to about 60% in renal failure. 

Recently, a case of vulture mortality was reported from the Indian subcontinent related to NS AID toxicity. Diclofenac is a widely available veterinary NS AID in the Indian subcontinent, used in domestic livestock. Vultures were exposed to the drug when they consumed carcasses of cattle that were treated with diclofenac shortly before death. Experimental studies of this drug in vultures showed marked nephrotoxicity. The gross observations were primarily deposits of urate on the surface of internal organs related to renal failure. Histopathological findings were acute necrosis of the proximal renal tubular epithelium with minimal inflammatory response and deposits of urate crystals (Oaks et al, 2004 Meteyer et al, 2005). 

These pediatric patients also suffered from clear signs of hypoxemia and renal failure (Azizi and Amid, 1990). Unfortunately, serum creatinine and renal function tests (RFTs) were not found in the charts. Arterial blood gases (ABGs) may provide useful information, but they may show a varied picture. In one pediatric study of mustard casualties, most (43%) cases showed a simple metabolic acidosis. The other groups showed showed the following ... 

Nephrogenic systemic fibrosis (NSF) is a sclerosing disorder found in patients with impaired renal function. It was recognized in 1997 and first reported in 2000 [92], The majority of reported cases are associated with acyclic Gd-based clinical CAs, such as Gd—DTPA—BMA, in patients with renal deficiency. CAs will usually be excreted within 2 h in patients with normal renal function. However, the half-life is prolonged in patients with renal failure, and can be between 30 and 120h [93]. The persistence of CAs increases the risk of dechelation and increases the tissue exposure to Gd(III). Certainly, this risk also depends on the strength of the chelations. A recent clinical study showed the association of NSF with Gd—DTPA and Gd-DTPA-BMA [94]. However, no validated mechanism has been established for NSF. The association with CAs is still controversial, and many questions remain unanswered. 

Kayexalate (sodium polystjrene sulfonate) in sorbitol is commonly used to treat hjrperkalemia in patients with renal insufficiency. Case reports have documented intestinal necrosis after the administration of kayexalate in sorbitol (26,27). In one study, there was an incidence of 1.8%, and the authors concluded that sorbitol-associated complications may not be uncommon postoperatively (28). Furthermore, it has been suggested that some cases of idiopathic colonic ulcers in patients with renal failure are due to the effects of sorbitol. While kayexalate crystals, which are purple, irregular, and jagged, can be an incidental finding and are not known to cause injury, they are a helpful histological clue to the possibility that sorbitol has been administered (29). 

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