RESUMO
Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.
Assuntos
Cistite/complicações , Complicações do Diabetes/microbiologia , Enfisema/diagnóstico por imagem , Pielonefrite/complicações , Choque Séptico/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Tratamento Conservador , Cistite/diagnóstico , Cistite/tratamento farmacológico , Cistite/microbiologia , Complicações do Diabetes/patologia , Enfisema/etiologia , Escherichia coli/isolamento & purificação , Feminino , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Vômito/diagnóstico , Vômito/etiologiaRESUMO
The thyroid gland and the kidney are closely related. Thyroid hormones (TH) contribute to the homeostasis of the human being through complex interactions of fluids and electrolytes, protein synthesis, etc. The effects on the kidney of TH may be pre renal or direct actions. Decreasing glomerular filtration (GF) this balance especially in advanced stages of chronic kidney disease (CKD) is altered. CKD is linked to alterations in TH levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low free triiodothyronine (FT3) syndrome. These alterations are linked in micro inflammation, endothelial damage, cardiac abnormalities, and high mortality. In this study, we describe the most common thyroid abnormalities reported in CKD with dialytic stage approach.
La glándula tiroides y el riñón están estrechamente relacionados. Las hormonas tiroideas (HT) contribuyen en la homeostasis del ser humano a través de complejas interacciones de líquidos y electrolitos, síntesis de proteínas, etc. Los efectos de las HT sobre el riñón pueden ser pre-renales o directos. Está demostrado que al disminuir la filtración glomerular (FG) se altera este equilibrio, sobre todo en estadios avanzados de la enfermedad renal crónica (ERC). La ERC está vinculada con alteraciones en los niveles de HT y/o su metabolismo, lo que resulta en una alta prevalencia de hipotiroidismo subclínico y el síndrome de T3 libre baja. Estas alteraciones están relacionadas con micro inflamation, daño endotelial, alteraciones cardiacas y alta mortalidad. El presente estudio, describe las alteraciones tiroideas más frecuentes reportadas en ERC con enfoque en la etapa dialítica.
Assuntos
Diálise Renal , Insuficiência Renal Crônica/complicações , Doenças da Glândula Tireoide/etiologia , Humanos , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Doenças da Glândula Tireoide/fisiopatologiaRESUMO
Kocuria kristinae is a gram-positive coccus of the family of Micrococcaceae. It inhabits the skin and mucous and human oropharynx and some mammals. Clinical cases of proven infections are scarce, affecting patients with indwelling devices and severe underlying diseases. We report two unusual case of a K. kristinae infection in a hemodialysis. First is a case of bacteremia associated with permanent hemodialysis catheter in a 20-year-old female; and second is a case of acute peritonitis in a 68-year-old male patient on continuous ambulatory peritoneal dialysis. A review of other reported K. kristinae infections is provided.