End-Stage Renal Disease in a Solitary Kidney: A Complex Clinical Presentation with Multiple Systemic Complications | Chapter 4 | Medical Science: Updates and Prospects Vol. 1

 

Background: End-stage renal disease (ESRD) represents the terminal phase of chronic kidney disease (CKD), characterised by irreversible loss of renal function requiring renal replacement therapy. Patients with a solitary functioning kidney face unique challenges when progressing to ESRD, particularly when multiple comorbidities are present.

 

Case Presentation: The clinical course of a 49-year-old female with ESRD and a solitary kidney who developed numerous life-threatening complications, was presented. The patient had undergone right nephrectomy two decades prior and presented with severe uremia, anuria, and multisystem involvement including hepatic dysfunction, haematological abnormalities, and cardiopulmonary complications. Despite regular hemodialysis and comprehensive medical management, she experienced recurrent pleural effusions requiring multiple interventions, along with persistent electrolyte disturbances and severe anaemia.

 

Clinical Findings: Laboratory investigations revealed markedly elevated serum urea (110-190 mg/dL) and creatinine (8-13 mg/dL) levels, with a glomerular filtration rate of 8 mL/min. Imaging studies demonstrated bilateral massive pleural effusions with septations, and abdominal ultrasonography showed moderate to gross ascites with splenomegaly. The patient also exhibited pancytopenia, hyperkalemia, and hemoptysis, requiring intensive multidisciplinary care.

 

Management and Outcome: The patient received bi-weekly to tri-weekly heparin-free hemodialysis through an arteriovenous fistula, supplemented with erythropoietin therapy and blood transfusions for refractory anaemia. Tube thoracostomy and therapeutic thoracentesis were performed repeatedly to manage recurrent pleural effusions and associated respiratory distress.

 

Conclusion: This case underscores the significant clinical challenges encountered in managing ESRD patients with a solitary kidney and multiple comorbidities. Early recognition of CKD, timely initiation of renal replacement therapy, aggressive management of complications, and patient education remain critical components in improving outcomes. The case highlights the importance of integrated multidisciplinary care and the need for heightened awareness regarding CKD progression in high-risk populations.

 

 

Author(s) Details

Vinay Singh
Department of Medicine, Maulana Azad Medical College, New Delhi, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v1/6543

A Case of Dengue Presented with Pleural Effusion | Chapter 1 | Disease and Health: Research Developments Vol. 9

Dengue is caused by any one of four related viruses transmitted by mosquitoes. Dengue fever caused by the dengue virus (a Flavivirus), transmitted by female Aedes mosquito, remains a major global health concern, particularly in tropical and subtropical regions. It is a febrile illness, a disease of tropical areas, commonly encountered in India. Most of the infections are asymptomatic. The course of dengue infection varies from individual to individual and even in the same individual from time to time. The patient with dengue fever can present with a wide range of clinical manifestations from mild fever to life-threatening Dengue Shock Syndrome (DSS) and severe Dengue Hemorrhagic Fever (DHF). Pleuro- Pulmonary complications involve parenchymal infiltration, pleural effusion(small, moderate, massive), pneumonitis, non-cardiogenic pulmonary oedema, hemorrhage-hemoptysis, and acute respiratory failure. A report of a case of a 55-year-old male who developed bilateral pleural effusion, pedal oedema, acute respiratory failure and who was semiconscious has been discussed in this case report. The dengue patient described in our case report presented with a typical history of fever with chills, myalgias with conjunctival redness and rash. He presented with features of plasma leakage namely pleural effusion, pedal oedema, ascites and hypotension. Thus, in conclusion, pulmonary complications in dengue coincide with plasma-leakage syndrome namely pleural effusion, infiltration, pneumonitis, acute respiratory failure, ARDS, and non-cardiogenic pulmonary oedema. Appropriate serum investigations with serial chest X-rays with thoracocentesis may help in early diagnosis and management.

 

Author (s) Details

 

Aditya Kumar Gautam
Department of Respiratory Medicine, Uttar Pradesh University of Medical Science, Saifai, Etawah, Uttar Pradesh, India.

 

Adesh Kumar
Department of Respiratory Medicine, Uttar Pradesh University of Medical Science, Saifai, Etawah, Uttar Pradesh, India.

 

Prashant Yadav
Department of Respiratory Medicine, Uttar Pradesh University of Medical Science, Saifai, Etawah, Uttar Pradesh, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrd/v9/4853

Effect of Medical Thoracoscopy Guided Pleural Biopsy for Diagnosis of Moderate to Massive Exudative Pleural Effusion | Chapter 5 | Advanced Concepts in Medicine and Medical Research Vol. 10

This branch highlights about the value of healing thoracoscopic guided parietal pleural surgical procedure in the etiological diagnosis of exudative moderate to massive pleural effusions at a country tertiary care centre of northward India. Medical thoracoscopy has been proved to be an efficient procedure in diagnosing unexplained exudative pleural effusions accompanying excellent security. Pleural biopsy under direct vision maybe successfully and carefully used for etiological diagnosis. This was a cross divided study conducted in male and female inmates between 18 to 70 years adult of undiagnosed and moderate to massive exudative pleural effusions. Undiagnosed pleural outpouring was defined as failure to obtain a diagnosis by primary pleural fluid analysis including pleural fluid adenosine deaminase (ADA) levels <70 U/L and not completely three pleural fluid analysis negative for diseased cells. The study was conducted upon 90 sufferers with exudative moderate to massive pleural outpouring, who necessary intercostal drainage (ICD) for management. Exudative pleural effusions were likewise smear negative for acid fast bacterium (AFB) and malignant cytology.Thoracoscopic pleural examples were diagnostic in 86 cases out of a total 90 patients (95.5%). Histopathological test of thoracoscopic specimens disclosed, Malignancy- in 31 cases (34.4%), Inflammatory 28 (31.11%), Infection in 25 patients (27.8%) and Sarcoidosis in two cases (2.22%). Four cases (4.4%) were still inconclusive on histopathology. Thus, thoracoscopic pleural examination is considered golden standard in diagnosis of malignant pleural outpouring and tubercular pleural outpouring. The safety and diagnostic yield of a healing thoracoscopic guided pleural surgical procedure are both good. Therefore, doctors endure only use it after taking the appropriate training.

Author(s) Details:

Aditya Kumar Gautam,
Department of Respiratory Medicine, U P University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.

Adesh Kumar,
Department of Respiratory Medicine, U P University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.

Ashish Kumar Gupta,
Department of Respiratory Medicine, U P University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.

Somnath Bhattacharya,
Department of Respiratory Medicine, U P University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.

Prashant Yadav,
Department of Respiratory Medicine, U P University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.

Suryakant,
Department of Respiratory Medicine, King George Medical University, Lucknow, Uttar Pradesh, India.

Please see the link here: https://stm.bookpi.org/ACMMR-V10/article/view/12819

Determining the Effectiveness of CBNAAT in the Diagnosis of Extrapulmonary Tuberculosis | Chapter 12 | Advanced Concepts in Medicine and Medical Research Vol. 4

 This affiliate aims to determine the influence and reliability of CBNAAT in the diagnosis of extra pulmonary infection (EPTB) cases in comparison to AFB taint. Tuberculosis is still a major community health issue around the globe. Mycobacterium tuberculosis is thought to pollute one-after second of the world's state. The two types of clinical proof of tuberculosis (TB) are pulmonary TB (PTB) and extrapulmonary TB (EPTB). While pulmonary tuberculosis is most accepted presentation, extrapulmonary infection is also an main clinical question. Diagnosing extrapulmonary tuberculosis continues expected a challenge due to the paucibacillary type of the samples collected from unreachable sites and variable dispassionate presentation of the disease. Various direct and unintended methods of experiment are available for diagnosing extrapulmonary infection accurately. Two of these tests which are usually performed and are surely accessible are AFB taint and CBNAAT. AFB smear test is a system of visualization of acid-fast bacilli under microscope inasmuch as CBNAAT is a cartridge-located nucleic acid elaboration test that has long been used to pinpoint pulmonary tuberculosis (PTB).The study is a retrospective explanatory study conducted at MGM Hospital Aurangabad, Maharashtra, India. The study secondhand data from January 2017 to July 2018. Data from 166 subjects with possible extrapulmonary TB were obtained. The efficacy of CBNAAT in the disease of EPTB was compared to that of AFB besmirch.AFB smear and CBNAAT were acted on samples taken from 166 suspected EPTB inmates. Lymph node, liquid matter, pleural fluid, tissue, CSF, stomachic lavage, cystic fluid, peritoneal fluid, ascitic fluid, colonic fluid, synovial fluid, and excretion samples were collected. In AFB smear results, 17 cases were certain for TB bacilli while 149 proven negative. In the CBNAAT results, 25 cases were positive for TB bacterium whereas 141 proven negative. Eight cases were AFB smear negative but CBNAAT positive in a corresponding examination.The candor and quick reaction time of CBNAAT manage a valuable tool for diagnosing EPTB cases. For the diagnosis of cases accompanying EPTB, CBNAAT is more useful than AFB sully. However, other demonstrative tools concede possibility be taken into consideration in addition to CBNAAT for better diagnostic yield overall.

Author(s) Details:

Shivprasad Kasat,
Department of Respiratory Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India.

Mahendra Biradar,
Department of Respiratory Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India.

Ashish Deshmukh,
Department of Respiratory Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India.

Sunil Jadhav,
Department of Respiratory Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India.

Hafiz Deshmukh,
Department of Respiratory Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India.

Please see the link here: https://stm.bookpi.org/ACMMR-V4/article/view/12481

Primary Effusion Lymphoma: A Rare Case Presentation | Chapter 13 | Current Innovations in Disease and Health Research Vol. 2

 This member discuss about a case report to reinforce awareness of the entity, Primary outpouring lymphoma (PEL) which is a rare virulence with extreme mortality rate. It aims to emphasize significance of thorough annals taking and examination in diagnosing this hostile lymphoma. A primary outpouring lymphoma (PEL) is a rare form of high-grade non-Hodgkin's lymphoma (NHL) that occasionally occurs in inmates with compromised exemption or HIV infection.We present a case of a 56-old age-old African-American male with a record of what happened of HIV admitted to the emergency room with right lung lower flap pneumonia and parapneumonic effusion. Thoracentesis and pleural fluid study of animal led to the diagnosis of PEL. The patient taken treatment accompanying chemotherapy and antiretroviral therapy (ART). The importance is to review immunocompromised patients presenting accompanying pleural effusion for PEL, as it is a excellent ailment with a extreme mortality rate. This case report spurs clinicians to consider a broad differential, exceptionally in HIV patients pronounced with exudative pleural effusion, to search further with pleural fluid study of animal.

Author(s) Details:

Rahul Gujarathi,
Hospital Medicine, University of Florida Health, Jacksonville, USA.

Narsimha Candula,
Hospital Medicine, University of Florida Health, Jacksonville, USA.

Venu Chippa,
Internal Medicine, St. Vincent Medical Center, Evansville, USA.

Meet Kadakia,
Hematology/Oncology, University of Florida College of Medicine – Jacksonville, Jacksonville, USA.

Ahmad Alkhasawneh,
Pathology, University of Florida College of Medicine – Jacksonville, Jacksonville, USA.

Please see the link here: https://stm.bookpi.org/CIDHR-V2/article/view/11201

Study about Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis | Chapter 10 | Recent Developments in Medicine and Medical Research Vol. 2

 PPF, or pancreaticopleural fistula, is a rare yet dangerous consequence of chronic pancreatitis. In middle-aged males with a history of alcohol consumption, PPF should be considered in the differential diagnosis of recurrent and large pleural effusions. Because the patients often report with respiratory symptoms associated to the pleural effusion rather than pancreatitis, the diagnosis requires a high index of suspicion. Dyspnea, or chest tightness, may be evident at first, with or without a history of stomach pain or steatorrhea. The gold standard for diagnosis is abdominal computer tomography (CT) or magnetic resonance cholangiopancreatography (MRCP). Treatment options include conservative, surgical, and endoscopic treatments. Patients with PPF are given conservative treatment at first, but if their condition does not improve, they are exposed to surgery or ERCP treatment.

Study goals are as follows:

Identify the unusual cause of recurrent pleural effusion, the Pancreaticopleural Fistula (PPF).

PPF was assessed in individuals with chronic pancreatitis who had recurring pleural effusions.

PPF management solutions are available.

Author (S) Details

Harveen Kaur
Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India

Dilbag Singh
Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India

N. C. Kajal
Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India.

 

View Book :-

https://stm.bookpi.org/RDMMR-V2/article/view/4281

A Brief Study on Meigs’ Syndrome | Chapter 5 | New Frontiers in Medicine and Medical Research Vol. 4

 Meigs' syndrome is a rare complication that includes a benign ovarian neoplasm, ascites, and pleural effusion. Meigs syndrome can occur in about 1% of ovarian neoplasia cases. Many metastatic cancers have similar signs and symptoms. Early discovery and treatment of the illness results in a higher prognosis and survival rate.

The goal of this study is to figure out what causes Meigs syndrome.

• Meigs' syndrome assessment.

• Meigs' syndrome management options are available.

Author (S) Details

Divya Khanduja
Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India.

N. C. Kajal
Department of Pulmonary Medicine, Government Medical College, Amritsar, Punjab, India.

View Book :- https://stm.bookpi.org/NFMMR-V4/article/view/2884