Cutaneous Manifestations in Patients with Chronic Kidney Diseases on Hemodialysis | Chapter 14 | Advancement and New Understanding in Medical Science Vol. 4

Background: The skin acts as an important diagnostic window to systemic disease which is true for renal diseases. Cutaneous and mucosal disorders are of the common problems in patients on long long-term haemodialysis. The aim of this study was to evaluate the frequency and nature of cutaneous lesions among patients with chronic kidney diseases who received maintenance haemodialysis.

 

Methods: The study was carried out on patients suffering from chronic kidney disease, who were attending skin OPD, nephrology ward for hemodialysis Command Hospital Lucknow and hemodialysis and skin OPD UPUMS Saifai, Etawah. Eighty patients with chronic kidney diseases on haemodialysis were studied. All of the patients were fully examined for cutaneous, hair, nail and mucosal changes. Diagnostic measures such as scraping and biopsy of the lesions was were carried out, where necessary.

 

Results: The patients were 30 females and 50 males with a mean age of 47.6 years. The duration of haemodialysis was 36±11 months. All patients included in this study had at least one cutaneous manifestation attributable to CRF. The most prevalent findings were xerosis (66.2%) followed by pallor (57.5%), pruritus (51.25%), infections (33.75%), AV shunt dermatitis (16.25%), pigmentary changes (13.75%), purpura, ecchymoses (8.75%) and perforating disorders (2.5%). Hair changes were diffuse alopecia (16.25%), brittles, lustreless hair (3.75%) and sparse body hairs (1.25%). Oral changes were candidiasis (10%), angular cheilitis (3.75%), gingivitis (2.75%), fissured tongue (2.75%) and lichen planus (1.25%). Nail changes were leukonychia (10%), dystrophic nails (7.5%) onychomycosis (6.25%), subungual hyperkeratosis (5%) and half and half nails (1.25%).

 

Conclusions: At least one cutaneous manifestation is found in all CRF patients. The aetiology of CRF does not affect the cutaneous, hair or nail abnormalities. Factors such as diagnostic climate and early treatment influence some disorders such as xerosis, pruritus and infections. Oral hygiene to prevent mucosal lesions; nutritional supplementation to prevent angular cheilitis and hair loss; and prompt recognition and treatment of fungal infections like onychomycosis and tinea pedis, which are increased in CRF.

Author(s) Details:

Sweta S. Kumar,
Department of Dermatology, UPUMS, Saifai, Etawah (U.P.), India.

Manoj Kumar,
Department of Medicine, UPUMS, Saifai, Etawah (U.P.), India.

Santosh Kumar,
Department of Respiratory Medicine, ASMC, Etah (U.P.), India.

Please see the link here: https://stm.bookpi.org/ANUMS-V4/article/view/13220

Treatment of 2,4-Dimethylamine Herbicide Intoxication Using Alkaline Diuresis and Pre-emptive Haemodialysis | Chapter 1 | Advanced Concepts in Medicine and Medical Research Vol. 12

 Introduction: Chlorophenoxy herbicides are class of synthetic herbicides used to control broad leaved weeds. Their poisoning is very rare and l has no antidote. The mission of this case report is to emphasize the role of accurate diagnosis and management of 2, 4-D herbicide intoxication.

Case Report: We report a case of 19 year old male admitted after 6h of the deliberate ingestion of the contents of a half bottle (300 ml) of weedkiller named Dallas contents. Soon after ingestion the patient gave history of vomiting, after which patient became unconscious.

Patient was unresponsive to deep painful stimulus. He was sweating profusely with a temperature of 39 degree Celsius. Patient was electively intubated for airway protection.

Patient’s metabolic acidosis also worsened. Patient’s output dropped to 5-10 ml/hr. Patient was then taken on Haemodialysis. Patient’s urine output improved and GCS also improved.

Conclusion: 2,4-Dimethylamine intoxication is uncommon, doesn’t have an antidote with very high morbidity and mortality. Other therapies, such as gastrointestinal decontamination, first emergency resuscitation, and supportive treatment with haemodialysis when needed, must be added to alkaline diuresis, which is a life-saving treatment.

Author(s) Details:

Manjiri Naik,
Department of Medicine, MGM Medical College and Hospital, Aurangabad, India.

Shamisha Khade,
Department of Medicine, MGM Medical College and Hospital, Aurangabad, India.

Please see the link here: https://stm.bookpi.org/ACMMR-V12/article/view/12966

Candidemia in an Immunocompromised Patient | Chapter 13 | New Horizons in Medicine and Medical Research Vol. 11

 Symptoms of rhabdomyolysis and subsequently acute renal damage were evident in an immunocompromised patient with a documented history of cerebrovascular accident (CVA), long-lasting right-sided hemiparesis, type 2 diabetes mellitus, and hypertension (AKI). Guillain Barre syndrome subsequently struck him.

Plasmapheresis was initially performed after haemodialysis. Following hemodialysis, the patient experienced many episodes of vomiting as well as limb weakness. On Day 6, a bloodstream infection with Candida kefyr and a urinary tract infection with Enterococcus faecalis were detected. A culture revealed the growth of Enterococcus faecalis. We describe a severe case of C. kefyr bloodstream infection. The patient made a full recovery and was successfully released with ongoing follow-up for the next six months.

Author(s) Details:

Lakshmi Jyothi,
Microbiology, All India Institute of Medical Sciences, Hyderabad, India.

Naveen P. Reddy,
General Medicine, Mediciti Institute of Medical Sciences, Hyderabad, India.

Shazia Naaz,
Microbiology, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Sananthnagar, Hyderabad, India.

Please see the link here: https://stm.bookpi.org/NHMMR-V11/article/view/7148

Studies on Superficial Fungal Infections in ESRD Patients over the Past 16 Years | Chapter 3 | Recent Progress in Microbiology and Biotechnology Vol. 5

 Background: The rising prevalence of end-stage renal disease is a global public health issue that affects millions of people around the world. It's worth noting that anywhere from 50% to 100% of people in this population have been found to have at least one dermatological condition. We looked at patients with end-stage renal disease who had acquired superficial fungal infections in this study.

Methods and Results: From January 2000 to June 2016, we analysed 2112 patients with end-stage renal disease who were on haemodialysis at least three times a week for at least three months at our facility. We detected 1500 suspected cases of superficial fungal infections among the above 2112 patients, and 1040 cultures tested positive. Tinea capitis, 28.8% Pityriasis versicolor, 16.7% Tinea corporis, 5.3 percent Tinea mannum, 32.4 percent Onychomycosis, 13.5 percent Tinea cruris, and 3.1 percent Tinea pedis were found on macroscopic inspection of the scalp, skin, and nails. Trichyopyton rubrum was found to be 29.1%, Trychophyton mentagrophyte was 22.9 percent, Trychophyton violaceum was 5.1 percent, Trichophyton verrucosum was 0.9 percent, Microsporum canis was 0.1 percent, Epidermophyton flucossum was 3.1 percent, Trychophyton tonsurans was 3.1 percent, Scopulariopsis brevicaulis was 6.9%, and Malassezia was 28 Onychomycosis was the most common clinical abnormality, and Trichophyton rubrum was the most common fungal isolate.

Conclusion: Superficial mycoses are common all over the world. The current study shows that a significant number of patients with end-stage renal disease have a high prevalence of superficial fungal infection. As a result, early detection of skin lesions and identification of these superficial fungal infections alerts us to begin early and judicious management in order to reduce associated morbidity and thus improve the quality of life in the said patients.

Author (s) Details

Upma Narain
Tejas Microdiagnostics, Allahabad, Uttar Pradesh, India.

Arvind Gupta
Division of Nephrology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India.

View Book :- https://stm.bookpi.org/RPMB-V5/article/view/866