Hydroelectrolytic Disorders Research Articles

Postoperative Acute Renal Failure: Etiologies and Prognostic Factors

Postoperative acute renal failure is a rare complication in the surgical context. It is the consequence of a significant and prolonged decrease in the glomerular filtration rate, leading to a failure to eliminate nitrogen catabolism products and a hydroelectrolytic disorder. Early recognition of risk factors and prevention of spinal cord ischemia are the two fundamental elements in the management of postoperative renal failure.

A Study of Hydroelectrolytic and Acid-Base Disturbances in MIS-C Patients: A Perspective on Antidiuretic Hormone Secretion.

COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) is a rare autoimmune disorder characterized by a range of polymorphic manifestations, similar to but distinct from other well-known inflammatory syndromes in children. We conducted a retrospective-descriptive study in which we summarized the clinical presentation of, biomarker variations in, and complications occurring in patients diagnosed with MIS-C, admitted to the Emergency Clinical Hospital for Children "Sf. Ioan", Galati, between July 2020 and June 2024. A total of 36 children met the MIS-C classification criteria according to the WHO-approved case definitions. A total of 41.7% (n = 15) were male and 58.3% (n = 21) were female. The median age of the study group was 4 years (IQR: 1.75-9.25 years). Surgical involvement was suspected in 16.7% (n = 6) of the patients, while 52.8% (n = 19) required intensive care. Clinically, fever was the most common symptom present in 89% (n = 32) of the cases. Gastrointestinal disorders were also common, with 50% (n = 18) presenting with inappetence, 42% (n = 15) with vomiting, and 39% (n = 14) with abdominal pain from admission, which worsened over time. Paraclinically, all patients exhibited signs of inflammation, and 86.1% (n = 31) had hydroelectrolytic and acid-base imbalances. The median hospital stay was 10 days (IQR: 7-12 days), with a stagnant clinical course in most cases. The inflammatory mechanisms in MIS-C, which can affect the secretion of antidiuretic hormone (ADH), were correlated with hydroelectrolytic disturbances and may lead to severe complications. For this reason, it is imperative to evaluate hydroelectrolytic disorders in the context of MIS-C and use diagnostic and prognostic biomarkers to develop effective therapeutic management strategies, ultimately improving the quality of life of affected children.

805. BOCHDALEK HERNIA - CASE REPORT

Abstract Introduction Bochdalek hernia is a rare type of diaphragmatic hernia congenital and is quite uncommon in adulthood, representing only 0.17-6% of all diaphragmatic hernias. The objective of the present study is to report the technique surgery performed on a patient with a bochdalek hernia. Methods The information was obtained through medical record review, interview with the patient and literature review. Results/Discussion A 49-year-old female patient was admitted to a hospital in Natal (RN- Brazil) with vomiting for seven months, average of 3-4 vomits daily after meals, associated with dysphagia, epigastric pain and weight loss of 26 kg during this period. The physical examination, she was dehydrated, emaciated and with a flaccid abdomen and painless. Laboratory exams, she presented high levels of ureia and hypokalemia. CT scan of the chest and abdomen with contrast showed a hernia right posterolateral diaphragm with insinuation of the transverse colon and portion distal part of the stomach, in addition to significant gastric stasis, without signs of ischemia. Vigorous hydration was carried out and fasting was maintained, in addition, was inserted nasogastric tube and began parenteral nutrition. After ten days of parenteral nutrition and correction of hydro electrolyte disorders, there was an improvement in symptoms with laboratory normalization. So, she undergo a surgical intervention by videolaparoscopy. Surgical intervention took place with the pneumoperitoneum with Veress needle and trocars inserted (2 10-inch trocars). mm and 3 of 5 mm). Introduction of 30° optics. Cavity inventory identified massive right posterolateral diaphragmatic hernia, containing transverse colon and part of the stomach. Hepatic retractor was positioned to retracted the right hepatic lobe. Completely reduced the hernia through the Bochdalek foramen, after undoing content adhesions with the diaphragm. Afterwards, the closing of the defect with 2-0 Ethibond thread and a biocompatible mesh placed over the suture (Phasix) 10x10 cm and fixed with the same thread in separate stitches. Left drain blake type number 24 Fr, was left in the right hemithorax. The procedure was done uneventful. Conclusions Bochdalek hernia is a structural defect in the diaphragm, which can cause the passage of practically any intra-abdominal organ to the chest. Surgical repair of the defect is the only existing treatment option. In this case, we have a late presentation and in a complicated form. We opted for clinical stabilization of the patient, with nutrition and timely videolaparoscopy on the tenth day of hospitalization. The correction of hernia laparoscopically allows wide access to the workplace and with good mobility for dissection of the hernial sac, in addition to unquestionable acceleration of postoperative recovery and reduction of surgical trauma and size of the incisions. This way, we have a shorter hospitalization time with early return to the patient's daily activities.

Kidney involvement in Wilson's disease: a review of the literature.

Wilson's disease (WD) is a rare inherited disease due to the mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and its pathological accumulation in various organs such as the liver, the nervous system, or the kidneys. Whereas liver failure and neuropsychiatric disorders are the most common features, less is known about the renal complications. We conducted a review of the literature to define the characteristics and pathophysiology of kidney involvement during WD. This review shed light on strong evidence for direct copper toxicity to renal tubular cells. Excessive tubular copper accumulation might present with various degrees of tubular dysfunction, ranging from mild hydroelectrolytic and acid-base disorders to complete Fanconi syndrome. Proximal and distal renal tubular acidosis also favors development of nephrolithiasis, nephrocalcinosis, and bone metabolism abnormalities. Indirect complications might involve renal hypoperfusion as occurs in hepatorenal or cardiorenal syndrome, but also tubular casts' formation during acute hemolysis, rhabdomyolysis, or bile cast nephropathy. Acute kidney failure is not uncommon in severe WD patients, and independently increases mortality. Finally, specific and long-term therapy by D-penicillamin, one of the most efficient drugs in WD, can cause glomerular injuries, such as membranous nephropathy, minimal-change disease, and, rarely, severe glomerulonephritis. Altogether, our study supports the need for interdisciplinary evaluation of WD patients involving nephrologists, with regular monitoring of tubular and glomerular functions, to provide adequate prevention of renal and bone involvement.

Juvenile Systemic Lupus Erithemathosus And Dengue Fever: A Case Report

The clinical management of patients with systemic lupus erythematosus in emergency situations requires a thorough understanding of the clinical features and complications associated with this condition. The objective of this study is to report a clinical case of an individual with systemic lupus erythematosus undergoing treatment with azathioprine associated with dengue virus infection and severe clinical manifestations. The 27-year-old male patient developed fever, myalgia, and diarrhea eight days before admission, was admitted to the emergency room of a private hospital in São Paulo with clinical worsening associated with hypotension and drowsiness, and a sepsis protocol was opened, as evidenced in the initial laboratory tests of acute renal failure Kdigo III, hydroelectrolyte disorders, blood dyscrasias, pancytopenia, antibiotic therapy for septic shock, abdominal focus in the first hour, use of vasopressor drugs, and admitted to an intensive care bed. During hospitalization, a patient diagnosed with group D dengue and active systemic lupus erythematosus, presenting renal dysfunction requiring renal replacement therapy, liver failure, collection secondary to dengue virus infection, necrotizing pancreatitis, blood dyscrasias, respiratory failure, and alveolar hemorrhage secondary to capillaritis due to dengue or systemic lupus erythematosus, treated with broad-spectrum antibiotics, human immunoglobulin, corticosteroid therapy, however, despite all the therapeutic arsenal and advanced support, the patient progresses to death after 42 days of hospitalization. These situations pose significant challenges in the management of medical emergencies and endemic diseases, and therefore require a comprehensive understanding to ensure appropriate treatment and improved clinical outcomes.

¿Guillain Barre syndrome and inadequate secretion of antidiuretic hormone, is their relationship possible?

Guillain-Barré syndrome (GBS) is a polyradiculoneuropathy of acute onset and the most common cause of acute flaccid paralysis. It is characterized by the appearance of sensory and/or motor symptoms, accompanied by a decrease or absence of muscle stretch reflexes and other symptoms such as facial paralysis, altered eye movements, bulbar symptoms, altered wakefulness, dysautonomia and ataxia. On the other hand, hydroelectrolyte disorders are associated with serious neurological diseases as a poor prognostic factor; the most affected electrolyte is sodium; in fact, hyponatremia is the most common disorder in hospitalized patients, regardless of the cause; in GBS, it is a frequent finding on admission. It is important to recognize hyponatremia, due to its high morbidity and mortality; it is also a marker of an underlying disease. Syndrome of inappropriate secretion of antidiuretic hormone (SSIADH) is the most common cause of hyponatremia and has been associated with Guillain Barre syndrome; in this way, its diagnosis is a challenge for the doctor; finally, below we describe details of a 70-year-old male patient who was admitted to the intensive care unit, with hyponatremia with a SSIHAD, with good subsequent evolution.

Chronic Kidney Disease Associated with Ischemic Heart Disease: To What Extent Do Biomarkers Help?

Chronic kidney disease represents a complex and multifaceted pathology characterized by the presence of structural or functional renal anomalies associated with a persistent reduction in renal function. As the disease progresses, complications arise due to the chronic inflammatory syndrome, hydro-electrolytic disorders, and toxicity secondary to the uremic environment. Cardiovascular complications are the leading cause of death for these patients. Ischemic cardiac pathology can be both a consequence and complication of chronic kidney disease, highlighting the need to identify specific cardiorenal dysfunction biomarkers targeting pathophysiological mechanisms common to both conditions. This identification is crucial for establishing accurate diagnoses, prognoses, and risk stratifications for patients. This work is intended to elucidate the intricate relationship between chronic kidney disease and ischemic heart disease and to investigate the roles of cardiorenal biomarkers, including cardiac troponin, natriuretic peptides, galectin-3, copeptin, fibroblast growth factor 23 and its co-receptor Klotho, soluble suppression of tumorigenicity 2, and plasma growth differentiation factor 15.

A CASE REPORT ON BILIARY ILEUS AS A RARE TRIGGER FOR INTESTINAL OBSTRUCTION

Introduction: Biliary ileus is a rare mechanical obstruction. It is caused by the entrapment of biliary macro-lithiasis in a portion of the digestive tract arising from a bilio-digestive fistula. We report a clinical case to better understand this disease, as well as to illustrate the diagnostic and therapeutic pitfalls, and to determine the current therapeutic strategy. Observation: We report the case of a 71-year-old patient who was admitted to the emergency department for an occlusive syndrome consisting of cessation of matter and gas, vomiting and abdominal pain for 48 hours. An injected abdomino-pelvic CT scan showed a biliary ileus with 3 jejunal and ileal enclave lithiases giving a upper intestinal obstruction. There were no signs of acute cholecystitis. Management was straightforward with enterolithotomy alone after correction of hydroelectrolyte disorders. Postoperative management was straightforward. Conclusion: Biliary ileus is a rare surgical condition. The high mortality rate in the management of this pathology means that enterolithotomy remains the least invasive and most recommended method.

#6045 TWO-YEAR INPATIENT ACTIVITY OF A DEDICATED ONCONEPHROLOGY DEPARTMENT

Abstract Background and Aims Onconephrology is a rapidly evolving nephrology subspecialty that focuses on the interaction between cancer and the kidney. Our aim was to describe the clinical activity of a Nephrology Department in a cancer care center, in a 2-year period. Method We retrospectively analyzed the patients observed by the Nephrology Department at our center between 2021 and 2022. Demographic, clinical and laboratory data were collected. The statistical analysis was performed with SPSS software. Results During the 2-year period, there were 26,015 admissions, 636 of which required a Nephrology observation. Sixty-two per cent were female; the mean age was 68 years (SD ±12.4) with a median Charlson Comorbidity Index of 7. Most cancers were from gastrointestinal (24.1%, n = 153) or urologic origins (22.3%, n = 142), 37% had metastatic disease. Hematologic malignancies accounted for 12.1% of patients (n = 77). Nearly 44.5% of patients (n = 283) had chronic kidney disease (CKD), 20.8% (n = 59) of which were on hemodialysis (HD). Urinary tract obstruction (23.3%), cardiovascular risk factors (17.3%) and nephron loss (10.6%) were the most common causes of CKD. The main reasons for admission were renal dysfunction (23.7%; n = 151), infectious complications (23.3%, n = 148) and elective surgery (20.3%; n = 129). Of the patients observed, 40.7% (n = 259) had acute kidney injury (AKI), 23.3% (n = 148) acute-on-chronic kidney disease and 11.8% (n = 75) hydro-electrolytic disorders. Ten patients (1.6%) were evaluated for nephrotic syndrome (NS) or rapidly progressive renal failure (RPRF). Among AKI patients, intrinsic causes were the most prevalent (48.7% of all cases), with sepsis and ischemic and toxic acute tubular necrosis being the most frequent. Pre-renal and post-renal etiologies occurred in 29.7% and 21.6% of cases, respectively. Gynaecological and prostate tumours were the main neoplastic cause of post-renal AKI. There were 5 TMA cases in allogenic stem cell transplanted patients or treated with gemcitabine and six cases of acute interstitial nephritis, the majority immune check-point inhibitors-related. Over 54% (n = 142) of patients presented with AKI stage 3. About 13% (n = 34) needed renal replacement therapy (RRT), mainly continuous or hybrid techniques (58.8%; n = 20), and only 38% (n = 13) recovered renal function. The group of acute-on-chronic CKD patients included mostly stage 3b and 4 CKD. Most of them (54.1%; n = 80) had an intrinsic cause for kidney dysfunction. There was an equal distribution between stages of AKI severity. About 5% (n = 8) needed RRT and only two of those recovered. Hyponatremia was the most common electrolyte disturbance (56%; n = 42), followed by hypercalcemia (17.3%; n = 13). Over 40% of all cases of hyponatremia occurred in patients with metastatic lung cancer, probably related with the high prevalence of SIADH in this population. All but two patients with NS or RPRF underwent kidney biopsy. Among the patients with NS, its etiologies were: focal and segmental glomerulosclerosis secondary to pamidronate (n = 2), podocytopathy related to pazopanib (n = 1), paraneoplastic membranous nephropathy (n = 1), AL amyloidosis (n = 1) and TMA secondary to gemcitabine (n = 1). The causes of RPRF were ANCA-negative small vessel vasculitis, crescentic glomerulonephritis (GN) related to pembrolizumab and TMA. We also followed two patients with acute kidney disease, one with ATN secondary to bisphosphonates therapy and other with paraneoplastic fibrillary glomerulopathy. The median duration of hospitalization was 10 days (IQR 7.0 – 20.8), with median Nephrology follow-up time of 5.5 days (IQR 3.0 – 9.0). The overall mortality rate was 21.5%, and it was even higher on the subgroup with AKI (27.4%; p = 0.03). About 44% (n = 219) of patients were referred to outpatient Nephrology follow-up, at discharge. Conclusion Our data provides a picture of the rich inward activity developed at our cancer center by the nephrology team. The complexity of these patients highlights the importance of a multidisciplinary approach in their management. No surprisingly, there was a high mortality rate, which was even higher in the AKI-patients subset.

CAR-T Cells and the Kidney: Insights from the WHO Safety Database.

Chimeric antigen receptor T (CAR-T) cells have proven to be a game changer for treating several hematologic malignancies. Randomized controlled trials have highlighted potential life-threatening adverse drug reactions (ADRs), including cytokine release syndrome (CRS). Acute renal failure (ARF) has also been reported in 20% of the patients treated. However, an analysis of renal safety supported by large-scale real-life data seems warranted. We queried VigiBase® for all reports of the Standardised MedDRA Query "acute renal failure" (ARF) involving a CAR-T cell, registered until 24 July 2022. Disproportionality for this ADR was analyzed through calculation of the Information Component [IC (95% confidence interval)]. A positive lower end of the 95% confidence interval of the IC is the threshold used in statistical signal detection in VigiBase®. The same analysis was carried out for various hydroelectrolytic disorders. We gathered 224 reports of ARF, and 125 reports of hydroelectrolytic disorders involving CAR-T cells. CAR-T cells were disproportionately reported with ARF [IC 1.5 (1.3-1.7)], even after excluding reports mentioning CRS. A significant disproportionate reporting was also found for hypernatremia [IC 3.1 (2.2-3.8)], hyperphosphatemia [IC 3.1 (1.8-3.9)], hypophosphatemia [IC 2.0 (0.6-2.9)], metabolic acidosis [IC 1.8 (1.2-2.2)], hyponatremia [IC 1.6 (1.1-2.0)], and hypercalcemia [IC 1.4 (0.5-2.1)]. There was no disproportionate reporting of dyskalemia. This study is limited by the inherent flaws of pharmacovigilance approaches. Nonetheless, our findings suggest that ARF and an array of hydroelectrolytic disorders are potential ADRs of CAR-T cell therapy, in real-life settings and in a nonselected population.

Médicaments responsables de toxidermie chez des enfants de phototype foncé à Dakar

IntroductionToxidermia in the paediatric population accounts for 35 to 36% of adverse drug reactions in children [1]. In 2% of cases, they can affect the vital and/or functional prognosis [2]. The aim of this work was to determine the drugs responsible of toxidermia in pediatric population in a hospital environment in Dakar. MethodologyThis was a cross-sectional, observational, descriptive study, over a period of 10 years, of children seen in the 3 dermatological university hospitals of reference in Dakar. ResultsWe collected 116 cases, representing a hospital incidence of 0.08%. The sex ratio was 1.23. The mean age of the patients was 7 years. The types of toxidermia were Stevens Johnson/Lyell syndrome in 42.2%, EPF in 11.2%, EMP in 10.3%, urticaria in 8.6%. Mucosal involvement was found in 50.9%. Complications were hydro-electrolytic disorders in 22.4%, infection in 7.7% and hypothermia in 1.7%. The incriminated drug classes were antibiotics in 41.4%, antiepileptics in 17.2%, non steroidal anti-inflammatory drugs in 15.5%, analgesics in 15.5% and antimalarials in 8.6%. Traditional plants were incriminated in 7.7% of cases. ConclusionAntibiotics and antiepileptics are the most common drugs involved in children toxidermia in Dakar. Stevens Johnson/Lyell syndrome is the most frequent clinical form.

Clinical and Pharmacotherapeutic Profile of Patients with Type 2 Diabetes Mellitus Admitted to a Hospital Emergency Department

Type 2 diabetes mellitus (T2DM) is closely associated with other pathologies, which may require complex therapeutic approaches. We aim to characterize the clinical and pharmacological profile of T2DM patients admitted to an emergency department. Patients aged ≥65 years and who were already using at least one antidiabetic drug were included in this analysis. Blood glycemia, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hemoglobin were analyzed for each patient, as well as personal pathological history, diagnosis(s) at admission, and antidiabetic drugs used before. Outcome variables were analyzed using Pearson's Chi-Square, Fisher's exact test, and linear regression test. In total, 420 patients were randomly selected (48.6% male and 51.4% female). Patients with family support showed a lower incidence of high glycemia at admission (p = 0.016). Higher blood creatinine levels were associated with higher blood glycemia (p = 0.005), and hyperuricemia (HU) (p = 0.001), as well as HU, was associated with a higher incidence of acute cardiovascular diseases (ACD) (p = 0.007). Hemoglobin levels are lower with age (p = 0.0001), creatinine (p = 0.009), and female gender (p = 0.03). The lower the AST/ALT ratio, the higher the glycemia at admission (p < 0.0001). Obese patients with (p = 0.021) or without (p = 0.027) concomitant dyslipidemia had a higher incidence of ACD. Insulin (p = 0.003) and glucagon-like peptide-1 agonists (GLP1 RA) (p = 0.023) were associated with a higher incidence of decompensated heart failure, while sulfonylureas (p = 0.009), metformin-associated with dipeptidyl peptidase-4 inhibitors (DPP4i) (p = 0.029) or to a sulfonylurea (p = 0.003) with a lower incidence. Metformin, in monotherapy or associated with DPP4i, was associated with a lower incidence of acute kidney injury (p = 0.017) or acute chronic kidney injury (p = 0.014). SGLT2i monotherapy (p = 0.0003), associated with metformin (p = 0.026) or with DPP4i (p = 0.007), as well as insulin and sulfonylurea association (p = 0.026), were associated with hydroelectrolytic disorders, unlike GLP1 RA (p = 0.017), DPP4i associated with insulin (p = 0.034) or with a GLP1 RA (p = 0.003). Insulin was mainly used by autonomous and institutionalized patients (p = 0.0008), while metformin (p = 0.003) and GLP1 RA (p < 0.0001) were used by autonomous patients. Sulfonylureas were mostly used by male patients (p = 0.027), while SGLT2 (p = 0.0004) and GLP1 RA (p < 0.0001) were mostly used by patients within the age group 65-85 years. Sulfonylureas (p = 0.008), insulin associated with metformin (p = 0.040) or with a sulfonylurea (p = 0.048), as well as DPP4i and sulfonylurea association (p = 0.031), were associated with higher blood glycemia. T2DM patients are characterized by great heterogeneity from a clinical point of view presenting with several associated comorbidities, so the pharmacotherapeutic approach must consider all aspects that may affect disease progression.

Síndrome de Bart: relato de caso e revisão

MAB, newborn male, e.t , gestational age of 37 weeks and 5 days. During his initial care, no changes were noted, except for skin lesions: cutaneous aplasia on limbs, back, inguinal region and mucous membranes, as well as bullous lesions and nail alterations. The e.t o nt the anatomopathological exam was epidermolysis bullosa. The patient had a bad e.t o nt and developed neonatal sepsis, and several antibiotic therapy and dressings were performed. After presenting n e.t o ntent clinical worsening and refractoriness to the proposed treatment, he died at 57 days of life. Barts syndrome is a genetic condition, and its diagnosis is clinical, made through the triad: cutaneous aplasia, epidermolysis bullosa and nail dystrophies. This syndrome is linked to autosomal dominant inheritance and occur e.t oto a mutation in the type VII collagen gene. Despite having a good prognosis, its diagnosis must be early, so the treatment, which is based on topical dressings and antibiotics, can be started as soon as possible to prevent possible complications such as: sepsis, hemorrhages, hydroelectrolytic disorder and death.

BART SYNDROME: CASE REPORT AND REVIEW

MAB, newborn male, white, gestational age of 37 weeks and 5 days. During his initial care, no changes were noted, except for skin lesions: cutaneous aplasia on limbs, back, inguinal region and mucous membranes, as well as bullous lesions and nail alterations. The result of the anatomopathological exam was epidermolysis bullosa. The patient had a bad evolution and developed neonatal sepsis, and several antibiotic therapy and dressings were performed. After presenting an important clinical worsening and refractoriness to the proposed treatment, he died at 57 days of life. Barts syndrome is a genetic condition, and its diagnosis is clinical, made through the triad: cutaneous aplasia, epidermolysis bullosa and nail dystrophies. This syndrome is linked to autosomal dominant inheritance and occurs due to a mutation in the type VII collagen gene. Despite having a good prognosis, its diagnosis must be early, so the treatment, which is based on topical dressings and antibiotics, can be started as soon as possible to prevent possible complications such as: sepsis, hemorrhages, hydroelectrolytic disorder and death.

Ovarian Hyperstimulation Syndrome (OHS): A Rare Cause of Acute Renal Failure: A Case Report

We report in this work, the evolution and management of a case of ovarian hyperstimulation syndrome (OHS) complicated by severe acute renal failure (ARI). A young 31-year-old patient pregnant with twins after 17 weeks of amenorrhea was admitted to nephrology department for rapidly progressive acute renal failure (AKI) (creatinine increases in 48 hours from 28mg/l to 55mg/l) and was complicated by major hydro-electrolyte disorders and multi-organ failure. Her past medical history revealed an ovulation induction before her last pregnancy and a spontaneous abortion seven years ago before her hospitalization which occurred in the 2nd trimester of her 1st twin pregnancy obtained by medically assisted reproduction. Despite optimal care, the patient improves her renal function and her multiorgan failure after abortion in gynecological intensive care. Because of worldwide increase of infertility cases and the use of new ovulation induction techniques with these risks of serious complications, we report this interesting clinical case of OHS.

Pseudohipoaldosteronism Type 1: a case report supported by a literature review

In the neonatal period, hydro electrolytic disorders with dehydration and metabolic acidosis can cause admission to an intensive care unit and become a diagnostic challenge. Among such disorders, hyponatremia and hyperkalemia become diagnostic challenges with hormonal involvement, including aldosterone. Pseudohypoaldosteronism (PHA) resulting from the lack of response to aldosterone in target cells can be classified into three types and its suspected diagnosis in cases of hyponatremia, hyperkalemia with an elevation of serum aldosterone, can be confirmed by exome sequencing with identification of a potentially pathogenic. This study was based on the case report of a newborn of consanguineous parents who, after birth, evolved in the first week of life with shock, hyponatremia, hyperkalemia, and metabolic acidosis. An initial investigation ruled out congenital adrenal hyperplasia. The presence of hyperaldosteronism with increased plasma renin activity, associated with hyperkalemia and hyponatremia difficult to control with electrolyte replacement, led to a molecular investigation that confirmed PHA type 1 by a mutation in the SCCN1A gene. In neonates with severe hyponatremia that is difficult to resolve with conventional treatment and elevation of serum aldosterone, this pathology must be remembered and investigated, avoiding high morbidity and mortality.

Internal quality control of Na+ and K+ at clinical biochemistry laboratory

Background: the blood electrolyte analysis is a routine laboratory test, the proper execution of which would help in the diagnosis of hydro-electrolyte disorders. We undertook to assess the quality of the sodium and potassium from the pre-pre-analytical phase to the post-analytical phase. Material and Methods: This was a cross-sectional study which took in the laboratory of biochemistry at the Institute of Cardiology, Abidjan, Ivory Coast from March 1st to March 31, 2009. We used the flame photometer to measure the sodium and potassium electrolytes level in the internal control Exatrol-Normal from Biolabo® and those of the clinical samples. The pre-pre-analytical quality indicators depending on the physician’s order, the pre-analytical quality indicators and the post-analytical indicators under the control of the laboratory and based on the NF standard ISO 15189 version 2012 have been determined. Data were captured into Microsoft Access [Microsoft Corporation, Redmond, WA] and then imported and analyzed using QI Macros SPC Software for Excel®. The monthly dispersion parameters of the Exatrol Normal were used to establish the Levey-Jennings diagram and the Wesgard’s rules were used for the interpretation. Results: a total of 112 electrolytes analysis order were received. For the pre-pre-analytical phase, the analysis of these requests revealed that 81 (72.3%) requests carried no clinical information. The non-compliance of the samples were mainly represented by the sampling under tight tourniquet 4 (3.6%), followed by the non-respect of the succession tubes during multiple sampling 3 (2.7%). For the analytical phase, the monthly Levey-Jennings diagram showed a dispersion of the Exatrol-Normal® values ​​between the mean plus or minus 2 standard deviations [m ± 2SD]: 139.34 ± 2.84 mmol/L for sodium (Na+). For the potassium (K+), the values ​​of Exatrol-Normal® were between [m± SD]: 4.2±0.78 mmol/L. The interpretation of the two Levey-Jennings diagrams by Wesgard’s rules did not found any statistically significant mistake with regard to the distribution of Na+ and K+ levels. For clinical samples, isolated hyponatremia was the most common disturbance (30.4%) followed by isolated hypokalemia (12.5%). At the post-analytical phase we observed a mean turnaround time of 34 minutes with extremes ranging from 23 to 95 minutes. One case (0.9%) of transcription error was noted. Conclusion: the internal quality control process is applied in the clinical biochemistry laboratory at the Institute of Cardiology, Abidjan. A systematic verification system of the different phases of the analytical process makes it possible to identify errors at all levels of the analytical process and to take corrective action if necessary. Better collaboration between clinicians requesting electrolyte analysis and biologists performing the analysis is necessary to improve the pre-pre-analytical phase and, beyond that, better patient care.

Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: State of the Art and Perspectives.

Diagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk.

Acute kidney injury leading to the diagnosis of sporadic testicular Burkitt's lymphoma: A case report.

Burkitt's lymphoma of the testis (TBL) is a rare and extremely aggressive malignant usually diagnosed in front of a testicular mass. We report an exceptional case of a TBL revealed by an Acute Kidney Injury (AKI) of functional origin in a Tunisian man. A 53-year-old patient, known to smoke and drug addict, presented uncontrollable vomiting responsible for extracellular dehydration. Biology showed AKI and radiological explorations revealed compression of the stomach and the right urinary tract by a retro-peritoneal mass continuing with the right testicle. The testicular biopsy with immunohistochemical study concluded with a testicular Burkitt's lymphoma. After correction of hydro-electrolyte disorders with normalization of serum creatinine, the patient was transferred to oncology for chemotherapy. Unfortunately, he refused treatment. The high aggressiveness of TBL would explain the significant, and surprising intra-abdominal tumoral extension with compression of the stomach leading to the functional AKI observed in the reported case. A testicular mass is a usual circumstance for the discovery of a primary tumor of the testicle. In the case of TBL, the rapid tumor growth associated with a diagnostic delay can lead to an impressive extra gonadal extension. • Burkitt’s lymphoma of the testis is extremely aggressive. • The rapid tumor growth of Burkitt’s lymphoma of the testis can be responsible for an important tumoral extension. • Diagnostic delay can lead to an impressive extra gonadal extension of Burkitt’s lymphoma of the testis.

ROLE DE LA PRISE EN CHARGE NURITIONNELLE PERI OPERATOIRE SUR LA REHABILITATION POSTOPERATOIRE EN CHIRURGIE DIGESTIVE A SOISSONS - FRANCE

Perioperative nutritional management plays an essential role in postoperative rehabilitation: postoperative complications increase when perioperative malnutrition is present. Thesecomplications associatedto undernutrition can range from a simple hydro-electrolyte disorders prolonging the duration of hospitalization until death (29% versus 4% in normal subjects). Objective: To assessthe role of perioperative nutritional support on postoperative rehabilitation in digestive surgery. Type of study: Observational, analytical, prospective, monocentric study. Patients and methods: All patients hospitalized from May 2018 to April 2019 (12 months) who underwent digestive surgery by midline laparotomy were included. The Chi² test was used for correlation analysis between perioperative nutrition and postoperative rehabilitation. A p-value of less than 0.05 was considered significant. Results: Forty-seven patients were selected, aged 63 [32-100] years, sex ratio 1.47. Eighteen patients received preoperative nutritional support and 44 received postoperative nutrition. Pre- and postoperative protein intakes was correlated with first rising (p = 0,036 X² = 8,516) and complete ambulation (p &lt;0,001 X² = 26,605), respectively. Postoperativemobilizationwasearlier in patients who beneficiated fromearlyresumption of postoperativeenteral nutrition (p &lt;0,001 X² = 51,547). Perioperative nutrition (especially aminoacids intake) reduced the occurrence of postoperative complications and the duration of hospitalizationand improved survival at D30 (p = 0,002 X² = 14,586 for preoperative amino acids, p = 0,008, X² = 17,283 for postoperative amino acids). Conclusion:Digestive surgery being at risk of high morbidity and mortality, caloric and protein intake must be adequate in the perioperative period. Optimal adequate perioperative nutritional support will thus improve postoperative rehabilitation.