Severe Hypoalbuminemia Research Articles

Concomitant spinal and non-spinal osteoarticular infections

Abstract Background: Treatment of pyogenic spondylodiscitis or septic arthritis can be complicated with a variety of concomitant infectious processes. No study has focused on concomitant osteoarticular infections. Materials and Methods: Between 2015 and 2019, patients over 18 years old, who were diagnosed and treated for spinal infections (SIs) or non-spinal osteoarticular infections, were included. There were six patients with concomitant spinal and non-spinal osteoarticular infections (concomitant infection [CI] group), 30 patients with SI alone (SI group), and 18 patients with articular infection (AI) alone (AI group). The data gained from the patients in the CI group were compared those in the SI group and the AI group. Results: Factors contributing to statistical significance included past or present history of cancer (100% in the CI group, 27% in the SI group, and 33% in the AI group), C-reactive protein (CRP) levels (27.4 mg/dL in the CI group, 13.4 mg/dL in the SI group, and 13.8 mg/dL in the AI Group), albumin levels (2.4 g/dL in the CI group and 2.9 in both the SI group and the AI group), detection of Group B Streptococcus (GBS) (50% in the CI group, 3.3% in the SI group and 5.6% in the AI group), and duration of intravenous antibiotic therapy (131 days in the CI group, 67 days in the SI group and 29 days in the AI group). Conclusions: Patients with concomitant spinal and non-spinal osteoarticular infections were more likely to present with a past and present history of cancer, severe hypoalbuminemia, higher levels of CRP and GBS bacteremia.

Protein-losing enteropathy: is it Crohn's disease?

Case of a 24-year-old woman presenting due to edema in lower extremities. The patient had had infectious mononucleosis three weeks prior and had medical history of suspicion of Crohn's disease (CD) (due to a non-specific ileocolitis in a colonoscopy/EnteroRM). No ongoing medication. Laboratory evaluation unveiled hypoproteinemia with severe hypoalbuminemia, no renal abnormalities. A PLE was assumed, with post-infectious or CD being the most likely culprits. Alternative causes were extensively excluded. A videocapsule revealed white-tipped or granular villi, some white nodular villi and diffuse edema of the mucosa, and multiple extensive erosions and superficial ulcers in the jejunum and proximal ileum, not suggestive of CD. A push enteroscopy revealed unspecific histopathology. After incomplete response to enteral nutrition, corticotherapy was initiated resulting in sustained improvement. A follow-up Ileocolonoscopy and double balloon enteroscopy revealed no abnormalities. Six months post-treatment, the patient remains asymptomatic, with unremarkable laboratory results and no need for medication.

Clinical profile and laboratory parameters of confirmed pediatric scrub typhus cases in a tertiary health care institute

Background: Scrub typhus is one of the vector borne tropical infectious disease, caused by O. Tsutsugamushi. Because of nonspecific signs and symptoms and variable prevalence of pathognomic sign (eschar), diagnosis is very difficult in early stage. The purpose of present research was to differentiate that whether case presenting at our institution are different from previously conducted research in various regions. Methods: Hospital record of all reported cases of scrub typhus admitted to department of pediatrics at tertiary health care institute in North India over last two years (2018-2019) was retrieved and reviewed. Results: More cases were reported in male. Maximum number of cases were in 5-10 years i.e. 32 (50.0%) and only one case in less than 12 months. Maximum number cases were reported in August to October 53 (82.8%) as shown. Most common presenting complaint was fever. Most of cases reported with fever of duration of 7-14 days in (51.6%). Rash was present in 7 (10.5%) and eschar in 1 (1.5%). In lab parameters reported abnormalities severe hypoalbuminemia, hyperbilirubinemia, elevated transaminases, anemia, thrombocytopenia leucopenia and leucocytosis. Hepatitis in 48 (75%) was most common complication followed by pneumonia. Other reported complications were myocarditis, acute kidney injury, pneumonia, bleeding, meningitis, enchepalopathy , papilledema, ARDS and hemophagocytosis. Conclusions: Pediatrician should keep high index of suspicion for suspect scrub typhus in a child presents with febrile illness and early treat should be started. Hepatitis is most common complication. As Scrub typhus is associated with multisystem involvement, thorough assessment of patient should be done to look for these complications and appropriate management of complications should be provided to prevent mortality.

Liver dysfunction in children with scrub typhus: association with severity of illness and outcome

Background: Liver dysfunction is a common finding in children with scrub typhus. Adult literature has found a significant association between the extent of liver dysfunction and severity of illness and outcome. However, very few studies are available on children.Objectives: To study the extent of liver dysfunction in children with scrub typhus and its association with severity of illness and outcome.Method: It was a retrospective descriptive study conducted on children diagnosed with scrub typhus admitted to a tertiary care centre in south India from January 2016 to December 2020. Children from 1 month to 18 years of age were included. Demographic data, clinical details, laboratory parameters, course of illness and outcome data were collected and analysed. Results: Study population included 143 cases of scrub typhus. Mean age of the study population was 8.4 ± 4.4 years with a male: female ratio of 1.2:1. Fever was present in 100%, myalgia in 54.5%, decreased appetite in 54.5%, jaundice in 8.4% and hepatomegaly in 71.3% of children. Abnormal liver function tests were present in 75.5% children. Elevated aspartate transaminase (AST) was seen in 75.5%, elevated alanine transaminase (ALT) in 67.1%, hypoalbuminaemia in 47.5% and severe hypoalbuminaemia (<2.5g/dL) in 29.4%. Complications included meningitis (13.3%), shock (7.6%), meningoencephalitis (2.7%) and acute respiratory distress syndrome (2%). There were 2 (1.3%) deaths. Children with complications had higher AST (p <0.01), ALT (p = 0.018), low serum albumin (p<0.001) and prolonged international normalised ratio (INR) (p =0.003).Conclusions: Abnormal liver function tests were present in 75.5% of children with scrub typhus. Children with complications of scrub typhus had significantly higher median AST levels, ALT levels, low serum albumin levels and prolonged INR compared to children with no complications

An Effect of Giving Snakehead Fish Extract ( Channa striata ) on Albumin, Neutrophil, and Lymphocyte Levels in Hypoalbuminemia Patients

Background : Hypoalbuminemia is a condition where the albumin level in the blood falls below normal. Hypoalbuminemia is known as a marker of protein energy malnutrition, inflammation, infection, liver disease, kidney disease and postoperative stress. In Indonesia, malnutrition hospital data shows 40-50% of patients have hypoalbuminemia or are at risk of hypoalbuminemia, 12% of them are severe hypoalbuminemia, and the hospitalization period for patients with hospital malnutrition shows 90% longer than patients with good nutrition. Decreased albumin levels can be associated with a decrease in the immune system and slow healing of tissues/wounds due to infection. Neutrophils and lymphocytes whose numbers increase when inflammation occurs. Oral administration of high protein with snakehead fish extract ( Channa striata ) is an alternative treatment for hypoalbuminemia. Objective: The purpose of this study was to determine the effect of snakehead fish extract (Channa striata) on albumin, neutrophil, and lymphocyte levels in hypoalbuminemic patients. Method: Articles are compiled using a systematic method literature review , involving national and international journals by taking journals through Google scholar, Pubmed, Research Gate, Scient direct. Results: There was an effect of giving snakehead fish extract on albumin levels, neutrophil values, and lymphocyte values in hypoalbuinemic patients and experimental animals. Conclusion: The content of amino acids, albumin, Zn, Fe, Cu and unsaturated fatty acids in snakehead fish ( Ophiocephalus striatus) is quite effective as an effort to increase albumin levels, decrease neutrophil and lymphocyte values when inflammation occurs in hypoalbuminemic patients.
 
 Keywords: Channa striata extract , Albumin, Neutrophils, Lymphocytes, Hypoalbuminemia

Successful Use of Intravenous Immunoglobulin (IVIG) in Severe Life-Threatening Hypoalbuminemia in a Young African American (AA) Male with FSGS

Successful Use of Intravenous Immunoglobulin (IVIG) in Severe Life-Threatening Hypoalbuminemia in a Young African American (AA) Male with FSGS

Albumin Infusion Reduces Fluid Loading for Postresuscitation Syndrome in a Pig Model of Refractory Cardiac Arrest Resuscitated With Venoarterial Extra Corporeal Membrane Oxygenation.

Hemodynamic instability in postresuscitation syndrome worsens survival and neurological outcomes. Venoarterial extracorporeal membrane oxygenation (VA ECMO) for refractory cardiac arrest might improve outcomes. Hemodynamical support under VA ECMO relies on norepinephrine and crystalloids. The present work aims to assess the effects of albumin (ALB) infusion in a swine model of ischemic refractory cardiac arrest implanted by VA ECMO. Cardiac arrest was performed in 18 pigs and VA ECMO was initiated after 30 minutes cardiopulmonary resuscitation (CPR). Pigs were randomly assigned to standard care (norepinephrine + crystalloids) versus ALB group (ALB + standard care). Hemodynamical assessments were performed over 6 hours. Severe hypoalbuminemia was observed in the control group and could be reversed with ALB infusion. Total crystalloid load was significantly reduced with ALB infusion (1,000 [1,000-2,278] ml vs. 17,000 [10,000-19,000] ml, ALB versus control group, respectively, p < 0.001). There was no significant impact with regard to lactate clearance (29.16% [12.5-39.32] and 10.09% [6.78-29.36] for control versus ALB groups, respectively, p = 0.185), sublingual capillary microvascular parameters, or cerebral near-infrared spectrometer (NIRS) values. Compared to standard care, ALB infusion was highly effective in reducing fluid loading in a porcine model of postresuscitation syndrome after refractory cardiac arrest treated with VA ECMO.

An unusual cause of portal hypertension.

A 66-year-old male with a medical history of coronary artery disease presented with nonspecific symptoms of anorexia, lethargy and an increase in abdominal girth. He was diagnosed 3 months ago with chronic liver disease of undetermined aetiology. He did not smoke and was a social drinker till 4 months ago. He was taking tests showed progressive cholestatic liver enzymes (total bilirubin 1,09 mg/dL, AST 130 U/L, ALT 129 U/L, GGT 517 U/L and ALP 641 U/L) and a severe hypoalbuminemia. Laboratory workup made a metabolic, autoimmune, and viral aetiology of the suspected cirrhosis less probable. Urinalysis showed a rapidly progressive proteinuria in the nephrotic range accompanied by the presence of serum spike of monoclonal lambda light Furosemide, Aldactone, Pantoprazole, Acetylcysteine and Atorvastatin. He had no personal or familial history of liver diseases. Physical examination revealed a tender but distended abdomen and large ascites was present. The laboratory chain protein on electrophoresis with immunofixation. Doppler echocardiography revealed a hypertrophic cardiomyopathy based on diffuse left and right ventricular hypertrophy with relative apical sparing. A diagnostic paracentesis was undertaken and the results were consistent with portal hypertension (SAAG 1,6 g/ dL). Considering the concomitant presence of hypertrophic cardiomyopathy, nephrotic syndrome and a presentation of portal hypertension of undetermined aetiology in presence of a monoclonal IgG lambda light chain spike, a transjugular liver biopsy (figure 1 and 2) was performed with HVPG measurement consistent with significant portal hypertension (15 mmHg).

A remarkable presentation of a massive Budd-Chiari syndrome.

A 59-year-old female presented to the emergency department with malaise, significant weight loss, abdominal discomfort, dyspnoea and severely swollen peripheral extremities. She had a past medical history of sickle cell anaemia, a latent tuberculosis infection and a chronic hepatitis B that was treated with PEG-interferon alpha-2 in 2008. Since 2018, she was lost to follow-up. The patient was critically ill, sarcopenic and lethargic. Clinical examination revealed icteric sclerae and a markedly distended and diffusely tender abdomen and peripheral oedemas. Her vital signs included a blood pressure of 105/64 mmHg, tachycardia of 130 bpm, hypothermia of 35.6°C and a SpO2 of 100% in ambient air. Laboratory workup demonstrated a total bilirubin of 12.9 mg/dL, AST 500 U/L, ALT 218 U/L, ALP 178 U/L and GGT 126 U/L, a thrombocytopenia of 34 x10E3/ μL, 16,01 x10E3/μL leukocytes, a CRP of 94.8 mg/L and a lactate of 10,12 mmol/L. The serum creatinine was 1.04 mg/dL, eGFR 54.1 ml/min. The INR was 2.77 and there was a severe hypoalbuminemia (22 g/L). D-dimers were &gt;20 000 ng/ml. The patient presented also with spontaneous hypoglycaemia. A multiphasic contrast-enhanced thoracic and abdominal computed tomography (CT) was performed (figure 1). Given the results of the CT, a 2D echocardiogram was urgently requested (figure 2).

Management of Refractory Central Vein Stenosis in Hemodialysis Patient

BACKGROUND: Patient with hemodialysis (HD) is prone to central venous stenosis (CVS). The presence of CVS contributed to poor dialysis adequacy. Symptomatic CVS is treated with percutaneous transluminal angioplasty (PTA) with or without a stent. This report aimed to understand the characteristics of PTA with or without a stent. CASE PRESENTATION: A 43-year-old woman was admitted to the hospital with a chief complaint of a deteriorating swollen right arm with pain 1 week prior. Patient had been on HD since 2019, had AV shunt access, continuous ambulatory peritoneal dialysis (CAPD), and 4 times balloon angioplasty due to similar complaints. Diagnoses of the patient were AV shunt stenosis, chronic kidney disease Stage 5 on CAPD, heart failure Stage C FC II, hypertension on treatment, anemia related to renal disease, and severe hypoalbuminemia based on anamnesis and extensive examination. PTA with stent was conducted in this patient and showed TIMI Flow III. CONCLUSION: PTA is the primary treatment for symptomatic CVS. A stent implantation is used in cases that failed PTA treatment. PTA with a stent provides immediate symptom alleviation and benefits an angioplasty-resistant lesion by secondary patency.

ГЕНЕТИЧЕСКИЕ ПРИЧИНЫ СТЕРОИДРЕЗИСТЕНТНОГО НЕФРОТИЧЕСКОГО СИНДРОМА

Nephrotic syndrome (NS) is a severe glomerulopathy characterized by severe proteinuria, hypoproteinemia, hypoalbuminemia, hyperlipidemia and widespread edema. There’ve been over sixty genes identified to date that are responsible for the development, structural integrity and functioning of podocytes. Pathogenic nucleotide variants of these genes lead to the podocytopathy in steroid-resistant nephrotic syndrome in 30% of cases. Depending on the protein damaged, the severity of the course, the extrarenal manifestations as well as the therapeutic options may vary. The molecular genetic research has therefore resulted in the fore in recent decades when pediatric patients with steroid-resistant NS are diagnosed.

Clinical covariates that improve the description of high dose methotrexate pharmacokinetics in a diverse population to inform MTXPK.org.

The MTXPK.org webtool was launched in December 2019 and was developed to facilitate model-informed supportive care and optimal use of glucarpidase following the administration of high-dose methotrexate (HDMTX). One limitation identified during the original development of the MTXPK.org tool was the perceived generalizability because the modeled population comprised solely of Nordic pediatric patients receiving 24-h infusions for the treatment of acute lymphoblastic leukemia. The goal of our study is to describe the pharmacokinetics of HDMTX from a diverse patient population (e.g., races, ethnicity, indications for methotrexate, and variable infusion durations) and identify meaningful factors that account for methotrexate variability and improve the model's performance. To do this, retrospectively analyzed pharmacokinetic and toxicity data from pediatric and adolescent young adult patients who were receiving HDMTX (>0.5 g/m2 ) for the treatment of a cancer diagnosis from three pediatric medical centers. We performed population pharmacokinetic modeling referencing the original MTXPK.org NONMEM model (includes body surface area and serum creatinine as covariates) on 1668 patients, 7506 administrations of HDMTX, and 30,250 concentrations. Our results support the parameterizations of short infusion duration (<8 h) and the presence of Down syndrome on methotrexate clearance, the parameterization of severe hypoalbuminemia (<2.5 g/dL) on the intercompartmental clearance (Q2 and Q3), and the parameterization of pleural effusion on the volume of distribution (V1 and V2). These novel parameterizations will increase the generalizability of the MTXPK.org model once they are added to the webtool.

Lupus eritematoso sistémico en la unidad de cuidados intensivos de urgencias

ObjectivesTo compare the characteristics of patients who died versus those who survived with systemic lupus erythematosus (SLE) in the emergency intensive care unit (UCIE). Material and methodsRetrospective collection of clinical and laboratory findings of clinical histories of patients with SLE in the UCIE of the Hospital Clínico Quirúrgico de Holguín in the period from January 2016 to January 2021. A descriptive statistical study and univariate analysis were carried out for continuous and discrete variables. The APACHE II score was calculated. ResultsThere were 23 patients with SLE during the period worked. The frequency of SLE in the ICU of the Hospital Clínico Quirúrgico de Holguín is 1.5%, it is the most frequent rheumatic pathology in ICU. Mortality in the ICU was 39.13%. The most frequent reason for admission was respiratory failure (52.4%), mostly due to an infectious cause. The variables that were significantly associated with mortality in the UCIE were: high erythrocyte sedimentation rate (ESR), severe anemia, severe hypoalbuminemia, the relationship arterial oxygen pressure between the fraction of inspired oxygen (PaFi)<200 on admission. The APACHE II score in the deceased group was significantly higher (19.9) (P<.01). Acute renal failure requiring hemodialysis and the need for invasive mechanical ventilation in different modalities for variable times were significantly associated with higher mortality in ICU. ConclusionsSLE in the ICU of the Hospital Clínico Quirúrgico de Holguín has a high mortality rate, higher than that reported in previous studies. Poor prognostic factors were high ESR, severe anemia, severe hypoalbuminemia, PaFi<200, high APACHE II score, need for hemodialysis and invasive mechanical ventilation.

Relationship Between Serum Albumin Levels And Pulmonary Edema In Glomerulonephritis Patients

Background: Glomerulonephritis is an inflammatory disease of the glomerulus that causes changes in permeability, changes in kidney’s structure, and function of the glomerulus. Hypoalbuminemia in glomerulonephritis can decrease oncotic pressure resulting in extravasation of fluid into the interstitium. In severe hypoalbuminemia, extravasation of fluid can result in pulmonary edema. The subjective of this study was to analyze the correlation between serum albumin and the incidence of pulmonary edema by chest x-ray in patients with glomerulonephritis. Methods: The samples of this study were collected by purposive sampling using secondary data from the medical records of Dr. Kariadi Hospital in Semarang with a total of 46 subjects from January 2016-January 2021. The serum albumin was categorized as normal if serum albumin was &gt;3,5 g/dL, mild hypoalbuminemia if serum albumin was 2.5-3.5 g/dL and severe hypoalbuminemia if serum albumin was &lt;2.5 g/dL. Result: Mann Whitney test showed a significant relationship between between serum albumin and the incidence of pulmonary edema by chest x-ray in patients with glomerulonephritis (p = 0.016). A higher mean rank was found in patients with pulmonary edema compared to patients without pulmonary edema. Conclusion:There is a significant relationship between serum albumin and the incidence of pulmonary edema by chest x-ray in patients with glomerulonephritis. Patients with lower serum albumin have a greater tendency to develop pulmonary edema than patients with higher serum albumin.

Serum myostatin and irisin as predictive biomarkers of sarcopenia, malnutrition and mortality in patients with decompensated liver cirrhosis

Malnutrition and sarcopenia are nowadays considered the main complications of liver cirrhosis (LC). Myokines are signal peptides synthesized in muscles that regulate muscle strength and mass and mediate crosstalk between skeletal muscles and other organs. It is unknown whether circulating myokines can be used as biomarkers of malnutrition and sarcopenia and have independent prognostic value in LC. The purpose of the study was to assess the relationship of serum levels of myokines myostatin and irisin with nutritional status, skeletal muscle status, and survival in decompensated LC patients. 74 patients (55.30±11.40 years) were involved in the prospective study. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment, and skeletal muscle mass was assessed using the Skeletal Muscle Index. The concentration of serum myostatin and irisin was determined by enzyme immunoassay. Statistical data processing was performed in SPSS22 (© SPSS Inc.). It was established that the concentration of serum myostatin and irisin is not related to the LC severity according to the Child-Turcotte-Pugh, Model For End-Stage Liver Disease, and the grade of ascites. Patients with overt encephalopathy have higher myostatin levels. Patients with severe hypoalbuminemia have higher serum myostatin and lower serum irisin levels. The development of malnutrition and sarcopenia in decompensated LC patients is associated with increased serum myostatin concentration and decreased serum irisin concentration. Serum myostatin level can predict sarcopenia (AUC 0.834 in males and 0.827 in females, p&lt;0.01). Serum irisin level can predict severe malnutrition (AUC 0.830, p&lt;0.001). The mortality of patients with high myostatin levels (above 5.25 ng/ml in males and 3.55 ng/ml in females) and low irisin levels (less than 1.72 ng/ml) is significantly higher. In conclusion, the circulating myokines levels may be useful in the assessment of nutritional and skeletal muscle status, and prediction of mortality in LC patients.

Clinical Manifestation of Cytomegalovirus-Associated Protein-Losing Enteropathy in Children.

In children, CMV-associated protein-losing enteropathy (PLE) is characterised by a benign course and spontaneous healing but can lead to generalised oedema. Poorly defined, it is diagnosed after unnecessary invasive tests. Children with CMV-associated PLE between 2009 and 2019 in two French hospitals are retrospectively described. Clinical and biological signs, CMV identification, endoscopy and histological findings, disease management and course are analysed. CMV-associated PLE is proven in 21 immunocompetent and 22 immunosuppressed patients, with ages consistent with primo-infection and reactivation, respectively. The digestive symptoms prevail in immunocompetent children, mainly with vomiting (85.7% versus 50%, CI [1.2; 39.2], p = 0.02). Immunocompetent patients show more oedema (61.9% versus 4.5%, CI [3.6; 1502.4], p < 0.001), linked to more severe hypoalbuminemia (21.2 g/L [17.6-25.7] versus 29.6 g/L [24.9-33.9], p = 0.01). A severe course is observed in 23.8% of the immunocompetent patients and 54.5% of the immunosuppressed ones (p = 0.06). Evidence of CMV infection based on non-invasive methods is found on 88.9% of immunocompetent and 95.5% of immunosuppressed patients (p = 0.58), while endoscopy was performed on 95.2% and 100% of them, respectively (p = 0.48), without any therapeutic change. Thus, CMV-associated PLE should be suspected in children with generalised oedema. Not as benign as previously described, it can be confirmed using non-invasive tests.

Clinical profile and predictors of severity in children with scrub typhus admitted to paediatric intensive care unit

Background: Scrub typhus accounts for a significant portion of morbidity and mortality related to tropical infectious diseases. This study is done to determine the factors associated with complications and outcome in children with scrub typhus. Methods: It is a retrospective descriptive study conducted on children diagnosed with scrub typhus (IgM) admitted to the paediatric intensive care unit at a tertiary care centre in south India during 1 year of study period. Clinical profile, laboratory parameters, course of illness and outcome data were collected and analysed. Results: The study population included 88 children with scrub typhus. 32 children required intensive care unit admission. Remaining 56 children were included in non-severe scrub typhus group. Complications of scrub typhus included hepatic dysfunction (100%), pneumonitis 16 (50 %), meningoencephalitis 12 (37.5%), shock 12 (37.5%), acute respiratory distress syndrome (ARDS) 4 (12.5%), myocarditis 4 (12.5%), acute kidney injury (AKI) 2 (6.25%), multiple organ dysfunction syndrome (MODS) 2 (6.25%) and purpura fulminans 1 (3.1%). Mortality was observed in 2 (1.3%) children. It was found that anaemia and leucocytosis were predominantly associated with the risk of severe scrub typhus (odds ratio of 6.43 and 30.4 respectively, p value &lt;0.001). Among other laboratory parameters, C-reactive protein (CRP) of &gt;30 and hypoalbuminemia were significantly associated with mortality (p value &lt;0.001). The median CRP and AST levels were significantly high in the severe scrub typhus group (p value 0.02 and 0.012 respectively). Conclusions: Hepatic dysfunction was present in all children admitted to PICU. Children with scrub typhus had an increased risk of developing complications in the presence of anaemia, leucocytosis, CRP&gt;30 mg/l and severe hypoalbuminemia.

Hypoalbuminemia is a risk factor for invasive fungal infections and poor outcomes in infected kidney transplant recipients.

Invasive fungal infections (IFI), are estimated to occur in 2%-14% of kidney transplant recipients (KTRs) in the current era of immune suppression and are associated with high mortality rates. We hypothesized that hypoalbuminemia in KTRs is a risk factor for IFI and would be associated with poor outcomes. In this study, using data from a prospective cohort registry, we describe the frequency of IFI due to Blastomycosis, Coccidioidomycosis, Histoplasmosis, Aspergillosis, and Cryptococcus in KTRs with serum albumin levels measured 3-6months before diagnosis. Controls were selected based on incidence density sampling. KTRs were divided into three groups based on the pre-IFI serum albumin level: normal (≥4g/dL), mild (3-4g/dL), or severe (<3g/dL) hypoalbuminemia. Outcomes of interest were uncensored graft failure after IFI and overall mortality. A total of 113 KTRs with IFI were compared with 348 controls. The incidence rate of IFI among individuals with normal, mild, and severe hypoalbuminemia was 3.6, 8.7, and 29.3 per 100 person-years, respectively. After adjustment for multiple variables, the trend for risk of uncensored graft failure following IFI was greater in KTRS with mild (HR=2.1; 95% CI, .75-6.1) and severe (HR=4.47; 95% CI, 1.56-12.8) hypoalbuminemia (P-trend<.001) compared to those with normal serum albumin. Similarly, mortality was higher in severe hypoalbuminemia (HR=1.9; 95% CI, .67-5.6) compared to normal serum albumin (P-trend<.001). Hypoalbuminemia precedes the diagnosis of IFI in KTRs, and is associated with poor outcomes following IFI. Hypoalbuminemia may be a useful predictor of IFI in KTRs and could be incorporated into screening algorithms.

Reversible Bilateral Basal Ganglia and Brainstem Lesions in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report

&lt;p&gt;The pathophysiology behind neuropsychiatric SLE (NPSLE) remains poorly understood and its clinical and radiological manifestations are highly varied. In this report, we present a complex case of an adolescent female patient with a three-week history of systemic symptoms (fever, nausea, vomiting, weight-loss, polyarticular joint pain), progressive motor weakness, tremor, and altered mental status. Physical examination was significant for oromandibular and cervical dystonia rigidity, and general weakness with imposed right-sided hemiparesis. A head MRI demonstrated bilateral hyperintense lesions of the basal ganglia and brainstem, SS without restricted diffusion. The patient was diagnosed with NPSLE, lupus nephritis, electrolyte imbalance, severe hypoalbuminemia, lupus cardiomyopathy, autoimmune hemolytic anemia, pulmonary tuberculosis, and sepsis. The patient was given treatment in the ICU with pulse dose corticosteroids, intravenous antibiotics, intravenous immunoglobulins (IVIg), and supportive treatment with correction of hematologic and electrolyte abnormalities. Her condition improved rapidly. Full alertness was regained, and symptoms of oromandibular dystonia, tremor, and weakness diminished significantly. A follow-up MRI three weeks later revealed complete disappearance of lesions, which we attribute to resolution of the inflammatory process in the brain.&lt;/p&gt;

A Case of a Pregnant Woman with IgA Nephropathy Showing Histological Preeclampsia Findings without Hypertension Treated with Steroids: A Case Report and Literature Review.

A 35-year-old woman pregnant with twins developed nephrotic syndrome (NS) at 33 weeks' gestation, but her blood pressure remained within the normal range throughout gestation and puerperium. At 34 weeks' gestation, she delivered healthy twins via Caesarean section. After delivery, she developed massive proteinuria (21.1 g/day) and severe hypoalbuminemia (1.0 g/dL). A renal biopsy performed 19 days after delivery revealed IgA nephropathy (IgAN) and preeclampsia. She was treated with steroids, and the NS gradually resolved. This is a rare case of massive gestational proteinuria with IgAN and preeclampsia pathologically that did not meet the clinical criteria for preeclampsia.