The International Journal of Artificial Organs, 1999
A patient with end-stage renal disease developed severe hyperchloremic acidosis (venous serum tot... more A patient with end-stage renal disease developed severe hyperchloremic acidosis (venous serum total CO 2 level of 10 mmol/L) after treatment with 16 L of isotonic saline. Analysis of this case and published literature indicates that dilutional acidosis may result when very large volumes of isotonic saline are administered intravenously, especially in patients with impaired or absent renal function.
A n aggressive dialysis in a grossly azotemic patient, especially one with severe metabolic acido... more A n aggressive dialysis in a grossly azotemic patient, especially one with severe metabolic acidosis, can lead to dialysis disequilibrium syndrome (DDS). Mild forms present as nausea, vomiting, restlessness, and headache. Severe manifestations include seizures, obtundation, coma, and even death. This clinical picture is caused by cerebral edema induced by one or more of the following mechanisms: 1. "Reverse urea effect"-Dialysis removes urea faster from the blood than from the brain; consequently, water enters the brain. 2. "Cerebrospinal fluid acidosis"-Correction of systemic acidosis engenders the condition due to a lowering of brain pH. 3. "Idiogenic osmoles"-As a response to blood hyperosmolar state, osmoles are produced in the brain. As blood osmolality decreases under relatively quick dialysis, idiogenic osmoles tend to induce brain edema. Because the symptoms of DDS can be life-threatening, preventive measures in patients with severe uremia are important. The first strategy relies on raising blood osmolality by introducing solutes (osmoles) into the blood. The second approach, which is the most common, decreases the efficiency of the dialysis treatment by shortening the duration of a dialysis run to 25%-30% of normal, by lowering dialyzer blood flow or dialysate flow rate, by using a less efficient dialyzer, or by a combination of these maneuvers. Dialysis frequency is increased instead. Anticonvulsant drugs are needed in cases where the preventive measures have not been used or have been unsuccessful.
It is the goal of this section to publish material that provides information regarding specific i... more It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
It is the goal of this section to publish material that provides information regarding specific i... more It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
Minocycline is an oral antibiotic widely used for the long-term treatment of acne and rheumatoid ... more Minocycline is an oral antibiotic widely used for the long-term treatment of acne and rheumatoid arthritis. A few patients develop antineutrophil cytoplasmic antibodies (ANCAs) during minocycline therapy. In this report, the authors describe a case of severe pauci-immune crescentic and necrotizing glomerulonephritis associated with positive cytoplasmic ANCA (C-ANCA) titers and proteinase 3 (PR3) levels after minocycline therapy. Discontinuation of minocycline and initiation of immunosuppressive treatment resulted in improvement of renal function and decline in C-ANCA titers and PR3 levels. A high degree of suspicion, testing for ANCA titers, prompt discontinuation of the drug, and initiation of immunosuppressive treatment are crucial to the diagnosis and treatment of drug-induced ANCA-associated glomerulonephritis.
The authors describe an unusual case of acute renal failure in a 50-year-old woman with a history... more The authors describe an unusual case of acute renal failure in a 50-year-old woman with a history of breast carcinoma. The breast carcinoma was treated with 4 cycles of chemotherapy. After chemotherapy, she felt fatigued and noticed decreased urine output. Her serum creatinine level had risen from 0.8 to 10.1 mg/dL (71 to 893 mol/L). Renal biopsy was done that showed a severe crescentic glomerulonephritis secondary to dense deposit disease. This case is extremely unusual in that: (1) Dense deposit disease developed in a 50-year-old woman, whereas it is primarily a disease of children and young adults, and (2) the patient was being treated with immunosuppressive chemotherapy for breast carcinoma when dense deposit disease developed, thus posing a therapeutic dilemma. Am J Kidney Dis 44:E33-E37.
It is the goal of this section to publish material that provides information regarding specific i... more It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
The International Journal of Artificial Organs, 1999
A patient with end-stage renal disease developed severe hyperchloremic acidosis (venous serum tot... more A patient with end-stage renal disease developed severe hyperchloremic acidosis (venous serum total CO 2 level of 10 mmol/L) after treatment with 16 L of isotonic saline. Analysis of this case and published literature indicates that dilutional acidosis may result when very large volumes of isotonic saline are administered intravenously, especially in patients with impaired or absent renal function.
A n aggressive dialysis in a grossly azotemic patient, especially one with severe metabolic acido... more A n aggressive dialysis in a grossly azotemic patient, especially one with severe metabolic acidosis, can lead to dialysis disequilibrium syndrome (DDS). Mild forms present as nausea, vomiting, restlessness, and headache. Severe manifestations include seizures, obtundation, coma, and even death. This clinical picture is caused by cerebral edema induced by one or more of the following mechanisms: 1. "Reverse urea effect"-Dialysis removes urea faster from the blood than from the brain; consequently, water enters the brain. 2. "Cerebrospinal fluid acidosis"-Correction of systemic acidosis engenders the condition due to a lowering of brain pH. 3. "Idiogenic osmoles"-As a response to blood hyperosmolar state, osmoles are produced in the brain. As blood osmolality decreases under relatively quick dialysis, idiogenic osmoles tend to induce brain edema. Because the symptoms of DDS can be life-threatening, preventive measures in patients with severe uremia are important. The first strategy relies on raising blood osmolality by introducing solutes (osmoles) into the blood. The second approach, which is the most common, decreases the efficiency of the dialysis treatment by shortening the duration of a dialysis run to 25%-30% of normal, by lowering dialyzer blood flow or dialysate flow rate, by using a less efficient dialyzer, or by a combination of these maneuvers. Dialysis frequency is increased instead. Anticonvulsant drugs are needed in cases where the preventive measures have not been used or have been unsuccessful.
It is the goal of this section to publish material that provides information regarding specific i... more It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
It is the goal of this section to publish material that provides information regarding specific i... more It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
Minocycline is an oral antibiotic widely used for the long-term treatment of acne and rheumatoid ... more Minocycline is an oral antibiotic widely used for the long-term treatment of acne and rheumatoid arthritis. A few patients develop antineutrophil cytoplasmic antibodies (ANCAs) during minocycline therapy. In this report, the authors describe a case of severe pauci-immune crescentic and necrotizing glomerulonephritis associated with positive cytoplasmic ANCA (C-ANCA) titers and proteinase 3 (PR3) levels after minocycline therapy. Discontinuation of minocycline and initiation of immunosuppressive treatment resulted in improvement of renal function and decline in C-ANCA titers and PR3 levels. A high degree of suspicion, testing for ANCA titers, prompt discontinuation of the drug, and initiation of immunosuppressive treatment are crucial to the diagnosis and treatment of drug-induced ANCA-associated glomerulonephritis.
The authors describe an unusual case of acute renal failure in a 50-year-old woman with a history... more The authors describe an unusual case of acute renal failure in a 50-year-old woman with a history of breast carcinoma. The breast carcinoma was treated with 4 cycles of chemotherapy. After chemotherapy, she felt fatigued and noticed decreased urine output. Her serum creatinine level had risen from 0.8 to 10.1 mg/dL (71 to 893 mol/L). Renal biopsy was done that showed a severe crescentic glomerulonephritis secondary to dense deposit disease. This case is extremely unusual in that: (1) Dense deposit disease developed in a 50-year-old woman, whereas it is primarily a disease of children and young adults, and (2) the patient was being treated with immunosuppressive chemotherapy for breast carcinoma when dense deposit disease developed, thus posing a therapeutic dilemma. Am J Kidney Dis 44:E33-E37.
It is the goal of this section to publish material that provides information regarding specific i... more It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.
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Papers by Mandeep Sahani