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EN
Acute kidney injury (AKI) is proven risk factor associated with higher mortality and morbidity among hospitalized patients. The widespread use contrast media opens the discussion about the acute kidney injury as a result of used contrast - contrast induced nephropathy (CIN). CIN is defined as an acute, generally reversible decline in renal function that occurs 48-72 hours after intravascular injection of contrast medium. Pre-existing renal insufficiency is characterised independent risk factor for occurrence of CI-AKI, other factors,such as diabetes mellitus, hypertension, advanced age or hemodynamic instability increase the risk of AKI, but are not characterized as independent risk factors. Published new large retrospective single-center studies presented equal risk of AKI among patients receiving contrast enhanced computer tomography if compared to unenhanced computer tomography, based on serum creatinine levels. In our review we would like to present a persisting the problem of CIN after intravenous (iv) as well intra-arterial contrast media administration
EN
Evaluation of renal function is one of the primary tools used in treatment and monitoring kidney injury such as acute kidney injury (AKI) or chronic kidney disease (CKD) in Primary Care patients. Accompanying chronic diseases also have an impact on the assessment of renal function, treatment monitoring and adjustment of drug doses.
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EN
Malignancy or its treatment affect kidney in several ways. The most common are acute kidney injury and chronic kidney disease. Other form of kidney diseases can also be present such as nephrotic syndrome, tubulointerstitial nephritis, thrombotic microangipathy etc. In addition, electrolyte abnormalities such as hypercalcemia, hyponatremia and hypernatremia, hypokalemia and hyperkalemia, and hypomagnesemia. are observed. Treatment of malignancy associated kidney disease is usually symptomatic. Cessation of the offending agent or other supportive measures if needed i.e. renal replacement therapy are also implemented.
EN
ObjectivesThis study investigates common patterns in patients with exceptionally high creatine kinase (CK) levels to identify factors that could have contributed to the development of severe rhabdomyolysis in the studied cohort.Material and MethodsThe authors present a retrospective analysis of patients with massive rhabdomyolysis (measured CK activity >50 000 U/l) caused by xenobiotics. The patients were selected from a group of 7708 patients treated at the Regional Toxicological Center.ResultsThe most frequent causative agents were recreational drugs, sedatives and anti-epileptics. Six patients developed multi-organ failure, including 1 who died. Substance abuse disorder was diagnosed in 90% of the patients. Each patient had at least 1 contributory factor present (hypothermia, hyperthermia, injury, an episode of agitation, seizures, prolonged immobilization), and the median was 3 factors. Acute kidney injury was observed in 90% of the patients, and 70% needed renal replacement therapy due to acute renal failure, which meant a longer hospital stay. Creatinine concentration differences between days 2 and 1 of the presentation (Cdiff) correlated with the length of hospital stay (r = 0.73, p = 0.02). All patients with negative Cdiff values did not need dialysis. No patients experienced liver failure.ConclusionsMassive rhabdomyolysis seems to be the effect of coincidence of several factors rather than the myotoxic effect alone. A creatinine concentration difference between days 2 and 1 of hospitalization was a good prognostic factor for the need for further dialysis.
EN
Haff disease is a group of symptoms caused by rhabdomyolysis following ingestion of some species of fish and crayfish. Pathophysiology remains unknown. Outbreaks of the Haff disease have been reported in many regions of the world. In this article we present the case of a 38-years-old patient, professional fisherman, suspected of suffering from Haff disease. He developed symptoms of diffuse myalgia, headache, chest pressure, brown-colored urine and elevated blood pressure. Predominant laboratory abnormalities were elevated serum creatine kinase and creatinine concentrations. During hospitalization the patient required the renal replacement therapy. As a result of applied procedures, clinical and laboratory improvement was achieved. The patient was discharged home in good general condition. The Haff disease should be included in the differential diagnosis of rhabdomyolysis. Detailed medical interview, especially questions about recently consumed food and occupational exposure, is crucial in making a proper diagnosis. Med Pr. 2021;72(5):605–10
PL
Choroba Zalewu Wiślanego (Haff disease) jest zespołem objawów spowodowanych rabdomiolizą rozwiniętą po spożyciu niektórych gatunków ryb i skorupiaków. Patofizjologia choroby pozostaje nieznana. Jej ogniska epidemiczne były do tej pory odnotowywane w wielu regionach świata. W niniejszym artykule przedstawiono przypadek 38-letniego pacjenta, zawodowego rybaka, u którego wysunięto podejrzenie choroby Zalewu Wiślanego. Jako objawy chory podawał rozlane bóle mięśniowe, ból głowy, uczucie ucisku w klatce piersiowej, ciemne zabarwienie moczu oraz podwyższone wartości ciśnienia tętniczego. Dominującymi nieprawidłowościami w badaniach laboratoryjnych były podwyższone stężenia kinazy kreatynowej oraz kreatyniny w surowicy krwi. W trakcie hospitalizacji pacjent wymagał leczenia nerkozastępczego. W wyniku zastosowanego postępowania uzyskano poprawę kliniczną oraz laboratoryjną. Pacjenta wypisano do domu w stanie ogólnym dobrym. Choroba Zalewu Wiślanego powinna być uwzględniana w diagnostyce różnicowej rabdomiolizy. Kluczowe w postawieniu prawidłowej diagnozy jest szczegółowe badanie podmiotowe, a przede wszystkim istotne są pytania o ostatnio spożywane pokarmy oraz narażenie zawodowe. Med. Pr. 2021;72(5):605–610
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