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Biomedical subjects

B Truniger

Publications and source records attributed to B Truniger.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Acute kidney failure in infectious mononucleosis].

Overt renal disease is a rare complication of infectious mononucleosis (MI). In contrast, up to 16% of patients with MI have been shown to exhibit abnormalities in urinary sediment. Histological abnormalities--usually interstitial nephritis, and occasionally glomerular lesions--are rather common. Clinical symptoms include in rare cases isolated macrohematuria, occasionally a nephrotic or nephritic syndrome, and more commonly acute renal failure due to rhabdomyolysis, hepatorenal syndrome or acute interstitial nephritis. We report two observations of acute renal failure with a typically benign course and discuss these observations in the light of an updated literature survey of 34 patients.

Acute Kidney Injury↗
PubMed1990

[Hyperkalemic emergency: causes, diagnosis and therapy].

Eight patients with life threatening hyperkalemia were treated in the intensive care unit over a period of 2 years. Serum potassium at admission was 7.1-11.2. Two patients had to be resuscitated and 3 exhibited quadriplegia or paralyses but were alert. Seven showed marked ECG change: in 5 the QRS-complexes were extremely broadened and in one case an AV-rhythm was observed; the atrial wave was absent in all 7 patients. Renal failure was present in 7 of 8 patients. In 6 of these 8 cases drugs were also involved in the development of hyperkalemia. The following therapeutic procedure is recommended for hyperkalemia: (1) injection of calcium, (2) inhalation or injection of beta 2-mimetics (well documented in the literature; clinical experience limited), (3) insulin and glucose i.v., (4) sodium bicarbonate, but only in case of metabolic acidosis, (5) hemodialysis, (6) cation exchange resins or furosemide in non-acute situations.

Acute Kidney Injury↗
PubMed1989

[Psychogenic water intoxication].

Six new cases of psychogenic water intoxication are discussed in the light of 150 observations published in the literature since 1935. 87% of all patients were schizophrenic, and 13% had other psychoses and a variety of functional and organic psychopathies. Psychogenic polydipsia is a prerequisite of psychogenic water intoxication. Water intake either overrides an intact osmoregulation (46% of all cases) or, allied to an inadequate urinary dilutional capacity (54%), leads to a transitory, sometimes repeated, and (in 8% of all cases) lethal water intoxication and hypoosmolality. - The consequence of hypoosmolality is metabolic encephalopathy, with agitation, convulsions and coma as its most common symptoms. Profuse diuresis, enuresis and urinary retention, gastric dilatation, watery vomiting and watery diarrhea are diagnostically helpful symptoms of polydipsia typically denied by the patients. Hypoosmolality/hyponatremia are the hallmarks of water intoxication. However, fewer than 50% of all patients present with the expected maximal urinary dilution. Inadequate ADH activity and increased sensitivity of the renal tubule to antidiuretic hormone are the pathogenetic factors in this inappropriate urinary dilution, while psychosis, psychotropic drugs, diuretics, nicotine and alcohol withdrawal are possible causes and cofactors of polydipsia and inadequate urinary dilution. New aspects of treatment are discussed.

Aged↗
PubMed1988

[Renal manifestations of sarcoidosis].

Renal manifestations of sarcoidosis are rare. In addition to calcium nephropathy, granulomatous interstitial nephritis and glomerulo-nephritis (GN) account for most cases. The latter two manifestations are described in 4 patients and in a detailed review of the literature. In comparison to a nonselected population of sarcoidosis patients, granulomatous interstitial nephritis is found more frequently in male patients above 40 years of age; it is associated more frequently with other extrathoracic manifestations of sarcoidosis; and it causes renal insufficiency of varying degree, which is at least partially reversible with steroid therapy. Predominant findings are silent microhematuria, sterile pyuria, mild proteinuria and a variety of tubular functional disorders. Glomerulonephritis (39 observations) has been described with increasing frequency in sarcoidosis. Because of the well known immunological abnormalities of sarcoidosis, frequent association of sarcoidosis with GN could be expected but this association has not yet been proven statistically. Sarcoidosis-associated GN includes a variety of histological forms, viz. membranous, proliferative and sclerosing GN. Glomerulonephritis may appear before sarcoidosis. Conversely, both diseases may appear simultaneously, or GN may follow all other manifestations of sarcoidosis with a latency period of many years.

Aged↗
PubMed1987

[Microhematuria of renal origin--differential diagnosis, clarification and interpretation].

Microhematuria offers a wide spectrum of diagnostic possibilities. Once the finding is confirmed, the diagnosis of prerenal, renal-parenchymatous and postrenal (or even factitious) hematuria and differentiation between glomerular and nonglomerular bleeding sources is based on the patient's history, a complete clinical status, special urinary findings (mainly red cell casts, proteinuria and red cell morphology) and blood chemistry (serum creatinine or creatinine clearance). If on the basis of this information glomerular or renal-parenchymatous microhematuria seems likely, further diagnostic procedures include immunological tests and, if indicated and justified, renal biopsy. Urography and other imaging procedures, urinary cytology and cystoscopy (firmly indicated when doubts persist or all the evidence points to postrenal hematuria) are deferred whenever glomerular hematuria seems likely. The special aspects of isolated renal microhematuria are discussed.

Diagnosis, Differential↗
PubMed1987

[Generalized melanosis of macro- and microphages in metastasizing melanoma].

A patient suffering from a metastasizing malignant melanoma of the skin developed diffuse melanosis of the skin and melanuria a few weeks before death occurred. At autopsy, disseminated metastases of malignant melanoma were associated with marked melanosis of the organs and particularly of the mononuclear phagocytic system. In addition, neutrophilic granulocytes of the peripheral blood frequently contained melanin granules. The presence of melanin in blood monocytes and granulocytes may be useful for the diagnosis of (metastasizing) malignant melanoma.

Humans↗
PubMed1986

[Acute rhabdomyolysis].

By damaging cell membrane integrity, acute rhabdomyolysis leads to electrolyte shifts according to the concentration gradients and the liberation of intracellular substances. Diagnosis is confirmed by the presence of a high serum creatinkinase activity (CK) and myoglobinuria. For clinical purposes myoglobinuria is demonstrated by a blood-positive dipstick in the absence of hematuria or hemoglobinuria. Rhabdomyolysis is usually acquired and is rarely due to hereditary enzyme defects. The authors report on 61 patients admitted in the last 15 years with rhabodomyolysis. In the past 4 1/2 years the diagnosis was suggested by CK greater than 5000U/1 in 49 patients, representing 1.6% of all admissions in the departments of medicine and surgery. Originally described in crush situations, rhabdomyolysis has been observed with increasing frequency as a consequence of muscular stress and self crush due to coma or hemi- and paraplegia during the last decades. 24% of the patients with this diagnosis had had an intoxication, and in 70% there were multiple simultaneous causes. Autoimmune diseases, infections of bacterial, viral and fungal origin, endocrinopathies, and thermic and ischemic injuries can also provoke rhabdomyolysis. As a consequence of fluid shift into the damaged muscle a compartment syndrome may lead to vascular or neural defects. In 80% of cases there is initial hypocalcemia, turning later into hypercalcemia. Other frequent electrolyte disorders accompanying rhabdomyolysis are hyperkalemia, hyperphosphatemia and a widened anion gap. 6 of 13 patients showed the typical blood changes found in patients with disseminated intravascular coagulation. Acute renal failure developed in 30 patients, 15 of whom underwent dialysis or hemofiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

[Significance of autopsy. Continuous evaluation of autopsy findings by internists].

To continuously monitor the impact of autopsy results, a short questionnaire was forwarded with each list of autopsy diagnoses to the clinician who had requested the autopsy. This continuous feedback between clinician and pathologist reveals unsolved problems and provides the opportunity for their interdisciplinary evaluation. The 1188 autopsies were done from 1980 to 1984 at the Institute of Pathology for the Medical Clinic, Cantonal Hospital, Lucerne, an acute-care medical teaching hospital department containing about 200 beds. The autopsy rate was 52% for in-hospital deaths. The clinician deemed that about 9/10 of all autopsies had confirmed his diagnosis. About 3/4 of all autopsies disclosed previously unknown and clinically important findings. Major discrepancies between clinical diagnosis and autopsy findings were noted in about 10% of all autopsies. Further, in approximately 1/10 of all autopsies the findings were considered to be of potential therapeutic relevance had they been known before death. The results confirm the relevance of autopsy for the practice of controlled clinical medicine based on objective criteria.

Autopsy↗
PubMed1984

[New diagnostic and therapeutic aspects of acute kidney failure].

In a 20 months' period 20 patients were dialyzed at the Cantonal Hospital, Lucerne, because of acute renal failure (ARF). Contrary to expectation, the main cause was not circulatory failure but traumatic and nontraumatic rhabdomyolysis (5 patients), septicemia (9 patients) and endogenous and exogenous intoxications. In only 2 patients did shock seem an important factor in the pathogenesis of ARF. In view of the many causes of rhabdomyolysis, the frequency of patients with myoglobinuric ARF is hardly surprising. Case history, brown-colored urine with a positive reaction for hemoglobin in the absence of significant hematuria and without significant hemolysis (as judged by the color of the plasma or serum) and, most important, high creatine kinase (10(4) to 10(6) U/l) point to the correct diagnosis. In patients who had undergone trauma or surgery the main cause of ARF was uncontrollable infection. A long interval between the accident or operation and the onset of ARF was typical in these cases. Both hemodialysis and peritoneal dialysis are adequate methods of treatment for ARF. For technical reasons, however, in more than 50% of patients with ARF due to trauma or surgery, peritoneal dialysis is not feasible. On the other hand, in patients with cardiovascular instability continuous arterio-venous hemofiltration serves as an alternative to hemodialysis. With the introduction of Y-shaped dialysis catheters and the single needle system with double pump and controlled ultrafiltration, hemodialysis has become an easier and safer procedure. For patients with prolonged-course ARF the authors prefer a combination of initial hemodialysis, followed by peritoneal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1983

[Magnesium and phosphorus--the forgotten electrolytes].

The clinical and pathophysiological significance and epidemiology of magnesium and phosphorus excess and deficit are discussed. In daily routine both ions largely remain "the forgotten electrolytes". With both elements deficits are clinically more important than excesses. Dietary intake, gastrointestinal and renal losses, shifts between intra- and extracellular fluid and sequestration within the extracellular compartment are the essential factors which determine body stores and the extracellular concentration of the electrolyte. The clinical signs of excess and deficit often lack specificity and - in the case of phosphorus deficiency - involve almost any organ. Since treatment of deficits is easy and success is rapid and involves virtually no risk a timely diagnosis is all the more important but often requires a high index of suspicion.

Humans↗