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D Verbeelen

Publications and source records attributed to D Verbeelen.

77 records · Page 5Linked to original sources
PubMedDate not supplied

Methotrexate should not be used for patients with end-stage kidney disease.

Methotrexate is a widely used disease-modifying anti-rheumatic drug. Its effectiveness has been proven in placebo-controlled trials and in comparison with other disease-modifying anti-rheumatic drugs. The pharmacokinetics of methotrexate are highly variable and unpredictable. In patients with normal renal function, the recommended dose in rheumatoid arthritis ranges between 7.5 and 15 mg/week, but in recent years, even dosages up to 25 mg weekly are used. Toxicity includes myelosuppression, gastrointestinal adverse effects, hepatotoxicity and pneumonitis. Renal impairment and age are considered major risk factors for developing methotrexate toxicity, but studies show conflicting results. Whether methotrexate can be administered to patients with end-stage kidney disease has not been formally tested. The present case illustrates the severe side effects of low-dose methotrexate treatment in a patient with end-stage kidney disease. Seven other cases have reported similar and even more severe and irreversible consequences after low-dose regimen. In view of these side effects we strongly recommend to monitor toxicity rigorously in patients with stage 3 or stage 4 kidney disease and not to use methotrexate in patients with stage 5 kidney disease.

Aged↗
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Late presentation and microcrystalline arthropathy in primary hyperoxaluria.

A 66 year-old woman was referred in 1981 because of renal insufficiency and pronounced nephrocalcinosis. The urinary oxalate excretion was elevated. Secondary hyperoxaluria was excluded. End-stage renal disease necessitated hemodialysis from late in 1982 up to her death in 1986, at the age of 71 years. During the course of the disease, an aggressive arthropathy developed in the fingers. Classical signs of oxalosis were found: deposits of calcium oxalate crystals in bone tissue, the pancreas, myocardium, subcutaneous tissue and especially in the kidneys. This rare case documents the possible occurrence of late clinical presentation and long survival in primary oxalosis.

Acute Kidney Injury↗
PubMedDate not supplied

Recurrent gastrointestinal blood loss of obscure origin: report of an exceptional case.

A 66-year old tailor was admitted because of venous insufficiency of the left lower leg. During the hospital course, recurrent severe gastrointestinal blood loss developed. A classical approach was extended by enteroscopy and radionuclide scanning, followed by exploratory laparatomy with removal of two intra-abdominal sewing needles and a jejunal leiomyoma. After surgery, bleeding did not recur. This case illustrates the difficult diagnostic work-up of obscure gastrointestinal bleeding. It also shows that intra-abdominal sewing needles may migrate in the intestinal tract and remain silent during many years, eventually causing gastrointestinal bleeding.

Abdomen↗