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Biomedical subjects

J L Pallot

Publications and source records attributed to J L Pallot.

17 recordsLinked to original sources
PubMed2000

[Acute renal failure after amoxicillin crystallization].

BACKGROUND: Drug-induced nephrolithiasis is a rare finding, especially with beta-lactamins. We report a case of acute renal failure due to amoxicillin crystallization. CASE REPORT: A 48 year-old woman was admitted because of pneumococcal meningitis. After 4 days on high-dose amoxicillin (320 mg/kg/day), she developed acute oliguric renal failure and amoxicillin crystallization was documented by infrared spectrometry. The outcome was favorable after amoxicillin dosage tapering, together with one single hemodialysis session and further hydratation. DISCUSSION: Amoxicillin is mainly excreted in the urine in its unchanged form. The risk of crystalluria is increased by low urinary pH, low urine output and high-dose of the drug. Such a crystalluria should be accurately identified by infrared spectrometry.

Acute Kidney Injury↗
PubMed1998

[Epidemiology and prognosis of acute renal insufficiency in 1997. Recent data].

In an unselected population, the annual incidence of acute renal failure (ARF) seems close to 200 patients per million inhabitants. In elderly patients, this incidence is five times higher than that of younger patients. Mortality is particularly high in intensive care units and doubles if ARF develops after rather than before admission. Death is mainly due to hypovolemic and septic shock, and to cardiovascular diseases. An increasing number of deaths is related to therapeutic limitation. In many cases, ARF can be prevented, e.g. by correcting any sodium deficit and hypovolemia before a surgical procedure, and by considering the true GFR of a given patient before prescribing a potentially nephrotoxic drug, especially in older patients. A poor previous health status, hospitalization prior to admission, and ARF occurring after admission are important predictive factors of mortality, as well as any acute organ dysfunction. Second generation severity scores seem to have a better performance than older ones. The use of continuous hemodialysis and hemofiltration is increasing in ARF patients, but it is not proven that mortality is thereby reduced. A beneficial effect of biocompatible membranes is not clearly demonstrated in these patients. Later, most ARF patients recover a normal, or nearly normal, renal function. Recovery is delayed in older patients and in those whose oliguric period is prolonged. Lastly, the high cost of therapy in ARF justifies the use of all currently preventive measures in patients at risk.

Acute Kidney Injury↗
PubMed1994

[Epidemiology and prognosis of acute renal insufficiency].

The annual incidence of acute renal failure (ARF) in the general population seems close to 150 per million inhabitants. For the past 20 years, there has been an increase in ARF of medical origin and a simultaneous decrease in surgical, traumatic and obstetrical ARF. Drug-induced ARF accounts for 20% of total cases. Factors of poor prognosis include a poor previous health status, the presence of oliguria, cardiac or respiratory insufficiency, sepsis, coma, a need for mechanical ventilation and, most importantly, the number of failing organs. The three main severity scoring systems used are SAPS, APACHE II and OSF. The predictive value of these scoring systems seems acceptable provided the data are collected when ARF is diagnosed and not on the patients' admission. After years, the overall survival rate does not exceed 30% to 50%. Full renal recovery is observed in 1/3 to 2/3 of surviving patients and varies according to the type of nephropathy. The social and financial consequences of these results emphasize the importance of preventing ARF, especially in its iatrogenic form.

Acute Kidney Injury↗
PubMed1992

Acute renal failure after the use of angiotensin-converting-enzyme inhibitors in patients without renal artery stenosis.

During a 4-year period, acute renal failure was observed in 27 patients (mean age 65 years) treated by various angiotensin-converting-enzyme (ACE) inhibitors for hypertension, heart failure, or a combination of both. None had significant renal artery stenosis on angiography. Overt volume depletion was present in 21 and hypotension in 12 cases. All patients received diuretic therapy and/or a low-salt diet. Other facilitating factors included cardiac failure, pre-existing chronic renal insufficiency, combined therapy with non-steroidal anti-inflammatory drugs, and diabetes mellitus. Twenty-two patients had two or more of these factors at presentation. A renal biopsy performed in 10 cases showed severe arteriosclerosis of small renal arteries in eight and acute tubular necrosis in five instances. Therapy comprised volume expansion, and withdrawal of diuretics and, except in two patients, of ACE inhibitors. Twenty-one patients recovered normal renal function, two died, and permanent renal damage remained in four. These results suggest that sodium depletion has a critical role in inducing acute renal failure, whose outcome is not always benign. A combination of diuretics and ACE inhibitors should be prescribed with caution, especially in older patients with small as well as with large renal vessel disease.

Acute Kidney Injury↗
PubMedDate not supplied

[Diabetic hyperlipemia with or without acute pancreatitis in patients with chronic alcoholism. A study of 4 cases].

Diabetic lipemia with and without acute pancreatitis in chronic alcoholism. A report of 4 cases. Diabetic lipemia was observed in 4 chronic alcoholic men after ingestion of high doses of alcohol and/or sugar-rich beverages, including one patient who was treated for insulin-dependent diabetes. None had a previous history of serum lipid disturbances. All had marked hyperglycemia, hyperosmolality and hypertriglyceridemia (mean: 60.8 mmol/l), 2 of undetermined type and 2 of type IV with eruptive xanthomas. Factitious hyponatremia was present in 3 cases, but true serum sodium was normal (138 mmol/l) or elevated (154, 156, 182 mmol/l) after correction. Three patients developed acute pancreatitis ascribed to high serum triglyceride levels and/or to alcohol ingestion. Serum and urine amylase activity was inhibited by hypertriglyceridemia. The diagnosis of pancreatitis was assessed twice by echography and computed tomographic scan, and once by tomographic scan and an elevation of the amylase on creatinine clearance ratio. It is likely that hypertriglyceridemia predisposed these patients to develop pancreatitis, alcoholism being a precipitating factor. We suggest that the diagnosis of acute pancreatitis should be systematically considered in any case of diabetic lipemia without true hyponatremia.

Acute Disease↗