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271 A Rare Case of Renal Recovery in a Young Patient with Multiple Myeloma
NKF 2011 Spring Clinical Meetings Abstracts
269 A CASE OF THYROTOXIC PERIODIC PARALYSIS Ankit Sakhuja, Pinky Patel, Aaron Dall. Medical College of Wisconsin, Milwaukee, WI, USA Thyrotoxic periodic paralysis is an uncommon disease affecting mostly young Asian males. It is usually associated with hyperthyroidism, mostly Grave’s disease. We present a case of thyrotoxic periodic paralysis in a young African American male with no significant past medical history. A 19 year old African American male with no significant past medical history presented to the emergency room with a history of significant weakness. He went to bed the night prior without any problems after a family dinner. He was however unable to get out of bed next morning and had to crawl out of bed. He denied any fever, diarrhea, URI, sick contacts, recent travel and insect or tick bites. His physical examination was significant for proximal muscle weakness more in lower extremities. Labs were significant for potassium of 2.6. meq/L, TSH 0.011 μIU/mL and fT4 2.71 ng/dL. His EKG showed U waves. Patient was diagnosed with thyrotoxic periodic paralysis, given 20 meq of potassium chloride and monitored in the hospital. His strength and potassium levels normalized within 24 hours. He was also started on propranolol and a thyroid scan confirmed Grave’s disease. Thyrotoxic periodic paralysis is an uncommon condition associated with hyperthyroidism. It usually presents in early morning and patients have significant hypokalemia on presentation. However the condition is usually self limited and potassium supplementation can lead to dangerous hyperkalemia. Propranolol has been shown to help abort the attack.
270 TRANSPLANTATION OF HEPATITIS C POSITIVE KIDNEYS INTO SELECTED HEPATITIS C NEGATIVE RECIPIENTS Muhammad Salahuddin, Haritha Sakhamuri, Bruce Sommer, Kenneth Jones, Thomas Peters, University of Florida, Jacksonville, Florida. Hepatitis C positive (HCV+) deceased organ donors may offer otherwise ideal organs, but transmission of hepatitis, particularly to hepatitis C negative (HCV-) recipients, may pose risks which some patients and physicians deem prohibitive. Since active and clinically apparent hepatitis C usually evolves over many years, even in the immunosuppressed host, use of HCV+ kidneys may, in selected HCVpatients, be appropriate. This may especially be so in potential recipients with an expected patient survival of 10 years or less. To determine outcome in HCV- recipients of HCV+ kidneys, 17 patients transplanted between October, 1999, to August, 2010 were identified. All deceased donors were HCV+ liver and kidney donors; in some cases additional organs were recovered. Donors averaged 40 years of age (range 22 to 56) and none had a history of liver disease. All recipients were over 60 years of age: range 61 to 74 (mean 66) years at the time of transplant. Of the 17 recipients, 11 were African American and 6 were Caucasian while 12 were male and 5 were female. Two patients (12%) sero-converted to HCV+ detected through polymerase chain reaction although these patients never had any evidence of clinical liver disease or elevation of hepatic enzymes. Over the course of the 10 years, 8 of the patients died at 1 month to 8 years, 2 of whom had required transplant nephrectomy within 2 months of transplantation; the other 6 died with renal function. The 9 living patients transplanted from 2000 to 2010 had median creatinine values at 1, 6, and 12 months posttransplant, respectively, of 1.8, 1.05, and 1.1 mg/dl, and currently have life-sustaining renal function with a mean serum creatinine of 1.35 mg/dl (range 0.9 to 2.63). None of the 17 patients were diagnosed with acute rejection, and none required retransplantation. Patient and graft survival without clinical HCV disease may be a routine occurrence in older recipients receiving kidneys from donors also donating a liver but positive for hepatitis C antibody.
A84
271 A RARE CASE OF RENAL RECOVERY IN A YOUNG PATIENT WITH MULTPIPLE MYELOMA. Hasan J. Salameh, Adeel Ahmad, Tina Kochar. University of Texas Medical Branch, Department of Nephrology, Galveston, Texas. Multiple Myeloma (MM) is an uncommon hematologic malignancy accounting for 1% of all malignancies. Renal involvement is a common complication of MM. Rapid intervention to reverse renal dysfunction is critical for management, especially in patients with light chain cast nephropathy. Recovery rate ranges from 5%-15%. We describe an atypical presentation of MM in a young patient with a favorable outcome. A previously healthy, 31year-old Caucasian male presented with complaints of abdominal pain radiating to the flanks, dark colored urine, and fatigue of 2 month duration. On physical examination, patient was noted to be afebrile and his blood pressure was 130/84 mmHg. He had pale conjunctivae, clear lung sounds bilaterally on auscultation, and was neurologically intact. Extremities revealed no pedal edema. Laboratory analysis revealed a normal white blood cell count, hemoglobin of 8.5 gm/dl, serum blood urea nitrogen of 79mg/dl, creatinine of 22.5 mg/dl, and serum calcium of 11.2 mg/dl. The computed tomography of abdomen and pelvis for abdominal pain evaluation demonstrated diffuse lytic bone lesions which initiated work-up for multiple myeloma. Serum and urine protein electrophoresis revealed low IgG, IgA, and IgM with predominant kappa light chains. However, there was no M-spike detected. Bone marrow biopsy showed 60% -70% of bone marrow area involvement by plasma cells. Kidney biopsy revealed cast nephropathy with moderate interstitial fibrosis. The patient was initiated on hemodialysis and received one cycle of chemotherapy (Bortezomib, Doxorubicin, and Dexamethasone). After 4 weeks of hemodialysis, patient’s renal function improved with no further need for dialysis. During his outpatient follow-up visits, creatinine remained stable around 2.0 mg/dl. The present case illustrates recovery of renal function with chemotherapy in a young patient with an atypical presentation of MM.
272 SOCIAL ADAPTABILITY INDEX: APPLICATION AND OUTCOMES IN DIALYSIS POPULATION Gurprataap Singh Sandhu, Muhammad Khattak, Preeti Rout, Jalaj Garg, Ranil DeSilva, Mark E. Williams, Shiva Gautam, Bradley Baird, Alexander Goldfarb-Rumyantzev, Beth Israel Deaconess Medical Center. Patient groups associated with disparities in health care are usually defined on the basis of race, gender or geographic location. Social Adaptability Index (SAI) calculated based on education, marital status, income, employment and substance abuse has been strongly associated with clinical outcome in other patient populations and may be used to identify individuals at risk. We used data from United States Renal Data System (USRDS) to evaluate the role of SAI in survival of patients on dialysis. We used Cox model analyses to study the association between SAI and patient survival in patients with ESRD on dialysis, as well as in the subgroups based on age, race, sex, comorbidites and diabetic status. We analyzed 3,396 patients (age of ESRD onset 56.9±16.1 years, 54.2% males, 64.2% White, 30.3% African American). Mean SAI of the entire population was 7.1±2.5 (range 0 to 12 points). SAI was higher in Whites (7.4±2.4) than African Americans (6.5±2.5) [ANOVA, p<0.001] and greater in men (7.4±2.4) than in women (6.7±2.5) [T-test, p<0.001]. In Cox model adjusted for potential confounders SAI was associated with decreased mortality (HR of 0.97, [95% CI 0.95-0.99], p=0.006). Subgroup analysis demonstrated association of SAI with survival in most of the subgroups. Potential limitations of the study include reverse causality, possible misclassification and retrospective design. We demonstrated that SAI is significantly associated with mortality in dialysis patients. SAI could be used to identify individuals at risk for inferior clinical outcomes
Am J Kidney Dis. 2011;57(4):A1-A108
269 A CASE OF THYROTOXIC PERIODIC PARALYSIS Ankit Sakhuja, Pinky Patel, Aaron Dall. Medical College of Wisconsin, Milwaukee, WI, USA Thyrotoxic periodic paralysis is an uncommon disease affecting mostly young Asian males. It is usually associated with hyperthyroidism, mostly Grave’s disease. We present a case of thyrotoxic periodic paralysis in a young African American male with no significant past medical history. A 19 year old African American male with no significant past medical history presented to the emergency room with a history of significant weakness. He went to bed the night prior without any problems after a family dinner. He was however unable to get out of bed next morning and had to crawl out of bed. He denied any fever, diarrhea, URI, sick contacts, recent travel and insect or tick bites. His physical examination was significant for proximal muscle weakness more in lower extremities. Labs were significant for potassium of 2.6. meq/L, TSH 0.011 μIU/mL and fT4 2.71 ng/dL. His EKG showed U waves. Patient was diagnosed with thyrotoxic periodic paralysis, given 20 meq of potassium chloride and monitored in the hospital. His strength and potassium levels normalized within 24 hours. He was also started on propranolol and a thyroid scan confirmed Grave’s disease. Thyrotoxic periodic paralysis is an uncommon condition associated with hyperthyroidism. It usually presents in early morning and patients have significant hypokalemia on presentation. However the condition is usually self limited and potassium supplementation can lead to dangerous hyperkalemia. Propranolol has been shown to help abort the attack.
270 TRANSPLANTATION OF HEPATITIS C POSITIVE KIDNEYS INTO SELECTED HEPATITIS C NEGATIVE RECIPIENTS Muhammad Salahuddin, Haritha Sakhamuri, Bruce Sommer, Kenneth Jones, Thomas Peters, University of Florida, Jacksonville, Florida. Hepatitis C positive (HCV+) deceased organ donors may offer otherwise ideal organs, but transmission of hepatitis, particularly to hepatitis C negative (HCV-) recipients, may pose risks which some patients and physicians deem prohibitive. Since active and clinically apparent hepatitis C usually evolves over many years, even in the immunosuppressed host, use of HCV+ kidneys may, in selected HCVpatients, be appropriate. This may especially be so in potential recipients with an expected patient survival of 10 years or less. To determine outcome in HCV- recipients of HCV+ kidneys, 17 patients transplanted between October, 1999, to August, 2010 were identified. All deceased donors were HCV+ liver and kidney donors; in some cases additional organs were recovered. Donors averaged 40 years of age (range 22 to 56) and none had a history of liver disease. All recipients were over 60 years of age: range 61 to 74 (mean 66) years at the time of transplant. Of the 17 recipients, 11 were African American and 6 were Caucasian while 12 were male and 5 were female. Two patients (12%) sero-converted to HCV+ detected through polymerase chain reaction although these patients never had any evidence of clinical liver disease or elevation of hepatic enzymes. Over the course of the 10 years, 8 of the patients died at 1 month to 8 years, 2 of whom had required transplant nephrectomy within 2 months of transplantation; the other 6 died with renal function. The 9 living patients transplanted from 2000 to 2010 had median creatinine values at 1, 6, and 12 months posttransplant, respectively, of 1.8, 1.05, and 1.1 mg/dl, and currently have life-sustaining renal function with a mean serum creatinine of 1.35 mg/dl (range 0.9 to 2.63). None of the 17 patients were diagnosed with acute rejection, and none required retransplantation. Patient and graft survival without clinical HCV disease may be a routine occurrence in older recipients receiving kidneys from donors also donating a liver but positive for hepatitis C antibody.
A84
271 A RARE CASE OF RENAL RECOVERY IN A YOUNG PATIENT WITH MULTPIPLE MYELOMA. Hasan J. Salameh, Adeel Ahmad, Tina Kochar. University of Texas Medical Branch, Department of Nephrology, Galveston, Texas. Multiple Myeloma (MM) is an uncommon hematologic malignancy accounting for 1% of all malignancies. Renal involvement is a common complication of MM. Rapid intervention to reverse renal dysfunction is critical for management, especially in patients with light chain cast nephropathy. Recovery rate ranges from 5%-15%. We describe an atypical presentation of MM in a young patient with a favorable outcome. A previously healthy, 31year-old Caucasian male presented with complaints of abdominal pain radiating to the flanks, dark colored urine, and fatigue of 2 month duration. On physical examination, patient was noted to be afebrile and his blood pressure was 130/84 mmHg. He had pale conjunctivae, clear lung sounds bilaterally on auscultation, and was neurologically intact. Extremities revealed no pedal edema. Laboratory analysis revealed a normal white blood cell count, hemoglobin of 8.5 gm/dl, serum blood urea nitrogen of 79mg/dl, creatinine of 22.5 mg/dl, and serum calcium of 11.2 mg/dl. The computed tomography of abdomen and pelvis for abdominal pain evaluation demonstrated diffuse lytic bone lesions which initiated work-up for multiple myeloma. Serum and urine protein electrophoresis revealed low IgG, IgA, and IgM with predominant kappa light chains. However, there was no M-spike detected. Bone marrow biopsy showed 60% -70% of bone marrow area involvement by plasma cells. Kidney biopsy revealed cast nephropathy with moderate interstitial fibrosis. The patient was initiated on hemodialysis and received one cycle of chemotherapy (Bortezomib, Doxorubicin, and Dexamethasone). After 4 weeks of hemodialysis, patient’s renal function improved with no further need for dialysis. During his outpatient follow-up visits, creatinine remained stable around 2.0 mg/dl. The present case illustrates recovery of renal function with chemotherapy in a young patient with an atypical presentation of MM.
272 SOCIAL ADAPTABILITY INDEX: APPLICATION AND OUTCOMES IN DIALYSIS POPULATION Gurprataap Singh Sandhu, Muhammad Khattak, Preeti Rout, Jalaj Garg, Ranil DeSilva, Mark E. Williams, Shiva Gautam, Bradley Baird, Alexander Goldfarb-Rumyantzev, Beth Israel Deaconess Medical Center. Patient groups associated with disparities in health care are usually defined on the basis of race, gender or geographic location. Social Adaptability Index (SAI) calculated based on education, marital status, income, employment and substance abuse has been strongly associated with clinical outcome in other patient populations and may be used to identify individuals at risk. We used data from United States Renal Data System (USRDS) to evaluate the role of SAI in survival of patients on dialysis. We used Cox model analyses to study the association between SAI and patient survival in patients with ESRD on dialysis, as well as in the subgroups based on age, race, sex, comorbidites and diabetic status. We analyzed 3,396 patients (age of ESRD onset 56.9±16.1 years, 54.2% males, 64.2% White, 30.3% African American). Mean SAI of the entire population was 7.1±2.5 (range 0 to 12 points). SAI was higher in Whites (7.4±2.4) than African Americans (6.5±2.5) [ANOVA, p<0.001] and greater in men (7.4±2.4) than in women (6.7±2.5) [T-test, p<0.001]. In Cox model adjusted for potential confounders SAI was associated with decreased mortality (HR of 0.97, [95% CI 0.95-0.99], p=0.006). Subgroup analysis demonstrated association of SAI with survival in most of the subgroups. Potential limitations of the study include reverse causality, possible misclassification and retrospective design. We demonstrated that SAI is significantly associated with mortality in dialysis patients. SAI could be used to identify individuals at risk for inferior clinical outcomes
Am J Kidney Dis. 2011;57(4):A1-A108