Thrombotic thrombocytopenic purpura in a previously splenectomized patient

-

i-

Nephrotic

Membranous Protein

glomerulonephritis

Renal vein thrombosis selectivity

thrombocytopenic

thrombocytopenic

purpura

purpura Splenectomy

Howell-Jolly

in a pre-

inhibitors

Steroids

Idiopathic thrombocytopenic purpura was diagnosed in a 26 year old man who had rectal bleeding and marked thrombocytopenia (10,000 platelets/mm3). Complete recovery followed treatment with steroids and splenectomy. There was no clinical, laboratory or histopathologic evidence of thrombotic thrombocytopenic purpura. Several months later typical thrombotic thrombocytopenic purpura developed; recovery followed treatment with steroids, aspirin and dipyridamole. The presence of Howell-Jolly bodies and a negative scan indicated that an accessory spleen was not present. Benefits attributed to splenectomy in thrombotic thrombocytopenic purpura, therefore, may in fact be due to the platelet inhibitory properties of common anesthetic agents, or to some other factor in the surgical procedure rather than to removal of the spleen per se.

purpura

Platelet

bodies

Zacharski LR, Lusted D, Glick JL: Thrombotic thrombocytopenic viously splenectomized patient. Am J Med 60: 1061-1063, 1976.

Idiopathic

Thrombotic

A case of the nephrotic syndrome with unilateral renal vein thrombosis is reported. An 18 year old man presented with a six month history of edema and the recent development of a left-sided varicocele. Roentgenograms revealed an enlarged left kidney and a thrombus in the left renal vein. Renal function studies showed nearly identical creatinine excretion, and similar total protein excretion and protein selectivity from each kidney. The thrombus in the left renal vein did therefore not cause a decrease in glomerular filtration rate or an increase of quantitative protein excretion. Urinary output was high and the serum level of antttombin III was decreased. These findings suggest a mechanism to explain the increased thrombotic tendency in this and other patients with the nephrotic syndrome. A biopsy specimen showed membranous glomerulonephritis.

Kauffmann RH, de Graeff J, Brute1 de la Riviere G, van Es LA: Unilateral renal vein thrombosis and nephrotic syndrome. Report of a case with protein selectivity and antithrombin ill clearance studies. Am J Med 60: 10481054, 1976.

Ill

syndrome

Antithrombin

Myeloma

kidney

Malignant nephropathy

Dialysis

lymphoma

Renal failure

kid-

fluid

Immune

sclerosis complexes

Systemic

Scleroderma

in sdero-

A patient with scleroderma who presented with pericarditis and effusion is described. Aspirates from this pericardial effusion had the characteristics of an exudate with no evidence of autoantibodies, immune complexes or complement depletion. These findings suggest that the mechanisms operating in the production of pericardial effusion in scleroderma may be different from those found in rheumatoid arthritis and systemic lupus erythematosus.

Gladman DD, Gordon DA, Urowitz MB Levy HL: Pericardial fluid analysis derma (systemic sclerosis). Am J Med 60: 1064-1068, 1976.

Pericardltis

Pericardial

The first cases of malignant lymphoma with a “myeloma kidney” type of acute renal failure are presented. With appropriate therapy, both patients regained partial renal function: the first after three months of dialysis. It is suggested that the term paraproteinemic nephropathy is preferable to “myeloma kidney.”

Burke JF Jr, Flis R, Lasker N, Simenhoff M: Malignant lymphoma with “WeiOma ney” acute renal failure. Am J Med 60: 10551060, 1976.

Paraproteinemic