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Nephrologist (kidney)
31 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
The University of Texas Southwestern (1979)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Castle Connolly Top Doctors: Texas™ (2009)
Associations
American Board of Internal Medicine

Affiliations ?

Dr. Fenves is affiliated with 10 hospitals.

Hospital Affilations

Score

Rankings

  • Medical City Dallas Hospital
    7777 Forest Ln, Dallas, TX 75230
    • Currently 4 of 4 crosses
    Top 25%
  • Massachusetts General Hospital
    55 Fruit St, Boston, MA 02114
    • Currently 4 of 4 crosses
    Top 25%
  • Baylor University Medical Center *
    3500 Gaston Ave, Dallas, TX 75246
    • Currently 4 of 4 crosses
    Top 25%
  • Medical Center Of Lewisville
    500 W Main St, Lewisville, TX 75057
    • Currently 3 of 4 crosses
    Top 50%
  • Baylor Medical Center At Garland
    2300 Marie Curie Dr, Garland, TX 75042
    • Currently 3 of 4 crosses
    Top 50%
  • Medical Center Of Plano
    3901 W 15th St, Plano, TX 75075
    • Currently 2 of 4 crosses
  • Baylor Specialty Hospital
    3504 Swiss Ave, Dallas, TX 75204
    • Currently 1 of 4 crosses
  • RHD Memorial Medical Center
    7 Medical Pkwy, Dallas, TX 75234
    • Currently 1 of 4 crosses
  • Health South
  • Methodist Richardson Medical Center
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Fenves has contributed to 36 publications.
    Title Disseminated Adenovirus Infection in Renal Transplant Recipients: the Role of Cidofovir and Intravenous Immunoglobulin.
    Date September 2010
    Journal Transplant Infectious Disease : an Official Journal of the Transplantation Society
    Excerpt

    Disseminated adenovirus (ADV) infection in solid organ transplant patients is associated with high mortality. Limited studies have shown benefit from using cidofovir (CDV), as well as intravenous immunoglobulin (IVIG). In this study, we report 2 renal transplant patients who presented with fever and pulmonary infiltrates. Both patients continued to worsen despite antibiotic therapy. Bronchoalveolar lavage viral culture and serum polymerase chain reaction (PCR) were positive for ADV. Patients were treated with CDV, IVIG, and reduction in immunosuppression. A progressive decline in serum ADV DNA by PCR correlated with clinical improvement and pulmonary infiltrates improved. Both patients recovered. Allograft function was preserved although reversible acute kidney injury was observed in both patients. To the best of our knowledge, this is the first successful use of CDV and IVIG in renal transplant patients with disseminated ADV infection.

    Title Effect of Dipyridamole Plus Aspirin on Hemodialysis Graft Patency.
    Date May 2009
    Journal The New England Journal of Medicine
    Excerpt

    Arteriovenous graft stenosis leading to thrombosis is a major cause of complications in patients undergoing hemodialysis. Procedural interventions may restore patency but are costly. Although there is no proven pharmacologic therapy, dipyridamole may be promising because of its known vascular antiproliferative activity.

    Title Bilateral Infiltrating Renal Inflammatory Pseudotumor Responsive to Corticosteroid Therapy.
    Date January 2008
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Excerpt

    Inflammatory pseudotumor (IPT) is a quasi-neoplastic lesion that most commonly involves the lung, but has been shown to occur in nearly every tissue type. Renal involvement is very uncommon. We report the second case of IPT ever published presenting as bilateral infiltrating renal masses. Although most renal IPTs were treated with nephrectomy, our patient was managed successfully with conservative steroid treatment, thereby avoiding the alternative of dialysis or kidney transplantation.

    Title Increased Anion Gap Metabolic Acidosis As a Result of 5-oxoproline (pyroglutamic Acid): a Role for Acetaminophen.
    Date September 2007
    Journal Clinical Journal of the American Society of Nephrology : Cjasn
    Excerpt

    The endogenous organic acid metabolic acidoses that occur commonly in adults include lactic acidosis; ketoacidosis; acidosis that results from the ingestion of toxic substances such as methanol, ethylene glycol, or paraldehyde; and a component of the acidosis of kidney failure. Another rare but underdiagnosed cause of severe, high anion gap metabolic acidosis in adults is that due to accumulation of 5-oxoproline (pyroglutamic acid). Reported are four patients with this syndrome, and reviewed are 18 adult patients who were reported previously in the literature. Twenty-one patients had major exposure to acetaminophen (one only acute exposure). Eighteen (82%) of the 22 patients were women. Most of the patients were malnourished as a result of multiple medical comorbidities, and most had some degree of kidney dysfunction or overt failure. The chronic ingestion of acetaminophen, especially by malnourished women, may generate high anion gap metabolic acidosis. This undoubtedly is an underdiagnosed condition because measurements of serum and/or urinary 5-oxoproline levels are not readily available.

    Title Renovascular Hypertension: Clinical Concepts.
    Date December 2006
    Journal Minerva Medica
    Excerpt

    Systemic hypertension is a common disorder in clinical practice and causes significant morbidity and premature death. A small percentage (< 5%) of patients with hypertension may have renovascular hypertension. Strictly speaking, the term renovascular hypertension should be applied only when the blood pressure rises as a consequence of renal ischemia. Thus, the mere presence of renal artery stenosis is not synonymous with renovascular hypertension. Treatment strategies should be directed at ''renovascular hypertension'' rather than an anatomic renal artery stenosis (which may be discovered accidentally). Management of renal artery stenosis/renovascular hypertension is imprecise at best. This article discusses the patho-physiology of renovascular hypertension and how to approach a patient with renal artery stenosis.

    Title An Update on Renovascular Hypertension.
    Date January 2006
    Journal Current Cardiology Reports
    Excerpt

    Renovascular hypertension (RVH) represents a secondary and potentially remediable form of hypertension. Elevated blood pressure is only one of a broad array of pathophysiologic consequences that are associated with decreased renal perfusion. Our ability to accurately and noninvasively detect stenotic lesions within the renal artery is growing. However, functional assessment of renal parenchyma and hemodynamic significance of renal artery lesions is still limited. Advances in endovascular techniques spurred interest in the concept of ischemic nephropathy and the effect of renal artery revascularization on renal function. Despite the relative frequency of atherosclerotic renal artery stenosis (ARAS), there currently is no consensus on the most appropriate therapy. In this article, we focus on the two most common causes of RVH, ARAS and fibromuscular dysplasia. We discuss the therapeutic strategies, disease mechanisms, clinical findings, evolving trends, and developments.

    Title Hypertension and the Kidney.
    Date November 2005
    Journal Seminars in Nephrology
    Excerpt

    Hypertension is an important and widely prevalent risk factor for the development of chronic kidney disease (CKD), which unfortunately may progress to end-stage renal disease. CKD is a progressive condition that causes significant morbidity and mortality. Diabetes is the leading cause of end-stage renal disease in the Western world. Both hypertension and diabetes are the causative factors for the occurrence of CKD and its consequences. Aggressive control of hypertension and diabetes is indicated to reduce the risk for kidney disease in the community. Certainly, effective control of hypertension is a proven modality to prevent renal disease. The concept of decreasing the systemic blood pressure as well as the intraglomerular pressure has led to the application of rational therapeutic options in patients with renal insufficiency. Although treatment of hypertension alone is critical, drugs that block the renin-angiotensin system have been shown to have special renal (and cardiovascular) benefits. Early detection and treatment of microalbuminuria is an integral part of disease management. This article reviews the pathophysiologic and therapeutic implications of the link between hypertension and the kidney.

    Title Drug Treatment of Hypertensive Urgencies and Emergencies.
    Date November 2005
    Journal Seminars in Nephrology
    Excerpt

    Although systemic hypertension is a common clinical condition, hypertensive emergencies are distinctly unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these conditions because immediate treatment of severe hypertension is indicated. The diagnosis of hypertensive emergencies depends on the consideration of the clinical manifestations as well as the absolute level of blood pressure. Depending on the target organ that is affected, manifestations of hypertensive emergencies can be quite profound, yet variable. Thus, the physician has to make an accurate clinical diagnosis properly to render appropriate therapy. Fortunately, effective drug therapy is available to decrease blood pressure quickly in hypertensive emergencies. Physicians should be familiar with the pharmacologic and clinical actions of drugs that are used in the treatment of hypertensive emergencies. With proper clinical diagnosis, hypertensive emergencies can be treated successfully and the complications can be prevented with timely intervention. This review discusses the treatment of hypertensive emergencies in general and the therapeutic role of fenoldopam in particular.

    Title Andrew Zoltan Fenves, Md: a Conversation with the Editor. Interview by William Clifford Roberts.
    Date October 2005
    Journal Proceedings (baylor University. Medical Center)
    Title Arbs and Target Organ Protection. Exploring Benefits Beyond Their Antihypertensive Effects.
    Date September 2004
    Journal Postgraduate Medicine
    Excerpt

    Recognition of the role of the renin-angiotensin-aldosterone system (RAAS) in initiating and maintaining hypertension prompted the development of drugs that disrupt the RAAS, notably the angiotensin-converting enzyme (ACE) inhibitors and, more recently, the angiotensin II receptor blockers (ARBs). This article focuses on the use of ARBs in hypertension management and reviews evidence emerging from clinical trials that ARBs offer target organ protection over and above their antihypertensive activity.

    Title Fatal Mesenteric Fibromuscular Dysplasia: a Case Report and Review of the Literature.
    Date June 2004
    Journal Archives of Internal Medicine
    Excerpt

    Fibromuscular dysplasia is a rare nonatherosclerotic, noninflammatory angiopathy of uncertain etiology and high morbidity. Because of its propensity to affect medium-sized vessels in a variety of locations, presenting symptoms may vary substantially, resulting in a delayed or missed diagnosis. We describe a 57-year-old woman who, on multiple occasions, presented with progressive gastrointestinal symptoms and eventually underwent surgical revascularization for celiac and superior mesenteric artery stenosis of uncertain etiology. Her postoperative course was complicated by bowel ischemia, multiple organ failure, and death. Autopsy findings proved useful in determining the underlying disease process and cause of death. This case report and a review of the literature illustrate the high morbidity and mortality that are caused by mesenteric fibromuscular dysplasia, the challenge in establishing a correct diagnosis, and the importance of early detection and treatment.

    Title Nephrotic Syndrome Presenting As Dural Sinus Thrombosis.
    Date September 2002
    Journal The American Journal of Medicine
    Title Improving Survival of Octogenarian Patients Selected for Haemodialysis.
    Date February 2002
    Journal Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
    Excerpt

    BACKGROUND: The incidence of end-stage renal disease (ESRD) among patients over the age of 80 has nearly tripled in the last decade, making the 'old-old' the fastest growing ESRD demographic group. Despite this, very little information is available on the characteristics and survival of patients who initiate haemodialysis (HD) after reaching this age. METHODS: We performed a retrospective study on all patients who entered an outpatient HD programme after the age of 80, from January 1988 to September 1998. A total of 106 charts were reviewed from a single nephrology practice group. Eleven patients were excluded due to incomplete data. The survival probability was calculated using the Kaplan-Meier method. RESULTS: The characteristics of 95 patients were as follows: mean age at initiation of dialysis, 83.7 years; female, 50.5%; Caucasian, 40.0%, African-American, 30.0%; Hispanic, 10.0%; Asian, 4.3%; polytetrafluorethylene grafts, 80.0%; primary fistulas, 5.6%; tunnelled catheters, 5.6%; mean established Kt/V, 1.68; urea reduction ratio (URR), 0.74; estimated dry weight (EDW), 60.3 kg. ESRD was attributed to hypertension in 37%, diabetes in 22% and analgesic use in 8%. The 1-, 2- and 5-year survival probability of the entire group was 82.6+/-4.0%, 64.0+/-5.6%, and 19.6+/-6.0%, respectively. The median survival was 29 months. When comparing survival probability of patients who were in the highest quartiles of URR and EDW to those in the lowest quartile there was no discernible difference. However, the 2-year survival probability of patients initiated after January 1, 1995 (76.9+/-8.4) was significantly better than those initiated from 1988-1994 (47.8+/-6.5; P<0.05). CONCLUSIONS: From analysis of this cohort, we conclude that: (i) elderly patients selected for outpatient HD programmes have substantially better survival than previously reported; (ii) Kt/V does not correlate with survival in this demographic group; and (iii) contemporary dialysis practice is associated with better likelihood of survival of elderly patients in outpatient HD programmes.

    Title Collapsing Focal Segmental Glomerulosclerosis Following Treatment with High-dose Pamidronate.
    Date August 2001
    Journal Journal of the American Society of Nephrology : Jasn
    Excerpt

    Collapsing focal segmental glomerulosclerosis (FSGS) is a distinct clinicopathologic entity seen most commonly in young African American patients who present with renal insufficiency and nephrotic syndrome. The only epidemiologic factor previously linked to collapsing FSGS is HIV infection. Here clinicopathologic findings are reported for a distinctive population of seven patients, who were older, Caucasian, and HIV negative and developed collapsing FSGS during active treatment of malignancy (multiple myeloma in six patients and metastatic breast carcinoma in one). Although oncologic treatment regimens included vincristine for four patients, doxorubicin for five patients, cisplatin for two patients, and total-body irradiation for one patient, the only agent common to all patients was pamidronate (Aredia). All patients had normal renal function before the administration of pamidronate. Patients began therapy with pamidronate at or below the recommended dose of 90 mg, intravenously, monthly, which was increased to 180 mg monthly in two patients and 360 mg monthly in three patients. Patients received pamidronate for 15 to 48 mo before presentation with renal insufficiency (mean serum creatinine, 3.6 mg/dl) and full nephrotic syndrome (mean 24-h urinary protein excretion, 12.4 g/d). Pamidronate, which is a member of the class of bisphosphonates, is widely used in the treatment of hypercalcemia of malignancy and osteolytic metastases. At the recommended dose of 90 mg, intravenously, monthly, renal toxicity is infrequent; however, higher doses have produced nephrotoxicity in animal models. The temporal association between pamidronate therapy and the development of renal insufficiency, the use of escalating doses that exceed recommended levels, and the distinctive pattern of glomerular and tubular injury strongly suggest a mechanism of drug-associated podocyte and tubular toxicity. These data provide the first association of collapsing FSGS with toxicity to a therapeutic agent.

    Title Chloramine-induced Methemoglobinemia in a Hemodialysis Patient.
    Date January 2001
    Journal Seminars in Dialysis
    Title Fibromuscular Dysplasia of the Renal Arteries.
    Date October 2000
    Journal Current Hypertension Reports
    Excerpt

    Although renovascular hypertension is less common than primary hypertension, it is important for clinicians to recognize this clinical entity because of its distinct pathophysiology and specific therapy. It is estimated that about 5% of the overall hypertensive population have renovascular hypertension. Whereas most renovascular lesions are caused by atherosclerosis, stenosis due to fibrous dysplasia is an important disease. In children and young adults, fibromuscular dysplasia of the renal arteries is the most common cause of renovascular hypertension. This review deals with the pathology, clinical characteristics, diagnosis, and therapy of renovascular hypertension associated with fibromuscular dysplasias.

    Title Membranous Glomerulonephritis Associated with Graves' Disease.
    Date February 1999
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Excerpt

    Renal involvement in thyroid diseases is an unusual event. Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis has been reported in propylthiouracil-treated patients. Membranous glomerulonephritis has been reported in association with both antithyroglobulin and thyroid antimicrosomal antibodies. The development of membranous glomerulonephritis may be associated with administration of 131I. We present a patient who developed membranous glomerulonephritis after administration of 131I. The clinical and pathological features of renal involvement in thyroid diseases are reviewed.

    Title Intermittent Fever and Pancytopenia in a Young Mexican Man.
    Date November 1997
    Journal Southern Medical Journal
    Excerpt

    We report a case of brucellosis in a young Mexican man who had weight loss, fever, and nausea. Physical examination revealed hepatosplenomegaly, and examination of the blood showed pancytopenia. This case illustrates the need for a high index of suspicion when patients living in the southern United States have these symptoms.

    Title Anaritide in Acute Tubular Necrosis. Auriculin Anaritide Acute Renal Failure Study Group.
    Date March 1997
    Journal The New England Journal of Medicine
    Excerpt

    BACKGROUND: Atrial natriuretic peptide, a hormone synthesized by the cardiac atria, increases the glomerular filtration rate by dilating afferent arterioles while constricting efferent arterioles. It has been shown to improve glomerular filtration, urinary output, and renal histopathology in laboratory animals with acute renal dysfunction. Anaritide is a 25-amino-acid synthetic form of atrial natriuretic peptide. METHODS: We conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial of anaritide in 504 critically ill patients with acute tubular necrosis. The patients received a 24-hour intravenous infusion of either anaritide (0.2 microgram per kilogram of body weight per minute) or placebo. The primary end point was dialysis-free survival for 21 days after treatment. Other end points included the need for dialysis, changes in the serum creatinine concentration, and mortality. RESULTS: The rate of dialysis-free survival was 47 percent in the placebo group and 43 percent in the anaritide group (P = 0.35). In the prospectively defined subgroup of 120 patients with oliguria (urinary output, < 400 ml per day), dialysis-free survival was 8 percent in the placebo group (5 of 60 patients) and 27 percent in the anaritide group (16 of 60 patients, P = 0.008). Anaritide-treated patients with oliguria who no longer had oliguria after treatment benefited the most. Conversely, among the 378 patients without oliguria, dialysis-free survival was 59 percent in the placebo group (116 of 195 patients) and 48 percent in the anaritide group (88 of 183 patients, P = 0.03). CONCLUSIONS: The administration of anaritide did not improve the overall rate of dialysis-free survival in critically ill patients with acute tubular necrosis. However, anaritide may improve dialysis-free survival in patients with oliguria and may worsen it in patients without oliguria who have acute tubular necrosis.

    Title Effect of Ramipril on Blood Pressure and Protein Excretion Rate in Normotensive Nondiabetic Patients with Proteinuria.
    Date January 1997
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Excerpt

    Angiotensin-converting enzyme inhibitors reduce proteinuria in both normotensive and hypertensive patients with proteinuric renal disease. However, the mechanism of the antiproteinuric effect has not been clarified. We performed a prospective, double-blind, placebo-controlled, randomized crossover trial to test the hypothesis that the antiproteinuric effect of ramipril was due to an improvement in glomerular permselectivity independent of blood pressure and glomerular filtration rate. The effect of low-dose (1.25 mg/d) and high-dose (5 mg/d) ramipril was assessed in 15 normotensive nondiabetic patients with proteinuria (> 150 mg/d). The study was divided into four 12-week periods: placebo, high- or low-dose ramipril, crossover to low- or high-dose ramipril, and placebo. Blood pressure, glomerular filtration rate, renal plasma flow rate, urinary protein excretion rate, and plasma angiotensin II levels were measured at the end of each period. Mean arterial pressure, urine protein to creatinine ratio, and albumin excretion rate decreased significantly during low- and high-dose ramipril. Glomerular filtration rate and renal plasma flow rate were not changed significantly. Plasma angiotensin II levels decreased with both low- and high-dose ramipril. There were no episodes of hypotension and only one subject developed cough during ramipril that did not require discontinuation of the study drug. In conclusion, administration of ramipril in both low and high doses lowered blood pressure and reduced proteinuria in this cohort of normotensive patients with a variety of proteinuric renal diseases. The antiproteinuric effect of ramipril is probably mediated by a reduction in glomerular capillary pressure.

    Title Metformin-associated Lactic Acidosis.
    Date August 1996
    Journal The American Journal of Medicine
    Title Beer Potomania: Two Cases and Review of the Literature.
    Date June 1996
    Journal Clinical Nephrology
    Excerpt

    The association of severe hyponatremia and the ingestion of large quantities of beer, termed beer potomania, has been known for several years. We report two new cases, and review 20 others from the medical literature. These patients usually have a history of binge beer drinking, poor dietary intake, and then present with severe hyponatremia and various mental status changes or seizures. Typical laboratory findings include hyponatremia, hypokalemia, and a very dilute urine. The patients respond quickly to the administration of sodium chloride containing i.v. fluids. We propose that the pivotal pathophysiologic mechanism in beer potomania syndrome is the minimal intake of solute and the hypoosmolality of the beer ingested. This will lead to the inability to excrete sufficient amounts of free water to keep up with the ingestion of large quantities of the hyposmolar beer. Treatment with isotonic sodium chloride results in the rapid clearance of the accumulated excess free water.

    Title Deferoxamine Therapy and Mucormycosis in Dialysis Patients: Report of an International Registry.
    Date January 1992
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Excerpt

    Fifty-nine cases of mucormycosis in dialysis patients have been reported to the registry (25 new cases and 34 previously reported cases). The presenting forms of mucormycosis included disseminated in 44%, rhinocerebral in 31%, and other forms in 25%. The diagnosis was made during life in only 39%, while the diagnosis was discovered at autopsy in 61% of the cases. The fungus, cultured in only 36%, was always Rhizopus. The infection was fatal in 86% of cases. No known risk factors for fungal infections, eg, diabetes mellitus, liver disease, splenectomy, neutropenia, steroid therapy, or other immunosuppressive therapy, were present in 70% of patients, but 78% of patients were being treated with deferoxamine. The role played by this drug and more particularly by its iron chelate, feroxamine, in the pathogenesis of mucormycosis in these patients is underscored. Because of this risk, deferoxamine therapy in dialysis patients should be limited to severe aluminum toxicity, the deferoxamine should be given at the lowest possible dose, and dialytic methods to augment the removal of feroxamine should be studied.

    Title Registry on Mucormycosis in Dialysis Patients.
    Date November 1989
    Journal The Journal of Infectious Diseases
    Title Acute Renal Failure Secondary to Oral Ciprofloxacin Therapy: a Presentation of Three Cases and a Review of the Literature.
    Date September 1989
    Journal Clinical Nephrology
    Excerpt

    The fluoroquinolones represent a new class of antimicrobial agents with a broad spectrum of activity. We report three cases of acute renal failure following ciprofloxacin in patients without a previous history of renal insufficiency. The average baseline creatinine was 1.1 mg/dl and rose to an average of 4.0 mg/dl during therapy. The length of antecedent ciprofloxacin therapy ranged from several days to several weeks. Other causes of acute renal failure and postobstructive uropathy were excluded. Kidney size was normal-to-increased. Gallium scans were positive in one of two patients studied. Peripheral eosinophilia developed in one case, suggesting an acute hypersensitivity reaction to the drug. The acute renal failure in all cases was non-oliguric and was completely reversed after discontinuation of ciprofloxacin. In two of the three reported cases there was an increased creatinine to BUN ratio, but increased production of creatinine (i.e., rhabdomyolysis) was unlikely with a normal serum creatinine phosphokinase (CPK). In addition, we performed in vitro studies which eliminated the possibility of methodological artifact. The nephrotoxicity of the quinolones has been linked to the development of crystalluria in experimental animals. However, in humans, crystalluria is unlikely and renal damage has not been noted. There have been only two previous case reports of acute renal failure due to oral ciprofloxacin therapy. In one, biopsy showed acute interstitial nephritis. We conclude that oral ciprofloxacin therapy may lead to acute renal failure secondary to tubulointerstitial nephritis characterized by an increased creatinine to BUN ratio. Patients placed on ciprofloxacin therapy need to be followed closely.

    Title Mucormycosis Among Patients on Dialysis.
    Date August 1989
    Journal The New England Journal of Medicine
    Title Fatal Rhizopus Infections in Hemodialysis Patients Receiving Deferoxamine.
    Date November 1987
    Journal Annals of Internal Medicine
    Excerpt

    Four hemodialysis patients receiving deferoxamine for metal overload had fatal rhinocerebral rhizopus infections. Serious fungal infections are not commonly seen in patients on dialysis, and none of these patients had the usual risk factors for rhizopus infection. Deferoxamine is being used with increased frequency in dialysis patients for aluminum and iron overload states. We propose that there is a link between the deferoxamine therapy and this unusual infection. Deferoxamine may serve as a specific growth factor for Rhizopus species or may alter host immune function. We suggest searching for fungal organisms in patients with unexplained illnesses receiving deferoxamine.

    Title Carpal Tunnel Syndrome with Cystic Bone Lesions Secondary to Amyloidosis in Chronic Hemodialysis Patients.
    Date March 1986
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Excerpt

    Carpal tunnel syndrome (CTS) is increasingly recognized in patients undergoing chronic hemodialysis. Although the etiology remains obscure, angioaccess-related vascular engorgement and edema, and ischemic neuropathy are two likely possibilities. Amyloidosis is a relatively rare cause of CTS and had previously been thought to occur almost exclusively in patients with multiple myeloma. We report seven patients on chronic hemodialysis who developed CTS and were shown to have amyloid deposition within the synovium. Amyloid was demonstrated by characteristic staining with Congo red on polarizing microscopy and confirmed by electron microscopy. Six patients also exhibited radiolucent carpal bone cysts which were histologically shown to be due to bone replacement by an amyloid-positive synovitis. The average age of the patient and time on dialysis were 59.1 and 7.9 years, respectively. Serum and urine immunoelectrophoresis and bone marrow aspirates showed no evidence for plasma cell dyscrasia in six patients, while one patient did manifest a monoclonal IgA spike. Autopsies in three patients and liver biopsy in another showed no other evidence for disseminated amyloid. These hemodialysis patients exhibited a unique syndrome of CTS, lytic lesions of the carpal bones, and amyloid deposition in the synovium and within the bone cysts.

    Title Legionnaires' Disease Associated with Acute Renal Failure: a Report of Two Cases and Review of the Literature.
    Date June 1985
    Journal Clinical Nephrology
    Excerpt

    Renal involvement is a well described complication of Legionnaires' disease and is often manifested as mild, transient azotemia, hematuria, proteinuria, pyuria or cylinduria. Acute renal failure complicating Legionnaires' disease has also been described, and some patients have required hemodialysis. Renal morphology has only been described in a few cases. We report two cases of Legionnaires' disease who developed acute renal failure. The serotype of the Legionella pneumophilia isolated from one of the patients had never been isolated from humans before. This patient expired and at autopsy the kidney revealed acute tubular necrosis, but there was no evidence for interstitial or glomerular disease. Renal morphology in six previously reported cases revealed acute tubulointerstitial nephritis in three cases and acute tubular necrosis in the other three. We conclude that acute renal failure may accompany severe Legionnaires' disease, and the development of the renal failure is not related to hemodynamic factors, while nephrotoxic antibiotics may be a contributing factor.

    Title Lithium Intoxication Associated with Acute Renal Failure.
    Date December 1984
    Journal Southern Medical Journal
    Excerpt

    Lithium can produce transient natriuresis, nephrogenic diabetes insipidus, and partial distal renal tubular acidosis. Lithium intoxication is commonly associated with mild renal insufficiency and may produce acute renal failure. We have described a case of acute renal failure in a patient with severe lithium intoxication, as well as cardiac arrhythmias and hypothyroidism, both of which have been reported to occur with lithium toxicity. Treatment with daily hemodialysis eventually produced complete recovery. Lithium clearance occurs quickly with hemodialysis, but a rebound effect occurs as lithium in intracellular water equilibrates with extracellular fluid. Prolonged dialysis may be required to reduce the blood lithium level to the therapeutic range. We conclude that lithium intoxication may produce severe reversible renal failure as a result of direct tubular epithelial damage.

    Title Reversibility of Pamidronate-associated Glomerulosclerosis.
    Date
    Journal Proceedings (baylor University. Medical Center)
    Excerpt

    Bisphosphonates such as pamidronate are widely used in the treatment of patients with lytic bony lesions secondary to breast cancer or multiple myeloma, yet they have been associated with deterioration of renal function and histopathological changes in the kidney. There have been recent reports associating the use of pamidronate with the development of the collapsing variant of focal segmental glomerulosclerosis (CFSGS), a rapidly progressive variant of focal segmental glomerulosclerosis that leads to end-stage renal disease. We describe five patients who developed worsening renal function, proteinuria, and nephrotic syndrome while taking pamidronate; three of them had biopsy-proven CFSGS. Pamidronate was discontinued, and a longitudinal follow-up was performed for 10 to 23 months. One patient was able to discontinue hemodialysis, and all patients experienced improvement in renal function and a decrease in proteinuria. In some patients who develop pamidronate-associated CFSGS, renal damage appears to be reversible if the syndrome is recognized early and pamidronate is stopped.

    Title Effectiveness of Normal Saline Diuresis in Treating Lithium Overdose.
    Date
    Journal Proceedings (baylor University. Medical Center)
    Excerpt

    Lithium carbonate is a common treatment for mood disorders, but it has a very narrow therapeutic index and can be toxic to multiple organ systems. Unfortunately, many patients suffer toxic effects through the course of their therapy. We describe a patient with toxic effects from a high dose of lithium who was successfully treated with normal saline diuresis. We discuss the properties that make lithium susceptible to normal saline diuresis and explore alternative options for treatment of lithium toxicity.

    Title Pulmonary Invasive Mucormycosis in a Patient with Secondary Iron Overload Following Deferoxamine Therapy.
    Date
    Journal Proceedings (baylor University. Medical Center)
    Excerpt

    Mucormycosis (zygomycosis) is an acute and often fatal opportunistic fungal infection. Predisposing factors in the development of mucormycosis are nonspecific and include hyperglycemia, hematologic malignancies, neutropenia, pharmacologic immunosuppression, solid organ or bone marrow/stem cell transplantation, burns, trauma, malnutrition, and intravenous drug use. Mucormycosis has also been described in patients with iron and aluminum overload, patients on dialysis, and patients receiving iron chelating therapy. We describe a 75-year-old man with myelodysplastic syndrome and iron overload secondary to multiple red blood cell transfusions who had been treated with deferoxamine chelation therapy. He was admitted to the hospital for atrial fibrillation, developed multiple organ failure, and died. Pulmonary invasive mucormycosis was demonstrated at autopsy. This case further documents an association between invasive mucormycosis, iron overload, and deferoxamine therapy.

    Title 5-oxoproline (pyroglutamic) Acidosis Associated with Chronic Acetaminophen Use.
    Date
    Journal Proceedings (baylor University. Medical Center)
    Title Subcutaneous Beta2-microglobulin Amyloid Shoulder Nodulesin a Long-term Hemodialysis Patient.
    Date
    Journal Proceedings (baylor University. Medical Center)
    Excerpt

    beta2-Microglobulin accumulation with resultant tumor formation is a known albeit rare complication of long-term hemodialysis. Although these tumors may occur in various locations, subcutaneous shoulder nodules are very infrequent. We report a patient with end-stage kidney failure who had been on hemodialysis for 16 years and noted left shoulder nodules after initiation of hemodialysis; these nodules had slowly grown larger. Biopsy of one of these nodules revealed beta2-microglobulin amyloidosis by histopathology, Congo red stain, electron microscopy, and immunohistochemistry.

    Title Optimizing Blood Pressure Control in Patients with Chronic Kidney Disease.
    Date
    Journal Proceedings (baylor University. Medical Center)
    Excerpt

    The majority of patients with chronic kidney disease have hypertension, which is an independent risk factor for progression of kidney disease and cardiovascular disease. Therefore, hypertension should be stringently controlled to a blood pressure level of <130/80 mm Hg. Achieving this goal, which usually requires two or more antihypertensive agents, slows the progression of kidney disease and reduces the risk of cardiovascular disease. All antihypertensive treatments for patients with chronic kidney disease should include a renin-angiotensin-aldosterone system (RAAS) inhibitor (an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Initial therapy with fixed-dose RAAS inhibitor-based combinations should be considered, because this approach has been shown to bring significantly more patients to target blood pressure levels, compared with stepped-care treatment or sequential monotherapy. Fixed-dose combination therapy may also improve patient adherence to treatment by reducing the number of pills taken daily and the number of office visits for dosage adjustments. Recent clinical data suggest that the combination of a RAAS inhibitor and a dihydropyridine calcium channel blocker may provide more cardiovascular benefit than the generally recommended combination of a RAAS inhibitor and a diuretic in patients at high risk for cardiovascular events.

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