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New vaginectomy study results reported from Harvard University, Medical Department
2009 JUN 1 - (NewsRx.com) -- "PRESENTATION A 60-year-old white Latino female with a clinical diagnosis of diabetes mellitus (diagnosed in 1993) and hypertension was referred to the chronic kidney disease clinic at Brigham and Women's Hospital for the evaluation of acute kidney injury; serum creatinine had increased from a baseline of 0.9 to 1.5 mg/dl in a 11-week period. She was asymptomatic at the time of presentation," scientists in the United States report. "Her past medical history included a total abdominal hysterectomy with bilateral salpingo oophorectomy and upper vaginectomy for high-grade squamous intraepithelial lesion of the cervix, 11 weeks prior to presentation. Three weeks prior to presentation (8 weeks after surgery) and within a week of each other, she was evaluated for two consecutive episodes of acute onset of chest pain with pulmonary edema in the setting of severe hypertension. Both episodes had blood pressures in excess of 190-200 mm Hg systolic that resolved with intravenous diuretics. Cardiovascular workup revealed no evidence of ischemic heart disease. Additionally, renal evaluation included magnetic resonance angiography with and without gadolinium, which did not reveal renal artery stenosis. However, serum creatinine peaked at 1.9 mg/dl immediately after surgical procedure and remained elevated at 1.5 mg/dl throughout the course of her current presentation (corresponding to a glomerular filtration rate of 33 ml/min per 1.73m(2), estimated by the modification in diet in renal disease III (MDRD 3) equation). At presentation, medications included amlodipine, furosemide, metoprolol, lisinopril, atorvastatin, insulin glargine, cyanocobalamin, acetylsalicylic acid, and naproxen. The patient had no prior exposure to radiocontrast agents. Physical examination revealed an overweight women weighing 207 lbs with a blood pressure of 142/60 mm Hg and a heart rate of 60 beats per minute. The rest of the examination was unremarkable. Her laboratory data is summarized in Table 1. A postoperative kidney ultrasound showed no hydronephrosis. The etiology of the acute kidney injury was unclear. Progressive diabetic nephropathy exacerbated by other contributory factors, such as exposure to lisinopril, acetylsalicylic acid, or naproxen, was regarded as the most plausible explanation. Despite discontinuation of these medications, kidney function did not improve; it worsened in a 4-week period after presentation," wrote A.K. Rocuts and colleagues, Harvard University, Medical Department. The researchers concluded: "Hence, a kidney biopsy was performed." Rocuts and colleagues published their study in Kidney International (Acute phosphate nephropathy. Kidney International, 2009;75(9):987-991). For additional information, contact A.K. Singh, Harvard University, Brigham & Women's Hospital, School Medical, Dept. of Medical, Renal Division, Boston, MA 02115, USA. The publisher's contact information for the journal Kidney International is: Nature Publishing Group, 75 Varick St., 9TH Flr, New York, NY 10013-1917, USA. Keywords: United States, Boston, Abdominal Hysterectomy, Angiography, Angiology, Blood Pressure, Cardiology, Cardiovascular, Chest Pain, Diabetes Diagnosis, Diabetes Mellitus, Endocrinology, Gastroenterology, Gynecology, Heart Disease, Hypertension, Kidney Disease, Magnetic Resonance, Myocardial Ischemia, Nephrology, Nephropathy, Oophorectomy, Pulmonary Edema, Renal Artery Obstruction, Salpingo-oophorectomy, Stenosis, Surgery, Vaginectomy, Harvard University, Medical Department. This article was prepared by Pain & Central Nervous System Week editors from staff and other reports. Copyright 2009, Pain & Central Nervous System Week via NewsRx.com.
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