In this prospective randomized trial, we compared the effects of cyclosporine-and cyclophosphamide-based treatment regimens in patients with idiopathic membranous nephropathy. Twenty-eight patients were randomized to receive treatment with one of the three therapeutic regimens: cyclosporine with methylprednisolone, cyclophosphamide with methylprednisolone or lisinopril (control). Renal function and nephrotic syndrome parameters were determined at baseline and during a 9-month treatment period. At the end of the study period, renal function improved significantly in the cyclophosphamide and deteriorated significantly in the cyclosporine group. Serum albumin levels increased significantly in the cyclosporine and cyclophosphamide group. Total cholesterol levels and proteinuria were significantly reduced in all groups. In the comparison between the groups, serum albumin levels were significantly lower in the control group and there were no differences in the rest of the studied parameters at the end of the study. Six patients from the cyclosporine group (1/10 complete and 5/10 partial), all cyclophosphamide-treated (4/8 complete and 4/8 partial) and all 10 lisinopriltreated patients (10/10 partial) were on remission at the end of the study. In conclusion, cyclosporine-based regimens are not inferior to cyclophosphamide-based regimens. Cyclophosphamide is associated with more complete remissions after 9 months of treatment. Lisinopril is associated with a significant proteinuria reduction and without inducing any complete remissions.

In this article, we describe the case of a 49-year-old male gypsy on hemodialysis that was referred to our center due to high fever, breathlessness, and productive cough with bloody sputum. Forty-five days before hospitalization, he was treated for vasculitis with prednisolone and intravenous cyclophosphamide. Soon after admission he was resuscitated and intubated after a cardiac arrest. A large worm load of Strongyloides stercoralis larvae was identified in the sputum. The patient was treated with thiopental 25 mg/kgBW/12 h through a Levine tube and died 24 h later.

The aim of this study was to evaluate the severity of proteinuria using the protein/creatinine ratio in a random urine sample. In 45 patients (male 28, female 17; mean age 50.68 +/- 18.26 years) with proteinuria of various causes, we measured the 24-hour protein excretion per 1.73 m(2) of body surface and, during the same day, the protein/creatinine ratio in three different urine samples (8 am, 12 pm, 4 pm). The 24 h proteinuria was defined as mild (<1 g), moderate (1-3.4 g), and severe (>3.4 g) in 7, 27, and 11 patients, respectively. The sensitivity for protein/creatinine ratio compared to the 24 h proteinuria as a method of reference was 86-100% in the mild, 78-100% in the moderate, and 73-82% in the severe proteinuria, whereas the specificity was 84-100%, 78-83%, and 100% respectively. The patients with better renal function had significantly higher proteinuria levels. There was a similarity in the 24 h proteinuria and the protein/creatinine ratio measurements in all renal function and level-of-proteinuria groups. The protein/creatinine ratio of the morning and midday samples had a very good association with the 24 h sample, whereas it was not associated significantly with the evening sample (4 pm). In conclusion, the degree of 24 h proteinuria levels can be evaluated by calculating the protein/creatinine ratio in a random urine sample collected at any time from morning until midday. Protein/creatinine ratio is independent of the severity of proteinuria or renal function, and it can replace in clinical practice the cumbersome 24 h urine collections.

In the present report, we describe the case of a 76-year-old hemodialysis patient who was admitted with clinical features of neurological thoracic exit syndrome due to subclavian artery pseudoaneurysm following the insertion of a dual lumen vascular internal jugular catheter (vascath) with excellent outcome after endo-arterial stent placement.

A 65-year-old male with type II diabetes who had been on antidiabetic medication for 10 years was admitted to our hospital due to an altered state of consciousness, attributed to hypoglycemia, renal failure, and metabolic acidosis. From his medical history it was known that an artificial urinary sphincter (AUS) had been placed 9 years previously due to incontinence caused by reduced outlet resistance (also known as intrinsic sphincter deficiency) following prostate surgery. On placement of the AUS his renal function was normal (serum creatinine 1 mg/dL) and two years later he was diagnosed with a slightly deteriorated renal function (serum creatinine 1.8 mg/dL) without any urological follow-up until the day of admission to our clinic. On examination he was tachycardic (120 bpm) with tachypnoe, arterial hypertension (170/100 mmHg), edema of the lower extremities, and fine crackles on the lung bases. He was also suffering from dribbling during the last days and on palpation there was also found to be significant bladder distension. From the paraclinical examination he showed normochromic anemia (Ht=22%, Hb=7.6 gr/dL), severely compro- Accepted: May 11, 2011 CASE REPORT mised renal function (serum creatinine 6.4 mg/dL, serum urea 200 mg/dL), metabolic acidosis (pH=7.15, pCO 2 =20 mmHg, HCO 3 =10 mEq/L) and sterile leucocyturia (>100 per high power field). The urinary culture was negative. Pulmonary congestion was detected on the chest x-ray. A renal ultrasound revealed bilateral hydronephrosis with kidneys of normal size (left: 10.7 cm, right: 11.2 cm) increased echogenicity, and reduced thickness of the cortex, as well as the presence of an AUS in the pelvic area and the scrotum that was reconfirmed in the plain abdominal x-ray. Intravenous urography showed a slow parenchymal infiltration of the contrast media and a very slow excretory stage with a significant bladder distension. Other urological problems like ureteral or urethral stenosis were excluded as the urine flow was strong and uninterrupted after the activation of the AUS. Transdermal nephrostomies were inserted in order to assess the functional capacity of each kidney; the left one functioned properly with a urine volume of 2.5 L to 3 L per 24 hours. Despite the satisfactory urine output his renal function did not improve and he started chronic hemodialysis 22 days post-insertion of the nephrostomies.