Uremic frost in end stage renal disease nejmicm1716367 (pdf io)

Uremic Frost in End-Stage Renal DiseaseJoana M.. Five months earlier, he had stopped attending his regular hemodialysis [thẩm tách máu chạy thận nhân tạo] sessions; he reported that he h

Uremic Frost in End-Stage Renal Disease

Joana M Martins, M.D., and Rita Magriço, M.D August

16, 2018 N Engl J Med 2018; 379:669 DOI:

10.1056/NEJMicm1716367

A 39-year-old man with end-stage renal

disease [bệnh thận giai đoạn cuối] presented to the emergency department [khoa cấp cứu] with anorexia [chán ăn], nausea [buồn nôn],

vomiting [nôn], and oliguria [thiểu niệu] Five months earlier, he had stopped attending his regular hemodialysis [thẩm tách máu (chạy

thận nhân tạo)] sessions; he reported that he had thought that the sessions were not needed

because he continued to have urine [nước tiểu] output On physical examination [thăm khám lâm sàng], his blood pressure [huyết áp] was 167/80 mm Hg He was lethargic [ngủ gà, lơ

mơ] and had slowed speech [nói chậm] and

edema [phù] of the legs, and his breath [hơi

thở] had a urine-like odor [mùi giống như nước tiểu] His skin [da] had diffuse [adj - lan tỏa]

crystalline [adj- tinh thể] white deposits [chất lắng, cặn] that were distributed mainly on his face [mặt] (Panel A), abdomen [bụng] (Panel B), and arms [cánh tay] Laboratory studies showed

a blood urea nitrogen[BUN] level of 231 mg per deciliter (82.5 mmol per liter), a creatinine level

of 20.0 mg per deciliter (1770 μmol per liter), a sodium [Natri] level of 125 mmol per liter, and a potassium [Kali] level of 7.7 mmol per liter The patient underwent immediate [lập tức]

hemodialysis Uremic frost is associated with

severe azotemia [tăng azote máu] and results from crystallization [sự kết tinh] of urea on the skin after sweat [mồ hôi] evaporates [bốc hơi]

It is a rare finding in locations where

hemodialysis is widely available The patient’s lethargy [tình trạng ngủ gà, lơ mơ] abated as he resumed regular hemodialysis sessions, and he had complete regression of the uremic frost at

2 weeks after presentation

Joana M Martins, M.D Rita Magriço, M.D Hospital

Garcia de Orta, Lisbon, Portugal