Patients suffering from Diogenes syndrome are usually discovered by chance, either because of a somatic illness, or as a result of social intervention related to their behavioural problems. The Diogenes syndrome is a fascinating object of study for the clinician who takes care of patients living in uncommon conditions, on the edge of society and unaware of the particularity of their lifestyles. Its rare occurrence contrasts with the fact that it is well-known, partly due to it being named after the Greek philosopher « Diogène de Sinope », who taught cynicism philosophy and a return to a natural way of life, and partly because of its rare characteristics. This particular geriatric syndrome has been described for the first time only quite recently, as the 2 primary descriptions by geriatricians and psychiatrists date from 19 respectively. This is accompanied by a self-imposed isolation, the refusal of external help and a tendency to accumulate heteroclite objects. Symptoms include living in extreme squalor, a neglected physical state and unhygienic conditions. Em seguida, ele manteve a prednisona diária e a ciclofosfamida intravenosa mensal e evoluiu com melhora progressiva da função renal.Diogenes syndrome is a behavioural disorder of the elderly. O paciente foi submetido à pulsoterapia com metilprednisolona (por 3 dias) e ciclofosfamida. ![]() Uma biópsia percutânea renal revelou glomerulonefrite crescente, com leve atrofia tubular. Os testes de ANF (fator antinuclear), ANCA, anti- DNA, sorologia para vírus da hepatite B, C e HIV foram negativos. Foi internado com lesão renal aguda e realizou seis sessões de hemodiálise durante os primeiros 16 dias de internação, e depois foi transferido para um hospital terciário para investigação diagnóstica. Relatamos um caso de um homem de 38 anos, usuário crônico de cocaína, álcool e cigarros que apresentava urina vermelha, oligúria, pernas e pálpebras inchadas, além dos sintomas urêmicos, anorexia, êmese e confusão mental. A GNRP se manifesta clinicamente como uma síndrome nefrítica, com um declínio rápido e progressivo da função renal, e seu achado histopatológico é a presença de crescentes em mais de 50% dos glomérulos. Nos últimos anos, o uso de cocaína adulterada com levamisol tem sido associado à vasculite por ANCA e GNRP pauci-imune. ![]() A maioria dos casos está relacionada à rabdomiólise, mas outros mecanismos são hipertensão maligna, isquemia renal e glomerulonefrite rapidamente progressiva (GNRP) associada à vasculite por ANCA. RESUMO Um amplo espectro de complicações renais pode ocorrer com o uso agudo e crônico de cocaína. ![]() Then he maintained daily prednisone and monthly intravenous cyclophosphamide and evolved with progressive improvement of renal function. The patient underwent pulse therapy with methylprednisolone (for 3 days) and cyclophosphamide. ![]() A renal percutaneous biopsy revealed crescentic glomerulonephritis with mild tubular atrophy. Tests of ANF ( antinuclear factor), ANCA, anti- DNA, serology for hepatitis B, C, and HIV virus were negative. He was admitted with acute kidney injury and performed six hemodialysis sessions during the first 16 days of hospitalization and then was transferred to a tertiary hospital for diagnostic investigation. We report a case of a 38-year-old man chronic user of cocaine, alcohol, and cigarettes who had red urine, oliguria, swollen legs and eyelids, as well as the uremic symptoms anorexia, emesis, and mental confusion. RPGN is clinically manifested as a nephritic syndrome with a rapid and progressive decline in renal function, and its histopathological finding is the presence of crescents in more than 50% of the glomeruli. In recent years, the use of cocaine adulterated with levamisole has been associated with ANCA vasculitis and pauci-immune RPGN. Most cases are related to rhabdomyolysis, but other mechanisms are malignant hypertension, renal ischemia, and rapidly progressive glomerulonephritis (RPGN) associated- ANCA vasculitis. ABSTRACT A wide spectrum of renal complications can occur with acute and chronic use of cocaine.
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