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No
n-o
ligu
ric
acu
te r
enal
fai
lure
ln
ulin
bac
klea
k P
ulm
on
ary
tub
ercu
losi
s D
iag
no
sis
Lab
ora
tory
tes
ts
Tu
bu
le s
ecre
tio
n o
f P
AH
ln
ulin
cle
aran
ce
Tu
bu
le c
atio
n t
ran
spo
rt
Pat
ho
log
y R
oen
tgen
olo
gy
Mye
rs B
D,
Hilb
erm
an M
, S
pen
cer
RJ,
Jam
iso
n R
L:
Glo
mar
ula
r an
d t
ub
ula
r fu
nct
ion
in
B
ob
row
itz
ID:
Act
ive
tub
ercu
losi
s u
nd
iag
no
sed
un
til
auto
psy
. A
m
J M
ed
1982
; 72
: n
on
-olig
uri
c ac
ute
ren
al f
ailu
re.
Am
J M
ed 1
982;
72:
642
-649
. 65
0-65
8.
Glo
mer
ula
r an
d tu
bu
lar
fun
ctio
n w
ere
eval
uat
ed i
n 3
0 n
on
-olig
uri
c p
atie
nts
wit
h i
ncr
easi
ng
az-
T
wen
ty-o
ne
pat
ien
ts i
n w
ho
m t
ub
ercu
losi
s w
as t
he
pri
mar
y ca
use
of
dea
th,
bu
t wh
ich
was
no
t o
tem
ia f
ollo
win
g o
pen
hea
rt s
urg
ery.
Fra
ctio
nal
cle
aran
ces
(8)
of
test
so
lute
s re
lati
ve t
o t
hat
d
iag
no
sed
un
til n
ecro
psy
, ar
e re
view
ed.
Df
the
21 d
eath
s, 1
1 w
ere
du
e to
pu
lmo
nar
y tu
ber
culo
sis
of
inu
lin w
ere
det
erm
ined
. In
16
pat
ien
ts,
0 d
extr
an (rad
ius
22 t
o 3
0 A
) e
xce
ed
ed
un
ity,
a f
ind
ing
an
d 1
0 to
mili
ary
tub
ercu
losi
s.
Pro
per
eva
luat
ion
of
the
fact
ors
des
crib
ed i
n t
his
stu
dy
mig
ht
attr
ibu
ted
to i
nu
lin b
ackl
eak
thro
ug
h n
ecro
tic
tub
ule
s. T
hes
e p
atie
nts
wer
e cl
assi
fied
as
hav
ing
h
ave
led
to
th
e co
rrec
t d
iag
no
sis
in m
any
of
the
pat
ien
ts.
All
bu
t on
e p
atie
nt
in th
is s
erie
s h
ad
acu
te r
enal
fai
lwe.
In
the
rem
ain
ing
pat
ien
ts (
N =
14
), d
kxV
an w
as n
orm
al.
Th
ese
pat
ien
ts w
ere
feve
r. F
ailu
re t
o d
imin
ish
th
e p
yrex
ia w
hic
h w
as b
elie
ved
to
be
du
e to
sp
ecif
ic l
un
g in
fect
ion
s,
con
sid
ered
to
hav
e p
m-r
enal
fai
lure
. C
lear
ance
o
f in
ulin
(Cl”
) was
lo
wer
in
acu
te r
enal
fai
lure
w
ith
pre
sum
ably
eff
ecti
ve a
nti
bio
tics
, an
d th
e in
abili
ty o
f th
e th
erap
y to
co
ntr
ol o
ther
co
nd
iiio
ns
than
in
pre
ren
al f
ailu
re (
12 f
2
vers
us
18 f
2
ml/m
in/
1.73
m2;
p <
0.02
5).
Th
e ap
par
ent
dif
- th
ou
gh
to
cau
se t
he
feve
r in
dic
ate
the
pre
sen
ce o
f tu
ber
culo
sis.
Tu
ber
culo
sis,
esp
ecia
lly m
iliar
y fe
ren
ce i
n g
lom
eru
lar
filt
rati
on
rate
wh
en C
&n
is u
sed
as
an i
nd
ex w
as a
bo
lish
ed,
ho
wev
er,
wh
en
dis
ease
s, s
ho
uld
be
con
sid
ered
as
a p
oss
ible
eti
olo
gy
of
feve
r o
f u
nkn
ow
n o
rig
in. I
f th
e d
iiis
C,,
in a
cute
ren
al f
ailu
re w
as c
orr
ecte
d
for
tub
ule
bac
klea
k o
f in
ulin
. In
acu
te r
enal
fai
lure
, o
f tu
ber
culo
sis
is h
igh
ly s
ug
ges
tive
, eve
n w
ith
ou
t b
acte
rio
log
ic c
on
firm
atio
n, a
th
erap
euti
c tr
ial
frac
tio
nal
cle
aran
ce o
f p
-am
ino
hip
pu
rate
(&
,,)
was
7.1
f
1.0.
an
d f
ract
ion
al e
xcre
tio
n o
f p
o-
of
anti
tub
ercu
losi
s d
rug
s sh
ou
ld b
e st
arte
d.
tass
ium
(F
EK
) was
160
f
18 p
erce
nt.
Th
ese
fin
din
gs
stro
ng
ly s
ug
ges
t th
at s
ecre
tory
ab
ility
in
b
oth
pro
xim
al a
nd
term
!ria
l tu
bu
le s
egm
ents
, res
pec
tive
ly, i
s p
rese
rved
in a
cute
ren
al f
ailu
re.
An
tico
agu
lan
t th
erap
y H
epar
in
War
fari
n
Hea
r-l
failu
re
Car
dia
c d
isea
se
Car
dio
ton
lc
agen
ts
Co
um
arln
s T
hro
mb
osi
s E
mb
ollz
atlo
n
Dey
kin
D:
Cu
rren
t st
atu
s o
f an
tico
agu
lan
t th
erap
y. A
m J
Med
198
2; 7
2: 6
59-6
64.
Web
er
KT
: N
ew h
op
e fo
r th
e fa
ilin
g h
eart
. A
m J
Med
198
2; 7
2: 6
65-6
7 1.
An
tico
agu
lan
t th
erap
y h
as s
too
d th
e te
st o
f tim
e. F
ulld
ose
hep
arin
an
d w
arfa
rin
pre
ven
t re
curr
ing
O
ne
sixt
h o
f th
is n
atio
n’s
cit
izen
s h
ave
dis
ease
of
the
hea
rt a
nd
blo
od
ves
sels
; an
est
imat
ed
pu
lmo
nar
y em
bo
lism
an
d d
eep
ven
ou
s th
rom
bo
sis.
Th
eir
use
is
ind
icat
ed i
n p
atie
nts
wh
o h
ave
3.5
to 4
mill
ion
Am
eric
ans
hav
e ch
ron
ic c
ard
iac
failu
re.
Th
e in
div
idu
al a
nd
co
llect
ive
loss
es
exp
erie
nce
d
ven
ou
s th
rom
bo
emb
olis
m
un
less
co
ntr
ain
dic
atio
ns
are
com
pel
ling
. L
ow
do
se
asso
ciat
ed w
ith
hea
rt f
ailu
re a
re e
no
rmo
us.
Sta
nd
ard
med
ical
th
erap
y w
ith
dig
ital
is a
nd
diu
reti
cs
hep
arin
is
succ
essf
ul
in p
reve
nti
ng
th
e in
itia
l ep
iso
de
of
ven
ou
s th
rom
bo
sis
in m
ost
pat
ien
ts
is f
req
uen
tly
inad
equ
ate
to c
on
tro
l th
e m
orb
idit
y as
soci
ated
w
ith
th
is o
ften
tim
es
mal
ign
ant
at h
ii ri
sk f
or
the
dev
elo
pm
ent o
f tt
vom
bo
ph
leb
itii.
War
fari
n r
edu
ces
the
inci
den
ce o
f sy
stem
ic
pro
cess
. M
ore
eff
ecti
ve m
edic
al t
her
apy
is th
eref
ore
nee
ded
. Th
e re
cen
t d
evel
op
men
t o
f p
ote
nt,
em
bo
lizat
ion
in
pat
ien
ts w
ith
hea
rt d
isea
se a
nd
atr
ial
fib
rilla
tio
n a
nd
in
pat
ien
ts w
ith
art
ific
ial
ora
lly a
ctiv
e ca
rdio
ton
ic a
gen
ts m
ay m
ake
this
ob
ject
ive
a re
alit
y. A
t th
e p
rese
nt
tim
e, t
he
new
h
eart
val
ves.
Evi
den
ce i
s ac
cum
ula
tin
g t
o s
ug
ges
t th
at w
arfa
rin
may
sti
ll re
tain
an
im
po
rtan
t ca
rdio
ton
ic a
gen
ts a
re s
till
in th
e ex
per
imen
tal
stag
es o
f in
vest
igat
ion
. O
bje
ctiv
e p
aram
eter
s ro
le i
n th
e m
anag
emen
t o
f p
atie
nts
wit
h m
yoca
rdia
l in
farc
tio
n.
Ho
wev
er,
ble
edin
g r
emai
ns
an
of
ven
tric
ula
r fu
nct
ion
an
d t
he
pat
ien
ts’
qu
alit
y o
f lif
e m
ust
be
mo
nit
ore
d i
f mea
nin
gfu
l ve
rdic
ts
inev
itab
le ri
sk in
pat
ien
ts r
ecei
vin
g a
nti
coag
ula
nt
ther
apy.
Th
e ri
sk,
ho
wev
er,
can
be
dim
inis
hed
ar
e to
be
ren
der
ed.
Info
rmat
ion
mu
st b
e g
ath
ered
th
at in
dic
ates
wh
eth
er p
rolo
ng
ed th
erap
y w
ith
w
hen
bo
th th
e p
hys
icia
n a
nd
pat
ien
t u
nd
erst
and
the
mec
han
ism
of
acti
on
of
the
dru
gs
and
the
thes
e ag
ents
is d
etri
men
tal t
o t
he
myo
card
ium
. Des
pit
e th
is c
avea
t, t
he
avai
lab
ility
of
com
po
un
ds
fact
ors
th
at p
red
isp
ose
to
ble
edin
g.
hav
ing
po
ten
t in
otr
op
ic p
rop
erti
es h
as g
ener
ated
mu
ch a
nti
cip
atio
n a
nd
exc
item
ent
in c
linic
al
card
iolo
gy.
Con
tinue
d on
pag
e A
62
