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Uda S, Nakayama T, Hirose M, Yoshimura A. [Minimal change nephrotic syndrome]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2004; 62:1829-36. [PMID: 15500126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In minimal change nephrotic syndrome (MCNS), selective proteinuria is associated with structural alterations of the glomerular epithelial cells, such as effacement of the foot process. Although the pathogenesis of MCNS has not been completely clarified, clinical and experimental observations suggest that it results from T cell dysfunction in the pathogenesis. Recently, it has been proposed that the occurrence of MCNS has been associated with type 2 Th (Th2) lymphocyte-dependent conditions and some vascular permeability factors, which are induced by T cell disorder. In general, MCNS has the good long-term outcome with sustained remission and preserved renal function, because almost cases are responsible for the treatment. However, some patients show frequent relapses or resistance to this treatment and need large doses of immunosuppressive agents for a long time. Therefore, we should be care for the complications associated with prolonged these therapies.
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102
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Ejaz I, Khan HI, Javaid BK, Rasool G, Bhatti MT. Histopathological diagnosis and outcome of paediatric nephrotic syndrome. JCPSP-JOURNAL OF THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN 2004; 14:229-33. [PMID: 15228828 DOI: 04.2004/jcpsp.229233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2002] [Accepted: 03/10/2004] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine the histological picture and outcome of treatment in cases of childhood nephrotic syndrome who needed renal biopsy. DESIGN An analytical study. PLACE AND DURATION OF STUDY Department of Paediatrics, King Edward Medical College, and Mayo Hospital, Lahore from 1st June 1996 to 31st December, 2001 over a period of 5-1/2 years. SUBJECTS AND METHODS Children suffering from nephortic syndrome who had atypical features at presentation were initially or late non-responders; frequent relapsers on < 1mg kg/day and were steroid dependent or frequently relapsed on < 1 mg kg/day but developed steroid toxicity were included. Renal biopsy was performed in these patients. Treatment was administered according to the histopathology reports. Prednisolone 60 mg /m2/day followed after response by 40 mg /m2 on alternate days (AD) which was later tapered off. In minimal change nephrotic syndrome (MCNS) with frequent relapses cyclophosphamide, cyclosporine and levimisole were used. For steroid resistant focal segmental glomerulosclerosis (FSGS) intravenous pulses of methyl-prednisolone and cyclosporine were also given. These patients were followed to see the response of the therapy. RESULTS The commonest diagnosis was focal segmental glomerulosclerosis (FSGS) (42%) followed by minimal change disease (MCNS) (22%), membranoproliferative or mesangiocapillary glomerulonephritis (MPGN) (14%) and Mesangioproliferative glomerulonephritis (Mes PGN) (12%). There were 6% cases of membranous nephropathy and 4% of diffuse proliferative glomerulonephritis. On presentation, 40% had hematuria, 20% were found to be hypertensive, 12% patients had renal insufficiency and in 4% C3 level was low. Majority of the patients with MPGN and FSGS had atypical features whereas none of the patients with membranous nephropathy had any of these features. Thirty percent cases each of FSGS and MCNS were responders. Among non-responders there were 4 cases of FSGS and one of MPGN. CONCLUSION FSGS was the commonest histology in cases of childhood nephrotic syndrome that needed renal biopsy. Highest frequency of atypical features was seen in MPGN and FSGS.
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103
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Sipiczki T, Ondrik Z, Abrahám G, Pokorny G, Túri S, Sonkodi S, Kemény E, Iványi B. [The incidence of renal diseases as diagnosed by biopsy in Hungary]. Orv Hetil 2004; 145:1373-9. [PMID: 15384747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM AND METHODS The authors analysed the incidence of renal diseases as diagnosed by biopsy in the population living on the southern Great Hungarian Plain. 798 biopsy specimens were examined between 1990 and 2002. RESULTS The most common diseases in decreasing order of frequency were IgA nephropathy (15%), membranous nephropathy (12%), thin-basement-membrane nephropathy (8%), minimal change nephropathy (7%), lupus glomerulonephritis (7%), focal sclerosis (6%), hypertensive kidney disease and arteriolosclerosis (5%), diabetic nephropathy (5%), and crescentic glomerulonephritis (4%). The most frequent diseases in decreasing order of frequency in children were minimal change nephropathy, thin-basement-membrane nephropathy, Henoch-Schönlein nephropathy and IgA nephropathy; in adults were IgA nephropathy, membranous nephropathy, lupus glomerulonephritis and thin-basement-membrane nephropathy; and in the elderly were membranous nephropathy, amyloidosis, crescentic glomerulonephritis and diabetic nephropathy. The incidence of the diseases differed significantly between the genders in IgA nephropathy, thin-basement-membrane nephropathy, lupus glomerulonephritis, chronic sclerosing nephropathy and Alport nephropathy. At the time of the biopsy, 69 patients were suffering from diabetes mellitus. 37 patients were diagnosed as having diabetic nephropathy, and 32 as having non-diabetic nephropathy. In 6 cases, the diabetic nephropathy was accompanied by other glomerular disorders. In more than half of the diabetic patients with non-diabetic nephropathy, membranous nephropathy or focal sclerosis was diagnosed. Crescentic glomerulonephritis was diagnosed on 30 occasions, which was due to vasculitis in 20 cases, proliferative glomerulonephritis in 7 cases and anti-glomerular-basement-membrane nephritis in 3 cases. In the middle-aged and the elderly, the renal disease was relatively often a consequence of systemic disease. CONCLUSION The incidence and the gender distribution of renal diseases diagnosed by biopsy were similar to those reported by other European kidney biopsy centres. IgA nephropathy was the most frequent disease in the biopsy registry of the authors. The high incidence of thin-basement-membrane nephropathy seems to be related to consequent biopsy examinations of glomerular haematuria. In diabetics and the elderly, the diagnosis of the renal disease may be challenging.
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104
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Weissinger EM, Wittke S, Kaiser T, Haller H, Bartel S, Krebs R, Golovko I, Rupprecht HD, Haubitz M, Hecker H, Mischak H, Fliser D. Proteomic patterns established with capillary electrophoresis and mass spectrometry for diagnostic purposes. Kidney Int 2004; 65:2426-34. [PMID: 15149356 DOI: 10.1111/j.1523-1755.2004.00659.x] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proteomics applied in large scale may provide a useful diagnostic tool. METHODS We developed an online combination of capillary electrophoresis with mass spectrometry, allowing fast and sensitive evaluation of polypeptides found in body fluids. Utilizing this technology, polypeptide patterns from urine are established within 45 minutes. About 900 to 2500 polypeptides as well as their concentrations are detected in individual urine samples without the need for specific reagents such as antibodies. To test this method for clinical application, we examined spot urine samples from 57 healthy individuals, 16 patients with minimal change disease (MCD), 18 patients with membranous glomerulonephritis (MGN), and 10 patients with focal segmental glomerulosclerosis (FSGS). RESULTS One-hundred seventy-three polypeptides were present in more than 90% of the urine samples obtained from healthy individuals, while 690 polypeptides were present with more than 50% probability. These data permitted the establishment of a "normal" polypeptide pattern in healthy individuals. Polypeptides found in the urine of patients differed significantly from the normal controls. These differences allowed the distinction of specific protein spectra in patients with different primary renal diseases. Abnormal pattern of proteins were found even in urine from patients in clinical remission. CONCLUSION The data indicate that capillary electrophoresis with mass spectrometry coupling provides a promising tool that permits fast and accurate identification and differentiation of protein patterns in body fluids of healthy and diseased individuals, thus enabling diagnosis based on these patterns.
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105
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Herron MD, Kohan DE, Hansen CD. Minimal change nephropathy associated with pemphigus vulgaris: a new relationship? J Am Acad Dermatol 2004; 50:645. [PMID: 15034520 DOI: 10.1016/s0190-9622(02)61624-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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106
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Li YH, Huang HC, Liu G, Zhang YK. [The clinic significance of urinary podocytes in patients with focal segmental glomerulosclerosis]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2004; 36:135-8. [PMID: 15100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To address the significance of urinary podocytes in the diagnosis of human focal segmental glomerulosclerosis(FSGS). METHODS Twelve patients with FSGS and 20 patients with minimal change disease (MCD) were diagnosed by routine renal biopsy, and 8 healthy persons as controls. Morning urinary sediments was collected and centrifuged onto glass slides. Urinary podocytes were identified by immunofluorescent staining of podocyte specific protein Podocalyxin(PCX). The state of podocytes in glomeruli was observed using immunofluorescence. RESULTS Urinary podocytes were found in 8 out of 12 FSGS patients(66.67%), whereas none of 20 patients with MCD and control had podocytes in their urine. FSGS patients with positives urinary podocytes had prominent manifestation of nephropathy syndrome, whereas no nephrotic syndrome in patients with negative urinary podocytes. Focal absence of the expression of PCX, a marker protein of podocytes in glomeruli was found in FSGS patients, and the locations of absence were consistent with the lesions of focal sclerosis in glomeruli. In contrast, PCX was expressed integrally in MCD patients. CONCLUSION Appearances of podocytes in urine of patients with nephropathy may be used as one of the reliable, convenient and unharmful accessorial methods for distinguished diagnosis of FSGS and MCD.
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107
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Uramatsu T, Furusu A, Shimamine R, Muraya Y, Miyazaki M, Taguchi T, Kohno S. [Nephrotic syndrome after bee stings]. ACTA ACUST UNITED AC 2004; 93:380-2. [PMID: 15007949 DOI: 10.2169/naika.93.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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108
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Donia AF, Gazareen SH, Ahmed HA, Moustafa FE, Shoeib AA, Ismail AM, Khamis S, Sobh MA. Pulse cyclophosphamide inadequately suppresses reoccurrence of minimal change nephrotic syndrome in corticoid-dependent children. Nephrol Dial Transplant 2004; 18:2054-8. [PMID: 13679480 DOI: 10.1093/ndt/gfg300] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In minimal change nephrotic syndrome (MNCS), the most common primary nephrotic syndrome in children, approximately 95% of cases show excellent responses to steroid therapy. However, responding patients may become steroid dependent and experience serious side effects. Although oral cyclophosphamide has been recommended in these patients, long-term side effects such as gonadal toxicity are an important concern. Therefore, cyclophosphamide pulses given intravenously may provide an option that maintains remission with less-frequent side effects. METHODS We treated 20 primary steroid-dependent MCNS patients (15 boys and five girls) with intravenous cyclophosphamide. The patients were children with ages ranging from 3 to 15 years of age. Remission was induced by steroids followed by cyclophosphamide at a dose of 500 mg/m2 body surface area per month for 6 months. During this period, we attempted to completely withdraw steroids and maintain patients on cyclophosphamide alone. We monitored the patients for the occurrence of relapse and side effects during this period and for an additional 6 months after withdrawal of cyclophosphamide. RESULTS At the end of the 6-month cyclophosphamide treatment period (i.e. 4 months after steroid discontinuation), nine patients (45%) were in remission on cyclophosphamide alone. However, patients that maintained treatment-free remission (cyclophosphamide responders) decreased to five (25%), two (10%) and one (5%) at 6 months, 1 year and 2 years, respectively. CONCLUSION We found that a 6-month course of pulse cyclophosphamide produced unfavourable effects in the majority of paediatric patients with steroid-dependent nephrotic syndrome.
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Aleixandre Blanquer F, Navarro Navarro C, Velasco García R, Jover Cerdá J. Síndrome nefrótico corticosensible y tiroiditis de Hashimoto simultáneos. An Pediatr (Barc) 2004; 61:191-2. [PMID: 15274892 DOI: 10.1016/s1695-4033(04)78385-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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110
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Ilyas M, Tolaymat A. Minimal change nephrotic syndrome with Guillain-Barré syndrome. Pediatr Nephrol 2004; 19:105-6. [PMID: 14648330 DOI: 10.1007/s00467-003-1349-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2003] [Revised: 10/01/2003] [Accepted: 10/01/2003] [Indexed: 10/26/2022]
Abstract
A 17-year-old white male with a diagnosis of Guillain-Barré syndrome (GBS) developed severe proteinuria and edema 5 days later. Renal biopsy confirmed minimal change nephrotic syndrome (MCNS). To our knowledge this is the first report of such an association between ex novo MCNS and GBS in a pediatric patient. The NS responded to steroid therapy. The pertinent literature is reviewed.
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111
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García Donaire JA, Manzanera MI, Valentín MO, Espejo B, Gutiérrez Martínez E, Praga M. [Relapsing nephrotic syndrome in a diabetic patient with minimal change]. Nefrologia 2004; 24:179-82. [PMID: 15219093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Although nondiabetic nephropathies are common among type 2 diabetic patients, very few cases of minimal change nephrotic syndrome have been reported in diabetic patients. We describe a type 2 diabetic patient that rapidly developed a nephrotic syndrome accompanied by a mild worsening of renal function. Proteinuria was negative one year before and no signs of diabetic retinopathy were found. Renal biopsy established the diagnosis of minimal change disease. Steroid treatment induced a complete remission of nephrotic syndrome and recovery of normal renal function. However, massive proteinuria relapsed two years later. A second cycle of steroids was followed by a disappearance of proteinuria, but a third bout of nephrotic syndrome was observed 6 months later. An 8-weeks cycle of steroids plus chlorambucil induced a complete and persistent remission. Throughout a five-year follow up, no relapse of the nephrotic syndrome was observed and microalbuminuria is negative.
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112
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Niaudet P. [Lipoid nephrosis in childhood]. LA REVUE DU PRATICIEN 2003; 53:2027-32. [PMID: 15008217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Lipoid nephrosis or idiopathic nephrotic syndrome, the most frequent glomerular disease in childhood, is defined by the association of a nephrotic syndrome and minimal changes on renal biopsy or unspecific lesions such as focal and segmental glomerular sclerosis or diffuse mesangial proliferation. Several complications related to the nephrotic syndrome may occur: infections particularly bacterial infections, thrombo-embolic accidents, hypovolemia with shock. Other complications are secondary to the treatment: steroid therapy, immunosuppressants. The outcome is related to the response to steroid therapy. In case of steroid responsiveness, the risk is the relapse when the steroid dosage is tapered or stopped and the complications related to the treatment which is given to maintain remission. In case of steroid resistance, the risk is that of progression to renal failure which occurs in approximately 50% of patients after 5 years. Moreover, the nephrotic syndrome may recur after renal transplantation.
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113
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Yang JY. [Considerations in diagnosis and treatment of glomerular diseases in children--opportunities and challenges]. ZHONGHUA ER KE ZA ZHI = CHINESE JOURNAL OF PEDIATRICS 2003; 41:801-3. [PMID: 14728880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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114
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Fogo AB. Quiz page. Acute interstitial nephritis and minimal change disease lesion, caused by NSAID injury. Am J Kidney Dis 2003; 42:A41, E1. [PMID: 12900841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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115
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Ahmed M. Minimal change nephrotic syndrome presenting as acute renal failure. Indian Pediatr 2003; 40:676-8. [PMID: 12881627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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116
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117
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Sato S, Ishizaki M, Shimizu A, Ghazizadeh M, Kitamura H, Adachi A, Sasaki Y, Dai W, Wakamatsu K, Sugisaki Y. Identification of an electron densification of the glomerular basement membrane in renal biopsy specimens. MEDICAL ELECTRON MICROSCOPY : OFFICIAL JOURNAL OF THE CLINICAL ELECTRON MICROSCOPY SOCIETY OF JAPAN 2003; 36:106-11. [PMID: 12825124 DOI: 10.1007/s00795-002-0208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ultrastructural examination of renal biopsy specimens is often necessary to establish a diagnosis. We have noted, in some renal biopsies, that normal-appearing glomerular basement membrane (GBM) shows an electron densification. The aim of this study was to describe this phenomenon and assess the degree of its occurrence. We reviewed ultrastructural pathology records of 153 renal biopsy patients with special reference to the careful examination of the electron micrographs. Of these, 28 cases (18%) showed a definite and homogeneous electron densification of normal-appearing GBM in the glomeruli. The pathological diagnosis in these cases was IgA nephropathy in 15, minimal change nephrotic syndrome in 6, interstitial nephritis in 3, membranoproliferative glomerulonephritis in 2, and nephritis of Henoch-Schonlein purpura and membranous nephropathy in 1 case each. In addition, frequent deposition of IgG without C3 in the GBM (86%) and glomerular endothelial cell edema (96%) were observed. No apparent correlation could be ascertained between the presence of the electron densification and pathological diagnosis. It is suggested that electron densification of the GBM may be caused by the penetration of some electron-dense materials into the GBM as a result of an abnormality in the glomerular filtration barrier and that this could be considered as a sign of altered properties of the lamina densa.
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MESH Headings
- Adolescent
- Adult
- Aged
- Basement Membrane/ultrastructure
- Biopsy
- Child
- Female
- Glomerulonephritis, IGA/diagnosis
- Glomerulonephritis, IGA/pathology
- Glomerulonephritis, Membranoproliferative/diagnosis
- Glomerulonephritis, Membranoproliferative/pathology
- Glomerulonephritis, Membranous/diagnosis
- Glomerulonephritis, Membranous/pathology
- Humans
- Kidney Diseases/diagnosis
- Kidney Diseases/pathology
- Kidney Glomerulus/ultrastructure
- Male
- Microscopy, Electron
- Middle Aged
- Nephritis, Interstitial/diagnosis
- Nephritis, Interstitial/pathology
- Nephrosis, Lipoid/diagnosis
- Nephrosis, Lipoid/pathology
- Retrospective Studies
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118
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Talwar R, Dash SC, Kucheria K. A case of chronic myeloid leukemia complicated with minimal change nephrotic syndrome. Acta Haematol 2003; 109:101-3. [PMID: 12624495 DOI: 10.1159/000068492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Indexed: 11/19/2022]
Abstract
We present a 28-year-old patient with chronic myeloid leukemia (CML) in chronic phase complicated with nephrotic syndrome. The bone marrow cells revealed the presence of Philadelphia chromosome, the cytogenetic hallmark of CML, that results from a balanced, reciprocal translocation between the long arms of chromosomes 9 and 22, t(9;22)(q34;q11). This reciprocal translocation leads to the formation of the BCR/ABL fusion gene, the presence of which was confirmed using the highly sensitive fluorescence in situ hybridization technique. The renal biopsy was compatible with minimal change nephrotic syndrome. To the best of our knowledge, this is the first case of minimal change nephrotic syndrome associated with CML before the administration of any therapy.
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MESH Headings
- Adult
- Biopsy
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 9
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Kidney/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Nephrosis, Lipoid/complications
- Nephrosis, Lipoid/diagnosis
- Proteinuria
- Translocation, Genetic
- Ultrasonography
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Index of suspicion. Pediatr Rev 2003; 24:63-9. [PMID: 12563040 DOI: 10.1542/pir.24-2-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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120
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Dizer U, Beker CM, Yavuz I, Ortatatli M, Ozguven V, Pahsa A. Minimal change disease in a patient receiving IFN-alpha therapy for chronic hepatitis C virus infection. J Interferon Cytokine Res 2003; 23:51-4. [PMID: 12639299 DOI: 10.1089/10799900360520450] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic syndromes. The principal types of renal disorders associated with chronic HCV infection are cryoglobulinemia or noncryoglobulinemic membranoproliferative glomerulonephritis (MPGN). Interferon-alpha (IFN-alpha) may precipitate or exacerbate the occurrence of MPGN. Our patient was a 32-year-old man who tested positive for HCV in July 1997. The patient was treated with IFN-alpha in another medical center for 6 months because his liver biopsy showed chronic active hepatitis. In December 1998, he applied to our clinic for a follow-up examination. The level of aspartate aminotransferase (AST) was 44 U/L, and that of alanine aminotransferase (ALT) was 69 U/L. HCV RNA was positive in serum, and chronic HCV infection was detected by liver biopsy. IFN-alpha therapy (5 million U/day) was administered for 6 months longer. In May 1999, the patient came to our polyclinic with edema of the feet and legs. We detected proteinuria, serum cholesterol of 269 mg/dl, AST of 50 U/L, ALT of 41 U/L, serum total protein of 3.4 g/dl, serum albumin of 1.2 g/dl, positive cryoglobulin, and urine protein of 9.84 g/day. Cryoglobulinemic MPGN was suspected and kidney biopsy was performed, resulting in a diagnosis of minimal change disease (MCD).
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Mon C, Sánchez Hernández R, Fernández Reyes MJ, Estébanez C, Ortiz M, Alvarez-Ude F, Mampaso F. [Minimal-change disease with mesangial IgA deposits associated with Sjogren syndrome]. Nefrologia 2002; 22:386-9. [PMID: 12369132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Sjögren's syndrome may be accompanied by a dysregulation of IgA system implying the presence of increased serum polymeric IgA or circulating immune complexes and their consequent deposition within the kidney. In this context IgA nephropathy may only represent one of the complications brought by IgA deposition. Glomerular involvement and primary Sjögren's syndrome has been described previously only in isolated case reports, membranous nephropathy and membranoproliferative glomerulonephritis have been reported. We have not found any case of minimal change disease and glomerular IgA deposition associated with Sjögren's syndrome. In this patient nephrotic syndrome was related to serum increase of CA 19-9; this association has been reported in only three previous cases.
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Kang SW, Kang SJ, Kim HO, Nam ES, Lee JH, Koh HJ. Photodynamic therapy using verteporfin-induced minimal change nephrotic syndrome. Am J Ophthalmol 2002; 134:907-8. [PMID: 12470762 DOI: 10.1016/s0002-9394(02)01752-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a case of minimal change nephrotic syndrome (MCNS) after photodynamic therapy using verteporfin. DESIGN Interventional case report. METHODS After four cycles of photodynamic therapy, general weakness with generalized edema developed in an otherwise healthy 66-year-old woman, resulting in dyspnea and ascites. Urinalysis showed heavy proteinuria (4+) with decreased serum total protein and albumin, and increased total cholesterol levels, suggesting nephrotic syndrome. Renal biopsy and pathologic diagnosis were performed. RESULTS Renal biopsy revealed normal glomeruli and tubulointerstitium by light microscopy, with no immunoglobin or complement deposition. Transmission electron microscopy showed diffuse effacement of the foot processes of visceral epithelial cells, which is the characteristic finding of minimal change nephrotic syndrome. CONCLUSIONS We herein report a case of minimal change nephrotic syndrome after photodynamic therapy using verteporfin.
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Voznesenskaia TS, Sergeeva TV. [Nephrotic syndrome in minimal change disease (kidney), focal segmental glomerulosclerosis, and focal mesangioproliferative glomerulonephritis]. TERAPEVT ARKH 2002; 74:31-3. [PMID: 12136479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AIM To specify clinical and laboratory characteristics of minimal change disease (MCD), focal mesangioproliferative glomerulonephritis (MPGN), focal-segmental glomerulosclerosis (FSGS). MATERIAL AND METHODS A retrospective analysis of 45 case histories of children (renal biopsy for nephrotic syndrome) has shown that morphologically 13 of them had MCD, 15--FSGS and 17--focal MPGN. Clinical, laboratory, immunofluorescent and electron microscopy findings typical for each of the morphological types were studied. RESULTS The data obtained suggest that MCD, FSGS and focal MPGN may represent independent forms of glomerulonephritis. CONCLUSION If a differential diagnosis by renal biopsy is difficult, information from the disease history and clinico-laboratory evidence should be used.
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Kikuchi Y, Imakiire T, Hyodo T, Higashi K, Henmi N, Suzuki S, Miura S. Minimal change nephrotic syndrome, lymphadenopathy and hyperimmunoglobulinemia after immunization with a pneumococcal vaccine. Clin Nephrol 2002; 58:68-72. [PMID: 12141410 DOI: 10.5414/cnp58068] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 67-year-old female was admitted to our hospital with eruption and cervical lymphadenopathy which occurred one week after pneumococcal vaccination. Polyclonal hyperimmunoglobulinemia (IgG 6,620 mg/dl) and mild plasma cell proliferation (6.4%) in a bone marrow specimen were found, but a lymph node aspiration biopsy showed no specific findings. Normochromic and normocytic anemia with a positive direct Coombs test were also confirmed. Short-term intensive steroid therapy was given, but the systemic eruption and lymphadenopathy continued. About 4 months after vaccination, she suffered from edema in her face and legs and visual disturbance. When massive proteinuria (10.4 g/day) was found, she was admitted to our ward. A renal biopsy specimen showed a minor glomerular abnormality with mild interstitial plasmacytic infiltration. An abdominal CT scan showed hepatosplenomegaly and para-aortic lymphadenopathy. Uveitis was also found by ophthalmoscopy. These abnormalities completely disappeared after intensive steroid therapy including pulse therapy. On the basis of her clinical course and laboratory findings, it was suggested that minimal change nephrotic syndrome might be induced after vaccination, possibly due to hypersensitivity syndrome.
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Abstract
Malignant tumors may affect the kidney in a direct and in an indirect fashion. In addition, there are multiple paraneoplastic syndromes and the side effects of the tumor therapy. Therefore, clinicians may encounter a wide spectrum of disorders representing almost all aspects of kidney diseases. Importantly, practitioners taking care of patients with glomerulopathies must always consider the possibility of a co-existence of a malignancy, as highlighted by our case report.
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