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Özdemir Atikel Y, Derinkuyu BE, Bakkaloğlu SA. Unusual presentation of familial Mediterranean fever with co‐existing polyarteritis nodosa and acute post‐streptococcal glomerulonephritis. Clin Case Rep 2022; 10:e6022. [PMID: 35898740 PMCID: PMC9307881 DOI: 10.1002/ccr3.6022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/05/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Acute post‐streptococcal glomerulonephritis (APSGN) and polyarteritis nodosa (PAN) may occur simultaneously after streptococcal infection in a child who is previously healthy but carries a Mediterranean fever (MEFV) mutation. The homozygous M694V mutation in the MEFV gene may cause an augmented response to the streptococcal infection that plays a role in the development of both clinical manifestations.
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Affiliation(s)
- Yeşim Özdemir Atikel
- Department of Pediatric Nephrology Gazi University Faculty of Medicine Ankara Turkey
| | | | - Sevcan A. Bakkaloğlu
- Department of Pediatric Nephrology Gazi University Faculty of Medicine Ankara Turkey
- Department of Pediatric Rheumatology Gazi University Faculty of Medicine Ankara Turkey
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2
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Funes Hernandez M, Bhalla V, Isom RT. Self-limited hypertension due to kidney infarction: A Case Report. Kidney Med 2022; 4:100454. [PMID: 35509677 PMCID: PMC9058599 DOI: 10.1016/j.xkme.2022.100454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mario Funes Hernandez
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Address for Correspondence: Mario Funes Hernandez, MD, Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305
| | - Vivek Bhalla
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Robert Tristan Isom
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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3
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Jia S, Liu L, Ma J, Chen X. Application progress of multiple imaging modalities in Takayasu arteritis. Int J Cardiovasc Imaging 2021; 37:3591-3601. [PMID: 34287748 DOI: 10.1007/s10554-021-02348-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
Takayasu arteritis (TA) is a chronic, idiopathic, granulomatous large vessel vasculitis of unknown etiology. The clinical manifestations of TA are incredibly variable, mainly depending on the location of the lesions. In the light of its insidious progress and the diversity of clinical manifestations, a substantial proportion of patients might experience a considerable delay in diagnosis, which leads to irreversible malignant complications, highlighting the importance of early diagnosis. There has been accumulating evidence that early identification of disease is pivotal to initiate timely therapy and ameliorate the prognosis. Therefore, this review discusses and summarizes the latest evidence on the application progress of multiple imaging modalities.
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Affiliation(s)
- Shanshan Jia
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China
| | - Lu Liu
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China
| | - Jun Ma
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Guo Xue Xiang No.37, Chengdu, Sichuan, 610041, China.
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4
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Philip R, Dumont A, Le Mauff B, Martinet M, Martin Silva N, de Boysson H, Lobbedez T, Aouba A, Deshayes S. [ANCA and anti-MBG double-positive vasculitis: An update on the clinical and therapeutic specificities and comparison with the two eponymous vasculitis]. Rev Med Interne 2019; 41:21-26. [PMID: 31839271 DOI: 10.1016/j.revmed.2019.10.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/21/2019] [Accepted: 10/21/2019] [Indexed: 01/19/2023]
Abstract
Double-positive vasculitis with anti-polynuclear cytoplasm (ANCA) and anti-glomerular basement membrane (GBM) antibodies is a rare entity of systemic vasculitis defined by the presence of ANCA and anti-GBM antibodies. The gradual accumulation of clinical and therapeutic data shows the usefulness of identifying and differentiating this entity from the two vasculitis respectively associated with the isolated presence of each of these two antibodies. Indeed, the double-positive ANCA and anti-GBM vasculitis appears to associate the characteristics of the demography and the extra-renal and pulmonary involvement of the ANCA-associated vasculitis on the one hand, and of the histological type and severe renal prognosis of the anti-MBG vasculitis on the other hand, with the renal involvement which is the only involvement consistently observed in double-positive vasculitis. The aim of this focus is to describe the epidemiological, clinico-biological, histological and prognostic characteristics of this entity, in light of recent literature and ongoing therapeutic changes in the two eponymous vasculitis.
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Affiliation(s)
- R Philip
- Service de médecine interne et immunologie clinique, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - A Dumont
- Service de médecine interne et immunologie clinique, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - B Le Mauff
- Laboratoire d'Immunologie, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - M Martinet
- Laboratoire d'Immunologie, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - N Martin Silva
- Service de médecine interne et immunologie clinique, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - H de Boysson
- Service de médecine interne et immunologie clinique, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - T Lobbedez
- Service de néphrologie, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
| | - A Aouba
- Service de médecine interne et immunologie clinique, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France.
| | - S Deshayes
- Service de médecine interne et immunologie clinique, UNICAEN, Normandie Université, CHU de Caen Normandie, 14000 Caen, France
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Chatterjee U, Islam N, Sinha D, Ghosh P, Datta C. Orchitis: An unusual presentation of polyarteritis nodosa. INDIAN J PATHOL MICR 2018; 61:600-603. [DOI: 10.4103/ijpm.ijpm_569_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Ziaj S, Mitchell C, Roufosse C, Dubrey SW. Occult microscopic polyangiitis presenting as pyrexia of unknown origin. Br J Hosp Med (Lond) 2014; 75:172-3. [PMID: 24621636 DOI: 10.12968/hmed.2014.75.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Ziaj
- CT2 in Cardiology in the Department of Cardiology
| | - C Mitchell
- Consultant in Endocrinology in the Diabetes Department, Hillingdon Hospital, Uxbridge, Middlesex
| | - C Roufosse
- Consultant in Histopathology in the Department of Histopathology, Hammersmith Hospital, London
| | - S W Dubrey
- Consultant in Cardiology in the Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex
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7
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Yokota K, Inoue T, Akiyama Y, Kajiyama H, Funakubo Asanuma Y, Arai E, Suzuki H, Mimura T. Acute kidney injury in a patient with polyarteritis nodosa and multiple myeloma. Intern Med 2014; 53:263-7. [PMID: 24492698 DOI: 10.2169/internalmedicine.53.1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a Japanese man with polyarteritis nodosa (PAN) accompanied by multiple myeloma (MM). The patient was diagnosed with PAN. Concurrently, IgG kappa paraprotein was detected, and bone marrow changes indicative of MM were observed. Prednisolone (PSL) administered at a dose of 30 mg/day was initiated; however, the serum creatinine level increased. In spite of increasing the dose of PSL to 45 mg/day and initiating treatment with double filtration plasmapheresis, the patient's renal dysfunction continued to progress and haemodialysis was introduced. He died from pneumonia 12 months after admission. We conclude that renal failure is an important risk factor in the prognosis of PAN accompanied by MM.
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Affiliation(s)
- Kazuhiro Yokota
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
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AP-VAS 2012 case report: an atypical case of microscopic polyangiitis presenting with acute tubulointerstitial nephritis without glomerular change. CEN Case Rep 2013; 3:1-4. [PMID: 28509258 DOI: 10.1007/s13730-013-0103-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 10/31/2013] [Indexed: 10/25/2022] Open
Abstract
Renal involvement in myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis is frequently characterized by focal segmental crescentic and/or necrotizing glomerulonephritis. However, a few cases of only tubulointerstitial nephritis (TIN) involvement without any apparent glomerular lesions have been reported. Here we report just such a case. A 74-year-old woman was admitted to a nearby hospital with a 2-week history of pitting edema, fever and anemia. She developed acute renal failure without proteinuria and microscopic hematuria. The urinary excretion of N-acetyl-beta-D-glucosaminidase and beta2-microglobulin concentration were 30.3 U/ml and 42270 μg/ml, respectively. Gallium-67 scintigraphy revealed abnormal concentrations on both sides of her kidneys. Her MPO-ANCA titer was 92 EU (normal range <10 EU). Skin and renal biopsies demonstrated fibrinoid vasculitis, necrotizing angiitis and TIN without glomerular change. Microscopic polyangiitis was diagnosed based on clinical and pathological criteria. No other factor that could induce TIN was detected. This case illustrates an unusual renal presentation of acute renal failure due to necrotizing arteritis and TIN, consistent with MPO-ANCA-associated vasculitis lacking crescentic glomerulonephritis. The pathogenesis is currently unclear, but the low-affinity type of MPO-ANCA was identified.
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Galesic K, Ljubanovic D, Horvatic I. Treatment of renal manifestations of ANCA-associated vasculitis. J Nephropathol 2013; 2:6-19. [PMID: 24475421 PMCID: PMC3886180 DOI: 10.5812/nephropathol.8971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/25/2013] [Indexed: 01/06/2023] Open
Abstract
CONTEXT Vasculitis is a clinicopathological entity characterized by inflammation and necrosis of blood vessels. EVIDENCE ACQUISITIONS Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science have been searched. RESULTS Two major autoantigens for ANCA are myeloperoxidase (MPO) and proteinase 3 (PR3), which are proteins in the primary granules of neutrophils and in the lysosomes of monocytes. They are expressed in mature neutrophils of patients with ANCA, while absent in healthy subjects. CONCLUSIONS The kidney is the most commonly affected vital organ in ANCA-associated vasculitis, and patient outcomes are largely determined by the severity of renal disease at diagnosis and by its response to treatment.
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Affiliation(s)
- Kresimir Galesic
- Department of Nephrology, Dubrava University Hospital, Zagreb Medical School, Zagreb, Croatia
| | - Danica Ljubanovic
- Department of Pathology, Dubrava University Hospital, Zagreb Medical School, Zagreb, Croatia
| | - Ivica Horvatic
- Department of Nephrology, Dubrava University Hospital, Zagreb Medical School, Zagreb, Croatia
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Gheita TA, Khairy NA, Nasrallah MM, Hussein H. Subclinical renal involvement in essential cryoglobulinemic vasculitis and classic polyarteritis nodosa. Joint Bone Spine 2012; 79:274-80. [DOI: 10.1016/j.jbspin.2011.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/23/2011] [Indexed: 01/03/2023]
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Hicks J, Mierau G, Wartchow E, Eldin K. Renal Diseases Associated with Hematuria in Children and Adolescents: A Brief Tutorial. Ultrastruct Pathol 2012; 36:1-18. [DOI: 10.3109/01913123.2011.620731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Takala JH, Kautiainen H, Finne P, Leirisalo-Repo M. Wegener's granulomatosis in Finland in 1981-2000: risk of dialysis-dependent renal disease. Scand J Rheumatol 2011; 40:283-8. [PMID: 21231798 DOI: 10.3109/03009742.2010.533693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk of renal insufficiency requiring transient or chronic dialysis and its contributing factors in patients diagnosed with Wegener's granulomatosis (WG) between 1981 and 2000 in Finland. PATIENTS AND METHODS A retrospective cohort study using hospital discharge registers with a review of hospital case reports. Data were complemented with files from the Finnish Registry for Kidney Diseases. All files were reviewed by 8 October 2005. RESULTS A total of 492 patients received a verified diagnosis of WG in 1981-2000. Of these, 84 (17%) needed dialysis by the end of follow-up. Of the 84 dialysed patients, 32 (38%) recovered initially, 32 (38%) needed chronic dialysis (dialysed > 3 months), and 19 (23%) received a kidney transplant. Forty-one (49%) of the dialysed patients were alive at the end of follow-up: 16 with a kidney transplant, 14 on dialysis, and 11 without dialysis. The cumulative rate of developing renal involvement leading to dialysis was 14.6% [95% confidence interval (CI) 11.6-18.2] at 5 years and 29.6% (95% CI 21.5-40.0) at 20 years after onset of WG symptoms. Elevated creatinine levels at presentation were associated with an increased rate of renal insufficiency requiring chronic dialysis. Age, gender, and involvement of any particular organ system had no significant effect. CONCLUSIONS WG patients are at great risk of developing renal insufficiency, and this risk increases as the disease progresses. Elevated creatinine levels at presentation are associated with an increased risk of dialysis-dependent end-stage renal disease.
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Affiliation(s)
- J H Takala
- Helsinki University Central Hospital, Department of Medicine, Division of Rheumatology, Helsinki, Finland.
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13
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Sakaguchi Y, Uehata T, Kawabata H, Niihata K, Shimomura A, Suzuki A, Kaneko T, Shoji T, Shimazu K, Fushimi H, Tsubakihara Y. An autopsy-proven case of myeloperoxidase-antineutrophil cytoplasmic antibody-positive polyarteritis nodosa with acute renal failure and alveolar hemorrhage. Clin Exp Nephrol 2010; 15:281-4. [PMID: 21161718 DOI: 10.1007/s10157-010-0386-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 11/14/2010] [Indexed: 11/30/2022]
Abstract
An 80-year-old woman positive for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was admitted with a 3-month history of fever, general malaise, and weight loss, after unsuccessful treatment with antibiotics. Upon admission, her fever persisted, and there was concomitant deterioration of renal function without active urine sediments. Furthermore, she developed hemoptysis, and chest computed tomography (CT) scan revealed bilateral diffuse alveolar hemorrhage. Although a renal biopsy was not performed because of her dementia, we initially suspected microscopic polyangiitis (MPA) on the basis of her clinical course. Because of her poor general condition, she was administered a low dose of prednisolone. Although her fever subsided, she suffered from intractable alveolar hemorrhage and eventually died from respiratory failure. During the autopsy, fibrinoid necrosis was restricted to medium-sized arteries, including the arcuate arteries of the kidneys and the bronchial arteries, without necrotizing crescentic glomerulonephritis and alveolar capillaritis. Therefore, polyarteritis nodosa (PAN) was diagnosed. It is important to distinguish between MPA and PAN because they can lead to life-threatening complications, and their treatment strategies and prognosis are different. When a patient presents with MPO-ANCA, alveolar hemorrhage, and acute renal failure with little evidence of glomerulonephritis, a differential diagnosis of PAN should be made; however, it is difficult to do so without pathological findings. Therefore, pathological examination should be carried out whenever possible.
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Affiliation(s)
- Yusuke Sakaguchi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
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Visrutaratna P, Srisuwan T, Sirivanichai C. Pediatric renovascular hypertension in Thailand: CT angiographic findings. Pediatr Radiol 2009; 39:1321-6. [PMID: 19685045 DOI: 10.1007/s00247-009-1380-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 07/20/2009] [Accepted: 07/27/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Renovascular disease is an uncommon but important cause of hypertension in children. When unrecognized and untreated, renovascular hypertension in children can have serious complications. OBJECTIVE To review the causes of renovascular hypertension and computed tomography angiographic (CTA) findings in children and adolescents. MATERIALS AND METHODS Twenty-eight CTAs from January 2004 to March 2008 of 23 children and adolescents with hypertension were reviewed for the causes and CTA findings. RESULTS Nine of the 23 children (39%) had abnormal renal arteries with or without abnormal abdominal aortas. Four of these children had Takayasu arteritis, one had moyamoya disease, and one had median arcuate ligament syndrome. One with chronic pyelonephritis had severe stenosis of the proximal right renal artery. The other two children had renal artery stenosis with a nonspecific cause. One child with a normal abdominal aorta and renal arteries had a right suprarenal mass. On pathological examination a ganglioneuroma was found. CONCLUSION CTA can help in diagnosis of renovascular hypertension in children and adolescents. Although CTA is not a screening modality, it is appropriate in some situations.
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Affiliation(s)
- Pannee Visrutaratna
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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15
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Huang MN, Wu CH. Polyarteritis nodosa and antiphospholipid syndrome causing bilateral renal infarction. J Rheumatol 2009; 36:197. [PMID: 19208533 DOI: 10.3899/jrheum.080601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Min-Nung Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Sano F, Miyamae T, Nakagishi Y, Kinoshita J, Ozawa R, Imagawa T, Mori M, Asayama M, Yokota S. [Gastrointestinal involvement and renal infarction in a boy with classic polyarteritis nodosa diagnosed with 3D-computed tomography angiography]. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2008; 31:415-21. [PMID: 18974626 DOI: 10.2177/jsci.31.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of classic polyarteritis nodosa complicated with renal infarction. A 14-year-old boy manifested fever, abdominal pain, watery and bloody diarrhea, and weight loss. Laboratory findings indicated anemia, increased levels of C-reactive protein, and erythrocyte sedimentation rate. Lower gastrointestinal endoscopic examination revealed multiple colorectal ulcerations, and histopathological findings were non-specific, suggesting gastrointestinal involvement of Behcet disease. The patient was referred to our hospital, and suspected to have vasculitis syndrome since the abnormal laboratory findings included persistently increased levels of FDP-E/fibrin monomer as well as inflammatory markers, and the extraordinary high excretion of beta 2-microglobulin, which indicated abrupt and massive expression of HLA class I molecule on endothelial cells due to interferon-gammanemia. To examine the site of vasculitis, 3D-CT angiography was applied to demonstrate bilateral renal infarction and renal artery microaneurysms. Together with the clinical, laboratory, and 3D-CT angiographic findings, he was finally diagnosed as having classic polyarteritis nodosa. After 12 month-course of intravenous cyclophosphamide pulses and prednisolone/azatioprine therapy, complete disappearances of inflammatory manifestations, and renal infarction and microaneurysms were documented. The diagnosis of classic polyarteritis nodosa is frequently delayed because both clinical symptoms and signs, and laboratory findings are not disease-specific, but early diagnosis and treatment are necessary to prevent serious organ damage. In addition to the precise estimation of laboratory findings such as inflammatory markers, and FDP-E/D-dimer/fibrin monomer, the newly developed 3D-CT angiography, a less invasive imaging technique, will be helpful to diagnose patients with classic polyarteritis nodosa, and intervene the disease progression with early and active treatment.
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Affiliation(s)
- Fumie Sano
- Department of Pediatrics, Yokohama City University
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Avila J, Acosta E, Machargo MDV, Arteaga MF, Gallego E, Cañete H, García-Pérez JJ, Martín-Vasallo P. Autoantigenic nuclear proteins of a clinically atypical renal vasculitis. JOURNAL OF AUTOIMMUNE DISEASES 2008; 5:3. [PMID: 18625050 PMCID: PMC2483274 DOI: 10.1186/1740-2557-5-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 07/14/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Systemic vasculitides constitute a heterogeneous group of diseases of autoimmunological origin characterized by inflammation of blood vessels and antibodies that react against autoantigens in a process that ultimately affects blood vessel walls. An important number of these patients present kidney disease. An endeavour of this area of research is the identification of autoantigens involved in these diseases. Accordingly, we used serum from a patient suffering from a microscopic polyangiitis, P-ANCA positive, manifesting a clinically atypical renal necrotizing glomerulonephritis and interstitial nephropathy for the identification of autoantigens; we also determined the prevalence of corresponding autoantibodies in other vasculitides, diabetic microangiopathy and in general population. METHODS The patient's serum was used as a probe for the immunoscreening method SEREX to screen a human brain cDNA expression library. RESULTS Four positive clones were isolated and sequenced. Clones Jos002 code for protein HDAC5, Jos014 for TFC4, Jos107 for RTF1, and Jos313 for POLDIP3 polymerase. The four proteins are of nuclear localization. None of them had been reported as autoantigen. Recombinant proteins were synthesised and checked as antigens by western blot with different sera from controls and patients affected with other vasculitides and diabetic microangiopathy as well. Only the serum from the patient origin of this study recognized all recombinant proteins. CONCLUSION We identify four nuclear proteins, HDAC5, TFC4, RTF1 and POLDIP3 polymerase as new autoantigens that could be used as markers in the diagnosis of subfamilies in immune diseases, although we cannot determine the role of these proteins in the aetiopathogenic process.
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Affiliation(s)
- Julio Avila
- Departamento de Bioquímica y Biología Molecular, Laboratorio de Biología del Desarrollo, Universidad de La Laguna, 38206 La Laguna, Tenerife, Spain
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Mrkobrada M, Thiessen-Philbrook H, Haynes RB, Iansavichus AV, Rehman F, Garg AX. Need for quality improvement in renal systematic reviews. Clin J Am Soc Nephrol 2008; 3:1102-14. [PMID: 18400967 PMCID: PMC2440265 DOI: 10.2215/cjn.04401007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 02/11/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Systematic reviews of clinical studies aim to compile best available evidence for various diagnosis and treatment options. This study assessed the methodologic quality of all systematic reviews relevant to the practice of nephrology published in 2005. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched electronic databases (Medline, Embase, American College of Physicians Journal Club, Cochrane) and hand searched Cochrane renal group records. Clinical practice guidelines, case reports, narrative reviews, and pooled individual patient data meta-analyses were excluded. Methodologic quality was measured using a validated questionnaire (Overview Quality Assessment Questionnaire). For reviews of randomized trials, we also evaluated adherence to recommended reporting guidelines (Quality of Reporting of Meta-Analyses). RESULTS Ninety renal systematic reviews were published in year 2005, 60 of which focused on therapy. Many systematic reviews (54%) had major methodologic flaws. The most common review flaws were failure to assess the methodologic quality of included primary studies and failure to minimize bias in study inclusion. Only 2% of reviews of randomized trials fully adhered to reporting guidelines. A minority of journals (four of 48) endorsed adherence to consensus guidelines for review reporting, and these journals published systematic reviews of higher methodologic quality (P < 0.001). CONCLUSIONS The majority of systematic reviews had major methodologic flaws. The majority of journals do not endorse consensus guidelines for review reporting in their instructions to authors; however, journals that recommended such adherence published systemic reviews of higher methodologic quality.
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Affiliation(s)
- Marko Mrkobrada
- Division of Nephrology, University of Western Ontario, London, Ontario, Canada
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19
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de Groot K. [Renal manifestations in rheumatic diseases]. Internist (Berl) 2007; 48:779-85. [PMID: 17571244 DOI: 10.1007/s00108-007-1887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inflammatory rheumatic diseases other than systemic vasculitides and systemic lupus erythematosus are frequently associated with renal abnormalities, which are clinically less apparent due to the subtle course and the often only moderate impairment of renal function. These abnormalities include vascular, glomerular and tubulointerstitial changes. Renal manifestations in the course of rheumatoid arthritis influence the prognosis of the disease. Renal involvement due to AA amyloidosis following long-standing inflammatory joint disease can lead slowly, over years, to end-stage renal disease. A scleroderma renal crisis in the course of systemic sclerosis can potentially result in end-stage renal disease within days. The differential diagnosis of renal abnormalities in a rheumatic patient should include drug induced renal impairment as well as infection.
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Affiliation(s)
- K de Groot
- Med. Klinik III (Nephrologie, Hypertensiologie, Rheumatologie), Klinikum Offenbach GmbH, 63069 Offenbach.
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