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Kalmár T, Jakab D, Maróti Z, Lakatos O, Vas T, Bereczki C, Iványi B. The Apical Endocytic-Lysosomal Apparatus in CLCN5 Mutations with Phenotypic-Genotypic Correlations in Three Cases. Int J Mol Sci 2024; 25:966. [PMID: 38256038 PMCID: PMC10815395 DOI: 10.3390/ijms25020966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Dent disease type 1 is characterized by pathogenic CLCN5 gene variants and impaired receptor-mediated endocytosis in proximal tubules. However, mutation-related abnormalities in proximal tubules have not yet been described. Here, we present three patients with CLCN5 alterations and distinct morphological changes of the apical endocytic-lysosomal apparatus. The proximal tubular ultrastructure was investigated in kidney biopsy samples of three boys genotyped for non-nephrotic proteinuria. Controls: seven patients with nephrotic-range glomerular proteinuria. The genotyping findings revealed an already-known missense mutation in one patient and hitherto undescribed frameshift variants in two patients. Low-molecular-weight proteinuria, focal global glomerulosclerosis, proximal tubular changes, and tubular calcium deposits characterized each case. Three subsets of proximal tubular cells were observed: those without any abnormality, those with aplasia of apical endocytic-lysosomal apparatus and shrinkage of cells, and those with hypoplasia of apical endocytic apparatus, accumulation of proteinaceous substance in dysmorphic lysosomes, and dysmorphic mitochondria. The distribution of subsets varied from patient to patient. In one patient with a frameshift variant, an oxidative stress-like injury of proximal tubular cells and podocytes accompanied the above-mentioned alterations. Focal aplasia/hypoplasia of apical endocytic apparatus and subsequent changes in cytoplasmic organelles characterized proximal tubules in the CLCN5 pathogenic variants.
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Affiliation(s)
- Tibor Kalmár
- Department of Pediatrics, Albert Szent-Györgyi Medical School and Health Center, University of Szeged, 6720 Szeged, Hungary; (D.J.); (Z.M.); (C.B.)
| | - Dániel Jakab
- Department of Pediatrics, Albert Szent-Györgyi Medical School and Health Center, University of Szeged, 6720 Szeged, Hungary; (D.J.); (Z.M.); (C.B.)
| | - Zoltán Maróti
- Department of Pediatrics, Albert Szent-Györgyi Medical School and Health Center, University of Szeged, 6720 Szeged, Hungary; (D.J.); (Z.M.); (C.B.)
| | - Orsolya Lakatos
- Department of Pediatrics, University of Pécs, 7624 Pécs, Hungary;
| | - Tibor Vas
- Department of Internal Medicine, University of Pécs, 7624 Pécs, Hungary;
| | - Csaba Bereczki
- Department of Pediatrics, Albert Szent-Györgyi Medical School and Health Center, University of Szeged, 6720 Szeged, Hungary; (D.J.); (Z.M.); (C.B.)
| | - Béla Iványi
- Institute of Pathology, Albert Szent-Györgyi Medical School and Health Center, University of Szeged, 6720 Szeged, Hungary;
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Kalmár T, Turkevi-Nagy S, Bitó L, Kaiser L, Maróti Z, Jakab D, Letoha A, Légrády P, Iványi B. Phenotype-Genotype Correlations in Three Different Cases of Adult-Onset Genetic Focal Segmental Glomerulosclerosis. Int J Mol Sci 2023; 24:17489. [PMID: 38139322 PMCID: PMC10743622 DOI: 10.3390/ijms242417489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
This study highlights the importance of a combined diagnostic approach in the diagnosis of rare diseases, such as adult-onset genetic FSGS. We present three adult patient cases evaluated with kidney biopsy for proteinuria, chronic kidney disease, and hypertension, which were suggestive of adult-onset genetic FSGS. Renal biopsy samples and formalin-fixed, paraffin-embedded fetal kidneys were evaluated using standard light microscopical stainings, direct immunofluorescence on cryostat sections, and electron microscopy. Clinical exome sequencing was performed for each case, and 45 FSGS-related genes were analyzed. Identifying mutations in the PAX2, ACTN4, and COL4A5 genes have prompted a re-evaluation of the previous histopathological examinations. The PAX2 mutation led to a thinner nephrogenic zone and decreased number of glomeruli, resulting in oligohydramnios during fetal development and oligomeganephronia and adaptive focal-segmental glomerulosclerosis in adulthood. The ACTN4 mutation caused distinct electron-dense aggregates in podocyte cell bodies, while the COL4A5 mutation led to segmental sclerosis of glomeruli with marked interstitial fibrosis and tubular atrophy. The identification of specific mutations and their histopathological consequences can lead to a better understanding of the disease and its progression, as well as potential treatment options.
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Affiliation(s)
- Tibor Kalmár
- Department of Pediatrics, Albert Szent-Györgyi Health Centre, University of Szeged, Temesvari krt 35-37, 6726 Szeged, Hungary (Z.M.)
| | - Sándor Turkevi-Nagy
- Department of Pediatrics, Albert Szent-Györgyi Health Centre, University of Szeged, Temesvari krt 35-37, 6726 Szeged, Hungary (Z.M.)
| | - László Bitó
- Department of Internal Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, 6726 Szeged, Hungary
| | - László Kaiser
- Department of Pediatrics, Albert Szent-Györgyi Health Centre, University of Szeged, Temesvari krt 35-37, 6726 Szeged, Hungary (Z.M.)
| | - Zoltán Maróti
- Department of Pediatrics, Albert Szent-Györgyi Health Centre, University of Szeged, Temesvari krt 35-37, 6726 Szeged, Hungary (Z.M.)
| | - Dániel Jakab
- Department of Pediatrics, Albert Szent-Györgyi Health Centre, University of Szeged, Temesvari krt 35-37, 6726 Szeged, Hungary (Z.M.)
| | - Annamária Letoha
- Department of Internal Medicine, Centre of Clinical Infectology and Acute Internal Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, 6726 Szeged, Hungary
| | - Péter Légrády
- Department of Internal Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, 6726 Szeged, Hungary
| | - Béla Iványi
- Department of Pediatrics, Albert Szent-Györgyi Health Centre, University of Szeged, Temesvari krt 35-37, 6726 Szeged, Hungary (Z.M.)
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Bajcsi D, Bitó L, Turkevi-Nagy S, Nyári T, Kemény É, Légrády P, Ábrahám G, Iványi B. The value of PLA2R antigen and IgG subclass staining relative to anti-PLA2R seropositivity in the differential diagnosis of membranous nephropathy. BMC Nephrol 2023; 24:230. [PMID: 37550626 PMCID: PMC10408061 DOI: 10.1186/s12882-023-03273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The diagnostic performance of PLA2R and IgG subclass staining of kidney biopsies relative to anti-PLA2R seropositivity in the differentiation of primary and secondary membranous nephropathy (pMN, sMN) was examined. Besides PLA2R staining - which has a lower specificity than anti-PLA2R antibody serology - there is insufficient knowledge to decide which IgG1-4 subtype immunohistological patterns (IgG4-dominance, IgG4-dominance/IgG1-IgG4-codominance or IgG4-dominance/IgG4-codominance with any IgG subtype) could be used to distinguish between pMN and sMN. METHODS 87 consecutive Hungarian patients (84 Caucasians, 3 Romas) with the biopsy diagnosis of MN were classified clinically as pMN (n = 63) or sMN (n = 24). The PLA2R and IgG subclass staining was part of the diagnostic protocol. Anti-PLA2R antibodies were determined by an indirect immunofluorescence test in 74 patients with disease activity. RESULTS For pMN, the sensitivity of anti-PLA2R seropositivity was 61.1%, and the specificity was 90.0%; and similar values for PLA2R staining were 81.0%, and 66.7%, respectively. In all stages of pMN, IgG4-dominance was the dominant subclass pattern, while the second most frequent was IgG3/IgG4-codominance. The sensitivity and specificity scores were: IgG4-dominance 52.2% and 91.7%, IgG4-dominance/IgG3-IgG4-codominance 76.2% and 87.5%, IgG4-dominance/IgG1-IgG4-codominance 64.2% and 75%, and IgG4-dominance/codominance with any IgG subclass 92.1% and 70.8%, respectively. Anti-PLA2R seropositivity, glomerular PLA2R, and IgG4-dominance/codominance significantly correlated with each other. The IgG4 subclass was rarely encountered in sMN. CONCLUSION In our series, IgG4-dominance had the highest specificity in the differentiation of MN, just as high as that for anti-PLA2R seropositivity. The specificity values of PLA2R staining and IgG4-dominance/codominance with any IgG subclass or IgG4-dominance/IgG1-IgG4 codominance were ≤ 75%. Apart from IgG4 dominance, IgG4-dominance/IgG3-IgG4-codominance also had good statistical value in differentiating pMN from sMN. As IgG subclass switching during the progression of pMN was not the feature of our cohort, pMN in Hungarian patients is presumed to be an IgG4-related disorder right from the start. Although anti-PLA2R seropositivity has become the cornerstone for diagnosing pMN, if a kidney biopsy evaluation is conducted, besides the staining of PLA2R antigen, the evaluation of IgG subclasses provides relevant information for a differential diagnosis. Even in cases with IgG4-dominance, however, malignancy should be thoroughly checked.
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Affiliation(s)
- Dóra Bajcsi
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary.
| | - László Bitó
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
| | | | - Tibor Nyári
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
| | - Éva Kemény
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
| | - Péter Légrády
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
| | - György Ábrahám
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Szent-Györgyi Albert Health Center, University of Szeged, Szeged, Hungary
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Jakab D, Maróti Z, Iványi B, Bereczki C, Kalmár T. [A rare tubulopathy: Dent's disease in the background of focal segmental glomerular sclerosis]. Orv Hetil 2023; 164:788-791. [PMID: 37210717 DOI: 10.1556/650.2023.32787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
Dent's disease is a proximal tubulopathy with heterogeneous genetical background. The typical clinical finding is characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis/nephrolithiasis and progressive chronic kidney failure. The underlying cause of the disease is the genetic defect (most commonly CLCN5 mutation) of the receptor-mediated endocytosis in the structure of proximal tubules. The typical fenotype may be composed of extrarenal symptoms. In the event of clinical suspicion, Dent's disease is only verifiable by genetic testing without the necessity of any kidney biopsy. The clinical case can be associated with nephrotic-range proteinuria or kidney failure as an indication of kidney biopsy. The number of articles available at scientific literatures on Dent's disease with the inclusion of renal histology is very slight. According to the pathophysiology of the highlighted Dent's disease and additionally to the expected tubular pathology, global or focal segmental glomerular sclerosis may apply for the majority of cases. Orv Hetil. 2023; 164(20): 788-791.
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Affiliation(s)
- Dániel Jakab
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Gyermekgyógyászati Klinika és Gyermekegészségügyi Központ Szeged, Korányi fasor 14-15., 6725 Magyarország
| | - Zoltán Maróti
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Gyermekgyógyászati Klinika és Gyermekegészségügyi Központ Szeged, Korányi fasor 14-15., 6725 Magyarország
| | - Béla Iványi
- 2 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged Magyarország
| | - Csaba Bereczki
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Gyermekgyógyászati Klinika és Gyermekegészségügyi Központ Szeged, Korányi fasor 14-15., 6725 Magyarország
| | - Tibor Kalmár
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Gyermekgyógyászati Klinika és Gyermekegészségügyi Központ Szeged, Korányi fasor 14-15., 6725 Magyarország
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Semjén D, Dénes B, Somorácz Á, Fintha A, Forika G, Jenei A, Dobi D, Micsik T, Eizler KV, Giba N, Sánta F, Sejben A, Iványi B, Kuthi L. Renal Cell Carcinoma in End-Stage Renal Disease: A Retrospective Study in Patients from Hungary. Pathobiology 2023; 90:322-332. [PMID: 36696889 PMCID: PMC10614572 DOI: 10.1159/000529276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/14/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION End-stage renal disease (ESRD) and acquired cystic kidney disease (ACKD) are known risk factors for renal cell carcinoma (RCC). Hereby, the clinicopathological features of RCCs developed in ESRD were investigated. METHODS A database consisting of 34 tumors from 31 patients with ESRD among 2,566 nephrectomy samples of RCC was built. The demographic, clinical, and follow-up data along with pathological parameters were analyzed. The RCCs were diagnosed according to the current WHO Classification of Urinary and Male Genital Tumors. RESULTS Twenty-two tumors developed in men and 12 in women, with a median age of 56 years (range: 27-75 years). The causes of ESRD were glomerulonephritis (n = 7), hypertensive kidney disease (n = 6), autosomal dominant polycystic kidney disease (n = 6), chronic pyelonephritis (n = 4), diabetic nephropathy (n = 3), chemotherapy-induced nephropathy (n = 1), and undetermined (n = 4). ACKD complicated ESRD in 12 patients. The following histological subtypes were identified: clear cell RCC (n = 19), papillary RCC (n = 5), clear cell papillary tumor (n = 5), ACKD RCC (n = 3), and eosinophilic solid and cystic RCC (n = 2). The median tumor size was 31 mm (range: 10-80 mm), and 32 tumors were confined to the kidney (pT1-pT2). There was no tumor-specific death during the period of this study. Progression was registered in 1 patient. CONCLUSION In our cohort, the most common RCC subtype was clear cell RCC (55%), with a frequency that exceeded international data appreciably (14-25%). The incidence of clear cell papillary tumor and ACKD RCC (14.7% and 8.5%) was lower than data reported in the literature (30% and 40%). Our results indicate a favorable prognosis of RCC in ESRD.
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Affiliation(s)
- Dávid Semjén
- Department of Pathology, Medical School and Clinical Centre, University of Pécs, Pécs, Hungary
| | | | | | - Attila Fintha
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Gertrúd Forika
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Alex Jenei
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Deján Dobi
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Micsik
- Pathology Unit, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | | | - Nándor Giba
- Pathology Unit, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - Fanni Sánta
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Levente Kuthi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Balla Z, Kormányos ES, Kui B, Bálint ER, Fűr G, Orján EM, Iványi B, Vécsei L, Fülöp F, Varga G, Harazin A, Tubak V, Deli MA, Papp C, Gácser A, Madácsy T, Venglovecz V, Maléth J, Hegyi P, Kiss L, Rakonczay Z. Kynurenic Acid and Its Analogue SZR-72 Ameliorate the Severity of Experimental Acute Necrotizing Pancreatitis. Front Immunol 2021; 12:702764. [PMID: 34745090 PMCID: PMC8567016 DOI: 10.3389/fimmu.2021.702764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
The pathophysiology of acute pancreatitis (AP) is not well understood, and the disease does not have specific therapy. Tryptophan metabolite L-kynurenic acid (KYNA) and its synthetic analogue SZR-72 are antagonists of the N-methyl-D-aspartate receptor (NMDAR) and have immune modulatory roles in several inflammatory diseases. Our aims were to investigate the effects of KYNA and SZR-72 on experimental AP and to reveal their possible mode of action. AP was induced by intraperitoneal (i.p.) injection of L-ornithine-HCl (LO) in SPRD rats. Animals were pretreated with 75-300 mg/kg KYNA or SZR-72. Control animals were injected with physiological saline instead of LO, KYNA and/or SZR-72. Laboratory and histological parameters, as well as pancreatic and systemic circulation were measured to evaluate AP severity. Pancreatic heat shock protein-72 and IL-1β were measured by western blot and ELISA, respectively. Pancreatic expression of NMDAR1 was investigated by RT-PCR and immunohistochemistry. Viability of isolated pancreatic acinar cells in response to LO, KYNA, SZR-72 and/or NMDA administration was assessed by propidium-iodide assay. The effects of LO and/or SZR-72 on neutrophil granulocyte function was also studied. Almost all investigated laboratory and histological parameters of AP were significantly reduced by administration of 300 mg/kg KYNA or SZR-72, whereas the 150 mg/kg or 75 mg/kg doses were less or not effective, respectively. The decreased pancreatic microcirculation was also improved in the AP groups treated with 300 mg/kg KYNA or SZR-72. Interestingly, pancreatic heat shock protein-72 expression was significantly increased by administration of SZR-72, KYNA and/or LO. mRNA and protein expression of NMDAR1 was detected in pancreatic tissue. LO treatment caused acinar cell toxicity which was reversed by 250 µM KYNA or SZR-72. Treatment of acini with NMDA (25, 250, 2000 µM) did not influence the effects of KYNA or SZR-72. Moreover, SZR-72 reduced LO-induced H2O2 production of neutrophil granulocytes. KYNA and SZR-72 have dose-dependent protective effects on LO-induced AP or acinar toxicity which seem to be independent of pancreatic NMDA receptors. Furthermore, SZR-72 treatment suppressed AP-induced activation of neutrophil granulocytes. This study suggests that administration of KYNA and its derivative could be beneficial in AP.
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Affiliation(s)
- Zsolt Balla
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | | | - Balázs Kui
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Emese Réka Bálint
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Gabriella Fűr
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Erik Márk Orján
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary.,Hungarian Academy of Sciences-University of Szeged Neuroscience Research Group, Hungarian Academy of Sciences - University of Szeged, Szeged, Hungary
| | - Ferenc Fülöp
- Institute of Pharmaceutical Chemistry, University of Szeged, Szeged, Hungary.,Stereochemistry Research Team, Hungarian Academy of Sciences - University of Szeged, Szeged, Hungary
| | - Gabriella Varga
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - András Harazin
- Institute of Biophysics, Biological Research Centre, Szeged, Hungary
| | | | - Mária A Deli
- Institute of Biophysics, Biological Research Centre, Szeged, Hungary
| | - Csaba Papp
- Department of Microbiology, University of Szeged, Szeged, Hungary.,Hungarian Academy of Sciences-University of Szeged Lendület Mycobiome Research Group, University of Szeged, Szeged, Hungary
| | - Attila Gácser
- Department of Microbiology, University of Szeged, Szeged, Hungary.,Hungarian Academy of Sciences-University of Szeged Lendület Mycobiome Research Group, University of Szeged, Szeged, Hungary
| | - Tamara Madácsy
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Viktória Venglovecz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - József Maléth
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Department of Medicine, University of Szeged, Szeged, Hungary.,Hungarian Academy of Sciences-University of Szeged Translational Gastroenterology Research Group, Szeged, Hungary.,Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Lóránd Kiss
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Zoltán Rakonczay
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
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7
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Zombori T, Kuthi L, Hortobágyi T, Csörgő E, Árgyelán J, Kocsis L, Sejben I, Kaizer L, Radics B, Sejben A, Pancsa T, Nyári GR, Baráth B, Cserni G, Iványi B, Tiszlavicz L. “Dum spiro spero”: clinicopathologic characteristics of SARS-CoV-2 infection. Orv Hetil 2021; 162:1791-1802. [PMID: 34747358 DOI: 10.1556/650.2021.32387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A kórboncolás hozzájárul a súlyos akut légzőszervi szindrómát okozó koronavírus-2 (SARS-CoV-2-) fertőzés klinikopatológiai vonatkozásainak megismeréséhez. Célkitűzés: A SARS-CoV-2-fertőzöttek boncolása során gyűjtött tapasztalatok bemutatása. Módszer: Egymást követően boncolt, védőoltásban nem részesült, SARS-CoV-2-fertőzött elhunytak klinikai adatait, makro- és mikroszkópos észleleteit összegeztük; a tüdőkimetszéseket SARS-CoV-2-nukleokapszid-immunfestéssel vizsgáltuk. Eredmények: A boncolást a halálok megállapítására (n = 14), tumorgyanú (n = 9), illetve törvényi kötelezettség (n = 3) miatt végeztük. A fertőzést a klinikai észlelés vagy a boncolás során (n = 4) végzett SARS-CoV-2-nukleinsav-teszt igazolta. A tünetes betegség átlagos hossza 12,9 nap volt. 21 betegnél (medián életkor 69 év; 18 férfi) állt fenn COVID-19-pneumonia, mely 16 esetben önmagában, 4 esetben bakteriális pneumoniával vagy álhártyás colitisszel szövődve okozott halált; 1 antikoagulált pneumoniás beteg heveny retroperitonealis vérzésben halt meg. 3 betegnél a halált disszeminálódott malignus tumor, 1 betegnél coronariathrombosis, 1 mentálisan retardált betegnél pedig pulmonalis emboliás szövődmény okozta. A COVID-19-pneumoniás tüdők nehezek, tömöttek és vörösen foltozottak voltak. Szövettanilag a betegség időtartamától függően diffúz alveolaris károsodás korai exsudativ vagy későbbi proliferativ fázisa látszott atípusos pneumocytákkal; gyakori volt a microthrombosis (n = 7), a macrothrombosis (n = 5), illetve a pulmonalis embolia (n = 4). A SARS-CoV-2-immunfestés pozitívnak bizonyult az esetek 38,5%-ában, dominálóan az exsudativ fázisban. Minden elhunyt társbetegség(ek)ben szenvedett, így magasvérnyomás-betegségben (n = 17), érelmeszesedésben (n = 14), 2-es típusú diabetesben (n = 8), rosszindulatú daganatban (n = 6), krónikus obstruktív tüdőbetegségben (n = 4), elhízásban (n = 3), vesetranszplantáció utáni immunszuppresszióban (n = 3). Következtetés: Az irodalmi adatokkal összhangban, halálos COVID-19-pneumonia túlnyomóan idős, társbetegség(ek)től sújtott férfiakban alakult ki. A boncolási gyakorlatban a SARS-CoV-2-nukleokapszid-immunfestéstől a diffúz alveolaris károsodás korai fázisában várható pozitivitás. Orv Hetil. 2021; 162(45): 1791-1802. SUMMARY INTRODUCTION Autopsy is an important tool for the evaluation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Objectice: The aim of this study was to present our experience with autopsies of patients diagnosed with SARS-CoV-2 infection. METHOD Clinical data, macroscopic and microscopic findings of consecutive postmortems of non-vaccinated SARS-CoV-2 patients are summarized. Lung samples were evaluated with SARS-CoV-2 nucleocapsid immunohistochemistry. RESULTS Autopsies were performed to determine the cause of death (n = 14), suspected tumours (n = 9) or due to legal obligation (n = 3). SARS-CoV-2 infection was verified by ante mortem (n = 22) and post mortem (n = 4) polymerase chain reaction. The mean duration of symptomatic disease was 12.9 days. Of 21 patients with COVID-19 pneumonia, 16 died of respiratory failure, 4 had additional bacterial pneumonia or Clostridioides difficile infection, and 1 developed hemorrhagic complication (n = 1). Other causes of death included disseminated malignancies (n = 3), coronary thrombosis (n = 1) and pulmonary embolism (n = 1). The affected lungs were heavy and had patchy red appearance. Exudative or proliferative phases of diffuse alveolar damage (DAD) were detected with atypical pneumocytes. Microthrombosis (n = 7), macrothrombosis (n = 5) and pulmonary embolism (n = 4) were frequent. The SARS-CoV-2 immunohistochemical reaction was positive in 38.5% of cases. All patients had co-morbidities, namely, hypertension (n = 17), atherosclerosis (n = 14), diabetes (n = 8), malignancies (n = 6), chronic obstructive pulmonary diseases (n = 4), obesity (n = 3) and immunosuppression after kidney transplantation (n = 3). CONCLUSION Fatal COVID-19 pneumonia occurred mostly in elderly males with co-morbidities. In the autopsy practice, the SARS-CoV-2 nucleocapsid immunohistochemical reaction may confirm the infectious etiology in the early phase of DAD. Orv Hetil. 2021; 162(45): 1791-1802.
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Affiliation(s)
- Tamás Zombori
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Levente Kuthi
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Tibor Hortobágyi
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | | | | | | | | | - László Kaizer
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Bence Radics
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Anita Sejben
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Tamás Pancsa
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Gergely Róbert Nyári
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Bence Baráth
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Gábor Cserni
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725.,2 Bács-Kiskun Megyei Oktatókórház, Kecskemét
| | - Béla Iványi
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - László Tiszlavicz
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
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Zombori-Tóth N, Ugocsai K, Vincze Á, Furák J, Tiszlavicz L, Iványi B, Zombori T. Pulmonary necrotizing sarcoid granulomatosis. Orv Hetil 2021; 162:1541-1547. [PMID: 34537719 DOI: 10.1556/650.2021.32236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A nekrotizáló sarcoid granulomatosis a granulomatosus pulmonalis angitisek közé tartozó, ritka kórkép. Egyesek a sarcoidosis variánsának, mások primer pulmonalis vasculitisnek tartják. A kórkép klinikai és patológiai jellegzetességeit két eset bemutatásával ismertetjük. A 20 éves nőbeteg sürgősséggel került pulmonológiai osztályra száraz köhögés, jobb oldali, mély belégzéssel összefüggő mellkasi fájdalom és láz miatt, a 63 éves férfi beteget pedig pneumoniát követő kontroll-mellkasröntgenfelvételen látott elváltozás kivizsgálása során észlelték. Az autoimmun panel vizsgálata, a mikrobiológiai tesztek mindkét betegnél negatívnak bizonyultak, a légzésfunkciós vizsgálat és a bronchoszkópos vizsgálat nem talált eltérést. A mellkas-CT-felvételen lágyrész-denzitású nodulusok látszottak egyoldali dominanciával, a folyamatot nem kísérte a hilusi nyirokcsomók szimmetrikus megnagyobbodása. A nodulusok szövettani vizsgálata vált indokolttá, melyet videoasszisztált torakoszkópos tüdőreszekciós mintavétellel biztosítottak. Mikroszkóposan a tüdőparenchymában gócos nekrózisokat, a környezetükben el nem sajtosodó epitheloid sejtes granulomatosus gócokat, az átfutó artériákban pedig granulomatosus arteritist láttak; a klinikai adatok figyelembevételével a tüdő nekrotizáló sarcoid granulomatosisa diagnózisát állították fel. A tüdőbetegség mindkét betegnél egy év alatt spontán regrediált. Az irodalom adatait és az eseteket összegezve, a tüdő nekrotizáló sarcoid granulomatosisában mikrobiológiai vizsgálatokkal nem igazolható tüdőfertőzés, és az immunológiai kivizsgálás sem tár fel szisztémás autoimmun betegséget; a diagnózis a klinikai kép és a képalkotó vizsgálatok alapján indikált szövettani vizsgálattal állítható fel. A betegség szteroidkezelésre jól reagál, de előfordul spontán regresszió is, az utóbbira láttunk példát. Bár az entitás átmenetet képez a nekrotizáló vasculitisek és a sarcoidosis között, egyre több érv szól amellett, hogy a sarcoidosis spektrumába tartozik. Orv Hetil. 2021; 162(38): 1541-1547. Summary. Necrotizing sarcoid granulomatosis is a rare entity currently classified as a subtype of granulomatous pulmonary angiitis. It is considered to be either a variant of sarcoidosis or a primary pulmonary angiitis. Two cases are demonstrated to present its clinical and pathological features. A 20-year-old female patient was admitted to the department of pulmonology with dry cough, right-sided chest pain during hyperventilation and fever. A 63-year-old male patient was observed with a right-sided lesion on chest X-ray after pneumonia. In both cases, autoimmune panel examination, microbiology tests, spirometry function test and bronchoscopy were unremarkable. Chest CT scans have revealed nodules with soft-tissue density without bilateral hilar lymphadenopathy. In order to clarify the diagnosis, video-assisted thoracoscopic resection (biopsy) was performed. Microscopically, parenchymal focal necrosis with adjacent to non-caseating granulomas and granulomatous angiitis were detected. In both cases, spontaneous remission occurred within a year. Histological examination - integrated with clinical data and radiological tests' results - is the gold standard form of evaluation to confirm necrotizing sarcoid granulomatosis; furthermore, exclusion of pneumonia and autoimmune diseases are also required. The disease responds well to corticosteroids; moreover, spontaneous remission is often reported, as it happened in both cases. Necrotizing sarcoid granulomatosis is a transition between necrotizing vasculitides and sarcoidosis; although more and more evidence appears supporting the fact that necrotizing sarcoid granulomatosis may belong to the spectrum of sarcoidosis. Orv Hetil. 2021; 162(38): 1541-1547.
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Affiliation(s)
| | - Katalin Ugocsai
- 1 Csongrád-Csanád Megyei Mellkasi Betegségek Szakkórháza, Deszk
| | | | - József Furák
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Klinika, Szeged
| | - László Tiszlavicz
- 4 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 2., 6701
| | - Béla Iványi
- 4 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 2., 6701
| | - Tamás Zombori
- 4 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 2., 6701
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Pozsonyi Z, Peskó G, Takács H, Csuka D, Nagy V, Szilágyi Á, Hategan L, Muk B, Csányi B, Nyolczas N, Dézsi L, Molnár JM, Csillik A, Révész K, Iványi B, Szabó F, Birtalan K, Masszi T, Arányi Z, Sepp R. Variant Transthyretin Amyloidosis (ATTRv) in Hungary: First Data on Epidemiology and Clinical Features. Genes (Basel) 2021; 12:genes12081152. [PMID: 34440326 PMCID: PMC8392019 DOI: 10.3390/genes12081152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Variant transthyretin amyloidosis (ATTRv) is an autosomal dominant inherited disease, where the mutation of the transthyretin gene (TTR) results in the deposition of pathogenic protein fibrils in various tissues. The mutation type influences the clinical course. Until now, no data were available on the genotype, phenotype, and prevalence of Hungarian ATTRv patients. The aim of our study was to assess the prevalence, regional distribution, genotypes, and phenotypes of Hungarian patients with ATTRv. Methods: With the collaboration of Hungarian regional and university centers, we identified patients diagnosed with ATTRv. We also searched prior publications for case studies of Hungarian ATTRv patients. Results: 40 individuals in 23 families with ATTRv were identified within the borders of Hungary. At the time of the diagnosis, 24 of them were symptomatic. The two most common mutations were ATTRHis88Arg (nine families) and ATTRIle107Val (8 families). ATTRVal30Met was demonstrated in 2 families, and ATTRVal122del, ATTRPhe33Leu, ATTRIle84Ser, and ATTRAsp18Gly in one family each. The median age of the symptomatic patients at the time of clinical diagnosis was 65 years. The most common clinically significant organ involvement was restrictive cardiomyopathy, found in 24 patients. Polyneuropathy was diagnosed in 20 patients. A total of 19 patients showed a mixed phenotype. The leading symptom was heart failure in 8 cases (3 of them had only cardiac symptoms), polyneuropathy in 11 cases (all of them also had cardiac symptoms), and equally severe cardiac and neuropathy symptoms were present in 3 cases. Out of 24 symptomatic patients, 10 received targeted pharmacological therapy. The follow-up period ranged from 1 to 195 months. At the time of the retrospective analysis, 12 patients had already died, and 1 patient underwent heart transplantation. Conclusions: As TTR genotype influences the phenotype and clinical course of ATTRv, it is important to know the regional data. In Hungary, ATTRHis88Arg and ATTRIle107Val are the most common mutations in ATTRv, both presenting with mixed phenotype, but the median age at the time of the diagnosis is 9 years lower in patients with ATTRHis88Arg than in patients with ATTRIle107Val.
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Affiliation(s)
- Zoltán Pozsonyi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Gergely Peskó
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
- Correspondence:
| | - Hedvig Takács
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Viktória Nagy
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Ágnes Szilágyi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Lidia Hategan
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Balázs Muk
- Military Hospital—State Health Centre, H-1134 Budapest, Hungary;
| | - Beáta Csányi
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Noémi Nyolczas
- Gottsegen National Cardiovascular Center, H-1096 Budapest, Hungary;
| | - Lívia Dézsi
- Department of Neurology, University of Szeged, H-6725 Szeged, Hungary;
| | - Judit Mária Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, H-1088 Budapest, Hungary; (J.M.M.); (F.S.)
| | - Anita Csillik
- Department of Neurology, Semmelweis University, H-1088 Budapest, Hungary; (A.C.); (Z.A.)
| | - Katalin Révész
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Béla Iványi
- Department of Pathology, University of Szeged, H-6725 Szeged, Hungary;
| | - Fruzsina Szabó
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, H-1088 Budapest, Hungary; (J.M.M.); (F.S.)
| | - Krisztián Birtalan
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, H-1088 Budapest, Hungary; (A.C.); (Z.A.)
| | - Róbert Sepp
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
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Bitó L, Kalmár T, Maróti Z, Turkevi-Nagy S, Bereczki C, Iványi B. PAX2 Mutation-Related Oligomeganephronia in a Young Adult Patient. Case Rep Nephrol Dial 2020; 10:163-173. [PMID: 33363218 PMCID: PMC7747074 DOI: 10.1159/000510841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022] Open
Abstract
Oligomeganephronic hypoplasia, commonly referred to as oligomeganephronia (OMN), is a rare pediatric disorder characterized by small kidneys. Histologically a paucity of nephrons is observed which show compensatory enlargement. Hyperfiltration injury leads to end-stage kidney disease. Here we report a 23-year-old Caucasian female patient who presented with a 7-year history of nonnephrotic proteinuria, slow worsening of renal function, normal-sized kidneys, normal blood pressure, healthy weight, and normoglycemia. Evaluation of a kidney biopsy specimen revealed sparsely distributed and markedly enlarged glomeruli (glomerular density 0.63/mm<sup>2</sup>, glomerular diameter 268 µm), focal segmental glomerulosclerosis (FSGS), and 70% effacement of the foot processes. The glomerular basement membrane was normal (mean thickness 285 nm). The genetic analysis of 19 genes known to cause FSGS identified a heterozygous de novo nonsense mutation of PAX2 in exon 4 (NM_003990.3:c.430C>T and NP_003981.2:p.Gln144Ter). Clinical investigations ruled out optic nerve coloboma, hearing loss, and vesicoureteral reflux. Magnetic resonance imaging of the urogenital tract found the uterus to be bicornuate. Based on these data, OMN in nonhypoplastic kidneys and adaptive FSGS related to PAX2 mutation was diagnosed. Her kidney function worsened during the 30-month follow-up (last visit: eGFR-EPI 32 mL/min/1.73 m<sup>2</sup>) despite angiotensin-converting enzyme inhibitor treatment. To our best knowledge, our patient is the seventh in the English-language literature with a biopsy diagnosis of OMN in an adult, the first observed with normal-sized kidneys, and the first in whom a specific etiologic genetic diagnosis was established. Nonsense PAX2 mutations between the paired domain and the octapeptide domain appear to manifest in renal-limited phenotype.
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Affiliation(s)
- László Bitó
- First Department of Medicine, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Tibor Kalmár
- Department of Pediatrics and Pediatric Health Center, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Zoltán Maróti
- Department of Pediatrics and Pediatric Health Center, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Sándor Turkevi-Nagy
- Department of Pathology, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Csaba Bereczki
- Department of Pediatrics and Pediatric Health Center, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Department of Pathology, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
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Bajcsi D, Constantinou K, Krenács L, Barabás Z, Molnár S, Nyiraty S, Ábrahám G, Iványi B. Enyhe szövettani eltérések ellenére gyors progressziójú proliferativ glomerulonephritis monoklonális immunglobulin-G-depozitumokkal. Orv Hetil 2018; 159:1567-1572. [DOI: 10.1556/650.2018.31072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits is characterized by granular deposits of monoclonal IgG; histologically it has typically a membranoproliferative or endocapillary pattern, and seen electronmicroscopically there are dense deposits without substructure. Here, we present the case of a 62-year-old Caucasian woman who was admitted with rapidly progressive kidney failure. The patient’s status, the laboratory and imaging examinations did not support prerenal, postrenal and – among the intrinsic causes – vascular and tubulointerstitial origin. The proteinuria and dysmorphic microhematuria suggested rapidly progressive glomerulonephritis. Tests for anti-neutrophil cytoplasmic antibodies, anti-glomerular basement membrane, antinuclear antibodies and cryoglobulins were negative, the C3 and C4 levels were normal. The biopsy evaluation diagnosed proliferative glomerulonephritis with monoclonal IgG deposits because of mesangial granular deposits of IgG3-kappa, C3, and C1q, and ultrastructurally electron-dense deposits (incidence in our adult native kidney biopsy series: 0.18%). 31 glomeruli were assessed histologically. 29 glomeruli displayed mild mesangial hypercellularity, 2 glomeruli were globally sclerotic. Crescents were not observed. Mild arteriolar hyalinosis, interstitial fibrosis and tubular atrophy accompanied the glomerular alterations. In the postbiopsy evaluation, paraprotein or multiple myeloma was not detected. Despite the mild histological findings, the kidney failure progressed, and hemodialysis had to be started two weeks after the biopsy. Steroids, cyclophosphamide and rituximab did not affect her kidney function, and she remained on hemodialysis during the follow-up of 39 months. This report presents for the first time proliferative glomerulonephritis with monoclonal IgG deposits as the possible cause of rapidly progressive nephritic syndrome in the absence of pronounced glomerular proliferative, sclerotic or tubulointerstitial lesions. Orv Hetil. 2018; 159(38): 1567–1572.
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Affiliation(s)
- Dóra Bajcsi
- I. Belgyógyászati Klinika, Nephrologia-Hypertonia Centrum, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8–10., 6720
| | - Kypros Constantinou
- I. Belgyógyászati Klinika, Nephrologia-Hypertonia Centrum, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8–10., 6720
| | - László Krenács
- Daganatpatológiai és Molekuláris Diagnosztikai Laboratórium, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Zsolt Barabás
- Pándy Kálmán Tagkórház, Békés Megyei Központi Kórház Gyula
| | | | - Szabolcs Nyiraty
- I. Belgyógyászati Klinika, Nephrologia-Hypertonia Centrum, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8–10., 6720
| | - György Ábrahám
- I. Belgyógyászati Klinika, Nephrologia-Hypertonia Centrum, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8–10., 6720
| | - Béla Iványi
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
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12
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Iványi B, Rácz GZ, Gál P, Brinyiczki K, Bódi I, Kalmár T, Maróti Z, Bereczki C. Diffuse mesangial sclerosis in a PDSS2 mutation-induced coenzyme Q10 deficiency. Pediatr Nephrol 2018; 33:439-446. [PMID: 29032433 DOI: 10.1007/s00467-017-3814-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A 7-month-old male infant was admitted because he was suffering from nephrotic syndrome, along with encephalomyopathy, hypertrophic cardiomyopathy, clinically suspected deafness and retinitis pigmentosa, and an elevated serum lactate level. METHODS Coenzyme Q10 supplementation was started because of the clinical suspicion of primary CoQ10 deficiency. Despite intensive efforts, he passed away 4 weeks after admission. RESULTS The results of genetic tests, available postmortem, explored two hitherto undescribed mutations in the PDSS2 gene. Both were located within the polyprenyl synthetase domain. Clinical exome sequencing revealed a heterozygous missense mutation in exon 3, and our in-house joint-analysis algorithm detected a heterozygous large 2923-bp deletion that affected the 5 prime end of exon 8. Other causative defects in the CoQ10 and infantile nephrosis-related genes examined were not found. A postmortem histological, immunohistochemical, and electron microscopic evaluation of the glomeruli revealed collapsing-sclerosing lesions consistent with diffuse mesangial sclerosis. The extrarenal alterations included hypertrophic cardiomyopathy and diffuse alveolar damage. A histological evaluation of the central nervous system and skeletal muscles did not demonstrate any obvious abnormality. CONCLUSIONS Until now, the clinical features and the mutational status of 6 patients with a PDSS2 gene defect have been reported in the English literature. Here, we describe for the first time detailed kidney morphology features in a patient with nephrotic syndrome carrying mutations in the PDSS2 gene.
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Affiliation(s)
- Béla Iványi
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1, Szeged, 6725, Hungary.
| | - Gábor Z Rácz
- Department of Pediatrics and Pediatric Health Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Gál
- Department of Pediatrics and Pediatric Health Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Kitti Brinyiczki
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1, Szeged, 6725, Hungary
| | | | - Tibor Kalmár
- Department of Pediatrics and Pediatric Health Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Maróti
- Department of Pediatrics and Pediatric Health Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Csaba Bereczki
- Department of Pediatrics and Pediatric Health Center, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Ambrus N, Havasi K, Kalapos A, Sághy L, Makai A, Bogáts G, Hegedűs Z, Iványi B, Besenyi Z, Pápai Z, Nagy L, Forster T, Nemes A. Primary cardiac angiosarcoma: A case report. Echocardiography 2018; 35:267-271. [PMID: 29349900 DOI: 10.1111/echo.13808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cardiac angiosarcomas are the most common primary malignant cardiac tumors in adults. The diagnosis is often delayed due to nonspecific clinical symptoms at presentation. The cornerstones of diagnosis are echocardiography and the histological evaluation of the cardiac biopsy. The knowledge on the treatment is limited; the outcomes of chemotherapy, radiotherapy, complete surgical removal, and heart transplantation are controversial. We report a 38-year-old woman with a primary heart tumor which infiltrated the right atrial wall and the pericardium and caused pericardial effusion. Angiosarcoma was verified histologically. The surgical excision could not be radical, and the patient died 3 months from diagnosis.
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Affiliation(s)
- Nóra Ambrus
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Kálmán Havasi
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Attila Makai
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Bogáts
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Division of Cardiac Surgery, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zoltán Hegedűs
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Division of Cardiac Surgery, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Faculty of Medicine, Department of Pathology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Besenyi
- Affidea Diagnostics and Faculty of Medicine, Department of Radiology and Nuclear Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Pápai
- Department of Oncology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - László Nagy
- Department of Internal Medicine, Dr. István Bugyi Hospital, Szentes, Hungary
| | - Tamás Forster
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Faculty of Medicine, Second Department of Medicine and Cardiology Center, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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14
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Dobi D, Bodó Z, Kemény É, Bidiga L, Hódi Z, Szenohradszky P, Szederkényi E, Szilvási A, Iványi B. Peritubular capillary basement membrane multilayering in early and advanced transplant glomerulopathy: quantitative parameters and diagnostic aspects. Virchows Arch 2016; 469:563-573. [PMID: 27605054 DOI: 10.1007/s00428-016-2010-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/13/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022]
Abstract
The ultrastructural quantitative aspects of peritubular capillary basement membrane multilayering (PTCBML) were examined in 57 kidney transplant biopsies with transplant glomerulopathy (TG). The measurements included three cutoffs [permissive: 1 PTC with 5 basement membrane (BM) layers, intermediate: 3 PTCs with 5 layers or 1 PTC with 7 layers, strict: 1 PTC with 7 layers and 2 PTCs with 5 layers] and the mean number of BM layers (PTCcirc). Two groups were assigned, namely patients with mild TG (Banff cg1a and cg1b) and those with moderate-to-severe TG (cg2 and cg3). Their respective clinical, serological, and morphological characteristics were then compared. The clinical data revealed that mild TG corresponded to early chronic antibody-mediated rejection (cABMR), while moderate-to-severe TG corresponded to the advanced stage of the disease. The permissive threshold displayed the lowest specificity (73 %) and the highest sensitivity (83 %) for moderate-to-severe TG, and its corresponding PTCcirc value was 3 layers. In contrast, the strict threshold-adopted by the Banff 2013 classification-displayed a specificity and sensitivity of 93 and 52 %, respectively, and the corresponding PTCcirc was 4 layers. In mild TG, 26 % of the cases met the permissive cutoff and 6 % the strict cutoff. Mild TG was associated with a lower PTCcirc (2.6 layers vs 4.5 layers in moderate-to-severe TG; p < 0.0001). Amongst the various criteria, the permissive criterion was associated most frequently with mild TG, and had prognostic relevance. Because of this, we propose its usage as a marker of early cABMR-induced PTCBML if non-alloimmune causes of PTCBML can be ruled out.
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Affiliation(s)
- Deján Dobi
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary.
| | - Zsolt Bodó
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary
| | - Éva Kemény
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary
| | - László Bidiga
- Department of Pathology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4012, Hungary
| | - Zoltán Hódi
- Department of Surgery, Faculty of Medicine, University of Szeged, Szőkefalvi-Nagy u. 6, Szeged, H-6720, Hungary
| | - Pál Szenohradszky
- Department of Surgery, Faculty of Medicine, University of Szeged, Szőkefalvi-Nagy u. 6, Szeged, H-6720, Hungary
| | - Edit Szederkényi
- Department of Surgery, Faculty of Medicine, University of Szeged, Szőkefalvi-Nagy u. 6, Szeged, H-6720, Hungary
| | - Anikó Szilvási
- Transplantation Immunogenetics Laboratory, Hungarian National Blood Transfusion Service, Karolina út 19-21, Budapest, H-1113, Hungary
| | - Béla Iványi
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary
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15
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Kovács G, Kalmár T, Endreffy E, Ondrik Z, Iványi B, Rikker C, Haszon I, Túri S, Sinkó M, Bereczki C, Maróti Z. Efficient Targeted Next Generation Sequencing-Based Workflow for Differential Diagnosis of Alport-Related Disorders. PLoS One 2016; 11:e0149241. [PMID: 26934356 PMCID: PMC4775026 DOI: 10.1371/journal.pone.0149241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/28/2016] [Indexed: 01/02/2023] Open
Abstract
Alport syndrome (AS) is an inherited type IV collagen nephropathies characterized by microscopic hematuria during early childhood, the development of proteinuria and progression to end-stage renal disease. Since choosing the right therapy, even before the onset of proteinuria, can delay the onset of end-stage renal failure and improve life expectancy, the earliest possible differential diagnosis is desired. Practically, this means the identification of mutation(s) in COL4A3-A4-A5 genes. We used an efficient, next generation sequencing based workflow for simultaneous analysis of all three COL4A genes in three individuals and fourteen families involved by AS or showing different level of Alport-related symptoms. We successfully identified mutations in all investigated cases, including 14 unpublished mutations in our Hungarian cohort. We present an easy to use unified clinical/diagnostic terminology and workflow not only for X-linked but for autosomal AS, but also for Alport-related diseases. In families where a diagnosis has been established by molecular genetic analysis, the renal biopsy may be rendered unnecessary.
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Affiliation(s)
- Gábor Kovács
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Tibor Kalmár
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Emőke Endreffy
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Zoltán Ondrik
- University of Szeged, Faculty of Medicine, First Department of Internal Medicine, Szeged, Hungary
| | - Béla Iványi
- University of Szeged, Faculty of Medicine, Department of Pathology, Szeged, Hungary
| | - Csaba Rikker
- Péterfy Sándor Hospital Department of Internal Medicine 1, Budapest, Hungary
| | - Ibolya Haszon
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Sándor Túri
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Mária Sinkó
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Csaba Bereczki
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
| | - Zoltán Maróti
- University of Szeged, Faculty of Medicine, Department of Pediatrics and Pediatric Health Center, Szeged, Hungary
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16
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Sükösd F, Iványi B, Pajor L. What can be more prognostic than the pTNM category assessed on radical cystectomy specimens? Virchows Arch 2015; 467:481-2. [PMID: 26298542 DOI: 10.1007/s00428-015-1831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
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17
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Tobiás B, Halászlaki C, Balla B, Kósa JP, Árvai K, Horváth P, Takács I, Nagy Z, Horváth E, Horányi J, Járay B, Székely E, Székely T, Győri G, Putz Z, Dank M, Valkusz Z, Vasas B, Iványi B, Lakatos P. Genetic Alterations in Hungarian Patients with Papillary Thyroid Cancer. Pathol Oncol Res 2015; 22:27-33. [PMID: 26259532 DOI: 10.1007/s12253-015-9969-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
The incidence of thyroid cancers is increasing worldwide. Some somatic oncogene mutations (BRAF, NRAS, HRAS, KRAS) as well as gene translocations (RET/PTC, PAX8/PPAR-gamma) have been associated with the development of thyroid cancer. In our study, we analyzed these genetic alterations in 394 thyroid tissue samples (197 papillary carcinomas and 197 healthy). The somatic mutations and translocations were detected by Light Cycler melting method and Real-Time Polymerase Chain Reaction techniques, respectively. In tumorous samples, 86 BRAF (44.2%), 5 NRAS (3.1%), 2 HRAS (1.0%) and 1 KRAS (0.5%) mutations were found, as well as 9 RET/PTC1 (4.6%) and 1 RET/PTC3 (0.5%) translocations. No genetic alteration was seen in the non tumorous control thyroid tissues. No correlation was detected between the genetic variants and the pathological subtypes of papillary cancer as well as the severity of the disease. Our results are only partly concordant with the data found in the literature.
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Affiliation(s)
- Bálint Tobiás
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary.
| | - Csaba Halászlaki
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - Bernadett Balla
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - János P Kósa
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary.,PentaCore Laboratory, Budapest, Hungary
| | | | - Péter Horváth
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - István Takács
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - Zsolt Nagy
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - Evelin Horváth
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - János Horányi
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Balázs Járay
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Eszter Székely
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Tamás Székely
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Gabriella Győri
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Putz
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | - Magdolna Dank
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
| | | | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Péter Lakatos
- 1st Department of Internal Medicine, Semmelweis University, Korányi S. Str. 2a, Budapest, 1083, Hungary
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18
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Dobi D, Bodó Z, Kemény É, Boda K, Szenohradszky P, Szederkényi E, Laszik ZG, Iványi B. Morphologic Features and Clinical Impact of Arteritis Concurrent with Transplant Glomerulopathy. Pathol Oncol Res 2015. [PMID: 26202171 DOI: 10.1007/s12253-015-9962-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about the morphology and clinical relevance of arteritis in renal allograft biopsies with transplant glomerulopathy. We retrospectively reviewed the morphologic findings and clinical course of 59 patients with cg, 16 of which featured concurrent arteritis (fibrosing intimal arteritis with luminal narrowing in 15, and acute intimal arteritis in 1 case). Fifteen out of the 16 cases with arteritis fulfilled the morphological diagnostic criteria for chronic active antibody-mediated rejection, and 11 cases with arteritis showed morphological evidence of concurrent, ongoing T-cell-mediated alloimmune response (acute T-cell-mediated rejection in 5, borderline changes in 6 cases). Further, the Banff grades of interstitial inflammation in scarred and nonscarred cortex, total cortical inflammation, and arterial luminal narrowing were significantly higher in biopsies with arteritis. By immunohistochemistry, T-lymphocyte predominance over macrophages was found in the intimal infiltrates in 14 out of 16 cases, and cytotoxic T-lymphocytes were identified among intimal mononuclears in 10 cases. Patients with arteritis demonstrated a significantly shorter renal survival (7.5 vs. 29 months). In conclusion, T-cell-mediated mechanisms could play a role in the development of arteritis concurrent with cg. However, this finding does not exclude the possibility that antibody-mediated rejection can also contribute to the evolution of the lesion. Importantly, the lesion carries negative prognostic value likely via severe arterial luminal narrowing.
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Affiliation(s)
- Deján Dobi
- Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary.
| | - Zsolt Bodó
- Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary
| | - Éva Kemény
- Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary
| | - Krisztina Boda
- Department of Medical Physics and Informatics, University of Szeged, Koranyi fasor 9., H-6720, Szeged, Hungary
| | - Pál Szenohradszky
- Department of Surgery, University of Szeged, Szokefalvi-Nagy u. 6., H-6720, Szeged, Hungary
| | - Edit Szederkényi
- Department of Surgery, University of Szeged, Szokefalvi-Nagy u. 6., H-6720, Szeged, Hungary
| | - Zoltan G Laszik
- Department of Pathology, University of California, San Francisco, 513 Parnassus Avenue, Room S566, San Francisco, CA, 94143-0102, USA
| | - Béla Iványi
- Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary
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Borda B, Szederkényi E, Hódi Z, Iványi B, Kemény É, Keresztes C, Lázár G. SP042FREQUENCY OF T-CELL MEDIATED REJECTION IN NEW ONSET DIABETES AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv188.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Kui B, Balla Z, Vasas B, Végh ET, Pallagi P, Kormányos ES, Venglovecz V, Iványi B, Takács T, Hegyi P, Rakonczay Z. New insights into the methodology of L-arginine-induced acute pancreatitis. PLoS One 2015; 10:e0117588. [PMID: 25688985 PMCID: PMC4331527 DOI: 10.1371/journal.pone.0117588] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/29/2014] [Indexed: 02/06/2023] Open
Abstract
Animal models are ideal to study the pathomechanism and therapy of acute pancreatitis (AP). The use of L-arginine-induced AP model is nowadays becoming increasingly popular in mice. However, carefully looking through the literature, marked differences in disease severity could be observed. In fact, while setting up the L-arginine (2×4 g/kg i.p.)-induced AP model in BALB/c mice, we found a relatively low rate (around 15%) of pancreatic necrosis, whereas others have detected much higher rates (up to 55%). We suspected that this may be due to differences between mouse strains. We administered various concentrations (5–30%, pH = 7.4) and doses (2×4, 3×3, or 4×2.5 g/kg) of L-arginine-HCl in BALB/c, FVB/n and C57BL/6 mice. The potential gender-specific effect of L-arginine was investigated in C57BL/6 mice. The fate of mice in response to the i.p. injections of L arginine followed one of three courses. Some mice (1) developed severe AP or (2) remained AP-free by 72 h, whereas others (3) had to be euthanized (to avoid their death, which was caused by the high dose of L-arginine and not AP) within 12 h., In FVB/n and C57BL/6 mice, the pancreatic necrosis rate (about 50%) was significantly higher than that observed in BALB/c mice using 2×4 g/kg 10% L–arginine, but euthanasia was necessary in a large proportion of animals, The i.p. injection of lower L-arginine concentrations (e.g. 5–8%) in case of the 2×4 g/kg dose, or other L-arginine doses (3×3 or 4×2.5 g/kg, 10%) were better for inducing AP. We could not detect any significant differences between the AP severity of male and female mice. Taken together, when setting up the L-arginine-induced AP model, there are several important factors that are worth consideration such as the dose and concentration of the administered L arginine-HCl solution and also the strain of mice.
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Affiliation(s)
- Balázs Kui
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Balla
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Eszter T. Végh
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Petra Pallagi
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Viktória Venglovecz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Béla Iványi
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Tamás Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Hungarian Academy of Sciences-University of Szeged, Translational Gastroenterology Research Group, Szeged, Hungary
| | - Zoltán Rakonczay
- First Department of Medicine, University of Szeged, Szeged, Hungary
- * E-mail:
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21
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Krenács T, Iványi B, Bozóky B, Lászik Z, Krenács L, Rázga Z, Ormos J. Postembedding Immunoelectron Microscopy with Immunogold-Silver Staining (IGSS) in Epon 812, Durcupan ACM and LR-White Resin Embedded Tissues. J Histotechnol 2013. [DOI: 10.1179/his.1991.14.2.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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22
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Biczó G, Hegyi P, Dósa S, Shalbuyeva N, Berczi S, Sinervirta R, Hracskó Z, Siska A, Kukor Z, Jármay K, Venglovecz V, Varga IS, Iványi B, Alhonen L, Wittmann T, Gukovskaya A, Takács T, Rakonczay Z. The crucial role of early mitochondrial injury in L-lysine-induced acute pancreatitis. Antioxid Redox Signal 2011; 15:2669-81. [PMID: 21644850 PMCID: PMC4701124 DOI: 10.1089/ars.2011.4065] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Large doses of intraperitoneally injected basic amino acids, L-arginine, or L-ornithine, induce acute pancreatitis in rodents, although the mechanisms mediating pancreatic toxicity remain unknown. Another basic amino acid, L-lysine, was also shown to cause pancreatic acinar cell injury. The aim of the study was to get insight into the mechanisms through which L-lysine damages the rat exocrine pancreas, in particular to characterize the kinetics of L-lysine-induced mitochondrial injury, as well as the pathologic responses (including alteration of antioxidant systems) characteristic of acute pancreatitis. RESULTS We showed that intraperitoneal administration of 2 g/kg L-lysine induced severe acute necrotizing pancreatitis. L-lysine administration caused early pancreatic mitochondrial damage that preceded the activation of trypsinogen and the proinflammatory transcription factor nuclear factor-κB (NF-κB), which are commonly thought to play an important role in the development of acute pancreatitis. Our data demonstrate that L-lysine impairs adenosine triphosphate synthase activity of isolated pancreatic, but not liver, mitochondria. INNOVATION AND CONCLUSION Taken together, early mitochondrial injury caused by large doses of L-lysine may lead to the development of acute pancreatitis independently of pancreatic trypsinogen and NF-κB activation.
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Affiliation(s)
- György Biczó
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Szederkényi E, Iványi B, Morvay Z, Szenohradszki P, Borda B, Marofka F, Kemény E, Lázár G. Treatment of subclinical injuries detected by protocol biopsy improves the long-term kidney allograft function: a single center prospective randomized clinical trial. Transplant Proc 2011; 43:1239-43. [PMID: 21620099 DOI: 10.1016/j.transproceed.2011.03.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The long-term benefit of early treatment of subclinical disorders detected in kidney allografts by protocol biopsy is controversial. We collected 145 protocol biopsies from 113 recipients for comparison with 51 control patients in a single-center, prospective, randomized trial. METHODS Ultrasound-guided biopsies were performed in recipients with stable renal function. Samples were taken at 3 (n=66) and/or 12 months (n=79) after transplantation. The biopsies were evaluated according to the Banff scheme, and patients were treated based on the diagnosis. Changes in glomerular filtration rate (GFR) were compared with 51 patients who were randomized as a control group. RESULTS The findings on 38 samples (29%) were considered to be normal. Based on the pathology findings, such as subclinical acute rejection (n=23), calcineurin inhibitor toxicity (n=28), chronic rejection (n=6), and other specific pathologies (n=23), including polyoma virus nephropathy (n=2), induced treatment among 82 recipients (57%). Significantly better graft function was observed at 3-year follow-up among the biopsy group, compared with controls: GFR = 46.0 ± 13.8 vs 35 ± 15 mL/min (P=.002). The 5-year graft survival was significantly higher in the biopsy (81%) than in the control (55.6%) group (P=.0012). CONCLUSION Early detection and treatment of subclinical pathologies improved graft function and long-term survival. Protocol biopsies were a valuable tool for posttransplantation management.
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Affiliation(s)
- E Szederkényi
- Department of Clinical Surgery, Albert Szent-Györgyi Clinical Center, Faculty of Medicine, University of Szeged, Szeged, Hungary.
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Endreffy E, Ondrik Z, Iványi B, Maróti Z, Bereczki C, Haszon I, Györke Z, Worum E, Németh K, Rikker C, Ökrös Z, Túri S. Collagen type IV nephropathy: genetic heterogeneity examinations in affected Hungarian families. Mol Cell Probes 2010; 25:28-34. [PMID: 20951199 DOI: 10.1016/j.mcp.2010.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/03/2010] [Accepted: 10/07/2010] [Indexed: 11/24/2022]
Abstract
The Col4A3, Col4A4 and Col4A5 collagen type IV genes are found to be mutated in Col IV nephropathy. In males with a mutation in the Col4A5 gene (X-linked Alport syndrome: XL-AS), progressive renal disease always develops. Female carriers with a mutation in the Col4A5 gene can develop thin basement membrane nephropathy (TBMN). Males and females who carry 1 Col4A3 or Col4A4 mutation usually manifest TBMN with nonprogressive hematuria. In the event of 2 Col4A3 or Col4A4 gene mutations, the autosomal recessive AS will develop. We examined the cosegregation pattern of hematuria in 20 families. The renal biopsies led to diagnoses of AS in 7 families, and of TBMN in 6 families. In 7 others, the diagnosis of familial hematuria (FHU) was based on the clinical symptoms. Markers of the ColA3/Col4A4 and Col4A5 loci (Col4A3: CA11 and D2S401; Col4A4: HaeIII/RFLP; and Col4A5: DXS456, 2B6 and 2B20) were used to assess their linkage to the clinical symptoms and morphological alterations. Maximum likelihood and the FASTLINK version of the linkage program were applied to compute logarithm of the odds (LOD) scores. A linkage to the Col4A3/Col4A4 genes was identified in 5 families (FHU in 3, AS in 2 families, 25%, LOD score range: 0.20-3.51). The XL-AS pattern of inheritance seemed likely with Col4A5 in 9 families (45%, LOD: 0.43-4.20); we found 4 disease-causative mutations by high-resolution melting curve analysis (LC480) and sequencing in this group. In 2 FHU families, the linkage to chromosomes 2 and X was precluded. Knowledge of the genetic background of Col IV nephropathy is essential to avoid the misdiagnosis of FHU and early AS. The allele frequencies, heterozygosity content and polymorphism information content of the applied STR markers on unrelated Hungarian normal and affected chromosomes 2 and X were also calculated.
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Affiliation(s)
- Emoke Endreffy
- Department of Pediatrics and Child Health Center, H-6720 Szeged, Korányi fasor 14-15, Hungary.
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26
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Rakonczay Z, Hegyi P, Dósa S, Iványi B, Jármay K, Biczó G, Hracskó Z, Varga IS, Karg E, Kaszaki J, Varró A, Lonovics J, Boros I, Gukovsky I, Gukovskaya AS, Pandol SJ, Takács T. A new severe acute necrotizing pancreatitis model induced by L-ornithine in rats. Crit Care Med 2008; 36:2117-27. [PMID: 18594222 DOI: 10.1097/ccm.0b013e31817d7f5c] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Intraperitoneal administration of large doses of L-arginine is known to induce severe acute pancreatitis in rats. We therefore set out to determine whether metabolites of L-arginine (L-ornithine, L-citrulline, and nitric oxide) cause pancreatitis. DESIGN The authors conducted an in vivo animal study. SETTING This study was conducted at a university research laboratory. SUBJECTS Study subjects were male Wistar rats. INTERVENTIONS Dose-response and time course changes of laboratory and histologic parameters of pancreatitis were determined after L-arginine, L-ornithine, L-citrulline, or sodium nitroprusside (nitric oxide donor) injection. MEASUREMENTS AND MAIN RESULTS Intraperitoneal injection of 3 g/kg L-ornithine but not L-citrulline or nitroprusside caused severe acute pancreatitis; 4 to 6 g/kg L-ornithine killed the animals within hours. Serum and ascitic amylase activities were significantly increased, whereas pancreatic amylase activity was decreased after intraperitoneal injection of 3 g/kg L-ornithine. The increase in pancreatic trypsin activity (9-48 hrs) correlated with the degradation of IkappaB proteins and elevated interleukin-1beta levels. Oxidative stress in the pancreas was evident from 6 hrs; HSP72 synthesis was increased from 4 hrs after L-ornithine administration. Morphologic examination of the pancreas showed massive interstitial edema, apoptosis, and necrosis of acinar cells and infiltration of neutrophil granulocytes and monocytes 18 to 36 hrs after 3 g/kg L-ornithine injection. One month after L-ornithine injection, the pancreas appeared almost normal; the destructed parenchyma was partly replaced by fat. Equimolar administration of L-arginine resulted in lower pancreatic weight/body weight ratio, pancreatic myeloperoxidase activity, and histologic damage compared with the L-ornithine-treated group. L-ornithine levels in the blood were increased 54-fold after intraperitoneal administration of L-arginine. CONCLUSIONS We have developed a simple, noninvasive model of acute necrotizing pancreatitis in rats by intraperitoneal injection of 3 g/kg L-ornithine. Interestingly, we found that, compared with L-arginine, L-ornithine was even more effective at inducing pancreatitis. Large doses of L-arginine produce a toxic effect on the pancreas, at least in part, through L-ornithine.
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Affiliation(s)
- Zoltán Rakonczay
- First Department of Medicine, University of Szeged, Szeged, Hungary.
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Tóth-Molnár E, Venglovecz V, Ozsvári B, Rakonczay Z, Varró A, Papp JG, Tóth A, Lonovics J, Takács T, Ignáth I, Iványi B, Hegyi P. New experimental method to study acid/base transporters and their regulation in lacrimal gland ductal epithelia. Invest Ophthalmol Vis Sci 2007; 48:3746-55. [PMID: 17652747 DOI: 10.1167/iovs.06-1291] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The main function of the lacrimal gland is to produce the most aqueous component of the tear film covering the surfaces of the cornea and the conjunctiva. Studies have been conducted that characterize the mixed fluid and protein secretion of isolated acini, but no methods have been developed to characterize lacrimal gland ductal cell (LGDC) secretion. Secretory mechanisms of ductal epithelia may play physiological roles in the maintenance of the standard environments for the cornea and the conjunctiva. METHODS In this study, the authors developed a rapid method to isolate large quantities of intact lacrimal ducts. The preparation of isolated intact lacrimal gland ducts for the first time enabled the performance of real-time functional experiments on cleaned ducts. Electron microscopy and fluorescence measurements were used to evaluate the viability of lacrimal ducts. RESULTS Fluorescence measurements showed that LGDCs express functionally active Na(+)/H(+) exchanger (NHE) and Cl(-)/HCO(3)(-) exchanger (AE). Parasympathomimetic stimulation by carbachol stimulated NHE and AE through the elevation of intracellular calcium concentration. This mechanism can play a role in the regulation of ion and water secretion by LGDCs. CONCLUSIONS The authors have described a lacrimal gland duct isolation technique in which the intact ducts remain viable and the role of duct cells in tear film secretion can be characterized. These data combined with the novel isolation facilitated understanding of the regulation mechanisms of ductal cell secretion at cellular and molecular levels under normal and pathologic conditions.
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Affiliation(s)
- Edit Tóth-Molnár
- Department of Ophthalmology, University of Szeged, Szeged, Hungary
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Nagy J, Iványi B, Sonkodi I. [Merkel cell carcinoma]. Fogorv Sz 2006; 99:135-9. [PMID: 17016920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Merkel cell carcinoma (Mcc) is a very rare, malignant, neuroendocrine tumour. Mcc has an aggressive behavior, local recurrence, and regional or distant metastasis generally develop within a short period of time. At the Oral Medicine Department 158,056 patients were treated between 1970 and 2004. A single case of Mcc was diagnosed, in a 79-year-old woman. The tumour was localized to the upper lip. After successful cryosurgery and a 7-year tumour-free period, a new tumour developed in her palatine tonsil. It was an anaplastic carcinoma with neuroendocrine features, raising the possibility of a late haematogenous metastasis, a second field tumour, or a second primary tumour. The clinical, histological, immunohistochemical and genetic findings suggested that the tumour of the palatine tonsil is a second field tumour.
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Affiliation(s)
- Judit Nagy
- Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Fogászati és Szájsebészeti Klinika
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29
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Németh I, Iványi B, Pajor L. [Renal cell cancer]. Orv Hetil 2006; 147:1336-7. [PMID: 16999021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- István Németh
- Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Pathologiai Intézet.
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30
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Bogáts G, Piros G, Tiszlavicz L, Iványi B, Sasi V, Csepregil L, Simon J, Babik B, Csillik A, Kardos L, Palkó A, Matin K, Hanzély Z, Korányi K, Nyáry I, Végh M, Kolozsvári L, Kahán Z, Bajcsay A, Tóth A, Balázs G, Simor T, Pávics L, Palotás A. Erdheim-Chester's Disease of the Heart: A Diagnostic Conundrum and Collision with the Same Mass in the Orbit. Heart Surg Forum 2006; 9:E549-54. [PMID: 16403713 DOI: 10.1532/hsf98.20051109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Erdheim-Chester's disease is a rare multisystem xanthogranulomatosis, afflicting the skeletal system with the occasional involvement of soft tissues. We delineate an unusual case of a cardiac variant of Erdheim-Chester's disease presenting with pericardial effusion and as a collision with a synchronous orbital manifestation. We describe our diagnostic pathway and propose a novel treatment option involving nonsteroidal anti-inflammatory drugs. The role of cyclo-oxygenase in the disease process and inhibition thereof by NSAIDs is hypothesized and discussed.
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Affiliation(s)
- Gábor Bogáts
- Division of Cardiac Surgery, Center for Cardiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Endreffy E, Ondrik Z, Kemény E, Vas Z, Maróti Z, Lencse G, Bereczki C, Haszon I, Túri S, Iványi B. [Collagen type IV nephropathy: from thin basement membrane nephropathy to Alport syndrome]. Orv Hetil 2005; 146:2647-53. [PMID: 16468607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Collagen type IV nephropathy includes the Goodpasture syndrome, thin basement membrane nephropathy and the Alport syndrome. Mutations in the coding Col(IV)A3/A4 and Col(IV)A5 genes are probable causes of the latter two. Thin basement membrane nephropathy is mostly familial and has an autosomal dominant inheritance, at least 40% of the families have hematuria that co-segregates with the Col(IV)A3 and/or Col(IV)A4 loci. 85% of Alport syndrome cases are transmitted as an X-linked semidominant form due to Col(IV)A5 mutations. About 14% of Alport syndrome cases exhibit autosomal recessive, and 1% autosomal dominant inheritance, both caused by mutations in the Col(IV)A3 or Col(IV)A4 genes in boys and in girls. AIM The co-segregation pattern of hematuria was examined in two families with thin basement membrane nephropathy and one family with the Alport syndrome, using short tandem repeat markers, spanning the Col(IV)A3/A4 and Col(IV)A5 loci to assess their linkage to the clinical symptoms and morphological alterations in the renal biopsy specimens. METHODS Markers: Col(IV)A3: CAll and D2S401; Col(IV)A4: HaeIII/RFLP; and Col(IV)A5: DXS456, 2B6 and 2B20. RESULTS The hematuria displayed autosomal dominant inheritance and co-segregated with Col(IV)A3 markers in one of the thin basement membrane nephropathy families. In the second, the hematuria did not segregate with the Col(IV)A3/A4 or Col(IV)A5 loci, suggesting the possibility of another genetic locus for the disease. The Alport syndrome exhibited autosomal recessive inheritance and did not link to Col(IV)A5 markers, and the Col(IV)A3/A4 markers were informative only in part. CONCLUSION Knowledge of the inheritance and genetic background of collagen type IV nephropathy will be very important in the diagnostics and genetic counseling in the future.
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Affiliation(s)
- Emoke Endreffy
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos es Gyógyszerésztudományi Centrum, Altalános Orvostudományi Kar, Gyermekgyógyászati Klinika es Gyermekegészségügyi Központ, Szeged.
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Lipták P, Kemény E, Morvay Z, Szederkényi E, Szenohradszky P, Marofka F, Toldi J, Exner M, Iványi B. Peritubular capillary damage in acute humoral rejection: an ultrastructural study on human renal allografts. Am J Transplant 2005; 5:2870-6. [PMID: 16302999 DOI: 10.1111/j.1600-6143.2005.01102.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The ultrastructural features of peritubular capillary (PC) damage was studied in 12 kidney allografts with acute humoral rejection (AHR). AHR manifested in diffuse linear PC staining for C4d, and histology consistent with Banff grade III in 7 recipients and Banff grade II in 5. Allografts with acute tubular necrosis served as controls. First biopsies (post-transplantation day 16.2 +/- 2.2): The intra-capillary exudate comprised monocytes (59%), polymorphonuclears (14%), lymphocytes (12%) and not otherwise specified mononuclears (15%). Three patterns of focal PC endothelial injury were observed: lysis, an increased rate of apoptosis and fragmentation. No correlation was found between the respective damage types and the inflammatory cell types or the Banff grades. Controls revealed endothelial swelling, detachment from basement membrane and fragmentation. Follow-up biopsies: Monocytes transformed into macrophages intra-luminally. The reparative changes comprised endothelial cytoplasmic protrusions, binucleated endothelial cells and capillary sprouts. Early transplant capillaropathy and transplant glomerulopathy were noted in 2 recipients. Literature data indicate that lysis is mediated by anti-HLA alloantibodies; apoptosis, demonstrated first in the present study, may be induced by non-HLA-type anti-endothelial antibodies. Fragmentation is caused by ischemia. Ongoing endothelial injury leads to transplant capillaropathy and transplant glomerulopathy, the characteristic lesions of chronic rejection.
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Affiliation(s)
- P Lipták
- Department of Pathology, University of Szeged, Szeged, Hungary.
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Abstract
Chronic allograft nephropathy (CAN) is the leading cause of graft loss following kidney transplantation. One factor contributing to CAN is chronic alloimmune injury. However, the involvement of alloantigen-dependent and -independent factors in CAN is unclear. The pathomechanism of CAN has been extensively studied by utilizing the Fischer-to-Lewis (F344-to-LEW) rat model. Transplant capillaropathy (circumferential multiplication of the peritubular capillary basement membrane) and transplant glomerulopathy (reduplication of the glomerular basement membrane) have recently been validated clinicopathologically as ultrastructural indicators of chronic alloimmune injury. To investigate the presence of these markers, F344-to-LEW kidneys were examined by electron and light microscopy 32, 40 and 52 weeks after implantation. F344 rats with or without 30-min ischemia of the left kidney following right nephrectomy served as controls. All transplanted rats displayed marked proteinuria. On electron microscopy, transplant capillaropathy, transplant glomerulopathy, and T-cell cytotoxicity (indicator of ongoing cellular rejection) were absent. On light microscopy, the arteries were devoid of intimal fibrosis. Focal-segmental glomerulopathy resembling hyperfiltration injury was encountered, with mild interstitial infiltration, fibrosis, and tubular atrophy. The proteinuria and kidney pathology were more severe in transplanted than in ischemic or uninephrectomized rats. Because chronic-active rejection could not be detected between weeks 32 and 52, we propose that the alloantigen-dependent initial graft injury subsides, but induces the late events: glomerular hyperfiltration, proteinuria, and glomerulosclerosis. Accordingly, the model - in the late phase - is suitable to investigate alloantigen-independent factors of CAN and lacks markers of alloantigen-dependent processes.
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Affiliation(s)
- Péter Hamar
- Institute of Pathophysiology, Faculty of General Medicine, Semmelweis University, Budapest, Hungary.
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Németh I, Sükösd F, Béli L, Kiss A, Pajor L, Mikó T, Iványi B. [Adult renal neoplasms in the material of the Pathology Department of the Szeged University]. Orv Hetil 2005; 146:653-8. [PMID: 15889540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIMS The authors investigated the frequencies of the various histological types of adult renal tumours. METHODS The slides of 469 nephrectomies performed in the Department of Urology, Szeged University between 1990 and 2003 were revised according to the 1997 Heidelberg and 2004 WHO classification schemes. RESULTS 86.7% of all the tumours (n = 407) were malignant. Among the malignant tumours, the frequency of renal cell carcinomas was 91.1% (n = 371). 88.4% of the renal cell carcinomas (n = 328) were of conventional type, 5.6% (n = 21) were papillary and 4% (n = 15) were chromophobe. The authors observed 3 Bellini duct, 1 mucinous tubular and 3 non-classifiable carcinomas, with a combined incidence of 1.8%. 84.5% of the conventional carcinomas were clear cell (n = 277), 8.8% were eosinophilic granular (n = 29), 3.9% were multilocular cystic (n = 13) and 2.7% were sarcomatoid carcinomas (n = 9). The median age of the patients with conventional carcinoma was 60 (median, range: 25-84), in the papillary group it was 62 (43-78), and in the chromophobe group was 59 (17-77). The median age of patients affected by transitional cell carcinoma was 64 (range: 45-81). As far as benign tumours are concerned (13.2%, n = 62), oncocytomas (n = 37, 7.8% of all the tumours) affected mainly females, whereas angiomyolipomas (n = 21, 4.4% of all the tumours) occurred in females only. In 13 oncocytoma cases, the tumours were initially diagnosed as malignant. CONCLUSIONS Adult malignant renal tumours affect mainly patients around the age of 60. The commonest diagnosis was clear cell carcinoma of conventional type. The incidence of clear cell carcinoma was 5% higher than that reported in the literature (84.5% vs 70-80%) whereas that of papillary carcinoma was 5% lower (5% vs 10-15%). In comparison with the literature data, oncocytomas were relatively common (8% instead of 3%), and not rarely, it was difficult to distinguish them from renal cell carcinomas.
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MESH Headings
- Adenocarcinoma, Clear Cell/epidemiology
- Adenocarcinoma, Clear Cell/pathology
- Adenoma, Chromophobe/epidemiology
- Adenoma, Chromophobe/pathology
- Adenoma, Oxyphilic/epidemiology
- Adenoma, Oxyphilic/pathology
- Adult
- Aged
- Angiomyolipoma/epidemiology
- Angiomyolipoma/pathology
- Carcinoma/classification
- Carcinoma/epidemiology
- Carcinoma/pathology
- Carcinoma/surgery
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/pathology
- Carcinoma, Renal Cell/epidemiology
- Carcinoma, Renal Cell/pathology
- Carcinoma, Transitional Cell/epidemiology
- Carcinoma, Transitional Cell/pathology
- Female
- Humans
- Hungary/epidemiology
- Kidney Neoplasms/epidemiology
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Male
- Middle Aged
- Nephrectomy
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Affiliation(s)
- István Németh
- Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Patológiai Intézet
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Nagy J, Fehér LZ, Sonkodi I, Lesznyák J, Iványi B, Puskás LG. A second field metachronous Merkel cell carcinoma of the lip and the palatine tonsil confirmed by microarray-based comparative genomic hybridisation. Virchows Arch 2005; 446:278-86. [PMID: 15731927 DOI: 10.1007/s00428-004-1176-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 11/08/2004] [Indexed: 10/25/2022]
Abstract
Merkel cell carcinoma was diagnosed in a 79-year-old Caucasian woman. The tumour was localised to the upper lip and was in stage T2. After successful cryosurgery and a 7-year tumour-free period, a new tumour developed in her palatine tonsil. Histologically and immunohistochemically, this resembled the tumour in the lip. The regional lymph nodes were devoid of metastasis. The paraffin-embedded material of the two tumours and the unaffected lymphatic tissue were analysed with DNA microarrays for comparative genomic hybridisation to assess the genetic relationship of the tumours. In both tumours, regions on 2p and 10p were commonly over-represented, while 41 regions on chromosomes 1-4, 6, 8-9, 11 and 14-22 were commonly under-represented. Chromosomes 1, 3, 4, 16-18 and X were most frequently involved in the DNA losses. In gene copy numbers in the two tumours, 31 chromosome locations were found to be differently affected. The partly similar and partly different molecular patterns indicated a genetic relationship between the tumours and excluded the possibility that the tonsillar tumour was a metastasis. The findings suggest that a genetically altered field was the reason for the development of the tonsillar cancer; thus, it can be regarded pathogenetically as a second field tumour.
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Affiliation(s)
- Judit Nagy
- Department of Oral Medicine, University of Szeged Faculty of Medicine, Szeged, Hungary
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Abstract
The effects of levamisole treatment on long-term outcome were evaluated in a retrospective study of frequently-relapsing (FRNS, n=15), steroid-dependent (SDNS, n=13), and steroid-resistant (SRNS, n=6) nephrotic syndrome in 34 children (21 boys, 13 girls, mean age 5.0+/-3.4 years) during a 60-month follow-up period. The definition of frequent relapses was > or = 4 relapses per year. The current relapse was treated with prednisolone 60 mg/m2 per day for 4 weeks, then with 40 mg/m2 every other day for 4 weeks, after which the dose was tapered by 10 mg weekly. From the beginning of the 5th week, levamisole was introduced at a dose of 2 mg/kg per day. The duration of levamisole treatment was 17+/-7 months. Before starting levamisole treatment the mean level of proteinuria was 2.17+/-1.34 g/day and the relapse rate was 4.41/year. By the end of levamisole therapy, proteinuria had fallen to 0.142+/-0.211 g/day and the relapse rate to 0.41/year. No relapse occurred in 23 of the 34 patients during levamisole treatment. In the 24-month follow-up period after the discontinuation of levamisole, 28 children remained in total remission, while 6 had relapses. The cumulative steroid dose before levamisole therapy was 7,564.4+/-3,497.1 mg/year and following the introduction of levamisole 1,472.9+/-1,729.9 mg/year (P<0.0001). We observed reversible neutropenia in 5 patients, but no other side effects were seen. Our findings suggest that in FRNS and SDNS levamisole significantly reduces both the relapse rate and the cumulative steroid dose; therefore, it could be recommended for these patients. In SRNS patients it has also some benefit because proteinuria and the cumulative steroid dose could be reduced significantly.
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Affiliation(s)
- Viktória Sümegi
- Department of Pediatrics, University of Szeged, 14 Korányi Street, 6721 Szeged, Hungary.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Tamás Sipiczki
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Altalános Orvostudományi Kar, Pathologiai Intézet, Szeged
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Rakonczay Z, Duda E, Kaszaki J, Iványi B, Boros I, Lonovics J, Takács T. The anti-inflammatory effect of methylprednisolone occurs down-stream of nuclear factor-kappaB DNA binding in acute pancreatitis. Eur J Pharmacol 2003; 464:217-27. [PMID: 12620516 DOI: 10.1016/s0014-2999(03)01380-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Glucocorticoids are potent anti-inflammatory drugs. The molecular mechanisms underlying these effects have not yet been fully revealed. The aim of the present study was to establish whether methylprednisolone pretreatment is beneficial and if it can block the pancreatic DNA binding of the transcription factor nuclear factor-kappaB (NF-kappaB) and proinflammatory cytokine synthesis during cholecystokinin-octapeptide (CCK)-induced acute pancreatitis in rats. Additionally, we set out to investigate the potential effects of methylprednisolone and CCK on pancreatic heat shock protein (HSP) synthesis. The dose-response (5-40 mg/kg) and time-course (6-72 h) curves of methylprednisolone on pancreatic HSP60 and HSP72 synthesis were evaluated following methylprednisolone treatment. We demonstrated that methylprednisolone specifically and dose-dependently induced HSP72 in the pancreas of rats, while it did not have a significant effect on HSP60 expression. The pancreatitis was induced near the peak level of HSP72 synthesis (2 x 30 mg/kg body weight [b.w.] methylprednisolone i.m. at an interval of 12 h, followed by a 12-h recovery period after the second injection of methylprednisolone) by administering 2 x 100 microg/kg CCK subcutaneously at an interval of 1 h. The injections of CCK in the vehicle-pretreated group significantly elevated the levels of pancreatic HSP60 and HSP72 2-4 h after the second CCK injection. Methylprednisolone pretreatment ameliorated many of the examined laboratory (the pancreatic weight/body weight [p.w./b.w.] ratio, the serum amylase activity, the plasma trypsinogen activation peptide concentration, the pancreatic levels of tumor necrosis factor-alpha and interleukin-6, the degree of lipid peroxidation, protein oxidation, nonprotein sulfhydryl group content and the pancreatic myeloperoxidase activity) and morphological parameters of the disease. Methylprednisolone pretreatment did not influence pancreatic NF-kappaB DNA binding, but decreased proinflammatory cytokine synthesis in this acute pancreatitis model. The findings suggest that the anti-inflammatory effect of large doses of methylprednisolone in secretagogue-induced pancreatitis occurs downstream of NF-kappaB DNA binding, and that increased pancreatic HSP72 synthesis may play a role in the protective effect of the drug.
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Affiliation(s)
- Zoltán Rakonczay
- First Department of Medicine, University of Szeged, P.O. Box 469, Hungary.
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Takács T, Rakonczay Z, Varga IS, Iványi B, Mándi Y, Boros I, Lonovics J. Comparative effects of water immersion pretreatment on three different acute pancreatitis models in rats. Biochem Cell Biol 2002; 80:241-51. [PMID: 11998831 DOI: 10.1139/o02-006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cells respond to stress by upregulating the synthesis of cytoprotective heat shock proteins (HSPs) and antioxidant enzymes. The aim of this study was to compare the effects of cold (CWI) or hot water immersion (HWI) stress on three different acute pancreatitis models (cholecystokinin octapeptide (CCK), sodium taurocholate (TC), and L-arginine (Arg)). We examined the levels of pancreatic HSP60, HSP72, and antioxidants after the water immersion stress. Male Wistar rats were injected with CCK, TC, or Arg at the peak level of pancreatic HSP synthesis, as determined by Western blot analysis. HWI significantly elevated HSP72 expression and CWI significantly increased HSP60 expression in the pancreas. Water immersion stress decreased the levels of pancreatic antioxidants. CWI and-HWI pretreatment ameliorated most of the examined laboratory and morphological parameters of CCK-induced pancreatitis. CWI pretreatment decreased pancreatic edema and the serum amylase level; however, the morphological damage was more severe in TC-induced acute pancreatitis. Overall, CWI and HWI pretreatment only decreased the serum cytokine concentrations in Arg-induced pancreatitis. CWI and HWI resulted in differential induction of pancreatic HSP60 and HSP72 and the depletion of antioxidants. The findings suggest the possible roles of HSP60 and (or) HSP72 (but not that of the antioxidant enzymes) in the protection against CCK- and TC-induced acute pancreatitis. Unexpectedly, CWI pretreatment was detrimental to the morphological parameters of TC-induced pancreatitis. It was demonstrated that CWI and HWI pretreatment only influenced cytokine synthesis in Arg-induced pancreatitis.
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Affiliation(s)
- Tamas Takács
- First Department of Medicine, University of Szeged, Hungary.
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Rakonczay Z, Mándi Y, Kaszaki J, Iványi B, Boros I, Lonovics J, Takacs T. Induction of HSP72 by sodium arsenite fails to protect against cholecystokinin-octapeptide-induced acute pancreatitis in rats. Dig Dis Sci 2002; 47:1594-603. [PMID: 12141822 DOI: 10.1023/a:1015883522648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
A number of investigators have demonstrated that the preinduction of heat-shock protein (HSP) expression (particularly HSP60 and HSP72) by hyper- or hypothermia may have a protective effect against cerulein-induced acute pancreatitis. The aim of the present study was to induce HSPs in the pancreas and lungs by thermal (hot-water immersion, HWI) and nonthermal methods (injection of sodium arsenite intraperitoneally) and to investigate the potential effects of HSP preinduction on cholecystokinin-octapeptide (CCK) induced acute pancreatitis and pancreatitis-associated lung injury in rats. The dose-response and time-effect curves observed following HWI and sodium arsenite treatments were evaluated. Animals were injected with 3 x 75 microg/kg CCK subcutaneously at intervals of 2 hr at the peak level of HSP synthesis, as determined by Western blot analysis. The rats were killed by exsanguination through the abdominal aorta 2 or 6 hr after the last CCK injection. HWI and the injection of sodium arsenite significantly elevated the expression of HSP72 in the pancreas and lungs, whereas they did not influence the levels of HSP60. Overall, HWI pretreatment had a protective effect against CCK-induced pancreatitis and pancreatitis-associated lung injury. In contrast, the nonthermal preinduction of HSP72 by sodium arsenite did not result in any beneficial effects on the measured parameters of the disease. The findings suggest that the preinduction of HSP72 is not sufficient to protect against CCK-induced acute pancreatitis and pancreatitis-associated lung injury or that the beneficial effect of hyperthermia may not be exclusively related to HSP72 expression.
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Rakonczay Z, Takács T, Iványi B, Mándi Y, Pápai G, Boros I, Varga I, Jost K, Lonovics J. Induction of heat shock proteins fails to produce protection against trypsin-induced acute pancreatitis in rats. Clin Exp Med 2002; 2:89-97. [PMID: 12141532 DOI: 10.1007/s102380200012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Heat shock proteins (HSPs) are necessary in the synthesis, degradation, folding, transport, and translocation of different proteins. It is well known that the increased expression of HSPs may have a protective effect against cerulein-induced pancreatitis in rats or against choline-deficient ethionine-supplemented diet model pancreatitis in mice. The aim of this study was to investigate the potential effects of HSP preinduction by cold or hot water immersion on trypsin-induced acute pancreatitis in rats. Trypsin was injected into the interlobular tissue of the duodenal part of the pancreas at the peak level of HSP synthesis, as determined by Western blot analysis. The rats were sacrificed by exsanguination through the abdominal aorta 6 h after the trypsin injection. The serum amylase activity, the tumor necrosis factor-alpha, interleukin-1, and interleukin-6 levels, the pancreatic weight/body weight ratio, and the pancreatic contents of DNA, protein, amylase, lipase, and trypsinogen were measured. A biopsy for histology was taken. Hot water immersion significantly elevated the HSP72 expression, while cold water immersion significantly increased the HSP60 expression. Cold water immersion pretreatment ameliorated the pancreatic edema in trypsin-induced pancreatitis, however this was not due to the HSP60. Hot water immersion pretreatment did not have any effect on the measured parameters in trypsin-induced pancreatitis. The findings suggest that the induction of HSP60 or HSP72 are not enough to protect rats against the early phase of this localized necrohemorrhagic pancreatitis model.
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Affiliation(s)
- Z Rakonczay
- First Department of Medicine, University of Szeged, Hungary.
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Rakonczay Z, Iványi B, Varga I, Boros I, Jednákovits A, Németh I, Lonovics J, Takács T. Nontoxic heat shock protein coinducer BRX-220 protects against acute pancreatitis in rats. Free Radic Biol Med 2002; 32:1283-92. [PMID: 12057766 DOI: 10.1016/s0891-5849(02)00833-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nontoxic heat shock protein (HSP) inducer compounds open up promising therapeutic possibilities by activating one of the natural and highly conserved defense mechanisms of the organism. AIMS In the present experiments, we examined the effects of a HSP coinducer drug-candidate, BRX-220, on the cholecystokinin-octapeptide (CCK)-induced acute pancreatitis in rats. METHODS Male Wistar rats weighing 240 to 270 g were divided into two groups. In group B, 20 mg/kg BRX-220 was administered orally, followed by 75 microg/kg CCK subcutaneously three times, after 1, 3, and 5 h. This whole procedure was repeated for 5 d. The animals in group slashed circleB received physiological saline orally instead of BRX-220, but otherwise the protocol was the same as in group B. The rats were exsanguinated through the abdominal aorta 12 h after the last administration of CCK. We determined the serum amylase activity, the plasma trypsinogen activation peptide concentration, the pancreatic weight/body weight ratio, the DNA and total protein contents of the pancreas, the levels of pancreatic HSP60 and HSP72, the activities of pancreatic amylase, lipase, trypsinogen, and free radical scavenger enzymes (superoxide dismutase, catalase, and glutathione peroxidase), the degree of lipid peroxidation, protein oxidation, and the reduced glutathione level. Histopathological investigation of the pancreas was also performed in all cases. RESULTS Repeated CCK treatment resulted in the typical laboratory and morphological changes of experimentally induced pancreatitis. The pancreatic levels of HSP60 and HSP72 were significantly increased in the animals treated with BRX-220. In group B, the pancreatic total protein content and the amylase and trypsinogen activities were significantly higher vs. group slashed circleB. The plasma trypsinogen activation peptide concentration, and the pancreatic lipid peroxidation, protein oxidation, and the activity of Cu/Zn-superoxide dismutase were significantly decreased in group B vs. group slashed circleB, whereas the glutathione peroxidase activity was increased. The morphological damage in group B was significantly lower than that in group slashed circleB. CONCLUSION The HSP coinducer BRX-220, administered for 5 d, has a protective effect against CCK-induced acute pancreatitis.
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Rakonczay Z, Takács T, Iványi B, Mándi Y, Pápai G, Boros I, Varga IS, Jost K, Lonovics J. The effects of hypo- and hyperthermic pretreatment on sodium taurocholate-induced acute pancreatitis in rats. Pancreas 2002; 24:83-9. [PMID: 11741186 DOI: 10.1097/00006676-200201000-00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Heat shock proteins (HSPs) have indispensable functions in the synthesis, degradation, folding, transport, and translocation of intracellular proteins. HSPs are proteins that help cells to survive stress conditions by repairing damaged proteins. AIM To investigate the potential effects of HSP preinduction by cold-water (CWI) or hot-water immersion (HWI) on sodium taurocholate (TC)-induced acute pancreatitis in rats. METHODOLOGY TC was injected into the common biliopancreatic duct of the animals at the peak level of HSP synthesis, as determined by Western blot analysis. The rats were killed by exsanguination through the abdominal aorta 6 hours after the TC injection. The serum amylase activity, the IL-1, IL-6 and TNF-alpha levels, the pancreatic weight/body weight ratio, and the pancreatic contents of DNA, protein, amylase, lipase, and trypsinogen were measured, and a biopsy for histology was taken. RESULTS HWI significantly elevated HSP72 expression, whereas CWI significantly increased HSP60 expression. It was demonstrated that CWI pretreatment ameliorated the pancreatic edema and the serum amylase level increase, whereas the morphologic damage was more severe in this form of acute pancreatitis. HWI pretreatment did not have any effects on the measured parameters in TC-induced pancreatitis. CONCLUSIONS The findings suggest a possible role of HSP60, but not HSP72, in the slight protection in the early phase of this necrohemorrhagic pancreatitis model.
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Affiliation(s)
- Zoltán Rakonczay
- First Department of Medicine, University of Szeged, Szeged, Hungary.
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Rakonczay Z, Takács T, Mándi Y, Iványi B, Varga S, Pápai G, Boros I, Lonovics J. Water immersion pretreatment decreases pro-inflammatory cytokine production in cholecystokinin-octapeptide-induced acute pancreatitis in rats: possible role of HSP72. Int J Hyperthermia 2001; 17:520-35. [PMID: 11719968 DOI: 10.1080/02656730110081785] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Heat shock proteins (HSPs) are cytoprotective proteins that are expressed constitutively and/or at elevated levels upon the exposure of cells to stress. The aim of this study was to investigate the potential effects of HSP preinduction by cold- (CWI) or hot-water immersion (HWI) on pro-inflammatory cytokine production (IL-1, IL-6, TNF-alpha) in cholecystokinin-octapeptide(CCK)-induced acute pancreatitis. Rats were injected with 3 x 75 microg/kg CCK subcutaneously at intervals of 2 h at the peak level of HSP synthesis, as determined by Western blot analysis. The animals were killed by exsanguination through the abdominal aorta 2 h after the last CCK injection. The serum IL-1, IL-6, TNF-alpha, and amylase levels, the pancreatic weight/body weight ratio, and the pancreatic contents of DNA, protein, amylase, lipase and trypsinogen were measured; biopsy for histology was taken. HWI significantly elevated the HSP72 expression, while CWI significantly increased the HSP60 expression. HWI pretreatment decreased all of the measured serum cytokine levels in this acute pancreatitis model. CWI and HWI pretreatment ameliorated most of the examined laboratory and morphological parameters of CCK-induced pancreatitis. The findings suggest the possible roles of HSP60 and HSP72 in the protection against CCK-induced pancreatitis. HSP72 might also participate in the reduction of pro-inflammatory cytokine synthesis.
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Affiliation(s)
- Z Rakonczay
- First Department of Medicine, University of Szeged, Hungary.
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Simon J, Rudas L, Iványi B. [The role of autopsy in verifying diagnostic accuracy at the intensive care unit]. Orv Hetil 2001; 142:2373-6. [PMID: 11760454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The accuracy of the clinical diagnoses compared to the findings of an autopsy is a more relevant characteristic of the quality of care than the length of stay in the hospital or the daily costs of the stay. The aim of this retrospective study was: a) to compare the clinical and pathological diagnoses, b) to determine the amount of new information supplied by the autopsy and c) to determine wether the knowledge of correct clinical diagnosis would have resulted in a change of therapy. At the medical ICU 163 patients died during 1998, autopsy was performed in 110 cases. Agreement of clinical and pathological diagnoses and causes of death were retrospectively assessed by a board. Acute myocardial infarction accounted for 26% of deaths, pneumonia and respiratory insufficiency for 15%, cardiac failure for 14%, sepsis for 14%, stroke for 13%, pulmonary embolism for 5% and others for 13%. The accuracy of the clinical cause of death was proved in 81% of the cases. The main disease was diagnosed correctly in 86% of the cases. As a tool in quality control, the agreement of clinical and pathological diagnoses and causes of death proved to be good during the examined period of time.
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Affiliation(s)
- J Simon
- Altalános Orvostudományi Kar, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Szegedi Tudományegyetem, Szeged
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Iványi B, Fahmy H, Brown H, Szenohradszky P, Halloran PF, Solez K. Peritubular capillaries in chronic renal allograft rejection: a quantitative ultrastructural study. Hum Pathol 2000; 31:1129-38. [PMID: 11014582 DOI: 10.1053/hupa.2000.16677] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peritubular capillaries (PCs) with a circumferentially multilayered basement membrane have been suggested as an ultrastructural indicator of chronic renal allograft rejection (CR). The authors validated this lesion as a marker for CR, by analyzing its quantitative features, specificity, and sensitivity in 169 renal biopsy specimens. The mean number of circumferential layers (PCcirc) and the incidences of the grades (mild: 2 to 4, moderate: 5 to 6, severe: 7 or more layers) were investigated in biopsy specimens involving CR (CR(Bx), n = 46), acute rejection (n = 11), normal kidneys (n = 20), psoriatics treated with cyclosporine (n = 13), renal transplants with chronic cyclosporine toxicity (n = 12), native kidney diseases (NKD, n = 56), and transplant nephrectomies attributable to CR (Cr(nephr), n = 11). CR was diagnosed with regard to the clinical features and the presence of intimal fibrosis in 41 biopsy specimens or transplant glomerulopathy in 35 biopsy specimens (cg; identified only by electron microscopy in 10 cases). NKD included chronic glomerulonephritis, chronic tubulointerstitial nephritis, benign nephrosclerosis, thrombotic microangiopathy, diabetic nephropathy, and renal disease in elderly patients (median age, 72 years). All PCs around glomeruli were sampled (median, 14 profiles per case). PCs with a moderate/ severe lesion appeared as serrated profiles with a thick, ribbon-like basement membrane layer in semithin plastic sections. The numbers of circumferentially multilayered PCs were significantly characteristic of CR (PCcirc in CR(Bx): 2.87+/-1.83 SD; range, 0 to 7.36; P < .001 v other groups). A severe lesion occurred exclusively in CR (in 12% of the PCs in CR(Bx), and in 38% in CRnephr). A moderate lesion was observed in 0.6% of the PCs in NKD, 16% in CR(Bx), and 21% in CRnephr. Three or more PCs with a moderate lesion were encountered only in CR. A mild lesion was not suggestive of CR at all. In CR(Bx), 27 cases showed a severe lesion or 3 or more PCs with a moderate lesion (cpc; sensitivity: 59%). Four of the 27 cases lacked cg. The cumulative incidence of cpc and cg was 85%. In transplants with cyclosporine toxicity, the presence of cpc verified the coexistence of CR in 7 specimens. In conclusion, cpc is a specific marker of CR. The incidence of cpc increases as CR progresses. The lesion may be caused by a low-grade rejection injury to the PCs. Careful analysis of semithin sections promotes the better sampling of cpc. An ultrastructural demonstration of cpc and cg defines CR more precisely than does light microscopic evaluation per se.
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Affiliation(s)
- B Iványi
- Department of Pathology, Albert Szent-Györgyi Medical University, Szeged, Hungary
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Kovács L, Simon J, Kovács A, Pócsik A, Boros I, Iványi B, Pokorny G. [Diffuse alveolar hemorrhage in systemic lupus erythematosus]. Orv Hetil 2000; 141:179-83. [PMID: 10697987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Of the 120 systemic lupus erythematosus (SLE) patients treated by the authors, two have developed diffuse alveolar haemorrhage. The authors' objective is to present this rare, but severe manifestation. Patients 1 and 2 were 66- and 22-year old women, respectively. Both had SLE with multi-organ involvements including diffuse proliferative lupus nephritis. Before the diagnosis of the disease, both patients had experienced pneumonitis that resolved on corticosteroid treatment. Soon after the diagnosis, respiratory failure, haemoptoea and acute anaemia developed, accompanied by a rapid deterioration in the general condition. Chest radiographs revealed bilateral, diffuse, alveolar infiltrates. The pulmonary haemorrhage temporarily ceased in response to corticosteroid treatment, but both patients later died in consequence of active SLE and mixed bacterial and fungal sepsis. Post mortem examination demonstrated fibrosing alveolitis and alveolar bleeding in Patient 1, and an immune complex deposition-induced alveolocapillary inflammation with alveolar haemorrhage in Patient 2. Diffuse alveolar haemorrhage is a life-threatening manifestation of SLE. Its onset may be preceded by episodes of pneumonitis resolving on corticosteroid treatment. An active diagnostic workup, intensive observation and aggressive immunosuppressive treatment are the cornerstones of the management. The early detection and the active treatment of secondary infections are obligatory. The authors consider the most difficult challenge to be the optimum coordination of the above treatment modalities.
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Affiliation(s)
- L Kovács
- I. Belgyógyászati Klinika, Szent-Györgyi Albert Orvostudományi Egyetem, Szeged
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Abstract
BACKGROUND AND AIMS Lipomatous tumors of the liver are extremely rare; most of them are found incidentally at autopsy. Appropriate methods of the diagnosis of these lesions are ultrasonography (US), computed tomography (CT) and biopsy. CASE REPORT The case of a 65-year-old man who had undergone an upper-rectum resection because of exulcerated adenocarcinoma of the rectum is described. Six months later, routine control examination revealed a solid tumor in the left lobe of the liver. The tumor was not demonstrated by either sonography or CT before the operation. Repeated US, CT scan and fine-needle biopsy could not exclude the possibility of a metastatic tumor secondary to previous malignancy. The lesion was removed by wedge resection and was proven to be a lipoma. CONCLUSION Despite adequate preoperative examination (CT, biopsy and US), an anamnestic adenocarcinoma of the rectum can lead to inappropriate therapy. The inadequate result of our therapeutic policy can be explained by the extremely rare incidence of lipoma of the liver.
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Affiliation(s)
- K Szentpáli
- Department of Surgery, Albert Szent-Györgyi Medical University, H-6701 Szeged, P.O. Box 427, Hungary.
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Szenohradszky P, Smehák G, Szederkényi E, Marofka F, Csajbók E, Morvay Z, Ormos J, Iványi B. Renal allograft rupture: a clinicopathologic study of 37 nephrectomy cases in a series of 628 consecutive renal transplants. Transplant Proc 1999; 31:2107-11. [PMID: 10455984 DOI: 10.1016/s0041-1345(99)00277-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Szenohradszky
- Department of Surgery, Albert Szent-Györgyi Medical University, Szeged, Hungary
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Iványi B, Haszon I, Endreffy E, Szenohradszky P, Petri IB, Kalmár T, Butkowski RJ, Charonis AS, Túri S. Childhood membranous nephropathy, circulating antibodies to the 58-kD TIN antigen, and anti-tubular basement membrane nephritis: an 11-year follow-up. Am J Kidney Dis 1998; 32:1068-74. [PMID: 9856526 DOI: 10.1016/s0272-6386(98)70085-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Childhood membranous nephropathy (MNP) with anti-tubular basement membrane (anti-TBM) nephritis is a rare disorder that may have extrarenal manifestations. This article describes a new case to be added to the 10 previously reported. A renal biopsy specimen from a 1-year-old white boy with nephrotic syndrome, microhematuria, and hypertension showed MNP (granular global IgG, IgA and C3, and segmental IgM and C1q) associated with hypercellularity and granular deposits of IgM and C1q in the mesangium, arteriolar IgA, and linear TBM IgG, IgA, and C3. A biopsy at age 4 years showed MNP (IgG and C3) and linear IgG and C3 along the TBM. Six months later, temporary glucosuria suggested a mild tubular dysfunction. Biopsy at age 8 years showed sclerosing MNP (IgG and C3), linear TBM IgG and C3, and chronic active tubulointerstitial nephritis (TIN). Indirect immunofluorescence showed circulating anti-TBM antibodies, and the enzyme-linked immunosorbent assay (ELISA) approach verified strong reactivity with the 58-kd TIN antigen. Despite trials with steroids, chlorambucil, azathioprine, and cyclosporine, end-stage renal disease developed by the age of 9 years. At age 10 years, the patient received a cadaveric kidney transplant. With the patient now aged 12 years, the graft is still functioning well, without any clinical evidence of disease recurrence. Neurological, ocular, and abdominal symptoms, including nonbacterial diarrhea, were observed during the follow-up period. The pathophysiology of these extrarenal symptoms remains unclear. Serotyping and genotyping of HLA antigens (A2, A10, B12, B41, DR5 [1101, 1103-4, 1106 or 1108-1113], DR6 [1303, 1312, or 1413], DRB3 [*0101 and 0201-2 or 0301], DQA1 [*0501 homozygous], and DQB1 [*0301 homozygous]) did not indicate any HLA association similar to those described previously in childhood MNP with anti-TBM nephritis (HLA-B7 in four patients, HLA-DR8 in two patients). The presented case is the fifth in the literature that displays reactivity with the 58-kd TIN antigen, and for which data on HLA antigens are reported.
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Affiliation(s)
- B Iványi
- Department of Pathology, The Clinics of Pediatrics, Albert Szent-Györgyi Medical University, Szeged, Hungary.
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