1
|
de Menezes Neves PDM, Mohrbacher S, Lobato Vasques I, Barreira Cavalcante L, Hamamoto Sato VA, de Souza Oliveira É, Barbosa Pereira LV, Martins Bales A, Martins Frediani M, Renato Chocair P, Cuvello-Neto AL. Renal infarction secondary to Aspergillus spp. embolism following COVID-19. Lancet Infect Dis 2024; 24:e266-e267. [PMID: 38519259 DOI: 10.1016/s1473-3099(23)00780-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Sara Mohrbacher
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | - Victor Augusto Hamamoto Sato
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Érico de Souza Oliveira
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Leonardo Victor Barbosa Pereira
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Alessandra Martins Bales
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Marcella Martins Frediani
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Pedro Renato Chocair
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Américo Lourenço Cuvello-Neto
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil; Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo, Brazil
| |
Collapse
|
2
|
Soares LR, Pantoja Junior JMS, Jorge LB, Yu L, Cavalcante LB, Malheiros DMAC, Woronik V, Dias CB. Nephrotic syndrome in the elderly: epidemiological aspects, clinical data, and renal biopsy findings. Braz J Med Biol Res 2022; 55:e11861. [PMID: 35239780 PMCID: PMC8905670 DOI: 10.1590/1414-431x2022e11861] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Nephrotic syndrome is the most common clinical presentation of glomerular disease in elderly patients, and renal biopsy is an important diagnostic resource. The aim of this study was to describe nephrotic syndrome among elderly patients in Brazil, focusing on tubulointerstitial and vascular involvement. This was a retrospective study of patients over 65 years of age with nephrotic syndrome who underwent renal biopsy between January 2012 and December 2019. Of the 123 renal biopsies that occurred during the study period, 44 (35.8%) were performed for the investigation of nephrotic syndrome. Among those 44 cases, the main etiologies were membranous nephropathy in 13 cases (29.5%), amyloidosis in ten (22.7%), non-collapsing focal segmental glomerulosclerosis (FSGS) in four (9.1%), and collapsing FSGS in four (9.1%). Patients with minimal change disease (MCD) had the lowest degree of interstitial fibrosis compared with the other glomerulopathies, and histological signs of acute tubular necrosis (ATN) were less common among those with amyloidosis than among those with membranous nephropathy, FSGS, or MCD (P=0.0077). Of the patients with ATN, the frequency of acute kidney injury (AKI) was highest in those with MCD (P<0.001). All patients had some degree of vascular involvement, regardless of the type of glomerulopathy. In conclusion, the second most common cause of nephrotic syndrome in this population was amyloidosis, and acute interstitial tubule involvement was more marked in MCD. Vascular involvement is something that cannot be dissociated from the age of the patient and is not only due to the underlying glomerulopathy.
Collapse
Affiliation(s)
- L R Soares
- Divisão de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J M S Pantoja Junior
- Divisão de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L B Jorge
- Divisão de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L Yu
- Divisão de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L B Cavalcante
- Divisão de Anatomia Patológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D M A C Malheiros
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V Woronik
- Laboratório de Fisiopatologia Renal, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C B Dias
- Laboratório de Fisiopatologia Renal, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
3
|
Neves PDMDM, Lario FC, Mohrbacher S, Ferreira BMC, Sato VAH, Oliveira ÉS, Pereira LVB, Bales AM, Nardotto LL, Ferreira JN, Cavalcante LB, Chocair PR, Cuvello-Neto AL. Dialysis-related constrictive pericarditis: old enemies may sometimes come back. J Bras Nefrol 2022; 44:602-606. [PMID: 34251389 PMCID: PMC9838677 DOI: 10.1590/2175-8239-jbn-2020-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/02/2021] [Indexed: 01/26/2023] Open
Abstract
Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Several heart conditions have been associated with CKD, including myocardial and pericardial diseases. This paper describes a case of Dialysis-related constrictive pericarditis in a patient diagnosed with sudden hypotension during a hemodialysis session. A 65-year-old man diagnosed with hypertension, diabetes, obesity, and cirrhosis on hemodialysis for two years complained of symptoms during one of his sessions described as malaise, lipothymia, and confusion. The patient had a record of poor compliance with the prescribed diet and missed dialysis sessions. He was sluggish during the physical examination, and presented hypophonetic heart sounds, a blood pressure of 50/30mmHg, and a prolonged capillary refill time. The patient was referred to the intensive care unit and was started on antibiotics and vasoactive drugs. His workup did not show signs of infection, while electrocardiography showed low QRS-wave voltage. His echocardiogram showed signs consistent with a thickened pericardium without pericardial effusion. Cardiac catheterization showed equalization of diastolic pressures in all heart chambers indicative of constrictive pericarditis. The patient underwent a pericardiectomy. Examination of surgical specimens indicated he had marked fibrosis and areas of dystrophic calcification without evidence of infection, consistent with Dialysis-related constrictive pericarditis. Hypotension for unknown causes must be considered in the differential diagnosis of dialysis patients.
Collapse
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Divisão de Nefrologia, São Paulo, SP, Brasil
| | | | - Sara Mohrbacher
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil
| | | | | | - Érico Souza Oliveira
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil
| | | | | | | | | | - Lívia Barreira Cavalcante
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Divisão de Patologia, São Paulo, SP, Brasil
| | - Pedro Renato Chocair
- Hospital Alemão Oswaldo Cruz, Centro de Nefrologia e Diálise, São Paulo, SP, Brasil
| | | |
Collapse
|
4
|
Dias CB, Jorge LB, Woronik V, Cavalcante LB, Yu L. IgA nephropathy in patients with serum anti-neutrophil cytoplasmic autoantibody (ANCA) positivity: case series. ACTA ACUST UNITED AC 2021; 44:42-47. [PMID: 34289006 PMCID: PMC8943862 DOI: 10.1590/2175-8239-jbn-2021-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/06/2021] [Indexed: 01/11/2023]
Abstract
Some cases of patients with IgA nephropathy diagnosed via kidney biopsy and antineutrophil cytoplasmic antibody (ANCA) positivity have been reported. This article describes a case series comprising patients with IgA nephropathy and ANCA positivity seen at a medical center in the city of São Paulo, Brazil, from 1996 to 2016. A total of 111 patients underwent diagnostic kidney biopsies for IgA nephropathy. Five were ANCA-positive at the time of diagnosis; their mean age was 45 ± 15.3 years and they were predominantly females with a mean proteinuria of 2.2 ± 0.9 g/day and a median serum creatinine level of 2.5 (2.0 - 8,6) mg/dL; all had hematuria. Four of the five were cANCA-positive (80%); all had normal serum C3 and C4 levels; and 80% were positive for ANA. One case presented an association with infection, but no associations were found with medication. One patient had granuloma and another had a collapsing lesion. This article describes the cases of five ANCA-positive patients (with predominantly cANCA positivity) submitted to diagnostic kidney biopsies for IgA nephropathy; one patient had a collapsing lesion, but progressed well.
Collapse
Affiliation(s)
- Cristiane Bitencourt Dias
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiologia Renal, São Paulo, SP, Brasil
| | - Lectícia Barbosa Jorge
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brasil
| | - Viktoria Woronik
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiologia Renal, São Paulo, SP, Brasil
| | - Lívia Barreira Cavalcante
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Patologia, São Paulo, SP, Brasil
| | - Luis Yu
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brasil
| |
Collapse
|
5
|
Neves PDMDM, Pinheiro RBB, Dias CB, Yu L, Testagrossa LDA, Cavalcante LB, Malheiros DMAC, Jorge LB, Woronik V. Renal Outcomes in Brazilian Patients with Immunoglobulin A Nephropathy and Cellular Crescentic Lesions. Kidney Blood Press Res 2020; 45:431-441. [PMID: 32299081 DOI: 10.1159/000507251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/22/2019] [Accepted: 03/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy. The Oxford classification was recently updated to include crescents as markers of poor prognosis. The aim of this study was to evaluate the impact of cellular crescents on the prognosis of patients with IgAN in Brazil. METHODS This was a single-centre retrospective analysis of medical records and renal biopsies in patients with IgAN. The renal biopsy findings were classified according to the revised Oxford classification: mesangial hypercellularity, endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy or interstitial fibrosis (T), and crescent formation (C). We evaluated a composite outcome (progression to end-stage renal disease or creatinine doubling). We performed analyses between the patients with crescents in the renal biopsy specimen (C1/C2 group) and those without such crescents (C0 group). RESULTS We evaluated 111 patients, of whom 72 (65.0%) were women, 80 (72.0%) self-identified as White, 73 (65.6%) were hypertensive, and 95 (85.6%) had haematuria. The distribution of patients according to cellular crescentic lesions was: C0, 80 (72%); C1, 27 (24.4%); C2, 4 (3.6%). The composite outcome was observed in 33 (29.72%) of the 111 patients. In comparison with the C0 group, the C1/C2 group had higher proportions of patients with hypertension (p = 0.04), haematuria (p = 0.03), worse serum creatinine (p = 0.0007), and worse estimated glomerular filtration rate (p = 0.0007). The C1/C2 group also had higher proportions of patients in whom the biopsy specimen was classified as E1 (p = 0.009), S1 (p = 0.001), or T1/T2 (p = 0.03), In addition, the mean follow-up period was shorter in the C1/C2 group (p < 0.0001). Furthermore, the composite outcome was observed in a greater proportion of patients and in a shorter length of time in the C1/C2 group than in the C0 group (p = 0.002 and p = 0.0014, respectively). In a Cox regression analysis, the independent risk factors for the composite outcome had Oxford classifications of S1, T1/T2, and C1/C2. CONCLUSION Oxford classification findings of S1, T1/T2, or C1/C2 were independent risk factors for the composite outcome, corroborating previous studies.
Collapse
Affiliation(s)
| | | | | | - Luis Yu
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | | | - Viktoria Woronik
- Nephrology Department, University of São Paulo School of Medicine, São Paulo, Brazil
| |
Collapse
|
6
|
de Menezes Neves PDM, Reichert BV, Bridi RA, Yu L, Dias CB, Pinheiro RBB, de Abreu Testagrossa L, Cavalcante LB, Malheiros DMAC, Jorge LB, Woronik V. Atypical presentation of acute post-infectious glomerulonephritis in patients with sickle cell disease: report of two cases. BMC Nephrol 2020; 21:56. [PMID: 32093686 PMCID: PMC7038555 DOI: 10.1186/s12882-020-01715-x] [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: 10/09/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a highly prevalent genetic disease worldwide. In the natural evolution of SCD, glomerular lesions can develop, presenting histopathological patterns of segmental or focal membranoproliferative glomerulosclerosis, with or without thrombotic microangiopathy. We report two cases of acute post-infectious glomerulonephritis (APIGN), with atypical presentations, in patients with SCD. CASE PRESENTATION Case 1: An 18-year-old female with SCD presented with a 21-day history of progressive oedema, accompanied by dyspnoea, productive cough, fever, and chest pain. Blood tests showed the following: haemoglobin 6.1 g/dl; leucocytes 18,820 cells/mm3; and creatinine 0.49 mg/dl. A urine sample evidenced leucocyturia and haematuria. The 24-h proteinuria was 8.99 g, serum albumin level was 1.2 g/dl, low serum C3 levels and high levels of anti-streptolysin O. Renal biopsy was consistent with APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving to reversal of the renal alterations. Case 2: A 12-year-old male with SCD presented with a 20-day history of a non-productive cough and progressive oedema, together with hypertension. The serum creatinine concentration was 0.48 mg/dl. A urine sample evidenced leukocyturia and haematuria. The 24-h proteinuria was 12.5 g, and the serum albumin level was 2.6 g/dl. The levels of C3 and C4 were normal. Renal biopsy revealed APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving reversal of the renal alterations. CONCLUSIONS The presentation of the two cases reported here are not typical of SCD-related kidney injury. Analysis of the renal biopsy specimens elucidated the diagnosis, affecting the prognosis, because that of APIGN is highly favourable, unlike that of nephrotic syndrome associated with SCD glomerulopathy.
Collapse
Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil.
| | - Bernardo Vergara Reichert
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Ramaiane Aparecida Bridi
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Luis Yu
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Cristiane Bitencourt Dias
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | | | | | | | | | - Lectícia Barbosa Jorge
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| | - Viktoria Woronik
- Nephrology Division, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 7° andar, Cerqueira Cesar, São Paulo, Brazil
| |
Collapse
|
7
|
Wroclawski ML, Baccaglini W, Pazeto CL, Carbajo C, Matushita C, Carneiro A, Pompeo A, Glina S, Pompeo ACL, Cavalcante LB. Extrarenal Angiomyolipoma: differential diagnosis of retroperitoneal masses. Int Braz J Urol 2018; 44:639-641. [PMID: 29211401 PMCID: PMC5996806 DOI: 10.1590/s1677-5538.ibju.2016.0670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/07/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Willy Baccaglini
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | - Cristina Carbajo
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Chaline Matushita
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Arie Carneiro
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Alexandre Pompeo
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Sidney Glina
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | | |
Collapse
|
8
|
Abstract
Lung adenocarcinomas with a mixture of tubular or papillary pattern, sheet-like or trabecular architecture, eosinophilic cytoplasm with centrally located nuclei and alpha-fetoprotein-producing cells have been described as hepatoid adenocarcinomas. Hepatoid adenocarcinomas are mainly found in the stomach but rare cases in other organs have been described. Immunostaining for alpha-fetoprotein (AFP), hepatocyte paraffin 1 (HepPar-1) and thyroid transcription factor-1 (TTF-1) helps in the diagnostic workup. Tumor behavior is still not entirely known but it seems to be associated with early metastases. We report on a 66-year-old, heavy-smoker male patient who had a 10-month history of respiratory complaints and weight loss. At the time he was hospitalized, respiratory failure was already established. The computed tomography corresponded to a collapsed right lung due to a poorly defined expanding mass. The bronchoscopy revealed narrowing of the inferior and medium lobar bronchi. The patient developed irreversible shock and died. At the right lung inferior lobe was extensively replaced by a grayish diffuse neoplasia in a “pneumonia-like” gross pattern. Metastatic disease was found in the right adrenal gland and thoracic and abdominal lymph nodes. Microscopic dissemination through lymphatics, pleura, and airways was detected. Histological examination revealed a poorly differentiated adenocarcinoma with hepatoid features. Immunohistochemmistry stains were positive for keratin 7, polyclonal carcinoembryonic antigen (CEA) in a diffuse pattern, AFP and HepPar-1 antibody. TTF-1 showed a diffuse granular cytoplasmic staining of the neoplastic cells, and only focal nuclear positivity. Multiple bilateral emboli originated from deep venous thrombosis were present in large and medium branches of the pulmonary artery and contributed to the cause of death.
Collapse
Affiliation(s)
- Lívia Barreira Cavalcante
- Department of Pathology - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | | |
Collapse
|