A case of ovarian small cell carcinoma of the pulmonary type that was observed as it developed

INTRODUCTION

In the case reported here, the authors observed ovarian small cell carcinoma of the pulmonary type as it developed.

CASE

The patient was a 48-year-old woman who underwent a hysterectomy for CIN3 in 2007. A year later, the woman underwent screening for ovarian cancer. A gradually growing ovarian mass was noted. This mass was found to be a mixed tumor. This mixed tumor grew to 36 mm in size, and six months later it had enlarged to 119 mm. After surgery, the tumor was pathologically diagnosed as an ovarian small cell carcinoma of the pulmonary type with a neuroendocrine nature that was positive for CD56 and synaptophysin. Postoperatively, the patient received six courses of combined therapy with irinotecan and cisplatin (CPT-P therapy), and the patient has survived disease- free for over two years.

CONCLUSION

Findings suggested that ovarian small cell carcinoma of the pulmonary type is a type I ovarian malignancy that develops through an adenoma-carcinoma sequence.

A case of familial Mediterranean fever-associated systemic amyloidosis

Familial Mediterranean fever (FMF) is a chronic inflammatory disease, characterized by recurrent fever and polyserositis (pleuritis and/or peritonitis). The most important complication of FMF is amyloidosis, which causes chronic renal failure. Colchicine is the most effective treatment in acute attacks and amyloidosis development. However, the majority of patients with amyloidosis have a relentless progression to end-stage renal disease despite initiation of colchicine treatment. We present the case of a 38-year-old man with FMF-associated chronic renal failure due to systemic amyloidosis. The patient suffered from periodic fever and renal insufficiency, and was admitted to our hospital. Laboratory examination revealed an inflammatory reaction, renal dysfunction (serum creatinine 2.5 mg/dl), and proteinuria. Renal biopsy revealed segmental mesangial AA amyloid deposits in several glomeruli and the walls of several vessels. Genetic analysis showed that the patient was heterozygous for the MEFV gene (E148Q/M694I). Thus, he was diagnosed with FMF, and colchicine treatment was initiated. He remained almost attack free, with decreasing serum creatinine levels (1.6 mg/dl) and diminishing urinary protein excretion. In conclusion, renal amyloidosis is the most important long-term complication of FMF, and treatment with colchicine is effective for preventing progression. Therefore, colchicine treatment should be initiated as early as possible after the diagnosis of FMF.

Paroxysmal nocturnal hemoglobinuria in systemic lupus erythematosus: a case report

Introduction

Paroxysmal nocturnal hemoglobinuria is an acquired disorder of hemopoiesis and is characterized by recurrent episodes of intravascular hemolysis due to an increased sensitivity to complement-mediated hemolysis. Systemic lupus erythematosus with paroxysmal nocturnal hemoglobinuria is very rare. We report a case of paroxysmal nocturnal hemoglobinuria that developed in a patient with systemic lupus erythematosus and lupus nephritis.

Case presentation

A 29-year-old Mongolian woman had systemic lupus erythematosus, which manifested only as skin lesions when she was 12 years old. She had leg edema and proteinuria when she was 23 years old, and a renal biopsy revealed lupus nephritis (World Health Organization type IV). She had been treated with steroids and immunosuppressant therapy. At 29, she had headaches, nausea, general fatigue, and severe pancytopenia and was admitted to our hospital. A laboratory evaluation showed hemolytic anemia. Further examination showed a neutrophil alkaline phosphatase score of 46 points, a CD55 value of 18%, and a CD59 value of 78.6%. The results of Ham test and sugar water tests were positive. The constellation of symptoms throughout the clinical course and the laboratory findings suggested paroxysmal nocturnal hemoglobinuria.

Conclusions

To the best of our knowledge, systemic lupus erythematosus with paroxysmal nocturnal hemoglobinuria is very rare. Clinicians should be aware of the association between autoimmune and hematological diseases.

Effects of tridocosahexaenoyl-glycerol emulsion on proteinuria in rats with nephrotoxic serum nephritis

Background

Docosahexaenoic acid (DHA) is one of the n–3 polyunsaturated fatty acids and an important component of cell membrane phospholipids (PL). Nephrotoxic serum (NTS) nephritis was a worldwide model of the Goodpasture syndrome. We investigated the effects of tridocosahexaenoyl-glycerol (DHA-TG) emulsion on proteinuria in rats with NTS nephritis.

Methods

Sixteen male Wistar rats weighing approximately 200 g were used. Twelve rats were treated with NTS via the tail vein and divided into 3 groups (groups A, B, and C). Another 4 rats treated with saline served as controls (group D). DHA-TG and soybean oil emulsions were intraperitoneally administered to the rats in groups A and B, respectively, 24 h prior to NTS injection, and 0, 1, 2, 3, 4, and 5 days after the injection. Saline was administered to the rats in groups C and D in the same manner. All rats were sacrificed on day 6 to obtain plasma and kidney samples. Analyses of urinary protein levels and fatty acid composition of plasma and kidney as well as histological examination of the kidneys were performed.

Results

Urinary protein levels in group A were significantly lower than those in group C (35.0 ± 13.3 vs. 79.2 ± 11.8 mg/day on day 5, means ± SE, p < 0.05). DHA levels in the PL fraction of the kidneys in group A were significantly increased compared with those in groups B and C.

Conclusions

These results suggest that the DHA-TG emulsion may have beneficial effects on NTS nephritis in the rat.

Extracellular matrix metalloproteinase inducer is expressed in the proximal tubular epithelial cells of the human kidney

AIM

Matrix metalloproteinases (MMP) affect matrix remodelling, and extracellular matrix metalloproteinase inducer (EMMPRIN) has been reported to increase the levels of several MMP. However, the expression of EMMPRIN in the human kidney and its regulatory mechanisms are not well known. In this study, we examined EMMPRIN expression in the human kidney with the biopsied specimens, cultured proximal tubular epithelial cells (PTEC) and human mesangial cells (HMC).

METHODS

EMMPRIN expression was examined by immunofluorescent (IF) study, reverse transcription polymerase chain reaction, western blotting and enzyme-linked immunosorbent assay. We also examined soluble EMMPRIN in the conditioned medium of PTEC stimulated by various agents and its effect in the activities of MMP-2 and MMP-9. Also, IF study in the several kidney diseases was performed to elucidate its role in pathological condition.

RESULTS

EMMPRIN expression was diffusely observed in the tubular epithelial cells of most patients and healthy adults, but was never observed in glomeruli. Cultured PTEC expressed EMMPRIN, while HMC did not. Soluble EMMPRIN was also detected by enzyme-linked immunosorbent assay in the conditioned medium of PTEC. Epidermal growth factor (50 ng/mL) and phorbol 12-myristate 13-acetate (10(-7) mol/L) stimulated the secretion of soluble EMMPRIN and increased the MMP-2 activity, although these agents did not increase the level of EMMPRIN mRNA. From the IF study, EMMPRIN expression was shown to decrease in tubulointerstitial nephritis.

CONCLUSION

EMMPRIN is widely distributed in the tubular epithelial cells of the adult human kidney and may regulate MMP-2 activity via its secretion from PTEC.

Serum lipid profile and plasma fatty acid composition in hemodialysis patients--comparison with chronic kidney disease patients

Polyunsaturated fatty acids (PUFA) are reported to be associated with atherosclerotic and inflammatory diseases because they are the major components of the cytoplasmic membrane and are the precursor fatty acids for prostaglandins and leukotrienes. In the present study, the serum lipid profile and plasma fatty acid composition in hemodialysis (HD) patients were determined and compared with those in chronic kidney disease (CKD) patients. Seventeen HD patients (HD group) and 36 CKD patients (CKD group) were entered in the present study. The estimated glomerular filtration ratio (eGFR) in the CKD group was under 60 ml/min/1.73m2. In the analysis of the serum lipid profile, triglyceride concentrations in the HD group were significantly lower than those in the CKD group (90.9 +/- 41.0 mg/dl vs. 136.2 +/- 64.9 mg.dl, p = 0.011). In the analysis of the plasma fatty acid composition, alpha-linolenic acids (0.81 +/- 0.28% vs. 0.99 +/- 0.22%, p = 0.016), eicosapentaenoic acids (EPA) (2.31 +/- 0.89% vs. 3.24 +/- 1.79%, p = 0.048), docosahexaenoic acids (4.10 +/- 1.09% vs. 5.15 +/- 1.65%, p = 0.021), the ratios of EPA to arachidonic acids (0.458 +/- 0.195 vs. 0.727 +/- 0.438, p = 0.019), and the ratios of n-3 PUFA to n-6 PUFA (0.219 +/- 0.062 vs. 0.320 +/- 0.162, p = 0.017) in the HD group were significantly lower than those in the CKD group. These results suggest that there might be disorders not only in serum lipid metabolism but also in plasma fatty acid metabolism in HD patients.

Beneficial effect of neutrophil elastase inhibitor on anti-Thy1.1 nephritis in rats

BACKGROUND

Neutrophil elastase, one of the proteinases released by neutrophils, plays an important role at the sites of inflammation and was reported to be involved in the pathogenesis of glomerulonephritis. Sivelestat is a selective neutrophil elastase inhibitor used for acute lung injury associated with systemic inflammatory response syndrome. There have been few reports on the effects of sivelestat on renal disease.

METHODS

In male Wistar rats, anti-Thy1.1 nephritis was induced by the injection of anti-Thy1.1 antibody. The rats were divided into four groups: nephritic rats treated with low- (group A) and high-dose sivelestat (group B), those not treated with sivelestat (group C) and control rats (group D). Urine samples were obtained every day during the experiment. The rats were killed on day 6 in order to obtain the blood plasma and kidneys. Measurement of urine protein levels, blood biochemical values and histological examination of the kidneys were carried out.

RESULTS

Increased levels of proteinuria were observed in the nephritic rats (groups A, B and C) compared with group D. The proteinuria level was significantly suppressed by sivelestat in groups A and B in a dose-dependent fashion compared with group C. The light microscopy revealed an increased glomerular cell count in group C, which was significantly suppressed in group B. In the electron microscopic study, sivelestat suppressed the fusion of epithelial foot process, especially in group B.

CONCLUSION

Neutrophil elastase is suggested to be involved in the development of anti-Thy1.1 nephritis, and the neutrophil elastase inhibitor sivelestat reduces the tissue injury of anti-Thy1.1 nephritis in rats.

Fatty acid composition of plasma and kidney in rats with anti-Thy1.1 nephritis

BACKGROUND

n-3 Polyunsaturated fatty acids (PUFA) are reported to ameliorate atherosclerotic and inflammatory diseases because they compete with arachidonic acid and reduce its inflammatory metabolites. In the present study, the fatty acid composition of plasma and kidney in rats with anti-Thy1.1 nephritis was investigated.

MATERIALS AND METHODS

A group of male Wister rats weighing about 200 g was injected with anti-Thy1.1 antibody (1.25 mL/kg) through their tail veins (nephritis group). Rats in the control group were injected with saline. Five days after the injection, urinary protein levels were determined. All rats were then sacrificed and fatty acid composition of plasma and kidney were analyzed.

RESULTS

Eicosapentaenoic acids (EPA) levels in the kidney phospholipid (PL) fraction in the nephritis group were significantly lower than those in the control group (0.67 +/- 0.06 mol% vs. 0.96 +/- 0.06 mol%, p < 0.05). EPA levels in the plasma PL fraction in the nephritis group were also significantly lower than those in the control group (0.38 +/- 0.05 mol% vs. 0.59 +/- 0.03 mol%, p < 0.05). Urinary protein levels 5 days after the injection were inversely correlated with EPA levels in the kidney PL fraction (r2 = 0.65, p = 0.01). These results suggested that decreased EPA levels in the kidney PL fraction might play an important role in anti-Thy1.1 nephritis.

Nephrotic syndrome associated with interferon-beta-1b therapy for multiple sclerosis

A 43-year-old woman with multiple sclerosis (MS) had nephrotic syndrome 21 months after starting treatment with interferon (IFN)-beta-1b (subcutaneous administration). She had taken no drug except for the IFN-beta-1b. Because nephrotic syndrome may be induced by IFN therapy, the IFN was stopped. Percutaneous renal biopsy revealed that she had minimal change nephrotic syndrome. As nephrotic-range proteinuria, hypoalbuminemia, and general edema were worsening even 2 weeks after cessation of the drug, oral corticosteroid therapy (prednisolone 40 mg/day) was started. The nephrotic syndrome was treated successfully with prednisolone. The dosage of prednisolone was tapered, without a relapse, and then the corticosteroid therapy was stopped. IFN-beta-1b therapy was then resumed, and the patient is in remission for both nephrotic syndrome and MS. Though proteinuria and nephrotic syndrome is a rare adverse effect of IFN-beta-1b therapy, physicians treating MS patients with this agent should pay careful attention to new clinical symptoms and laboratory findings.

Roxithromycin inhibits transforming growth factor-? production by cultured human mesangial cells

BACKGROUND

Transforming growth factor-beta (TGF-beta) plays an important role in progression of renal injury. However, few materials which inhibit TGF-beta have been known. Roxithromycin (ROX), macrolide antibiotics, is known to have anti-inflammatory, immunomodulatory and tissue reparative effects besides its bacteriostatic activity, although the exact mechanism of its anti-inflammatory and immunomodulatory effects was not defined. We examined the effect of ROX on production of TGF-beta and type IV collagen by cultured human mesangial cells (HMC).

METHODS

Human mesangial cells were incubated with several concentrations of ROX and TGF-beta and type IV collagen levels in the culture supernatants were measured by enzyme-linked immunoassay. Amount of TGF-beta mRNA was also quantified by using a colourimetric mRNA quantification kit and semiquantitative reverse transcriptase polymerase chain reaction. We also examined the effect of ROX on tyrosine kinase, MAP kinase and NF-kappaB stimulated by thrombin.

RESULTS

Roxithromycin (0.1-10.0 microg/mL) inhibited TGF-beta production by HMC in a dose- and time-dependent manner without inducing cell injury. ROX (10.0 microg/mL) also inhibited mRNA expression of TGF-beta in HMC. Thrombin (5 U/mL) stimulated TGF-beta production by HMC and ROX significantly inhibited the stimulating effect of thrombin on TGF-beta production. ROX also inhibited the increment of type IV collagen production stimulated by thrombin. ROX (10.0 microg/mL) suppressed the thrombin-induced NF-kappaB activation, although ROX did not inhibit the activation of tyrosine kinase and MAP kinase by thrombin.

CONCLUSION

Roxithromycin has an inhibitory effect on TGF-beta production by HMC possibly via inhibition of NF-kappaB. ROX may be a potential agent for the treatment of glomerulosclerosis.

Comparison of lipid and fatty acid metabolism between minimal change nephrotic syndrome and membranous nephropathy

Polyunsaturated fatty acids have been reported to be associated with atherosclerotic and inflammatory diseases, as they are the major components of cytoplasmic membranes and the precursor fatty acids for prostaglandins and leukotrienes. Nephrotic syndrome is associated with serum lipid disorders, such as hypercholesterolemia due to the increased production of lipoproteins by the liver. However, there are few reports regarding the fatty acid metabolism in patients with nephrotic syndrome. In the present study, serum lipid concentrations and plasma fatty acid composition were measured in patients with minimal change nephritic syndrome (MCNS) and membranous nephropathy (MN). Seven patients with MCNS (MCNS group), 11 patients with MN (MN group) and 8 healthy subjects (control group) were enrolled in the study. All patients were diagnosed by percutaneous renal biopsy. Fasting blood samples were obtained and the serum lipid profile was measured enzymatically. The fatty acid composition of plasma was analyzed by gas-chromatography after transmethylation. There were no significant differences in serum urea nitrogen and creatinine levels among the three groups. Patients with MN were older than those with MCNS. In the serum lipid profile, hypercholesterolemia was observed both in the MCNS and MN groups. Regarding the plasma fatty acid composition, alpha-linolenic acid levels in the MCNS group were significantly higher than those in the control group (1.06 +/- 0.08 wt% vs. 0.77 +/- 0.16 wt%, p = 0.008) and docosahexaenoic acid levels in the MN group were significantly higher than those in the control group (5.51 +/- 1.17 wt% vs. 3.96 +/- 1.07 wt%, p = 0.005). These results suggest that nephrotic syndrome might not only disrupt lipid metabolism but also fatty acid metabolism.

Hypoxic conditions stimulate the production of angiogenin and vascular endothelial growth factor by human renal proximal tubular epithelial cells in culture

BACKGROUND

Chronic low oxygen in the tubulointerstitial area is a crucial cause of renal degradation and tubulointerstitial damage. Previous reports have suggested that the maintenance of renal blood flow plays a role in the suppression of progressive renal damage. Neovascularization is important for the maintenance of blood flow. We studied the production of angiogenic factors by culturing renal proximal tubular epithelial cells (PTEC) under hypoxic conditions.

METHODS

Cultured PTEC were exposed to normal and low-oxygen conditions. The levels of angiogenin (ANG) and vascular endothelial growth factor (VEGF) in the cell supernatants were measured by enzyme-linked immunosorbent assay. The messenger RNAs (mRNAs) of ANG and VEGF in the PTEC were examined by real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR). The presence of ANG, VEGF and hypoxia-inducible factor-1 (HIF-1) was studied by immunofluorescence techniques. The effect of cobalt chloride (CoCl(2)), which is an HIF-1 inducer, on the production of ANG and VEGF was also examined in order to elucidate the contribution of the HIF-1 pathway to the production of these cytokines.

RESULTS

ANG and VEGF were demonstrated to exist in the cell supernatants, and ANG and VEGF mRNAs were detected in the PTEC. Hypoxic conditions stimulated the secretion of ANG (2.5-fold vs normoxia, P<0.001) and VEGF (3.2-fold vs normoxia, P<0.001) by PTEC. Hypoxic conditions increased the mRNA expression of ANG for 6 h (1.38-fold vs normoxia, P<0.05) and VEGF for 24 h (2.04-fold vs normoxia, P<0.01). Hypoxic conditions also enhanced ANG, VEGF and HIF-1 protein expression in PTEC. The CoCl(2) increased the secretion of ANG (5.2-fold vs control, P<0.0001) and VEGF (2.3-fold vs control, P<0.0001) by PTEC.

CONCLUSION

Under hypoxic conditions, the ANG and VEGF secreted by PTEC may modulate angiogenesis and vascular remodeling in the renal interstitium via an increase in the production of HIF-1.

Hepatitis C virus-associated glomerulonephritis without hepatitis C virus in the blood

An 82-year-old woman with nephrotic syndrome and a 61-year-old woman with proteinuria and purpura on the lower extremities are reported. Both patients had test results positive for hepatitis C virus (HCV) antibody, but HCV RNA was not detected in the blood of either patient. The kidney biopsy showed membranoproliferative glomerulonephritis with capillary deposition of C3 and immunoglobulin M, indicating HCV-associated glomerulonephritis. These cases are suggestive to study the pathogenesis of this disease.

Effects of eicosapentaenoic acids on oxidative stress and plasma fatty acid composition in patients with lupus nephritis

Eicosapentaenoic acid (EPA) is one of the major components of fish oil, which was reported to have antiatherogenic, anti-inflammatory and immune suppressive effects. In the present study, highly purified EPA was administered to patients with lupus nephritis and the effects of EPA on urinary 8-isoprostane, a reliable marker of oxidative stress, were investigated in these patients. Six outpatients (1 man and 5 women), with lupus nephritis diagnosed by renal biopsy, were entered in the study. We administered 1800 mg EPA ethyl-ester (purity > 95%) daily and examined the urinary 8-isoprostane levels and plasma fatty acid composition before and 3 months after EPA treatment. The urinary 8-isoprostane levels were significantly decreased after the treatment compared with those before the treatment (from 530 +/- 113 pg/mg x Cr to 235 +/- 49 pg/mg x Cr, p = 0.02). The EPA levels in the plasma phospholipid (PL) fraction were significantly increased after the treatment (from 3.30 +/- 0.64 mol% to 8.01 +/- 0.47 mol%, p < 0.001). Arachidonic acid (AA) levels in the plasma PL fraction were significantly decreased after the treatment (from 9.47 +/- 0.28 mol% to 7.33 +/- 0.43 mol%, p < 0.001). The ratios of EPA to AA were significantly increased after the treatment (from 0.35 +/- 0.07 to 1.14 +/- 0.16, p < 0.001). Thus, this preliminary study indicated that EPA might exert beneficial effects on lupus nephritis by decreasing the oxidative stress.