1
|
Chen Y, Yu ZH. [Diagnosis and treatment of acute focal bacterial nephritis in children]. Zhonghua Er Ke Za Zhi 2024; 62:486-489. [PMID: 38623021 DOI: 10.3760/cma.j.cn112140-20231121-00384] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Y Chen
- Department of Nephrology, Rheumatology and Immunology, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350014, China
| | - Z H Yu
- Department of Nephrology, Rheumatology and Immunology, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350014, China
| |
Collapse
|
2
|
Mikami N, Sasaki K, Hashimoto N, Tsunematsu K, Hamada R. A case of tubulointerstitial nephritis mimicking acute focal bacterial nephritis. Lesson for the clinical nephrologist. J Nephrol 2024; 37:507-510. [PMID: 37819575 DOI: 10.1007/s40620-023-01738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/07/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Naoaki Mikami
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Keigo Sasaki
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Nobuhiro Hashimoto
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
- Department of Pediatrics, Hino Municipal Hospital, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kenichiro Tsunematsu
- Department of Pediatrics, Hino Municipal Hospital, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Riku Hamada
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
| |
Collapse
|
3
|
Lin T, Chen C, Tu J, Li H. Two Cases of Acute Focal Bacterial Nephritis With Central Nervous System Manifestations in Children and Literature Review. Clin Pediatr (Phila) 2023; 62:1385-1389. [PMID: 36908098 DOI: 10.1177/00099228231159060] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Acute focal bacterial nephritis (AFBN) is a kidney disease characterized by a localized bacterial infection that manifests as an inflammatory mass. Most children with AFBN have nonspecific symptoms including fever, vomiting, and abdominal discomfort, and some develop neurological symptoms such as meningeal irritation, unconsciousness, and seizures as their condition worsens. This was 2 cases of AFBN with central nervous system manifestations in children, and we analyzed its possible mechanisms of the clinical and radiographic features. We experience 2 very unusual cases of AFBN which were linked to central nervous system abnormalities. A 6-year-old boy with AFBN and clinically moderate ncephalitis/encephalopathy with a reversible splenial lesion (MERS) presented with neurological symptoms, including unconsciousness and convulsions. The second case involved an 8-year-old child with AFBN-associated acute encephalopathy who exhibited neurological symptoms, including unconsciousness. According to previous research, AFBN is linked to central nervous system impairment. As a result, when a clinician meets a patient with an inexplicable fever caused by a neurological condition, he should pay attention to this diagnosis of AFBN and follow it in the abdominal graph.
Collapse
Affiliation(s)
- Tiantian Lin
- Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Chaoying Chen
- Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Juan Tu
- Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Huarong Li
- Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| |
Collapse
|
4
|
Wright RD, Marro J, Northey SJ, Corkhill R, Beresford MW, Oni L. Urinary complement proteins are increased in children with IgA vasculitis (Henoch-Schönlein purpura) nephritis. Pediatr Nephrol 2022; 38:1491-1498. [PMID: 36227437 PMCID: PMC10060309 DOI: 10.1007/s00467-022-05747-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with immunoglobulin A vasculitis (IgAV Henoch-Schönlein purpura) frequently encounter nephritis (IgAV-N) with 1-2% risk of kidney failure. The pathophysiology of IgAV-N is not fully understood with speculation that complement may contribute. The aim of this study was to identify whether urinary complement proteins are increased in children with IgAV-N. METHODS A cross-sectional prospective cohort of children with IgAV were recruited together with controls including healthy children and children with systemic lupus erythematosus (SLE). Patients were subdivided according to the presence of nephritis. Urinary C3, C4, C5, and C5a were measured by enzyme-linked immunosorbent assay (ELISA) and corrected for urinary creatinine. RESULTS The study included 103 children; 47 with IgAV (37 IgAV without nephritis, IgAVwoN; 10 IgAV-N), 30 SLE and 26 healthy children. Urinary complement C3, C4, and C5 were all statistically significantly increased in all children with IgAV compared to SLE patients (all p < 0.05). In patients with IgAV-N, urinary complement C3, C4, C5, C5a were all statistically significantly increased compared to IgAVwoN (C3 14.65 μg/mmol [2.26-20.21] vs. 2.26 μg/mmol [0.15-3.14], p = 0.007; C4 6.52 μg/mmol [1.30-9.72] vs. 1.37 μg/mmol [0.38-2.43], p = 0.04; C5 1.36 μg/mmol [0.65-2.85] vs. 0.38 μg/mmol [0.03-0.72], p = 0.005; C5a 101.9 ng/mmol [15.36-230.0] vs. 18.33 ng/mmol [4.27-33.30], p = 0.01). Using logistic regression, the urinary complement components produced an outstanding ability to discriminate between patients with and without nephritis in IgAV (AUC 0.92, p < 0.001). CONCLUSIONS Children with IgAV-N have evidence of increased complement proteins present in their urine that may indicate a pathological role and may allow treatment stratification. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Rachael D Wright
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Julien Marro
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Sarah J Northey
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Rachel Corkhill
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | - Louise Oni
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.
| |
Collapse
|
5
|
Singh S, Clemente LC, Parra ER, Tchakarov A, Yang C, Li Y, Long JP, Yee C, Lin JS. Urinary T cells are detected in patients with immune checkpoint inhibitor-associated immune nephritis that are clonotypically identical to kidney T cell infiltrates. Oncoimmunology 2022; 11:2124678. [PMID: 36185804 PMCID: PMC9519023 DOI: 10.1080/2162402x.2022.2124678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 10/28/2022] Open
Abstract
Acute kidney injury (AKI) occurs in ~20% of patients receiving immune checkpoint inhibitor (ICI) therapy; however, only 2-5% will develop ICI-mediated immune nephritis. Conventional tests are nonspecific in diagnosing disease pathology and invasive procedures (i.e. kidney biopsy) may not be feasible. In other autoimmune renal diseases, urinary immune cells correlated with the pathology or were predictive of disease activity. Corresponding evidence and analysis are absent for ICI-mediated immune nephritis. We report the first investigation analyzing immune cell profiles of matched kidney biopsies and urine of patients with ICI-AKI. We demonstrated the presence of urinary T cells in patients with immune nephritis by flow cytometry analysis. Clonotype analysis of T cell receptor (TCR) sequences confirmed enrichment of kidney TCRs in urine. As ICI therapies become standard of care for more cancers, noninvasively assessing urinary immune cells of ICI therapy recipients can facilitate clinical management and an opportunity to tailor ICI-nephritis treatment.
Collapse
Affiliation(s)
- Shailbala Singh
- Department of Melanoma Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leticia C. Clemente
- Department of Translational Molecular Pathology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edwin R. Parra
- Department of Translational Molecular Pathology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda Tchakarov
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Chao Yang
- Department of Biostatistics, Division of Basic Sciences, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yisheng Li
- Department of Biostatistics, Division of Basic Sciences, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James P. Long
- Department of Biostatistics, Division of Basic Sciences, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cassian Yee
- Department of Melanoma Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Immunology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jamie S. Lin
- Section of Nephrology, Division of Internal Medicine, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
6
|
Becerir T, Girişgen İ, Ufuk F, Gülten G, Yuksel S. Acute focal bacterial nephritis and prolonged fever. Paediatr Int Child Health 2022; 42:169-172. [PMID: 37573549 DOI: 10.1080/20469047.2023.2235932] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2023] [Indexed: 08/15/2023]
Abstract
Acute focal bacterial nephritis (AFBN) is characterised by a complicated upper urinary tract infection ranging from acute pyelonephritis to renal abscess. Timely diagnosis of AFBN is important because antibiotic therapy of longer duration is required. A 10-year-old boy presented with fever for 5 days and bilateral flank pain. He was oriented and cooperative but appeared ill. Physical examination did not reveal any oedema or costovertebral angle tenderness. Acute phase reactants such as erythrocyte sedimentation rate and C-reactive protein were raised, serum creatinine was 1.25 mg/dL (0.31-0.88) and leucocyte esterase was positive in the urine. Ultrasonographic examination demonstrated bilaterally enlarged kidneys with increased echogenicity. Because of the high creatinine level, abdominal magnetic resonance imaging (MRI) was performed instead of computed tomography (CT) for further evaluation. The MRI showed an increase in the size of both kidneys, renal cortical heterogeneity and multiple cortical nodular lesions with diffusion restriction (constrained Brownian movement of water molecules) on diffusion-weighted MRI. A negative urine culture result in children presenting with fever and abdominal pain may mislead the clinicians, causing them to miss a nephro-urological diagnosis. It is therefore recommended that patients in whom the cause of fever cannot be determined be scanned by ultrasound and examined by CT or MRI so that undiagnosed and/or suspected cases of AFBN might be detected.
Collapse
Affiliation(s)
- Tülay Becerir
- Departments of Pediatric Nephrology, Pamukkale University School of Medicine, Kınıklı Yerleşkesi, Turkey
| | - İlknur Girişgen
- Departments of Pediatric Nephrology, Pamukkale University School of Medicine, Kınıklı Yerleşkesi, Turkey
| | - Furkan Ufuk
- Departments of Radiology, Pamukkale University School of Medicine, Kınıklı Yerleşkesi, Turkey
| | - Gülsün Gülten
- Departments of Pathology, Pamukkale University School of Medicine, Kınıklı Yerleşkesi, Turkey
| | - Selcuk Yuksel
- Departments of Pediatric Rheumatology and Nephrology, Pamukkale University School of Medicine, Kınıklı Yerleşkesi, Turkey
| |
Collapse
|
7
|
Balder JW, Blok BA, Meijer E, Franssen C, Luik PT, Remmelts HHF. [Glomerular hematuria: an atypical presentation of anti-glomerular basement membrane nephritis]. Ned Tijdschr Geneeskd 2022; 166:D6126. [PMID: 35138706] [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: 06/14/2023]
Abstract
BACKGROUND Urologic diseases can cause hematuria, but dysmorphic erythrocytes directs to a glomerular disease. The latter might occur isolated or in the presence of systemic complaints, proteinuria or kidney failure. These factors determine the differential diagnosis that ranges from an innocent IgA nephropathy to a fatal anti-glomerular basement membrane (GBM) nephritis. CASE A 30-year old patient attended the outpatient clinic because of glomerular hematuria and normal kidney function with working diagnosis IgA nephropathy. Three months later he presented to the emergency department with a severe acute kidney injury duo to an anti-GBM nephritis. In retrospect, the anti-GBM titer was already high during the outpatient clinic phase, but due to the preserved kidney function, anti-GBM nephritis was not added to the differential diagnosis. CONCLUSION Glomerular hematuria with a preserved kidney function could in a rare instance be caused by a subclinical anti-GBM nephritis. Follow-up of the kidney function and comprehensive laboratory testing - or even a kidney biopsy - could potentially lead to an early diagnosis of anti-GBM nephritis.
Collapse
Affiliation(s)
- Jan-Willem Balder
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
- Contact: Jan-Willem Balder
| | - Bastiaan A Blok
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
| | | | | | - Peter T Luik
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
| | | |
Collapse
|
8
|
Ma X, Zhang J, Zhang C, Yang X, Yu A, Huang Y, Zhang S, Ouyang G. Targeting Enrichment and Correlation Studies of Glutathione and Homocysteine in IgAVN Patient Urine Based on a Core-Shell Zr-Based Metal-Organic Framework. ACS Appl Mater Interfaces 2021; 13:40070-40078. [PMID: 34387999 DOI: 10.1021/acsami.1c09967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Aminothiols are closely related to chronic kidney disease, but little is known regarding levels of related aminothiols in the urine of immunoglobulin A vasculitis with nephritis (IgAVN) patients. Herein, a well-defined core-shell Zr-based metal-organic framework (Zr-MOF) composite SiO2@50Benz-Cys was constructed as a mercury ion affinity material via a solvent-assisted ligand exchange strategy for the selective extraction and enrichment of low-concentration aminothiols in IgAVN patient urine. SiO2@50Benz-Cys was competent to enrich the total glutathione (GSH) and total homocysteine (Hcy) in virtue of the excellent affinity after chelation with mercury ions. The extraction efficiencies were closely related to the pH, dithiothreitol amount, and the dose of functional Zr-MOF. Coupled with HPLC-MS/MS in optimized conditions, GSH and Hcy were determined with low detection limits of 0.5 and 1 nmol L-1, respectively. The recoveries of GSH and Hcy for the urine sample at three spiked levels were in the range of 85.3-105% and 79.5-103%, which showed good precision and accuracy. Benefiting from the matrix interference elimination in the process of extraction, the simultaneous detection of aminothiols in the urine of the healthy group and immunoglobulin A vasculitis (IgAV) and IgAVN patients was successfully carried out, suggesting that the Zr-MOF and the robust method together provided a potential application in the analysis of urinary biomolecules. The analysis of variance (ANOVA) showed that the levels of GSH and Hcy had significant differences between the patients and the control. This work is very valuable as it provides a better understanding of concentration alterations of GSH and Hcy in urine involved with IgAVN for clinical research.
Collapse
Affiliation(s)
- Xue Ma
- College of Chemistry, Key Laboratory of Molecular Sensing and Harmful Substances Detection Technology, Zhengzhou University, Kexue Avenue 100, Zhengzhou, Henan 450001, P. R. China
| | - Jinghua Zhang
- College of Medicine, Zhengzhou University, Kexue Avenue 100, Zhengzhou, Henan 450001, P. R. China
| | - Chong Zhang
- College of Chemistry, Key Laboratory of Molecular Sensing and Harmful Substances Detection Technology, Zhengzhou University, Kexue Avenue 100, Zhengzhou, Henan 450001, P. R. China
| | - Xiaoqing Yang
- Henan University of Chinese Medicine, Zhengzhou 450008, P. R. China
| | - Ajuan Yu
- College of Chemistry, Key Laboratory of Molecular Sensing and Harmful Substances Detection Technology, Zhengzhou University, Kexue Avenue 100, Zhengzhou, Henan 450001, P. R. China
| | - Yanjie Huang
- Henan University of Chinese Medicine, Zhengzhou 450008, P. R. China
| | - Shusheng Zhang
- Center of Advanced Analysis and Gene Sequencing, Key Laboratory of Molecular Sensing and Harmful Substances Detection Technology, Zhengzhou University, Kexue Avenue 100, Zhengzhou, Henan 450001, P. R. China
| | - Gangfeng Ouyang
- Center of Advanced Analysis and Gene Sequencing, Key Laboratory of Molecular Sensing and Harmful Substances Detection Technology, Zhengzhou University, Kexue Avenue 100, Zhengzhou, Henan 450001, P. R. China
| |
Collapse
|
9
|
Zhong Z, Tan J, Tang Y, Li Z, Qin W. Goodpasture syndrome manifesting as nephrotic-range proteinuria with anti-glomerular basement membrane antibody seronegativity: A case report. Medicine (Baltimore) 2020; 99:e22341. [PMID: 32991448 PMCID: PMC7523814 DOI: 10.1097/md.0000000000022341] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The Goodpasture syndrome is an extremely rare disease, with renal and pulmonary manifestations, and is mediated by anti-glomerular basement membrane (anti-GBM) antibodies. Renal pathological changes are mainly characterized by glomerular crescent formation and linear immunofluorescent staining for immunoglobulin G on the GBM. There are few reports on the atypical course of the syndrome involving serum-negative anti-GBM antibodies. Therefore, we present a case of Goodpasture syndrome that presented with nephrotic-range proteinuria and was seronegative for anti-GBM antibodies. PATIENT CONCERNS A 38-year-old Chinese man presented with a lung lesion that was discovered by physical examination a month prior to presentation. The chief concern was occasional hemoptysis without fever, cough, chest pain, and edema. DIAGNOSES Laboratory testing revealed that the urinary protein level and urine erythrocyte count were 7.4 g/24 hours and 144/high-power field (HPF), respectively. Serological testing for anti-GBM antibodies was negative. Chest computed tomography revealed multiple exudative lesions in both lungs, indicating alveolar infiltration and hemorrhage. Electronic bronchoscopy and pathological examination of the alveolar lavage fluid indicated no abnormalities. However, kidney biopsy suggested cellular crescent formation and segmental necrosis of the globuli, with linear IgG and complement C3 deposition on the GBM. These findings were consistent with the diagnosis of anti-GBM antibody nephritis. INTERVENTIONS The patient underwent 7 sessions of double filtration plasmapheresis. He was also administered with intravenous methylprednisolone and cyclophosphamide. After renal function stabilization, he was discharged under an immunosuppressive regimen comprising of glucocorticoids and cyclophosphamides. OUTCOMES Three months later, follow-up examination revealed that the 24-hour urine protein had increased to 13 g. Furthermore, the urine erythrocyte count was 243/HPF. After a 6-month follow-up, the patient achieved partial remission, with a proteinuria level of 3.9 g/24 hours and a urine erythrocyte count of 187/HPF. LESSONS This extremely rare case of Goodpasture syndrome manifested with seronegativity for anti-GBM antibodies and nephrotic-range proteinuria. Our findings emphasize the importance of renal biopsy for the clinical diagnosis of atypical cases. Furthermore, because renal involvement achieved only partial remission despite therapy, early detection and active treatment of the Goodpasture syndrome is necessary to improve the prognosis of patients.
Collapse
Affiliation(s)
- ZhengXia Zhong
- Division of Nephrology, Department of Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - JiaXing Tan
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - ZhengFu Li
- Department of Respiration, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| |
Collapse
|
10
|
Feit L, John D, Delgado Torres N, Sinert R. Flank pain and hematuria is not always a kidney stone. Am J Emerg Med 2020; 40:225.e1-225.e2. [PMID: 32958382 DOI: 10.1016/j.ajem.2020.07.046] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with flank pain and hematuria are common emergency department presentations of nephrolithiasis. We may anchor on this etiology and potentially miss other less common differentials. We present a case of a patient with hematuria and flank pain typical of nephrolithiasis who was diagnosed with a Page kidney causing secondary hypertension. A 50 year-old male with no significant past medical history presented to the Emergency Department with severe left-sided flank pain, vomiting, and blood-tinged urine. We pursued a diagnosis of nephrolithiasis and found a left renal subcapsular hematoma on non-contrast CT. A CTA was done with no active hemorrhage found. The patient had no history of recent trauma and was found to be hypertensive on evaluation. Urology was consulted and management for the patient's hypertension was initiated. He was diagnosed with Page Kidney and admitted to medicine for observation and hypertension management with an angiotensin-converting enzyme inhibitor. Page Kidney is a diagnosis that describes compression of the renal parenchyma by a hematoma or mass causing secondary hypertension through the activation of the renin-angiotensin-aldosterone system. Causes may include traumatic subcapsular hematoma, renal cyst rupture, tumor, hemorrhage, arteriovenous malformation, among others. Treatment may involve conservative measures including hypertension management, or more invasive measures like evacuation or nephrectomy. We describe the case of a patient presumed to have nephrolithiasis presenting with typical left-sided flank pain, diagnosed with Page kidney, and treated conservatively.
Collapse
Affiliation(s)
- Lisa Feit
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA.
| | - Delna John
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| | - Nayla Delgado Torres
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| | - Richard Sinert
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| |
Collapse
|
11
|
Abstract
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
Collapse
Affiliation(s)
- Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA.
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
| |
Collapse
|
12
|
Abstract
RATIONALE Fabry's disease is an X-linked inherited syndrome. Herein, we presented an unusual case of Fabry disease coexisting with immunoglobulin A nephropathy (IgAN) presenting with Alport syndrome-like pathological findings. PATIENT CONCERNS We report a 30-year-old male who presented with proteinuria and elevated serum creatinine and for whom the initial pathologic diagnosis supported Alport syndrome. DIAGNOSES A diagnosis of Fabry disease with immunoglobulin A nephropathy (IgAN) was finally made after further examination. INTERVENTIONS After the initial diagnosis the patient was treated with herbal medications and mecobalamin. OUTCOMES The patient was discharged 1 week later. He was maintained on these treatments and received regular follow-up in our hospital. LESSONS SUBSECTIONS AS PER STYLE FD coexisting with IgAN is rare and may have nonspecific clinical presentations. Laboratory examination and genetic diagnosis is needed for confirmation. Timely diagnosis and reproductive intervention is needed for therapy.
Collapse
Affiliation(s)
| | - Lin Li
- Department of Nephrology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Jiyun Yu
- Department of Nephrology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Shan Wu
- Department of Nephrology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | | | | | - Weixia Sun
- Department of Nephrology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| |
Collapse
|
13
|
Buscatti IM, Casella BB, Aikawa NE, Watanabe A, Farhat SCL, Campos LMA, Silva CA. Henoch-Schönlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center. Clin Rheumatol 2018; 37:1319-1324. [PMID: 29330742 DOI: 10.1007/s10067-017-3972-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 11/10/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate prevalence, initial risk factors, and outcomes in Henoch-Schönlein purpura nephritis (HSPN) patients in Latin America. Two hundred ninety-six patients (validated EULAR/PRINTO/PRES HSP criteria) were assessed by demographic data, clinical/laboratorial involvements, and treatments in the first 3 months after diagnosis. They were followed-up in a Latin American tertiary center and were divided in two groups: with and without nephritis. Persistent non-nephrotic proteinuria, nephrotic proteinuria, and acute/chronic kidney injury were also systematically evaluated at 1, 5, 10, and 15 years after diagnosis. HSPN was evidenced in 139/296 (47%) in the first 3 months. The median age at diagnosis was significantly higher in HSPN patients compared without renal involvement [6.6 (1.5-17.7) vs. 5.7 (0.9-13.5) years, p = 0.022]. The frequencies of persistent purpura (31 vs. 10%, p < 0.0001), recurrent abdominal pain (16 vs. 7%, p = 0.011), gastrointestinal bleeding (25 vs. 10%, p < 0.0001), and corticosteroid use (54 vs. 41%, p = 0.023) were significantly higher in the former group. Logistic regression demonstrated that the independent variables associated with HSNP were persistent purpura (OR = 3.601; 95% CI (1.605-8.079); p = 0.002) and gastrointestinal bleeding (OR = 2.991; 95% CI (1.245-7.183); p = 0.014). Further analysis of patients without HSPN in the first 3 months revealed that 29/118 (25%) had persistent non-nephrotic proteinuria and/or hematuria in 1 year, 19/61 (31%) in 5 years, 6/17 (35%) in 10 years and 4/6 (67%) in 15 years after diagnosis. None of them had chronic kidney injury or were submitted to renal replacement therapy. The present study observed HSPN in almost one half of patients in the first months of disease, and HSPN was associated with persistent purpura and gastrointestinal bleeding. One fourth of patients had nephritis only evidenced during follow-up without severe renal manifestations.
Collapse
Affiliation(s)
- Izabel M Buscatti
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Beatriz B Casella
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Nadia E Aikawa
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Andrea Watanabe
- Pediatric Nephrology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Sylvia C L Farhat
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Lucia M A Campos
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
- , São Paulo, Brazil.
| |
Collapse
|
14
|
Rekalov D, Prytkova A, Kulynych R, Protsenko G, Protsenko V. NEPHROPATHY IN EARLY RHEUMATOID ARTHRITIS PATIENTS: DOES A SIGNIFICANT RISK EXIST? Georgian Med News 2018:79-88. [PMID: 29461232] [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: 06/08/2023]
Abstract
Objective of the study layed in assessment of the pathophysiological relation between cell-mediated immunity (tumor necrosis factor-alpha (TNF-α) inflammatory cytokine) activation and renal dysfunction in the patients with early rheumatoid arthritis. We analyzed the data from 35 early rheumatoid arthritis (RA) patients of average age of 50,71±2,25 years (ranged 18-76 years, 80% of women) with 9,21±0,43 months mean duration of the disease by the time of the study initiation. Urine and blood tests were performed to verify the main indicators of kidney function and inflammation cytokines significant interaction. All signs of renal dysfunction at the baseline in the patients with early RA were associated with glomerular filtration rate decrease and excretion of urine protein increase. Dynamics of albuminuria, according to the analysis of variance for one-factor scheme, were significantly determined by the state of disease activity, reflecting the severity of joint damage. High urine β-2-microglobulin level was significantly associated with the expression rate of main inflammatory cytokines as per binary regression analysis. The obtained dependence showed the dynamics of expression of tubular disorders in early RA with a progressive deterioration which did associate with the levels of TNF-α expression, and variety of the urine miсroglobulin rates in the interval 200-350 μg/L. Reliable correlation (r=0.51, p<0.05) between beta-2-microglobulinuria and TNF-α levels was clearly shown, revealing the relationship described by the formula MGU=- 81+937×log10 (TNF-α) as per regression analysis. The severity of tubular damage in early RA is associated with TNF-α expression, especially in the patients with TNF-α above 250 pg/mL, when microalbuminuria rates were significantly higher (p=0.00043). We identified robust data that in the early RA patients with high TNF-α, the number of reported cases of microalbuminuria was significantly higher than in those with low levels.
Collapse
Affiliation(s)
- D Rekalov
- Zaporizhzhia State Medical University, Department of Internal Diseases-3; Department of pharmacology; Communal Utility "Zaporizhzhia Regional Clinical Hospital" of Zaporizhzhia Regional Council Hospital, Department of Rheumatology; National Scientific Center "M.D. Strazhesko Insitute of Cardiology, MAS of Ukraine Ukraine", Department of Myocardial Diseases and Clinical Rheumatology, Kyiv; Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - A Prytkova
- Zaporizhzhia State Medical University, Department of Internal Diseases-3; Department of pharmacology; Communal Utility "Zaporizhzhia Regional Clinical Hospital" of Zaporizhzhia Regional Council Hospital, Department of Rheumatology; National Scientific Center "M.D. Strazhesko Insitute of Cardiology, MAS of Ukraine Ukraine", Department of Myocardial Diseases and Clinical Rheumatology, Kyiv; Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - R Kulynych
- Zaporizhzhia State Medical University, Department of Internal Diseases-3; Department of pharmacology; Communal Utility "Zaporizhzhia Regional Clinical Hospital" of Zaporizhzhia Regional Council Hospital, Department of Rheumatology; National Scientific Center "M.D. Strazhesko Insitute of Cardiology, MAS of Ukraine Ukraine", Department of Myocardial Diseases and Clinical Rheumatology, Kyiv; Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - G Protsenko
- Zaporizhzhia State Medical University, Department of Internal Diseases-3; Department of pharmacology; Communal Utility "Zaporizhzhia Regional Clinical Hospital" of Zaporizhzhia Regional Council Hospital, Department of Rheumatology; National Scientific Center "M.D. Strazhesko Insitute of Cardiology, MAS of Ukraine Ukraine", Department of Myocardial Diseases and Clinical Rheumatology, Kyiv; Ukrainian National Cancer Institute, Kyiv, Ukraine
| | - V Protsenko
- Zaporizhzhia State Medical University, Department of Internal Diseases-3; Department of pharmacology; Communal Utility "Zaporizhzhia Regional Clinical Hospital" of Zaporizhzhia Regional Council Hospital, Department of Rheumatology; National Scientific Center "M.D. Strazhesko Insitute of Cardiology, MAS of Ukraine Ukraine", Department of Myocardial Diseases and Clinical Rheumatology, Kyiv; Ukrainian National Cancer Institute, Kyiv, Ukraine
| |
Collapse
|
15
|
Bakker AM, Vijgen GHEJ, Hartwig NG, Tramper-Stranders GA. [A child with abdominal pain and fever: consider acute lobar nephritis - diagnostic considerations when the appendix is invisible on ultrasound]. Ned Tijdschr Geneeskd 2018; 162:D2392. [PMID: 29600927] [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: 06/08/2023]
Abstract
Acute lobar nephritis (ALN) is a focal interstitial bacterial infection of the renal parenchyma. ALN is described as a midpoint between an acute pyelonephritis and renal abscess. ALN is underdiagnosed in children due to both non-specific symptoms and negative urinalysis/bacteriuria laboratory findings. The gold standard for diagnosis of ALN is CT scanning, however MRI can be considered to avoid radiation exposure. Diagnosing ALN is relevant, because it requires prolonged antibiotic treatment. Insufficient antibiotic treatment could cause renal scarring and subsequent hypertension or renal failure. Outpatient follow-up is indicated to exclude congenital urogenital abnormalities. We describe two paediatric patients with acute abdominal pain and fever who were suspected to have appendicitis (appendix not visualised by ultrasonography), but eventually were diagnosed with ALN and a renal abscess (despite absence of pyuria). These reports serve to highlight the issues around the recognition and diagnosis of ALN in children, and the need for clinicians to be mindful of this condition.
Collapse
Affiliation(s)
- A M Bakker
- Franciscus Gasthuis & Vlietland, Rotterdam
| | | | | | | |
Collapse
|
16
|
Akinyemi AJ, Faboya OL, Paul AA, Olayide I, Faboya OA, Oluwasola TA. Nephroprotective Effect of Essential Oils from Ginger (Zingiber officinale) and Turmeric (Curcuma longa) Rhizomes against Cadmium-induced Nephrotoxicity in Rats. J Oleo Sci 2018; 67:1339-1345. [PMID: 30305562 DOI: 10.5650/jos.ess18115] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Several studies have shown that cadmium (Cd) induces nephrotoxicity and many plant foods phytochemicals have been found useful but their possible mechanism of action still remains unexplored. Hence, this study aimed to investigate the nephroprotective effect of essential oils from Nigeria ginger and turmeric rhizomes in cadmium-treated rats by examining their effect on renal function biomarkers (creatinine, urea and BUN), inflammatory cytokines (IL-6, IL-10 and TNF-Alpha) and renal adenosine deaminase (ADA) activity. The result revealed that essential oils from ginger and turmeric rhizomes exert anti-inflammatory effect by preventing alterations of renal function markers and cytokines (IL-6, IL-10 and TNF-Alpha) levels in Cd-treated rats. In addition, the essential oils inhibited renal ADA activity in Cdtreated rats. In conclusion, inhibition of ADA activity and modulation of inflammatory cytokines could be suggested as the possible mechanism of action by which essential oils from ginger and turmeric rhizomes exert their nephroprotective activities.
Collapse
Affiliation(s)
| | | | | | - Israel Olayide
- Department of Chemical Sciences, Biochemistry Unit, Afe Babalola University
| | | | | |
Collapse
|
17
|
Dvir R, Paloschi V, Canducci F, Dell'Antonio G, Racca S, Caldara R, Pantaleo G, Clementi M, Secchi A. IL28B rs12979860 genotype as a predictor marker of progression to BKVirus Associated nephropathy, after kidney transplantation. Sci Rep 2017; 7:6746. [PMID: 28751760 PMCID: PMC5532253 DOI: 10.1038/s41598-017-06915-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 06/05/2017] [Indexed: 12/22/2022] Open
Abstract
BK virus (BKV) associated nephropathy (BKVAN) is still an important cause of allograft dysfunction after kidney transplantation (KT). Recent data have shown that the new interferon (IFN)-λ family has been ascribed antiviral properties similar to IFNα, and that the response to IFNλ in kidney is restricted to epithelial cells, suggesting that the IFNλ system evolves as specific protection of the epithelia. We aimed to test the hypothesis of correlation between a single nucleotide polymorphism (C/T dimorphism rs12979860) in the genomic region of IL28B and BKVAN, in patients after KT. Fifty kidney-transplanted patients were included as follow: Group 1 (BKV+/BKVAN+): 11 patients with active BKV- replication and biopsy-proven BKVAN; Group 2 (BKV+/BKVAN-): 22 patients with active BKV- replication but without evidence of BKVAN; Group 3 (BKV-/BKVAN-): 17 patients without evidence of BKV- replication (control group). Here we show that the C/C genotype was statistically higher in group 2 than in group 1 and BKVAN was detected significantly more frequently in patients with C/T and T/T genotypes than in patients with C/C genotype. We therefore propose IL28B polymorphism (rs12979860), as a predictor-marker to differentiate between patients with self-limited, even if persistent, BKV- reactivation and patients with a high risk of progression towards BKVAN, and to modulate the clinical management of these patients accordingly.
Collapse
Affiliation(s)
- Roee Dvir
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
| | - Vera Paloschi
- Transplant Unit, Department of Internal Medicine, San Raffaele Hospital IRCCS, Milan, Italy
| | - Filippo Canducci
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
- University of Insubria, Dept. of Biotechnology and Life Sciences, Varese, Italy
| | | | - Sara Racca
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
| | - Rossana Caldara
- Transplant Unit, Department of Internal Medicine, San Raffaele Hospital IRCCS, Milan, Italy
| | - Giuseppe Pantaleo
- UniSR-Social.Lab [Research Methods], Faculty of Psychology, Vita Salute San Raffaele University, Milan, Italy
| | - Massimo Clementi
- Laboratory of Clinical Microbiology & Virology, San Raffaele Hospital IRCCS, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Secchi
- Transplant Unit, Department of Internal Medicine, San Raffaele Hospital IRCCS, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
18
|
Sieger N, Kyriazis I, Schaudinn A, Kallidonis P, Neuhaus J, Liatsikos EN, Ganzer R, Stolzenburg JU. Acute focal bacterial nephritis is associated with invasive diagnostic procedures - a cohort of 138 cases extracted through a systematic review. BMC Infect Dis 2017; 17:240. [PMID: 28376724 PMCID: PMC5379728 DOI: 10.1186/s12879-017-2336-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 12/10/2016] [Accepted: 03/22/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Acute focal bacterial nephritis (AFBN) is a rare disease currently described only in case reports and small case series. In this study we summarize the clinical features of AFBN as has been documented in the literature and draw recommendations on the proper diagnosis and therapy. METHODS A systematic literature review was undertaken in PUBMED, Web of Science and The Cochrane Library online databases for relevant literature on AFBN in adults. RESULTS Literature review revealed a total of 38 articles according to our inclusion criteria, of which we could extract data from 138 cases of AFBN. Fever (98%) and flank pain (80%) were most commonly reported symptoms. E. coli was the most frequent pathogen. Diagnosis was set by CT and/or MRI (52%) with or without sonography or by sonography alone (20%) as well as by sonography combined with IVU. In total, sonography was applied in 83% of cases. All but one patient received antibiotic treatment. Kidney lesions were occasionally mistaken for neoplasms or renal abscesses and as a result, cases were subjected to percutaneous puncture (12.3%), surgical exploration (5.1%) and partial or radical nephrectomy (4.4%). Four cases (2.9%) developed a renal abscess. CONCLUSIONS The diagnosis of AFBN is set by characteristic clinico-radiological findings. Differential diagnoses of this interstitial bacterial infection include renal abscess and tumor. Correct diagnosis is occasionally impeded by atypical symptoms. Invasive diagnostic and therapeutic procedures should be limited as the majority of cases respond well to conservative treatment.
Collapse
Affiliation(s)
- Nadine Sieger
- Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Iason Kyriazis
- Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Department of Urology, University Hospital of Patras, Rio 265 04, Patras, Greece
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | | | - Jochen Neuhaus
- Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | | | - Roman Ganzer
- Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, University Hospital Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| |
Collapse
|
19
|
Vallverdú Vidal M, Iglesias Moles S, Palomera Fernandez M, Palomar Martinez M. [Isolated renal mucormycosis in a critically ill patient]. Rev Iberoam Micol 2017; 34:57-58. [PMID: 28081878 DOI: 10.1016/j.riam.2016.05.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 05/11/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Silvia Iglesias Moles
- Departamento de Cuidados intensivos, Hospital Universitario Arnau de Vilanova, Lérida, España
| | | | | |
Collapse
|
20
|
Lantinga MA, Darding AJM, de Sévaux RGL, Alam A, Bleeker-Rovers CP, Bobot M, Cornec-Le Gall E, Gevers TJG, Hassoun Z, Meijer E, Mrug M, Nevens F, Onuchic LF, Pei Y, Piccoli GB, Pirson Y, Rangan GK, Torra R, Visser FW, Jouret F, Kanaan N, Oyen WJG, Suwabe T, Torres VE, Drenth JPH. International Multi-Specialty Delphi Survey: Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection. Nephron Clin Pract 2016; 134:205-214. [PMID: 27599120 DOI: 10.1159/000446664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cyst infection is one of the complications of autosomal dominant polycystic kidney disease and polycystic liver disease. The diagnosis is typically made on a mix of clinical, laboratory and imaging abnormalities but the importance of individual items is uncertain. We aimed to perform a Delphi survey amongst physicians to achieve consensus on diagnostic criteria. METHODS We retrieved diagnostic items from the literature and conducted physician and patient interviews. All items were combined to create the online questionnaire. Participants rated each item during 3 consecutive rounds. Items were rated for diagnostic helpfulness for hepatic and renal cyst infection on a 9-point scale with anchors, from extremely unimportant (n = 1) to extremely important (n = 9). We determined consensus with the disagreement index. The median rating of each item was calculated and categorized into inappropriate (≤3.4), uncertain (3.5-6.4) or appropriate (≥6.5). By combining all items that reached an appropriate consensus rating, we developed a diagnostic algorithm based on expert consensus. RESULTS We invited 58 physicians to participate in the survey. In total, 35 (60%) responded to round 1 of which 91% (n = 32) and 86% (n = 30) responded to round 2 and 3, respectively. The final panel included 23 nephrologists, 5 hepatologists, a nuclear medicine specialist and an infectious disease physician from 11 countries (male 67%, mean age 47 ± 11 years, median clinical experience 21 years). The panel rated the diagnostic helpfulness of 59 potential items. Ultimately, 22 hepatic and 26 renal items were rated appropriate, including positive blood cultures and fluorodeoxyglucose positron-emission CT imaging. Ultrasonography and absence of intracystic bleeding were amongst those deemed uncertain or inappropriate. Subsequently, by combining items rated appropriate, we developed a clinical tool to diagnose hepatic and renal cyst infection. CONCLUSIONS We identified diagnostic items for hepatic and renal cyst infection and developed an expert-based diagnostic algorithm, which may aid physicians in the diagnostic work-up. A prospective study is necessary to validate this algorithm.
Collapse
|
21
|
Gaskill N, Guido B, Magro C. Recurrent adult onset Henoch-Schonlein Purpura: a case report. Dermatol Online J 2016; 22:13030/qt1r12k2z1. [PMID: 27617937] [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] [Received: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 06/06/2023] Open
Abstract
Henoch-Schonlein purpura is an immunoglobulin A (IgA)-immune complex mediated leukocytoclastic vasculitis that classically manifests with palpable purpura, abdominal pain, arthritis, and hematuria or proteinuria. The condition is much more predominant in children (90% of cases) and commonly follows an upper respiratory infection. We present a case of recurrent Henoch-Schonlein purpura (HSP) complicated by nephritis in an adult female initially categorized as IgA nephropathy (IgAN). We review the pathophysiologic basis of HSP nephritis as the variant of HSP accompanied by renal involvement and its pathogenetic commonality with IgA nephropathy.
Collapse
Affiliation(s)
| | | | - Cynthia Magro
- Department of Pathology, Weill Cornell Medicine, New York.
| |
Collapse
|
22
|
Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 2016; 36:94-99. [PMID: 27111516 DOI: 10.1016/j.intimp.2016.04.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [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: 12/26/2015] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been investigated as two new inflammatory markers used in the assessment of systemic inflammation in many diseases. The purpose of the study was to investigate their relation with disease activity in newly diagnosed SLE patients. METHODS The study population consisted of 116 SLE patients who did not receive any treatment and 136 healthy controls. We divided the patients into two groups according to the SLE Disease Activity Index 2000 (SLEDAI-2K) system. Group 1 included patients with a score of 9 and lower (patients with mild disease activity), and Group 2 included patients with a score of >9 (patients with severe disease activity). Correlations between NLR, PLR and disease activity were analyzed. RESULTS The NLR and PLR of SLE patients were significantly higher compared to those of the controls (both P<0.001). There was a statistically significant difference in NLR and PLR between Group 1 and Group 2 (both P<0.05). SLEDAI scores positively correlated with NLR (r=0.312, P<0.001) and PLR (r=0.298, P<0.001). Furthermore, SLE patients with nephritis had higher NLR levels than those without nephritis (P=0.027). Based on the ROC curve, the best NLR cut-off value to predict SLE patients with severe disease activity was 2.26, with 75% sensitivity and 50% specificity, whereas the best PLR cut-off value was 203.85, with 42.3% sensitivity and 83.9% specificity. CONCLUSION NLR and PLR were two useful inflammatory markers for assessment of disease activity in patients with SLE.
Collapse
Affiliation(s)
- Yunxiu Wu
- Department of Endocrinology and Metabolism of the Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Yanjuan Chen
- Department of Endocrinology and Metabolism of the Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Xianming Yang
- Department of Internal Medicine, Ward of the Shantou Third People's Hospital, Shantou, Guangdong, China
| | - Lishu Chen
- Department of Endocrinology and Metabolism of the Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Yihua Yang
- Department of Endocrinology and Metabolism of the Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China.
| |
Collapse
|
23
|
Li J, Du Y, Qi J, Sneha R, Chang A, Mohan C, Shih WC. Raman spectroscopy as a diagnostic tool for monitoring acute nephritis. J Biophotonics 2016; 9:260-269. [PMID: 25996441 DOI: 10.1002/jbio.201500109] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/15/2015] [Accepted: 04/27/2015] [Indexed: 06/04/2023]
Abstract
Both acute nephritis and chronic nephritis account for substantial morbidity and mortality worldwide, partly due to the lack of reliable tools for detecting disease early and monitoring its progression non-invasively. In this work, Raman spectroscopy coupled with multivariate analysis are employed for the first time to study the accelerated progression of nephritis in anti-GBM mouse model. Preliminary results show up to 98% discriminant accuracy for the severe and midly diseased and the healthy among two strains of mice with different susceptibility to acute glomerulonephritis. This technique has the potential for non-invasive or minimally-invasive early diagnosis, prognosis, and monitoring of renal disease progression.
Collapse
Affiliation(s)
- Jingting Li
- Department of Electrical and Computer Engineering, USA
| | - Yong Du
- Department of Biomedical Engineering, USA
| | - Ji Qi
- Department of Electrical and Computer Engineering, USA
| | | | - Anthony Chang
- Department of Pathology, The University of Chicago, USA
| | | | - Wei-Chuan Shih
- Department of Electrical and Computer Engineering, USA.
- Department of Biomedical Engineering, USA.
- Department of Chemistry, University of Houston, 4800, Calhoun, Rd. Houston, TX, 77204, USA.
| |
Collapse
|
24
|
Abstract
Diabetic nephropathy (DN) is a serious complication of diabetes. At its core, DN is a metabolic disorder which can also manifest itself in terms of local inflammation in the kidneys. Such inflammation can then drive the classical markers of fibrosis and structural remodeling. As a result, resolution of immune-mediated inflammation is critical towards achieving a cure for DN. Many immune cells play a part in DN, including key members of both the innate and adaptive immune systems. While these cells were classically understood to primarily function against pathogen insult, it has also become increasingly clear that they also serve a major role as internal sensors of damage. In fact, damage sensing may serve as the impetus for much of the inflammation that occurs in DN, in a vicious positive feedback cycle. Although direct targeting of these proinflammatory cells may be difficult, new approaches that focus on their metabolic profiles may be able to alleviate DN significantly, especially since dysregulation of the local metabolic environment may well be responsible for triggering inflammation to begin with. In this review, the authors consider the metabolic profile of several relevant immune types and discuss their respective roles.
Collapse
Affiliation(s)
- Zihan Zheng
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Feng Zheng
- Department of Nephrology, Advanced Institute for Medical Sciences, Second Hospital, Dalian Medical University, Dalian 116023, China
- Department of Nephrology and Basic Science Laboratory, Fujian Medical University, Fuzhou 350002, China
- *Feng Zheng:
| |
Collapse
|
25
|
Stasyshyn AR. [SIGNIFICANCE OF CHANGES OF RENAL FUNCTIONING PROGNOSTICATION IN THE PURULENT—SEPTIC COMPLICATIONS COURSE AFTER AN URGENT INTERVENTIONS, PERFORMED ON INTESTINE]. Klin Khir 2016:22-24. [PMID: 30265470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rate and severity of the renal function changes in an acute ileus (AI) in dynamics, aiming on determination of early diagnostic criteria for the purulent—septic complications (PSC) occurrence, were studied. Retrospective analysis of clinical and laboratory indices of renal functional state was conducted in 413 patients, and prospective investigations of 174 patients, operated for AI of various origin was done. Concentration index of creatinine, the glomerular filtration reduction, absolute and relative reabsorption of water, the sodium clearance, level of standardized excretion of protein and sodium, as well as of proximal and distal reabsorption of sodium, the middle—molecular mass peptides content in the blood serum and their concentration indices constitutes the most informative early diagnostic criteria of the PSC occurrence.
Collapse
|
26
|
Wang D, Wang F, Ding J, Xiao H, Zhong X, Liu X. [Retrospective study of primary IgA nephropathy with crescent formation and/or rapidly progressive glomerulonephritis in children]. Zhonghua Er Ke Za Zhi 2015; 53:670-675. [PMID: 26757967] [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: 06/05/2023]
Abstract
OBJECTIVE IgA nephropathy is the most common type of glomerulonephritis in the world. Its clinical and pathological manifestations vary. A few of the patients with IgA nephropathy present with rapidly progressive glomerulonephritis (RPGN) and/or crescent formation. Their conditions are serious and acute, but there are few reports on their characteristics, treatment and outcome. This study aimed to analyze the clinicalopathological features, treatment and prognosis of primary IgA nephropathy in children, to provide a reference for clinical diagnosis and treatment. METHOD A retrospective study was conducted in children with primary IgA nephropathy with crescent formation and/or rapidly progressive glomerulonephritis admitted to our department from 2000 to 2014. The patients meeting the inclusion and exclusion criteria were included. Patients were divided into RPGN group and non-RPGN group according to the clinical manifestations, crescent formation group and non-crescent group, crescentic IgA nephropathy group and non-crescentic IgA nephropathy group according to renal biopsy. Their clinical manifestations and pathological features, treatment and prognosis were compared. RESULT A total of 265 patients were recruited, 10 patients (3.8%) had RPGN, 151 patients (57.0%) had crescent formation, 19 cases (7.2%) showed crescentic IgA nephropathy.Compared with non-RPGN group, RPGN group showed more gross hematuria, higher serum creatinine, lower creatinine clearance correction at biopsy and follow-up, and more crescentic IgA nephropathy (P<0.05). The percent of patients who received methylprednisolone pulse and blood purification therapy in RPGN group is higher than that of non-RPGN group (P<0.05). Compared with non-crescent group, crescent formation group showed more gross hematuria at biopsy and follow-up, higher serum creatinine at biopsy, lower creatinine clearance correction, more 24-hour urinary protein at biopsy and higher serum creatinine at follow-up (P<0.05). The percentage of patients received more methylprednisolone pulse, oral steroids, cyclophosphamide pulse in crescent formation group was higher than that of non-crescent group (P<0.05). Compared with non-crescentic IgA nephropathy group, crescentic IgA nephropathy group showed more RPGN percent, higher serum creatinine, more 24-hour urinary protein at biopsy (P<0.05). The percentage of patients who received more methylprednisolone pulse and blood purification therapy in crescentic IgA nephropathy group was more than non-crescentic IgA nephropathy group (P<0.05). At follow-up, 20.0% of the patients with RPGN and crescent nephritis returned to normal renal function and the percent of crescent glomerulonephritis but not RPGN was 71.4%, RPGN but not crescent glomerulonephritis was 80.0%, crescent formation but not crescent nephritis was 87.5%. CONCLUSION In primary IgA nephropathy with crescent formation and/or rapidly progressive glomerulonephritis, the patients with both RPGN and crescentic IgA nephropathy showed the worst clinical manifestations, its prognosis was worst while the patients with crescent formation showed the mildest clinical manifestations and best prognosis.
Collapse
Affiliation(s)
- Dahai Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China;
| | - Huijie Xiao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Xiaoyu Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| |
Collapse
|
27
|
Affiliation(s)
- Adrian Baudy
- Southeast Louisiana Veterans Healthcare System and, Tulane University Medical School, New Orleans, LA 70112
| | - Vecihi Batuman
- Southeast Louisiana Veterans Healthcare System and, Tulane University Medical School, New Orleans, LA 70112.
| |
Collapse
|
28
|
Pallayova M, Mohammed A, Langman G, Taheri S, Dasgupta I. Predicting non-diabetic renal disease in type 2 diabetic adults: The value of glycated hemoglobin. J Diabetes Complications 2015; 29:718-23. [PMID: 25633572 DOI: 10.1016/j.jdiacomp.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/28/2014] [Accepted: 12/08/2014] [Indexed: 11/17/2022]
Abstract
AIMS The indications for renal biopsy in type 2 diabetes mellitus (T2D) are not well established. We investigated the prevalence, spectrum, and predictors of biopsy-proven non-diabetic renal disease (NDRD) in T2D. METHODS An observational, single-center, retrospective study of T2D adults who underwent renal biopsies (N = 51) over 10 years for nephrotic-range proteinuria, microscopic hematuria, or rapidly declining renal function. RESULTS Thirty-five (68.6%) biopsies were diagnostic of NDRD, and 16 (31.4%) revealed isolated diabetic nephropathy. The most common NDRDs were interstitial nephritis (20%), progressive crescentic glomerulonephritis (14%), membranous nephropathy (11%), and focal segmental glomerulosclerosis (11%). The odds for NDRD declined by 97% in the presence of diabetic retinopathy (P < 0.001). The deterioration of HbA1c during the year before biopsy predicted NDRD even after adjusting for diabetic retinopathy (OR, 7.65; 95% CI, 1.36-123.04; P = 0.003). A model based on the interaction between the HbA1c values 12 months before biopsy and the absolute change in these values during the preceding year predicted NDRD with 73.7% sensitivity and 75% specificity (AUC, 0.77; 95% CI, 0.59-0.94). CONCLUSIONS This study demonstrated a considerably high prevalence of NDRD in T2D adults undergoing renal biopsy. The absence of diabetic retinopathy, lower HbA1c values 12 months before biopsy and greater deterioration in HbA1c prior to biopsy predicted NDRD in T2D. Further studies are needed to validate the findings.
Collapse
Affiliation(s)
- Maria Pallayova
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
| | | | - Gerald Langman
- Department of Histopathology, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
| | - Shahrad Taheri
- Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country/National Institute for Health Research, University of Birmingham, Birmingham, UK; Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK.
| | - Indranil Dasgupta
- Renal Unit, Heartlands Hospital, Bordesley Green East, Birmingham, UK.
| |
Collapse
|
29
|
Ye Q, Shang SQ, Liu AM, Zhang T, Shen HQ, Chen XJ, Mao JH. 24h Urinary Protein Levels and Urine Protein/Creatinine Ratios Could Probably Forecast the Pathological Classification of HSPN. PLoS One 2015; 10:e0127767. [PMID: 25996387 PMCID: PMC4440756 DOI: 10.1371/journal.pone.0127767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 02/26/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022] Open
Abstract
This study aimed to assess the relevance of laboratory tests in Henoch-Schönlein purpura nephritis (HSPN) classification, and determine accurate classification factors. This prospective study included 694 HSPN patients who underwent ultrasound-guided percutaneous renal biopsy (PRB). Renal specimens were scored according to International Study of Kidney Disease in Children (ISKDC) classification. Meanwhile, blood samples were immediately collected for laboratory examination. The associations between laboratory parameters and HSPN classification were assessed. Significant differences in levels of serum Th1/Th2 cytokines, immunoglobulins, T-lymphocyte subsets, complement, and coagulation markers were obtained between HSPN patients and healthy children. Interestingly, 24h urinary protein (24h-UPRO) levels and urine protein/urine creatinine ratios could determine HPSN grade IIb, IIIa, and IIIb incidences, with areas under ROC curve of 0.767 and 0.731, respectively. At 24h-UPRO >580.35mg/L, prediction sensitivity and specificity were 75.2% and 70.0%, respectively. These values became 53.0% and 82.3%, respectively, with 24h-UPRO exceeding 1006.25mg/L. At urine protein/urine creatinine > 0.97, prediction sensitivity and specificity were 65.5% and 67.2%, respectively, values that became 57.4% and 80.0%, respectively, at ratios exceeding 1.2. Cell and humoral immunity, coagulation and fibrinolytic systems are all involved in the pathogenesis of HSPN, and type I hypersensitivity may be the disease trigger of HSPN. 24h-UPRO levels and urine protein/creatinine ratios could probably forecast the pathological classification of HSPN.
Collapse
Affiliation(s)
- Qing Ye
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- Zhejiang Key Laboratory for Diagnosis and Treatment of Neonatal Diseases, Hangzhou, PR China
| | - Shi-qiang Shang
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
| | - Ai-min Liu
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
| | - Ting Zhang
- Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Hong-qiang Shen
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
| | - Xue-jun Chen
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
| | - Jian-hua Mao
- The Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, PR China
- * E-mail:
| |
Collapse
|
30
|
Affiliation(s)
- Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Research Institute of Salt and Health, Seoul K-Clinic, Seoul, Korea
| |
Collapse
|
31
|
Mao S, Xuan X, Sha Y, Zhao S, Zhu C, Zhang A, Huang S. Clinico-pathological association of Henoch-Schoenlein purpura nephritis and IgA nephropathy in children. Int J Clin Exp Pathol 2015; 8:2334-2342. [PMID: 26045740 PMCID: PMC4440049] [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] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Henoch-Schonlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) are similar syndromes. We aimed to determine whether the crescent formation/immunocomplex in glomeruli is associated with the differences of the biochemical indexes between HSPN and IgAN. METHODS We investigated the medical records of 137 HSPN cases and 41 IgAN cases from January 2009 to April 2014 in Nanjing Children's Hospital of Nanjing Medical University. The clinical and pathological data were analyzed and compared between HSPN and IgAN. RESULTS HSPN patients had markedly higher levels of blood white blood cell (WBC), hemoglobulin (Hb) and platelet (PLT), lower levels of hematuria, blood nitrogen (BUN) and C4 compared with IgAN cases. Crescents formation and C3 deposition in the kidney did not affect these differences. Significantly lower levels of hematuria, blood IgG, IgM and C4 in HSPN compared with IgAN cases were observed among patients with IgG deposition. Markedly higher levels of WBC and Hb, lower levels of hematuria, creatinine (Cr), C4 in HSPN compared with IgAN cases were observed among patients with IgM deposition. No marked differences of the biochemical indexes were noted between HSPN and IgAN cases among patients with C1q deposition. Markedly higher levels of WBC and Hb, lower level of blood C4 in HSPN compared with IgAN cases were observed among patients with fibrogen deposition. CONCLUSIONS The different levels of biochemical indexes at presentation between HSPN and IgAN may be associated with the deposition of IgG, IgM, C1q and fibrogen in the kidney.
Collapse
Affiliation(s)
- Song Mao
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| | - Xiaoyan Xuan
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| | - Yugen Sha
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| | - Sanlong Zhao
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| | - Chunhua Zhu
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| | - Aihua Zhang
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| | - Songming Huang
- Department of Nephrology, Nanjing Children's Hospital, Affiliated to Nanjing Medical University Nanjing, China
| |
Collapse
|
32
|
Iga R, Uchino H, Kanazawa K, Usui S, Miyagi M, Kumashiro N, Hirose T. Acute focal bacterial nephritis in an occupational allergy. Lancet Infect Dis 2014; 14:656. [PMID: 24964943 DOI: 10.1016/s1473-3099(14)70738-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ryo Iga
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Ken Kanazawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Shuki Usui
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Masahiko Miyagi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| |
Collapse
|
33
|
Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR. Prospective study of BK virus infection and nephropathy during the first year after kidney transplantation. Iran J Kidney Dis 2014; 8:145-151. [PMID: 24685738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The aim of this study was to assess the prevalence and severity of BK virus infection, BK virus nephritis, and related risk factors among kidney transplant recipients. MATERIALS AND METHODS BK viremia during the first year of kidney transplantation was assessed prospectively in 32 successive recipients. BK virus DNA was extracted and determined in all samples by real-time polymerase reaction assay for 1 year after kidney transplantation. RESULTS The mean age of the patients was 33.3 ± 15.3 years. Sixteen patients (50%) received antithymocyte globulin for induction therapy. Living donor transplant consisted of 75% of the kidney donations. Maintenance immunosuppressive therapy included cyclosporine A in 27 patients (84.4%), plus tapering prednisolone and mycophenolate mofetil. BK viremia was detected in 8 patients (25%). The highest detected plasma viral load was less than 4000 copies per milliliter. BK virus was respectively positive in 5 (62.5%), 2 (25%), and 1 (12.5%) patients during the first 4, 8, and 12 months after transplantation. Biopsy-proven rejection and antirejection therapy by methylprednisolone pulses were 5 and 2.3 times more common in patients with BK virus infection (P = .01 and P = .01), respectively. CONCLUSIONS Despite occurrence of BK virus infection in 25% of our patients, BK nephropathy did not develop in any of them. Routine screening of BK virus infection, particularly in centers with low prevalence of BK virus nephritis, may not be cost effective for predicting this disease.
Collapse
|
34
|
Jung JS, Lee SM, Kim HJ, Jang SH, Lee JW. A case of septic pulmonary embolism associated with renal abscess mimicking pulmonary metastases of renal malignancy. Ann Nucl Med 2014; 28:381-5. [PMID: 24481822 DOI: 10.1007/s12149-014-0811-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/19/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
We report the case of a 46-year-old woman with acute febrile symptom who had multiple pulmonary nodules and a renal mass. She underwent (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to find a hidden malignancy and the cause of her fever. FDG PET/CT images demonstrated a renal mass and multiple lung nodules with intense FDG uptake, which was suspicious of a renal malignancy with multiple pulmonary metastatic lesions. CT-guided biopsies of the pulmonary and renal lesions only showed chronic inflammatory infiltrates without evidence of malignancy. She was diagnosed with septic pulmonary embolism from a renal abscess. One month after antibiotic treatment, the follow-up chest and abdomen CT showed improvement of the lung and renal lesions. This is the first case demonstrating the FDG PET/CT finding of septic pulmonary embolism associated with renal abscess in the published literature.
Collapse
Affiliation(s)
- Jo Sung Jung
- Department of Radiology, Sooncheonhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | | | | | | | | |
Collapse
|
35
|
Weis L, Metzger M, Haymann JP, Thervet E, Flamant M, Vrtovsnik F, Gauci C, Houillier P, Froissart M, Letavernier E, Stengel B, Boffa JJ. Renal function can improve at any stage of chronic kidney disease. PLoS One 2013; 8:e81835. [PMID: 24349134 PMCID: PMC3862566 DOI: 10.1371/journal.pone.0081835] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 02/21/2013] [Accepted: 10/28/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction Even though renal function decline is considered relentless in chronic kidney disease (CKD), improvement has been shown in patients with hypertensive nephropathy. Whether this can occur in any type of nephropathy and at any stage is unknown as are the features of patients who improve. Methods We identified 406 patients in the NephroTest cohort with glomerular filtration rates (mGFR) measured by 51Cr-EDTA clearance at least 3 times during at least 2 years of follow-up. Individual examination of mGFR trajectories by 4 independent nephrologists classified patients as improvers, defined as those showing a sustained mGFR increase, or nonimprovers. Twelve patients with erratic trajectories were excluded. Baseline data were compared between improvers and nonimprovers, as was the number of recommended therapeutic targets achieved over time (specifically, for systolic and diastolic blood pressure, proteinuria, and use of renin angiotensin system blockers). Results Measured GFR improved over time in 62 patients (15.3%). Their median mGFR slope was +1.88[IQR 1.38, 3.55] ml/min/year; it was −2.23[−3.9, −0.91] for the 332 nonimprovers. Improvers had various nephropathies, but not diabetic glomerulopathy or polycystic kidney disease. They did not differ from nonimprovers for age, sex, cardiovascular history, or CKD stage, but their urinary albumin excretion rate was lower. Improvers achieved significantly more recommended therapeutic targets (2.74±0.87) than nonimprovers (2.44±0.80, p<0.01). They also had fewer CKD-related metabolic complications and a lower prevalence of 25OH-vitamin-D deficiency. Conclusion GFR improvement is possible in CKD patients at any CKD stage through stage 4–5. It is noteworthy that this GFR improvement is associated with a decrease in the number of metabolic complications over time.
Collapse
Affiliation(s)
- Lise Weis
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France
| | - Marie Metzger
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, CESP, Villejuif, France
- UMRS 1018, Univ Paris-Sud, Villejuif, France
| | - Jean-Philippe Haymann
- Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
- INSERM UNIT 702, Paris, France
- UMR S 702, Univ Pierre et Marie Curie-Paris 6, Paris, France
| | - Eric Thervet
- Department of Nephrology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- UMR S 775, Univ Paris Descartes, Paris, France
| | - Martin Flamant
- Department of Physiology, AP-HP, Hôpital Bichat, Paris, France
| | | | - Cédric Gauci
- Department Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Pascal Houillier
- UMR S 775, Univ Paris Descartes, Paris, France
- Department Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Froissart
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, CESP, Villejuif, France
- UMR S 775, Univ Paris Descartes, Paris, France
- Department Physiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Emmanuel Letavernier
- Department of Physiology, AP-HP, Hôpital Tenon, Paris, France
- INSERM UNIT 702, Paris, France
- UMR S 702, Univ Pierre et Marie Curie-Paris 6, Paris, France
| | - Bénédicte Stengel
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, CESP, Villejuif, France
- UMRS 1018, Univ Paris-Sud, Villejuif, France
| | - Jean-Jacques Boffa
- Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France
- INSERM UNIT 702, Paris, France
- UMR S 702, Univ Pierre et Marie Curie-Paris 6, Paris, France
- * E-mail:
| | | |
Collapse
|
36
|
Working Group for National Survey on Status of Diagnosis and Treatment of Childhood Renal Disease. [Multicenter investigation of diagnosis and treatment of Henoch-Schonlein purpura nephritis in childhood]. Zhonghua Er Ke Za Zhi 2013; 51:881-7. [PMID: 24495756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To retrospectively investigate the current diagnosis and treatment of children with Henoch-Schonlein purpura nephritis in hospital, to survey the application of practical evidence-based guidelines in children with Henoch-Schonlein purpura nephritis. METHOD A nationwide survey in 40 hospitals was conducted and data of hospitalized children diagnosed as Henoch-Schonlein purpura nephritis for the first time during the period of 1st July 2008 to 30th June 2011 were analyzed. The collected information included age, gender, disease duration, clinical manifestations, relevant auxiliary examination results, renal biopsy, and treatment and so on. The data were collected and analyzed by the subspecialty group of nephrology, Chinese Society of Pediatrics. RESULT There were 4863 hospitalized children with Henoch-Schonlein purpura nephritis from July 1, 2008 to June 30, 2011 in 40 hospitals. The male (n = 2935) to female (n = 1928) ratio was 1.52: 1, the peak incidence between 6 to 13 years old. Renal impairment occurred in 96.7% (n = 4702) with 6 months from the onset of Henoch-Schonlein purpura. The most common clinical findings were proteinuria and hematuria (2831 patients, 58.2%); 1448 patients received renal biopsy, subclass III and II were the most common histological types; 3677 patients (75.6%) were treated with corticosteroids and immunosuppressants. The most common treatment scheme was corticosteroids only (1655 patients, 34.0%). More than half of the patients (362 patients, 56.2%) with pure hematuria received no corticosteroids or immunosuppressants. Patients with hematuria and proteinuria always received corticosteroids only (1017 patients, 35.9%). Corticosteroids with or without tripterygium glycosides were always given to the patients with subclass I and II in renal biopsy. The patients with subclass III and IV were mainly treated with combination of corticosteroids, cyclophosphamide and methylprednisolone. CONCLUSION The incidence of purpura nephritis has increased; the duration of renal impairment had no correlation with the gender. Compared to the female, the male patients are more likely to have proteinuria. The patients with mild proteinuria also can present with severe renal histological impairment. There was no unified treatment scheme in the immunosuppressants and non-specific drugs. Multi-center randomized controlled trials (RCTs) are needed to explore and manage the treatment of purpura nephritis.
Collapse
|
37
|
Guan N, Yao Y, Yang JY, Xiao HJ, Ding J. [Retrospective clinical features and renal pathological analysis of 15 children with anti-neutrophil cytoplasmic antibody-associated vasculitis]. Zhonghua Er Ke Za Zhi 2013; 51:283-287. [PMID: 23927802] [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: 06/02/2023]
Abstract
OBJECTIVE Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a disorder with poor prognosis. This study aimed to improve the diagnosis and treatment of ANCA associated vasculitis of children, to analyze the clinical features, pathological characteristics and the prognosis of children with ANCA-associated vasculitis. METHOD Fifteen children with ANCA associated vasculitis who were hospitalized from 2003 to 2012 in our hospital were included. Their data of pre-diagnosis status, clinical manifestations, renal pathology, treatment and prognosis were reviewed retrospectively. RESULT Of the 15 children, 11 were girls and 4 boys with a mean age of 10.7 years. Fourteen children were categorized as microscopic polyangitis. The time to diagnosis varied from 0.5 month to 40 months. Hematuria and proteinuria were revealed by urine analysis in all of them, only 6 children complained with gross hematuria or edema of oliguria. Decreased glomerular filtration rate was revealed in 13 children, 8 of whom had a creatinine clearance rate of less than 15 ml/(min·1.73 m(2)). Twelve children underwent renal biopsy, crescent formation was found in 11 children. Most of the crescents were cellular fibrous crescents or fibrous crescents. Six children were diagnosed as crescentic nephritis; the process of rapidly progressive nephritis was only observed in 2 children. Segmental glomerulosclerosis or global glomerulosclerosis were found in 10 children, 3 of them were diagnosed as sclerotic glomerulonephritis. Anemia and pulmonary injury were the most common extra renal manifestations. Other extra renal manifestations included rash, pain joint, gastrointestinal symptoms, abnormal findings of cardiac ultrasonography and headache. Eight children were treated with steroid combined with cyclophosphamide, 4 were treated with steroid and mycophenolate mofetil, 2 were treated with steroid, cyclophosphamide and mycophenolate mofetil, 3 children were treated with plasma exchange. Fourteen children were followed up for 0.5 month to 4 years. The renal function did not recover in children with creatinine clearance rate of less than 30 ml/(min·1.73 m(2)), who showed crescentic glomerulonephritis or sclerotic glomerulonephritis. The children who had creatinine clearance rate of more than 30 ml/(min·1.73 m(2))had better prognosis. CONCLUSION More attention should be paid to ANCA-associated vasculitis among school age girls with anemia or pulmonary diseases. The renal damage was serious in children; however, the clinical manifestations were not obvious. Children with a creatinine clearance rate of less than 30 ml/(min·1.73 m(2)) had poor prognosis. Early accurate diagnosis is very important.
Collapse
Affiliation(s)
- Na Guan
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | | | | | | | | |
Collapse
|
38
|
Calvo-Río V, Loricera J, Martín L, Ortiz-Sanjuán F, Alvarez L, González-Vela MC, González-Lamuño D, Mata C, Gortázar P, Rueda-Gotor J, Arias M, Peiró E, Martínez-Taboada VM, González-Gay MA, Blanco R. Henoch-Schönlein purpura nephritis and IgA nephropathy: a comparative clinical study. Clin Exp Rheumatol 2013; 31:S45-S51. [PMID: 23663681] [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] [Received: 02/26/2013] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Henoch-Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) are related syndromes. In the present study we aimed to compare the clinical characteristics and outcome of a large and unselected series of patients diagnosed as having HSPN and IgAN. METHODS Comparative study of a wide and unselected population of HSPN (142 patient) and IgAN (61 patients) from a teaching hospital of Northern Spain. RESULTS All of the following comparisons were expressed between HSPN vs. IgAN, respectively. HSPN patients were younger (30.6±26.4 vs. 37.1±16.5 years, p<0.001). Precipitating events, usually an upper respiratory tract infection and/or drug intake, were more frequently observed in HSPN (38% vs. 23%, p=0.03). Extra-renal manifestations were also more common in HSPN than in IgAN; skin lesions (100% vs. 1.8%; p<0.001), gastrointestinal (62% vs. 7.4%; p<0.001), and joint involvement (61.3% vs. 3.6%; p<0.001). However, nephritis was less severe in HSPN, renal insufficiency (25% in HSPN vs. 63.4% in IgAN; p<0.001), nephrotic syndrome (12.5%, vs. 43.7%; p<0.001), and nephritic syndrome (6.8% vs. 10.7%; NS). Leukocytosis was more frequent in HSPN (22.5% vs. 8.2%; p=0.015) and anaemia in IgAN (12.7% in HSPN vs. 36% in IgAN, p<0.001). The frequency of corticosteroid (79.6% vs. 69%; NS) and cytotoxic drug (19% vs. 16.5%, NS) use was similar. The frequency of relapses was similar (38.6% in HSPN vs. 36.3% in IgAN). After a median follow-up of 120.8 (IQR; 110-132) months in HSPN and 138.6 (IQR; 117-156) in IgAN, requirement for dialysis (2.9% vs. 43.5%; p<0.001), renal transplant (0% vs. 36%, p<0.001) and residual chronic renal insufficiency (4.9% vs. 63.8%; p<0.001) was more frequently observed in patients with in IgAN. CONCLUSIONS HSPN and IgAN represent different syndromes. IgAN has more severe renal involvement while HSPN is associated with more extra-renal manifestations.
Collapse
Affiliation(s)
- V Calvo-Río
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome characterized by fever, rash, eosinophilia, atypical lymphocytes, and multiorgan involvement has a significant mortality. Inpatient vancomycin use is increasing and appears to be emerging as an important etiology of DRESS syndrome. This study highlights the importance of vancomycin as a cause of DRESS syndrome. We reviewed all cases of DRESS syndrome among inpatients consulted by the Allergy & Immunology service at Massachusetts General Hospital (MGH) from July 2009 through December 2010. We also reviewed the use of inpatient parenteral vancomycin over the past 4 years at MGH. Six patients fulfilled clinical criteria for DRESS syndrome, including rash, fever, eosinophilia, and hepatitis, with five (83%) having vancomycin as the attributable cause. Onset of symptoms varied from 12 days to 4 weeks after start of vancomycin treatment. Systemic findings included atypical lymphocytes, lymphadenopathy, nephritis, hypotension, tachycardia, and pharyngitis. Treatment with corticosteroids was required in three cases. Recurrence of peripheral eosinophilia was a marker of disease relapse. In three of the five patients (60%), elevated human herpesvirus 6 (HHV6) IgG titers correlated with greater systemic involvement and prolonged time to resolution. MGH pharmacy records indicate a progressive increase in the number of patients treated with parenteral vancomycin over the last 4 years. Causative agents for DRESS syndrome in an inpatient setting is likely different from that seen in the general population. With increasing use of vancomycin, we are likely to see more cases of DRESS syndrome caused by vancomycin. Recognition of vancomycin as a common cause of inpatient DRESS syndrome is important.
Collapse
|
40
|
Watson L, Richardson ARW, Holt RCL, Jones CA, Beresford MW. Henoch schonlein purpura--a 5-year review and proposed pathway. PLoS One 2012; 7:e29512. [PMID: 22235302 PMCID: PMC3250434 DOI: 10.1371/journal.pone.0029512] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/29/2011] [Indexed: 11/18/2022] Open
Abstract
Henoch Schonlein Purpura (HSP) is the commonest systemic vasculitis of childhood typically presenting with a palpable purpuric rash and frequently involving the renal system. We are the first group to clinically assess, critically analyse and subsequently revise a nurse led monitoring pathway for this condition.A cohort of 102 children presenting with HSP to a secondary/tertiary level UK paediatric hospital over a five year period, were monitored using a nurse led care pathway. Using this cohort, the incidence (6.21 cases per 100,000 children per year) and natural disease course of HSP nephritis (46% initial renal inflammation; 9% subsequent renal referral; 1% renal biopsy and immunosuppression) was determined. Older patients were at higher risk of requiring a renal referral (renal referral 12.3 (8.4-13.5) years vs. normal outcome 6.0 (3.7-8.5) years; p<0.01). A normal urinalysis on day 7 had a 97% (confidence interval 90 to 99%) negative predictive value in predicting a normal renal outcome.Using this data and existing literature base, The Alder Hey Henoch Schonlein Purpura Pathway was developed, a revised pathway for the screening of poor renal outcome in HSP. This is based on a six-month monitoring period for all patients presenting with HSP, which importantly prioritises patients according to the urine findings on day 7 and thus intensively monitors those at higher risk of developing nephritis. The pathway could be easily adapted for use in different settings and resources.The introduction of a standardised pathway for the monitoring of HSP will facilitate the implementation of disease registries to further our understanding of the condition and permit future clinical trials.
Collapse
Affiliation(s)
- Louise Watson
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.
| | | | | | | | | |
Collapse
|
41
|
Iwano M. [Topics on nephritis: update 2012]. Nihon Jinzo Gakkai Shi 2012; 54:31-34. [PMID: 22413577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
42
|
Bischoff A. [Nephrotic or nephritic: what ails the kidneys?]. MMW Fortschr Med 2011; 153:14-17. [PMID: 22165339 DOI: 10.1007/bf03369100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
43
|
Affiliation(s)
- Henry G Cheng
- Department of Internal Medicine, UCLA Medical Center/UCLA-Olive View, Los Angeles, CA 90095-1720, USA.
| | | | | | | |
Collapse
|
44
|
Park JM, Won SC, Shin JI, Yim H, Pai KS. Cyclosporin A therapy for Henoch-Schönlein nephritis with nephrotic-range proteinuria. Pediatr Nephrol 2011; 26:411-7. [PMID: 21184240 DOI: 10.1007/s00467-010-1723-7] [Citation(s) in RCA: 42] [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] [Received: 10/14/2009] [Revised: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 11/26/2022]
Abstract
To evaluate the therapeutic role of cyclosporin A (CyA) for the treatment of Henoch-Schönlein nephritis (HSN), 29 patients (18 boys, 11 girls) with nephrotic-range proteinuria were analyzed retrospectively. Mean age was 8.6 years (range 2.0-15.5 years) at diagnosis of Henoch-Schönlein purpura (HSP). All patients had developed the nephrotic-range proteinuria at a mean interval of 4.4 months (range 0-50.7 months) after the diagnosis of HSP. Mean duration of CyA treatment was 12.3 months (range 2.6-55.0 months). Mean follow-up times were 3.7 years (range 1.2-12.9 years) from the beginning of the CyA treatment. Steroids were tapered off and stopped gradually after initiation of CyA. All patients responded to the CyA treatment within a mean of 1.8 months (range 1 week to 3.5 months). Twenty-three patients achieved stable remission with mean follow-up duration of 3.2 years and 6 patients seemed to become CyA-dependent, since they developed proteinuria when the treatment was stopped. Renal function was preserved in all patients but one who developed end-stage renal disease after poor compliance with CyA. We concluded that CyA treatment for HSN showing nephrotic-range proteinuria is very effective and a safe method, although some patients become CyA-dependent.
Collapse
Affiliation(s)
- Jee Min Park
- Department of Pediatrics, Ajou University School of Medicine, 5 Woncheon-Dong, Youngtong-Gu, 442-749, Suwon, Korea
| | | | | | | | | |
Collapse
|
45
|
Custović Z, Sosa S. Focal bacterial nephritis masquerading as renal cell carcinoma: case report. Acta Clin Croat 2011; 50:113-114. [PMID: 22034791] [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: 05/31/2023] Open
Abstract
Focal bacterial nephritis is a symptom associated with inflammation of the kidneys. It may occur in children, usually indicating abnormal urinary tract development. In adults, urinary tract infection is generally caused by gram-negative bacteria, with Escherichia (E.) coli accounting for 80% of all infections. This case report describes a female patient in whom E. coli urinary infection caused, via ascending route, focal bacterial nephritis masquerading as renal cell carcinoma.
Collapse
Affiliation(s)
- Zajim Custović
- Department of Urology, Dubrovnik General Hospital, Dubrovnik, Croatia.
| | | |
Collapse
|
46
|
JOSEPHSON B, BUCHT H, EK J, WERKO L. Renal extraction, its depression, and the tubular storage of p-aminohippuric acid (PAH) in the healthy and in the diseased human kidney. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 4:1-14. [PMID: 14921797 DOI: 10.3109/00365515209060626] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
47
|
Enache EM, Iancu LS. [Polyomavirus BK and its role in associated kidney transplantation pathology]. Rev Med Chir Soc Med Nat Iasi 2010; 114:515-521. [PMID: 20700995] [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: 05/29/2023]
Abstract
In the last three decades kidney transplantation became a therapeutic approach in Romania but, unfortunately, the increasing of kidney transplantation procedures is related to an increasing rate of associated pathology such as Polyomavirus BK Associated Nephropathy (BKVAN). Studies published recently emphasize that BKVAN is a consequence of different risks factors, particular viral pathogenesis, humoral and cellular immunity and high doses of immunosuppressive drugs used for a long time are the main conditions that influence the BKVAN's evolution. Since there is no specific and effective treatment, optimal medical management is to diagnose nephropathy in early stages, to stop viral replication, limiting tubular lesions and prevent progress toward destruction by decreasing doses of immunosuppressive agents.
Collapse
Affiliation(s)
- Ecaterina Mariana Enache
- Universitatea de Medicină si Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Disciplina de Microbiologie
| | | |
Collapse
|
48
|
Huang SM, Li Q, Guo YF. [Intensive reading of evidence-based guidelines on diagnosis and treatment of childhood common renal diseases (II)]. Zhonghua Er Ke Za Zhi 2009; 47:914-916. [PMID: 20193143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
49
|
Somers MJG, Sharma A, Grant PE, Guimaraes AR, Schneeberger EE. Case records of the Massachusetts General Hospital. Case 23-2009. A 13-year-old boy with headache, nausea, seizures, and hypertension. N Engl J Med 2009; 361:389-400. [PMID: 19625720 DOI: 10.1056/nejmcpc0900640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
50
|
Imai H. [Nephritis and nephropathy]. Nihon Jinzo Gakkai Shi 2008; 50:960-973. [PMID: 19172798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|