Asunto(s)
Lesión Renal Aguda , Necrosis Tubular Aguda , Humanos , Pronóstico , Masculino , Femenino , Necrosis Tubular Aguda/patología , Biopsia , Lesión Renal Aguda/patología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Persona de Mediana Edad , Anciano , Adulto , Estudios Retrospectivos , Riñón/patologíaRESUMEN
Anti-glomerular basement membrane (GBM) disease is a rare autoimmune condition characterized by the presence of positive anti-GBM autoantibodies, linear deposition of immunoglobulin G (IgG) along the GBM and severe kidney injury. In a limited number of cases, the association of anti-GBM disease with other glomerulonephritis has been reported. Herein, we present the case of a 66-year-old female patient with progressive worsen kidney function and decreased urine output. A renal biopsy revealed crescent glomerulonephritis with lineal IgG deposition along the GBM and mesangial IgA deposition, which supported the diagnosis of concurrent anti-GBM disease and IgA nephropathy (IgAN). In an extensive literature review, we identified a total of thirty-nine patients were reported anti-GBM disease combined with IgAN. The clinical characteristics of these patients demonstrate that the anti-GBM disease combined with IgAN tends to be milder with a more indolent course and a better prognosis than the classic anti-GBM disease, and its potential pathogenesis deserves to be further explored.
Asunto(s)
Enfermedad por Anticuerpos Antimembrana Basal Glomerular , Glomerulonefritis por IGA , Glomerulonefritis , Femenino , Humanos , Anciano , Glomerulonefritis por IGA/complicaciones , Glomerulonefritis por IGA/diagnóstico , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/complicaciones , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Autoanticuerpos , Inmunoglobulina GRESUMEN
INTRODUCTION: There is a lack of perfect solutions for maintenance hemodialysis (MHD) in patients with a high transmission risk of SARS-CoV-2. METHODS: MHD patients with a high risk of SARS-CoV-2 transmission from April 1 to June 30, 2022, were recruited. We performed 4-h continuous renal replacement therapy with Prismaflex dialysis machine and ST100 suite using continuous venovenous hemodiafiltration (CVVHDF) mode with a fluid exchange volume of 8000 mL/h. RESULTS: Forty-five MHD patients were included with a median dialysis age of 91 months. Overall spKt/V reached 0.96 ± 0.19. Urea reduction ratio was 50.29 ± 7.60% with the ultrafiltration of 2.18 ± 0.79 kg. Dry weight was significantly inversely correlated with spKt/V (R = -0.563, p < 0.001). Female gender was a significant positive factor of spKt/V. Preheating of replacement solution using an incubator solved the complication of shivering in most patients. CONCLUSION: Intensive short-time CVVHDF may be considered as an alternative for routine MHD during COVID-19 transitional period.
