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1.
Intern Med ; 2024 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-38749733

RESUMEN

We herein report a patient with systemic lupus erythematosus (SLE) and neuropsychiatric SLE (NPSLE), who had been misdiagnosed with schizophrenia for a long time and presented with pancytopenia. Brain magnetic resonance imaging revealed sporadic punctate hyperintense areas in the cerebral white matter. Single-photon emission computed tomography revealed a clear decrease in blood flow from the parietotemporal association area to the temporal lobe. NPSLE is a serious organ complication that significantly worsens the SLE prognosis. NPSLE symptoms are diverse and difficult to diagnose and differentiate from those of other neuropsychiatric disorders, especially in an early onset.

2.
Clin Exp Nephrol ; 28(5): 421-430, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38402497

RESUMEN

BACKGROUND: Amphiregulin (AREG) is a ligand of epidermal growth factor receptor (EGFR), which plays an important role in injury-induced kidney fibrosis. However, the clinical significance of serum soluble AREG in chronic kidney disease (CKD) is unclear. In this study, we elucidated the clinical significance of serum soluble AREG in CKD by analyzing the association of serum soluble AREG levels with renal function and other clinical parameters in patients with CKD. METHODS: In total, 418 Japanese patients with CKD were enrolled, and serum samples were collected for the determination of soluble AREG and creatinine (Cr) levels, and other clinical parameters. Additionally, these parameters were evaluated after 2 and 3 years. Moreover, immunohistochemical assay was performed ate AREG expression in the kidney tissues of patients with CKD. RESULTS: Soluble AREG levels were positively correlated with serum Cr (p < 0.0001). Notably, initial AREG levels were positively correlated with changes in renal function (ΔCr) after 2 (p < 0.0001) and 3 years (P = 0.048). Additionally, soluble AREG levels were significantly higher (p < 0.05) in patients with diabetic nephropathy or primary hypertension. Moreover, AREG was highly expressed in renal tubular cells in patients with advanced CKD, but only weakly expressed in patients with preserved renal function. CONCLUSION: Serum soluble AREG levels were significantly correlated with renal function, and changes in renal function after 2 and 3 years, indicating that serum soluble AREG levels might serve as a biomarker of renal function and renal prognosis in CKD.


Asunto(s)
Anfirregulina , Creatinina , Insuficiencia Renal Crónica , Humanos , Anfirregulina/sangre , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Anciano , Creatinina/sangre , Biomarcadores/sangre , Tasa de Filtración Glomerular , Riñón/fisiopatología , Riñón/metabolismo , Riñón/patología , Adulto , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/diagnóstico , Hipertensión , Relevancia Clínica
4.
Intern Med ; 62(1): 91-94, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35705272

RESUMEN

Vascular endothelial growth factor inhibitors and checkpoint inhibitors are effective treatments for solid tumors. These new classes of anti-cancer agents frequently cause kidney-related side effects. Although their anti-cancer effects may be enhanced when used in combination, the severity of their kidney-related side effects is unknown. We herein report the first case of thrombotic microangiopathy and mesangial proliferative glomerulonephritis caused by combined treatment with atezolizumab and bevacizumab in a 74-year-old man with hepatocellular carcinoma. The combination therapy was discontinued and replaced with intravenous methylprednisolone followed by oral prednisolone. Subsequently, the urinary protein excretion levels declined.


Asunto(s)
Carcinoma Hepatocelular , Glomerulonefritis , Neoplasias Hepáticas , Microangiopatías Trombóticas , Masculino , Humanos , Anciano , Bevacizumab/efectos adversos , Factor A de Crecimiento Endotelial Vascular , Microangiopatías Trombóticas/tratamiento farmacológico , Glomerulonefritis/inducido químicamente , Glomerulonefritis/tratamiento farmacológico , Carcinoma Hepatocelular/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico
6.
CEN Case Rep ; 12(1): 63-67, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-35870043

RESUMEN

Systemic capillary leak syndrome is a rare and life-threatening disorder, characterized by recurrent episodes of unexplained hypotension, hemoconcentration, and hypoalbuminemia. This condition is caused by leakage of plasma and proteins into the extravascular space and can be classified as either idiopathic or secondary. Secondary systemic capillary leak syndrome can result from cancer, infections, medications, or surgery. Systemic capillary leak syndrome frequently develops as a side effect of denileukin diftitox treatment of refractory cutaneous T-cell lymphoma. However, the pathophysiology of this disease is not well understood. Herein, we report a case of denileukin diftitox-induced systemic capillary leak syndrome.


Asunto(s)
Lesión Renal Aguda , Síndrome de Fuga Capilar , Neoplasias Cutáneas , Humanos , Síndrome de Fuga Capilar/diagnóstico , Síndrome de Fuga Capilar/tratamiento farmacológico , Síndrome de Fuga Capilar/inducido químicamente , Interleucina-2/efectos adversos , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/complicaciones
12.
Intern Med ; 61(14): 2187-2190, 2022 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-35283381

RESUMEN

Lumbar hernias are extremely rare. The posterolateral abdominal wall has two susceptible areas - the superior (Grynfeltt-Lesshaft's triangle) and the inferior (Petit's triangle) lumbar triangles - that cause superior and inferior lumbar hernias, respectively. We herein report a 67-year-old woman with nephrotic-range proteinuria caused by primary superior lumbar hernia. Superior lumbar hernias should be considered as a differential disease causing massive orthostatic proteinuria in adults. The present case highlights the importance of considering lumbar hernia in patients with flank swelling and the potential complications that may result from a missed diagnosis.


Asunto(s)
Pared Abdominal , Adulto , Anciano , Femenino , Hernia , Humanos , Región Lumbosacra , Proteinuria/complicaciones
13.
Rom J Intern Med ; 60(2): 127-131, 2022 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-35092658

RESUMEN

A 58-year-old woman with a history of Sjogren's syndrome was admitted to our hospital with cough, decreased right lung breath sounds and arthralgia in both thumbs. Chest computed tomography showed consolidation with air bronchogram in the right lung. Levels of anti-cyclic citrullinated peptide antibody and rheumatoid factor levels were significantly elevated. She was diagnosed with rheumatoid arthritis induced by bacterial organizing pneumonia. Treatment with salazosulfapyridine was added for rheumatoid arthritis and arthralgia gradually improved. This case highlights that respiratory infections could lead to anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis in patients with Sjogren's syndrome.


Asunto(s)
Artritis Reumatoide , Neumonía , Síndrome de Sjögren , Artralgia , Artritis Reumatoide/complicaciones , Autoanticuerpos , Femenino , Humanos , Persona de Mediana Edad , Péptidos Cíclicos , Síndrome de Sjögren/complicaciones
16.
Nephrol Dial Transplant ; 37(3): 454-468, 2022 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-34724064

RESUMEN

BACKGROUND: Zeb2, a zinc finger E-box-binding homeobox transcription factor, regulates transforming growth factor (TGF)-ß signaling pathway. However, its role in the pathogenesis of acute kidney injury (AKI) and AKI-to-chronic kidney disease (CKD) transition is unclear. METHODS: We evaluated Zeb2 function in a bilateral renal ischemia-reperfusion injury (IRI)-induced AKI model using proximal tubule-specific Zeb2 conditional knockout (Zeb2-cKO) and wild-type (WT) mice, and in renal biopsy samples. RESULTS: In Zeb2-cKO mice, the levels of plasma creatinine and blood urea nitrogen post-IRI were significantly lower than that in WT mice. Immunohistological analysis revealed mild tubular injury, reduced neutrophil infiltration, fewer fibrotic changes and reduced expression of fibrotic proteins [collagen type IV, α-smooth muscle actin (α-SMA), fibronectin and connective tissue growth factor (CTGF)], at 3-14 days post-IRI. Zeb2 expression was upregulated in proximal tubular cells post-IRI in WT mice. Zeb2 siRNA transfection reduced TGF-ß-stimulated mRNA and protein expression of collagen type IV, α-SMA, fibronectin and CTGF in cultured renal tubular cells. Patients with AKI-to-CKD transition exhibited high Zeb2 expression in renal tubules, as revealed by renal biopsy. Hypoxia and CoCl2-treatment upregulated Zeb2 promoter activity and mRNA and protein expression in cultured renal tubular epithelial cells, suggesting a regulatory role for hypoxia. CONCLUSIONS: Zeb2 was upregulated in renal tissues in both mice and humans with AKI. Zeb2 regulates fibrotic pathways in the pathogenesis of AKI and AKI-to-CKD transition. Therefore, inhibition of Zeb2 could be a potential therapeutic strategy for AKI.


Asunto(s)
Lesión Renal Aguda/patología , Daño por Reperfusión/complicaciones , Caja Homeótica 2 de Unión a E-Box con Dedos de Zinc/genética , Lesión Renal Aguda/etiología , Lesión Renal Aguda/genética , Lesión Renal Aguda/metabolismo , Animales , Fibrosis , Humanos , Riñón/patología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Daño por Reperfusión/genética , Caja Homeótica 2 de Unión a E-Box con Dedos de Zinc/metabolismo
18.
Rom J Intern Med ; 60(1): 85-89, 2022 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-34333880

RESUMEN

We herein report the first case of lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs' syndrome. Lupus-related protein-losing enteropathy and pseudo-pseudo Meigs' syndrome are extremely rare complications in patients with systemic lupus erythematosus, Both have a similar clinical course characterized by producing marked ascites, and respond to steroids in typical cases. However, in our case, steroid monotherapy was inadequate and the addition of hydroxychloroquine was effective for their treatment. Furthermore, no reports have previously confirmed elevated CA 125 levels with lupus-related protein-losing enteropathy or increased 99mTc-HSA activity with pseudo-pseudo Meigs' syndrome. In addition, we are the first to report an evaluation of the histopathology of lupus-related protein-losing enteropathy. Previously reported cases have been described as being caused by either pseudo-Meigs's syndrome or lupus-related protein-losing enteropathy as the cause of the rare pathology that causes marked pleural effusion and ascites in patients with systemic lupus erythematosus, but it has not been evaluated whether the other is co-occurring. Our case highlights that there is a potential case of overlapping lupus-related protein-losing enteropathy and pseudo-Pseudo-Meigs's syndrome. Furthermore, it is possible that patients with marked ascites with elevated CA 125 levels were mistakenly diagnosed with Meigs's syndrome or pseudo-Meigs's syndrome associated with malignant or benign ovarian tumors and underwent surgery. Clinicians should not forget SLE with pseudo-Pseudo-Meigs's syndrome as one of the differential diagnoses for marked ascites with elevated CA 125 levels.


Asunto(s)
Lupus Eritematoso Sistémico , Síndrome de Meigs , Enteropatías Perdedoras de Proteínas , Ascitis/tratamiento farmacológico , Ascitis/etiología , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Síndrome de Meigs/diagnóstico por imagen , Síndrome de Meigs/tratamiento farmacológico , Enteropatías Perdedoras de Proteínas/complicaciones , Enteropatías Perdedoras de Proteínas/etiología
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