ABSTRACT
BACKGROUND: Characterization of nevi involution could help to understand the biological behaviour of melanocytic neoplasms. OBJECTIVE: To describe the frequency and morphology of naevus involution in a series of patients with atypical naevus syndrome under digital follow-up with a SIAscopy program and, in a small sample of fading nevi, to analyse histopathological features and immunohistochemical biomarkers. METHODS: Seventy-four patients registered from April 2007 to July 2014 in the SIAscopy system of the Department of Dermatology of Hospital Arnau de Vilanova of Lleida, Spain, were reviewed. Fourteen naevus cases with fading features were prospectively excised during follow-up. Eleven already excised naevus controls were randomly selected from our archive. RESULTS: We observed that 81% of patients showed, at least, one involutive naevus and 25% of recorded nevi presented this phenomenon; the mean time of involution was 46.7 months. The predominant structural pattern was reticular (>70%), and the most frequently observed regression structures were vascular (33.8%). Histopathological significant higher intensity of inflammatory infiltrate in controls and higher presence of laminar and compact fibrosis and increase of vessels in cases were demonstrated. Regarding immunohistochemical biomarkers, only higher expression of cytoplasmic activated caspase 3 in controls was significant. CONCLUSIONS: Naevus involution is a common phenomenon in patients with dysplastic naevus syndrome. It is usually a slow process, more frequent in naevus with reticular pattern. SIAscopy regression structures are uncommon, with the exception of vascular ones. Histologically, fading involutive pattern is characterized by scarce inflammatory infiltrate and melanophages, delicate fibrosis and increase of vessels.
Subject(s)
Dysplastic Nevus Syndrome , Melanoma , Nevus , Skin Neoplasms , Follow-Up Studies , Humans , SpainABSTRACT
BACKGROUND: Cutaneous malignant melanoma arises from transformed melanocytes de novo or from congenital or acquired melanocytic naevi. We have recently reported that T-type Ca2+ channels (TT-Cs) are upregulated in human melanoma and play an important role in cell proliferation. OBJECTIVES: To describe for the first time in formalin-fixed paraffin-embedded tissue the immunoexpression of TT-Cs in biopsies of normal skin, acquired melanocytic naevi and melanoma, in order to evaluate their role in melanomagenesis and/or tumour progression, their utility as prognostic markers and their possible use in targeted therapies. METHODS: Tissue samples from normal skin, melanocytic naevi and melanoma were subjected to immunohistochemistry for two TT-Cs (Cav3.1, Cav3.2); markers of proliferation (Ki67), the cell cycle (cyclin D1), hypoxia (Glut1), vascularization (CD31) and autophagy (LC3); BRAF V600E mutation (VE1) and phosphatase and tensin homologue (PTEN). Immunostaining was evaluated by histoscore. In silico analysis was used to assess the prognostic value of TT-C overexpression. RESULTS: TT-C immunoexpression increased gradually from normal skin to common naevi, dysplastic naevi and melanoma samples, but with differences in the distribution of both isoforms. Particularly, Cav3.2 expression was significantly higher in metastatic melanoma than in primary melanoma. Statistical correlation showed a linear interaction between PTEN loss/BRAF V600E/Cav3.1/LC3/ Ki67/cyclin D1/Cav3.2/Glut1. Disease-free survival (DFS) and overall survival correlated inversely with overexpression of Cav3.2. DFS also correlated inversely with overexpression of Cav3.1. CONCLUSIONS: TT-C immunoexpression on melanocytic neoplasms is consistent with our previous in vitro studies and appears to be related to tumour progression. TT-C upregulation can be considered as a prognostic marker using The Cancer Genome Atlas database. The high expression of Cav3.2 in metastatic melanoma encourages the investigation of the use of TT-C blockers in targeted therapies.
Subject(s)
Biomarkers, Tumor/metabolism , Calcium Channels, T-Type/metabolism , Melanoma/diagnosis , Nevus, Pigmented/diagnosis , Skin Neoplasms/diagnosis , Cell Proliferation/physiology , Disease Progression , Disease-Free Survival , Humans , Immunohistochemistry , Kaplan-Meier Estimate , Melanoma/mortality , Neoplasm Recurrence, Local/etiology , Nevus, Pigmented/mortality , Prognosis , Skin Neoplasms/mortality , Up-RegulationSubject(s)
Acute Kidney Injury/etiology , Aorta, Abdominal/pathology , Aortic Aneurysm, Abdominal/complications , Aortic Rupture/etiology , Arteriovenous Fistula/etiology , Vena Cava, Inferior/pathology , Acute Kidney Injury/therapy , Aged , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/physiopathology , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/physiopathology , Arteriovenous Fistula/surgery , Coronary Artery Bypass , Fatal Outcome , Heart Failure/etiology , Humans , Hypertension/complications , Male , Multiple Organ Failure/etiology , Obesity/complications , Postoperative Complications/etiology , Renal DialysisABSTRACT
UNLABELLED: Hemodialysis (HD) patients have an impaired response to hepatitis B(HB) vaccines, and the persistence of immunity, the efficacy of revaccination and the periodicity of post-vaccination testing are not well defined. We present the experience during 13 years in an outpatient dialysis center of 136 HD patients who completed a HB vaccination program consisting in 3 doses of 40 microg intramuscular recombinant B vaccine (Engerix-B). In all patients anti-HBs titers were determined annually and in 31 patients every 6 months. Nonresponders patients and responders patients that lost their antibodies(< 10 UI/ml) received annually a booster double dose of vaccine. Seventy-four patients(54.4%) developed immunity and the remaining 62 patients were considered nonresponders. When compared both groups, gender and the etiology of chronic kidney disease did not differ between the two groups; nevertheless, nonresponders patients were significantly older than responders. After 1 year of follow-up, 32% of responders had no detectable anti-HBs levels, and only 18% of patients remained immunoreactive 6 years afer vaccination. The peak anti-HBs titer immediately after completion of the vaccination schedule was found to be a major predictor of maintaining immunity: 75% of patients with anti-HBs titers greater than 1000 IU/ml remained immunoreactive 3 years after vaccination compared to 47% of patients with titers between 100-999 IU/ml(p=0.08) and 34% of patients with titers between 11-99 IU/ml(p=0.02). The administration of additional doses of vaccine were effective in 24% of the nonresponders patients, and 69% of them remained seropositive at the end of the 1-year follow up. Repeated booster doses of vaccine in nonresponders patients to the first booster dose afforded seroconversion in 19.6% of the patients. Performing post-vaccination testing every six months it would have allowed to give booster doses of vaccine in 16% of responder patients before the annual period. CONCLUSION: This current study demonstrates that a HB vaccination schedule with a regular serological follow-up and repeated booster doses , affords an acceptable seroprotection in HD patients.
Subject(s)
Hepatitis B Antibodies/biosynthesis , Hepatitis B Antibodies/blood , Hepatitis B Vaccines/immunology , Renal Dialysis , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
UNLABELLED: Cystatin C is a marker of renal function and a major cardiovascular risk factor. In the general population, cystatin C appears to be influenced by factors other than renal function alone. However, information for serum cystatin C levels in chronic kidney disease (CKD) is lacking. METHODS: We studied 52 nondiabetic patients (38 men, mean age 49 years) with CKD stage 3 (22), 4 (25) or 5 (5) who had measurements of serum cystatin C levels, estimated glomerular filtration rate (MDRD), inflammatory (C-reactive protein, interleukin-6 and fibrinogen), and oxidative markers (anti-oxidized LDL antibodies, serum paraoxonase-1 activity and concentration), left ventricular mass index by echocardiography and other cardiovascular risk factors. RESULTS: Mean cystatin C levels were 2.35 +/- 0.9 mg/l. Cystatin C was positively correlated with creatinine serum levels, estimated glomerular filtration rate, PTH levels and negatively with anti-oxidized LDL antibodies. On the other hand, cystatin C was not related to inflammatory markers, serum paraoxonase-1 activity and concentration, proteinuria, HDL or LDL cholesterol, serum triglycerides, left ventricular mass index or demographic factors such as age, body mass index and blood pressure. After adjustment for PTH levels and anti- oxidized LDL antibodies, only estimated glomerular filtration rate was independently related serum cystatin C levels (beta = -0.500, p = 0.001). CONCLUSION: In nondiabetic patients with CKD, cystatin C is closely related to the degree of renal dysfunction. In contrast, inflammatory state, oxidative stress, left ventricular mass index and other cardiovascular risk factors are not related to cystatin C levels in this population.
Subject(s)
Cardiovascular Diseases/etiology , Cystatin C/blood , Inflammation/etiology , Kidney Diseases/complications , Kidney Diseases/metabolism , Oxidative Stress , Adult , Cardiovascular Diseases/epidemiology , Chronic Disease , Cross-Sectional Studies , Female , Humans , Kidney Diseases/blood , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
BACKGROUND: Spiral computed tomography angiography (CTA) is a sensitive and specific technique for visualizing renal arteries and diagnosing renal artery stenosis (RAS). Whether spiral CTA is associated with increased risk of contrast nephropathy (CN) in patients with impaired renal function is unknown. METHODS: We prospectively studied 50 patients with chronic renal insufficiency (serum creatinine concentration greater than 1.58 mg/dl) who underwent spiral CTA with iopromide, a nonionic, low-osmolar contrast agent. Fourteen patients had diabetes mellitus. Patients were encouraged to drink 1 l of water 12 hours before and 2 l over 24 hours after the procedure. The presence of CN was defined by an increase of 20% or more in the baseline serum creatinine level within or 72 hours after administration of the radio-contrast agent. RESULTS: In the entire group, mean serum creatinine levels increased significantly from 2.92 +/- 1.39 to 3.06 +/- 1.55 mg/dl (p = 0.02) and mean creatinine clearance decreased from 29.8 +/- 12.9 to 28.9 +/- 12.8 ml/min (p = 0.009) 72 h after administration of the contrast medium. Two patients experienced an increase in serum creatinine level of 20%. Renal function returned to baseline within seven days in the 2 patients. Absolute changes in creatinine clearance after the administration of radiocontrast medium were similar in nondiabetic and diabetic patients and in the subgroup of patients, with a baseline serum creatinine of < 3 mg/dl and > or = 3 mg/dl. CONCLUSIONS: In patients with chronic renal insufficiency, spiral CTA performed with iopromide, a nonionic, low-osmolar contrast medium and a prophylactic oral hydratation, is a minimally invasive technique with low risk of contrast nephropathy.
Subject(s)
Contrast Media/adverse effects , Iohexol/analogs & derivatives , Iohexol/adverse effects , Renal Artery Obstruction/diagnostic imaging , Renal Insufficiency/complications , Tomography, Spiral Computed , Water , Aged , Female , Humans , Kidney Function Tests , Male , Prospective Studies , Renal Artery Obstruction/complications , RiskABSTRACT
The renin-angiotenin-aldosterone system (RAAS) is not only involved in cardiovascular disease but also in renal pathophysiology and progression of renal disease. Several polymorphisms of genes coding for components of the RAAS have been identified. The I/D polymorphism of the ACE gene, a variant of the angiotensiogen gen, the M235T polymorphism, and the variant A1166 C polymorphism of the angiotensin II type 1 receptor gene are the most important. Several studies have suggested a potential role for I/D polymorphism of the ACE gen in the progression of renal diseases and in the cardiovascular death rate of patients with renal failure. Data on RAAS polymorphisms as determinants of the prevalence of renal diseases and the response to renoprotective therapies are conflicting. Given the polygenic nature of renal and cardiovascular disease and the growing number of candidate genes, large prospective and collaborative studies are required to assess the effect of RAAS polymorphisms on the progression of renal disease and on the response to renoprotective therapies.
Subject(s)
Polymorphism, Genetic , Renal Insufficiency/genetics , Renin-Angiotensin System/genetics , Cardiovascular Diseases/epidemiology , Humans , Renin-Angiotensin System/physiology , Risk FactorsABSTRACT
BACKGROUND: There is little information regarding the occurrence and distribution of cardiovascular abnormalities during the course of autosomal-dominant polycystic kidney disease (ADPKD). We conducted a cross-sectional study in three different groups of ADPKD patients to determine the profile and prevalence of cardiac involvement in this population. METHODS: Doppler color echocardiography was performed in 130 ADPKD patients. Patients were divided into normotensive (Group I, n=60), hypertensive (Group II, n=32) and those undergoing hemodialysis (Group III, n=38). RESULTS: There was a progressive increase in left ventricular mass (LVM) index (88.6+/-19.7, 127.6+/-40.4 and 150.5+/-56.5 g/m2, p < 0.0001) and in the prevalence of left ventricular hypertrophy (LVH) (3%, 43%, 62%, p < 0.0001) in Groups I, II and III, respectively. E/A ratio < 1 was found in 2% of normotensives, 46% of hypertensives and 62% of hemodialysis patients (p < 0.0001). Prevalence ofmitral valve prolapse and aortic and/or mitral regurgitation was 4.3% and 8.6%, respectively, in non-dialysis patients. The majority of valvular abnormalities occurred in dialysis patients, and were generally related to annular mitral calcification (28%) or aortic valve calcification (38%). Age, sex, systolic blood pressure (BP) and hemoglobin were independent predictors of LVM index in the entire population, systolic BP and creatinine in non-dialysis patients and systolic BP in dialysis patients. Age, heart rate and diastolic BP in the entire group, and age, heart rate and LVM index in non-dialysis patients remained as independent predictors of abnormal diastolic function. CONCLUSIONS: Cardiac involvement in ADPKD patients is a continuous process that evolves during the course of this disease. It is characterized by a low prevalence of specific valvular abnormalities, a progressive increase in LVM, LVH, and diastolic dysfunction, which are greatest in the latter stages of the disease. This study confirms the major influence of BP on cardiovascular abnormalities of ADPKD patients.
Subject(s)
Heart Diseases/complications , Hypertension/complications , Polycystic Kidney, Autosomal Dominant/complications , Adult , Cross-Sectional Studies , Diastole , Echocardiography, Doppler, Color , Echocardiography, Doppler, Pulsed , Female , Heart Diseases/diagnostic imaging , Heart Diseases/physiopathology , Heart Valve Diseases/complications , Hemodynamics , Humans , Hypertrophy, Left Ventricular/complications , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Middle Aged , Polycystic Kidney, Autosomal Dominant/therapy , Regression Analysis , Renal Dialysis , Risk FactorsABSTRACT
Left ventricular hypertrophy (LVH) is a common finding in hypertensive autosomal dominant polycystic kidney disease (ADPKD) patients. There are few studies on the influence of blood pressure (BP) and nonhemodynamic factors on LVH in these patients. The aim of this study was to evaluate the relationship between BP, humoral and neurohormonal factors and left ventricular mass (LVM) in hypertensive ADPKD patients. In 20 hypertensive ADPKD patients, ambulatory BP was monitored for 24 h, left ventricular dimensions were estimated by echocardiography, and plasma renin activity (PRA), plasma noradrenaline (NA), angiotensin II (Ang II), aldosterone, atrial natriuretic peptide (ANP) and insulin-like growth factor I (IGF-I) were also determined. Twenty age- and sex-matched essential hypertensive subjects served as controls. Ambulatory BP and LVM index were similar in the two groups, although male ADPKD patients had higher LVM indices than their matched controls. Eight ADPKD patients (40%) and 6 essential hypertensives (30%) showed LVH. PRA, Ang II, aldosterone, ANP and IGF-I levels were similar in the two groups, but plasma NA levels were higher in ADPKD patients than in controls (281 +/- 158 vs. 160 +/- 62 pg/ml, p = 0.004). ADPKD patients with LVH did not differ from those without LVH with regard to humoral and neurohormonal parameters, but had higher ambulatory BP levels. In ADPKD patients, correlation analysis revealed a significant association between LVM index and 24-hour systolic and diastolic BP, but not with any of the hormonal factors evaluated. On multiple regression analysis, 24-hour diastolic BP was the only independent variable linked to LVM index. In conclusion, ambulatory BP is one of the most important determinants of LVM in hypertensive ADPKD patients. Further studies are warranted to elucidate the role of nonhemodynamic factors in the pathogenesis of LVH in this population.
Subject(s)
Blood Pressure/physiology , Hypertension/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Polycystic Kidney, Autosomal Dominant/physiopathology , Adult , Analysis of Variance , Blood Pressure Monitoring, Ambulatory , Case-Control Studies , Chi-Square Distribution , Echocardiography, Doppler , Female , Humans , Hypertension/complications , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/etiology , Male , Middle Aged , Norepinephrine/blood , Polycystic Kidney, Autosomal Dominant/complications , Regression AnalysisABSTRACT
Cardiovascular abnormalities have been considered important extrarenal manifestations of autosomal dominant polycystic kidney disease (ADPKD). However, little is known about their prevalence in patients with ADPKD undergoing hemodialysis (HD). To investigate whether cardiac abnormalities are more prevalent in these patients, clinical and echocardiographic manifestations of cardiovascular disease were evaluated in a group of 32 patients with ADPKD and a matched control group of 32 patients without diabetes treated by chronic HD for more than 6 months. Predialysis systolic and diastolic blood pressure (BP), prevalence of hypertension, and number of patients requiring antihypertensive medications were lower in the ADPKD group than controls. There was no difference in the prevalence of cardiac events, including cardiac failure, ischemic heart disease, and arrhythmia. Systolic dysfunction, diastolic patterns, and left ventricular hypertrophy were similar in the two groups. In patients with ADPKD, simple regression analysis showed left ventricular mass (LVM) index was correlated with hemoglobin level and predialytic systolic and diastolic BPs. In multiple regression analysis, predialysis systolic BP was the only independent variable linked to LVM index. The prevalence of aortic, mitral, and tricuspid valve disease did not differ between groups. In conclusion, the occurrence of cardiovascular complications in patients with ADPKD is similar to that of HD patients with other primary renal diseases, although hypertension is less prevalent.
Subject(s)
Echocardiography , Heart Diseases/diagnostic imaging , Kidney Failure, Chronic/complications , Polycystic Kidney, Autosomal Dominant/complications , Aged , Arrhythmias, Cardiac/etiology , Echocardiography, Doppler, Pulsed , Female , Heart Diseases/complications , Heart Valve Diseases/complications , Heart Valve Diseases/diagnostic imaging , Humans , Hypertension/etiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Renal DialysisABSTRACT
Higher left ventricular mass (LVM) has been found in early stages of autosomal dominant polycystic kidney disease (ADPKD). The mechanisms involved in the increase of LVM are unknown. To investigate whether LVM in ADPKD may be influenced by abnormal diurnal BP variations, the 24-h ambulatory BP profile was analyzed in a group of young normotensive ADPKD patients. Ambulatory BP monitoring and two-dimensional echocardiography were performed in 26 young normotensive ADPKD with normal renal function and in 26 healthy control subjects. LVM index was higher in ADPKD patients than in controls (90.8+/-19.6 g/m2 versus 73.9+/-16.1 g/m2, P = 0.001). Average 24-h and daytime systolic, diastolic, and mean BP were similar in both groups. Nighttime diastolic and mean BP, but not systolic BP, were greater in ADPKD patients. The average and percent nocturnal decrease of systolic BP was lower in ADPKD patients than in control subjects (10.0 mm Hg [-3 to 24] versus 15.5 mm Hg [-4 to 31], P = 0.009, and 9.0% [-2 to 22] versus 14.2% [-2 to 25], P = 0.016, respectively). On the basis of their profile BP patterns, 54% of ADPKD subjects and 31% of controls were classified as nondippers (P = 0.092). There were no differences between dippers and nondippers in left ventricular wall thickness, chamber dimensions, and mass indexes. In ADPKD patients, simple regression analysis showed that LVM index was correlated with 24-h, daytime, and nighttime systolic BP. On multiple regression analysis, the 24-h systolic BP was the only variable linked to LVM index. It is concluded that young normotensive ADPKD patients have higher LVM that is closely related to the ambulatory systolic BP. The nocturnal fall in BP is attenuated in these patients, although it is not associated with the higher LVH that they present.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure/physiology , Echocardiography , Polycystic Kidney, Autosomal Dominant/diagnostic imaging , Polycystic Kidney, Autosomal Dominant/physiopathology , Adult , Blood Pressure Determination/methods , Female , Humans , Male , Office Visits , Reference ValuesABSTRACT
Severe hyperkalemia with minimal or nonspecific electrocardiographic (ECG) changes is unusual. We report data on seven patients with renal failure, metabolic acidosis, and severe hyperkalemia (K+ > or =8 mmol/L) without typical ECG changes. Initial ECGs revealed sinus rhythm and PR and QT intervals in the normal range. QRS intervals were slightly prolonged in two patients (110 ms), and incomplete right bundle branch block was evident in one. Thus, the absence of typical ECG changes does not preclude severe hyperkalemia.
Subject(s)
Electrocardiography , Hyperkalemia/physiopathology , Potassium/blood , Acidosis/blood , Acidosis/complications , Adult , Aged , Bundle-Branch Block/etiology , Bundle-Branch Block/physiopathology , Female , Follow-Up Studies , Heart Rate , Humans , Hyperkalemia/blood , Hyperkalemia/etiology , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Male , Middle Aged , Renal Insufficiency/blood , Renal Insufficiency/complications , Retrospective StudiesABSTRACT
Left ventricular hypertrophy is often found very early in the course of autosomal dominant polycystic kidney disease (ADPKD). Diastolic dysfunction has been shown in hypertensive adult patients with ADPKD with increased left ventricular mass (LVM), but there are no data about diastolic function in the young ADPKD population without hypertension and with normal renal function. To evaluate very early alterations in cardiac structure and diastolic function in young normotensive patients with ADPKD, color Doppler echocardiography was performed in 46 young normotensive patients with ADPKD and 35 healthy subjects. LVM, transmitral pulsed Doppler flow (diastolic function), and valvular abnormalities were studied. Patients with ADPKD showed higher LVM indices (LVMIs) than controls (89.7+/-17.3 v 68.5+/-17.2 g/m2; P < 0.0001). Peak early diastolic velocity (E wave) deceleration time and isovolumic relaxation time were significantly prolonged in patients with ADPKD compared with controls (E wave deceleration time, 182.5+/-51.3 v 149.4+/-34 msec; P=0.002; isovolumic relaxation time, 97.7+/-17.5 v 79+/-15 msec; P=0.0001). No differences were found in valvular abnormalities in the two groups. In conclusion, young normotensive patients with ADPKD showed increased LVMIs and Doppler abnormalities consistent with early diastolic dysfunction.
Subject(s)
Hypertrophy, Left Ventricular/diagnostic imaging , Polycystic Kidney, Autosomal Dominant/diagnostic imaging , Adolescent , Adult , Child , Diastole , Echocardiography/methods , Echocardiography/statistics & numerical data , Female , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Hypertrophy, Left Ventricular/physiopathology , Kidney/diagnostic imaging , Male , Polycystic Kidney, Autosomal Dominant/physiopathology , Reference Values , Time FactorsABSTRACT
Microalbuminuria (MA) is present in hypertensive autosomal-dominant polycystic kidney disease (ADPKD) patients, but has not been reported in normotensive ADPKD patients. We examined the prevalence of MA and the effect of different determinants on urinary albumin excretion in a group of 42 normotensive ADPKD patients. Metabolic parameters, plasma renin activity and aldosterone and serum angiotensin-converting enzyme (ACE) activity were determined. A 24-h urine sample two or three times over a 6-month period was collected to evaluate MA. Each patient underwent an echocardiography to measure left ventricular mass. Eight patients (19%) showed MA (61.6 mg/day, range 37-164), whereas 34 patients (81%) were normoalbuminuric (8.8 mg/day, range 2-29). The groups were matched for all possible confounding variables, but microalbuminuric patients showed a tendency towards greater systolic blood pressure, plasma renin activity and left ventricular mass. There was no correlation between MA and age, sex, body mass index, systolic or diastolic blood pressure, plasma renin activity, serum ACE levels or left ventricular index. The present study demonstrates a high prevalence of MA in normotensive ADPKD patients. MA may be a predictor of early renal and vascular damage in these patients.
Subject(s)
Albuminuria/diagnosis , Polycystic Kidney, Autosomal Dominant/urine , Adult , Albuminuria/epidemiology , Albuminuria/etiology , Case-Control Studies , Echocardiography , Female , Humans , Hypertension, Renal/etiology , Hypertension, Renal/urine , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Peptidyl-Dipeptidase A/blood , Polycystic Kidney, Autosomal Dominant/complications , Prevalence , Renin-Angiotensin System , Risk FactorsABSTRACT
We describe a 78-year-old patient with nephrotic syndrome due to minimal-change glomerulopathy, associated with a renal adenocarcinoma. Oliguric acute renal failure requiring hemodialysis was also observed. Surgical removal of the tumor and corticosteroid therapy resulted in resolution of the nephrotic state and improvement of the renal function. Nephrotic syndrome is an unusual complication of renal cell carcinomas, and the association of minimal-change glomerulopathy (MCG) and solid tumors is particularly uncommon. In spite of this, MCG should be considered in the nephropathies causing nephrotic syndrome and acute renal failure in patients with renal malignancies.
Subject(s)
Acute Kidney Injury/etiology , Carcinoma, Renal Cell/complications , Kidney Neoplasms/complications , Nephrosis, Lipoid/etiology , Acute Kidney Injury/therapy , Aged , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/surgery , Male , Nephrosis, Lipoid/drug therapy , PrognosisSubject(s)
Anti-Bacterial Agents/adverse effects , Catheterization/adverse effects , Catheters, Indwelling/adverse effects , Mupirocin/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/instrumentation , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Equipment Failure , Humans , Male , Mupirocin/administration & dosage , Ointments , Polyurethanes , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/prevention & controlABSTRACT
We report a case of pseudotumor cerebri (PC) in a maintenance hemodialysis patient that was associated with thrombosis of the right and left brachiocephalic veins caused by repeated subclavian and jugular vein catheterizations. Symptoms and signs of PC appeared when a right forearm Gortex graft was inserted. PC secondary to intracranial venous outflow obstruction is an important diagnostic consideration for hemodialysis patients with headache, visual disturbance, and papilledema.