[Renal involvement in benign monoclonal gammopathies: an underdiagnosed condition]. / Afectación renal en las gammpatías monoclonales benignas: una entidad infradiagnosticada?

Renal involvement is observed frequently in association with malignant gammopathies, mainly those related to light chain deposition, although has also been described in non-malignant monoclonal gammopathy. This study reports the clinicopathological findings and outcome in 9 patients with nephropaty secondary to monoclonal immunoglobulin deposit in absence of malignancy. They were three men and six women and they were 59.2+/-12 years old. All patients presented proteinuria and different levels of renal insufficiency (mean creatinin = 315+/-187 micromol/L) at the moment of diagnostic. Two patients required dialysis at the time of renal biopsy. The pathology studies revealed a nodular sclerosing glomerulopathy in four cases, mesangiocapilary glomerulonephritis in three cases, only tubular lesions in one and mesangial lesions in the other one. The treatment applied was: Prednisone alone (two cases), with chemotherapy associated (melfalan in two, clorambucil in one and ciclophosphamide in another one). One patient received plasmapheresis and mycophenolate and another patient undergone a bone marrow authotransplant associated to mycophenolate and prednisone. One of the two patients who required dialysis at the moment of presentation was not treated. After a follow-up of more than 4 years (4.89 +/-DE: 3.69) renal function improved or remained stable in three patients and proteinuria was disappeared in more than 50% of patients. Four patients had a worsening of renal function and they required dialysis during the time of follow-up (in 2,4 years +/- DE: 4,3). In any case malignitation was observed. Chemotherapy stabilized or improved renal function in 3 of nine patients (33%) with non-malignant monoclonal gammopathy. Non-malignant monoclonal gammopathy could go unnoticed. Appearance of abnormalities in renal routine tests deserves more in-depth diagnostic procedures, including renal biopsy. Evolution to end stage renal disease could probably be avoided or reduced in severity with early detection and treatment of this entity.

Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis.

The role of steroid treatment in drug-induced acute interstitial nephritis (DI-AIN) is controversial. We performed a multicenter retrospective study to determine the influence of steroids in 61 patients with biopsy-proven DI-AIN, 52 of whom were treated with steroids. The responsible drugs were antibiotics (56%), non-steroidal anti-inflammatory drugs (37%) or other drugs. The final serum creatinine was significantly lower in treated patients while almost half of untreated patients remained on chronic dialysis. Among treated patients, over half showed a complete recovery of baseline renal function, whereas the rest remained in renal failure. There were no significant initial differences between these two subgroups in terms of duration or dosage of steroids. After withdrawal of the presumed causative drug, we found that when steroid treatment was delayed (by an average of 34 days) renal function did not return to baseline levels compared to those who received steroid treatment within the first 2 weeks after withdrawal of the offending agent. We found a significant correlation between the delay in steroid treatment and the final serum creatinine. Renal biopsies, including three patients who underwent a second biopsy, showed a progression of interstitial fibrosis related to the delay in steroid treatment. Our study shows that steroids should be started promptly after diagnosis of DI-AIN to avoid subsequent interstitial fibrosis and an incomplete recovery of renal function.

Secular trend and intrapopulational variation in age at menopause in Spanish women.

Menopause is associated with the general ageing process and marks the end of follicular depletion, a process that begins in the intrauterine stage and lasts throughout the lifetime of women until their reproductive senescence. Controversy persists about whether the age at menopause is sensitive to the ecological determinants prevailing during the lifecycle or whether it has a predominantly genetic component that would allow groups of women to be characterized with respect to particular menstrual characteristics manifested throughout their fertile life. By contrast, there is a definite secular trend in age at menarche in populations that have registered improvements in their environment: sexual maturation is closely associated with the general processes of growth and development. These aspects were analysed in a sample of Spanish women, mothers and daughters, born between 1883 and 1941. The results show (a) indications--although not conclusive--of a secular trend in the age at menopause, (b) a possible association between the age at menopause of mothers and their daughters, and (c) an association at the individual level between age at menarche, particular characteristics of ovarian function (fetal loss) and age at menopause. The reproductive ageing process therefore seems to result from the expression of the influence of ecological conditions in which the lifecycle of the women develops and of a degree of heritability that affects not only the age at menopause but also a range of characteristics of ovarian function.

Lifetime dietary change and its relation to increase in weight in Spanish women.

INTRODUCTION: Changes in dietary patterns and a decrease in physical activity have occurred in Western countries. These are factors in the variation in body composition observed in populations, characterized by a progressive accumulation of fat with age and a consequent increase in the risk of suffering from common chronic illnesses such as obesity, cardiovascular disease and cancer. OBJECTIVE: To investigate weight gain throughout the life-cycle and its relation to modifications in dietary patterns, analyzing the causes of these modifications and their implications for patterns of adult overweight and obesity. DESIGN: Cross-sectional sample of Spanish women from a socio-economically disadvantaged class. SUBJECTS: 1037 healthy perimenopausal women (age: 45-65 y). MEASUREMENTS: Juvenile body mass index (BMI), current BMI, food frequency questionnaire, retrospective food habits. RESULTS AND CONCLUSIONS: Of these women, 48.8% had changed their dietary habits during their lifetime. A change in diet due to migration or marriage occurred at approximately 20 years of age and was characterized by an increased frequency of consumption of foods rich in protein and complex carbohydrates, while a change due to illness occurred at around 50 years of age and was characterized by a decrease in the consumption of these types of food. The change in dietary behavior due to migration was associated with weight gain. Weight gain was also inversely associated with BMI during youth; women who in their youth had a BMI<18.5 kg/m2 gained an average of 21.4 kg, compared with those with a BMI>27 kg/m2 in their youth, who gained an average of 5.4 kg. International Journal of Obesity (2000)24, 14-19

Characteristics of menstrual cycles in Moroccan girls: prevalence of dysfunctions and associated behaviours.

Population studies on normal and dysfunctional characteristics of menstrual cycles are scarce for western populations and practically non-existent for non-western ones. Recent data suggest that the type of menstrual cycle can be relevant for later gynaecological problems in several ways. The type of menstrual cycle is related to menarcheal age in a way that those with early maturation show more menstrual disorders which are the largest diagnosis category accounting for hysterectomies in adult women. On the other hand menstrual pain is often cited as the main single cause of school absenteeism among adolescent girls. The aim of this study is to describe characteristics of menstrual cycles, prevalence of main dysfunctions and their relationship to the age of maturity. The sample comprises 495 adolescent girls from Marrakech (Morocco) aged 12-19 years. At 13 years, 40% of these girls had reached menarche. The median age at menarche is 13.04. The prevalences of abdominal pain, premenstrual symptoms and irregularity are 69.60, 51.20 and 23.03 respectively. Abdominal pain is significantly more frequent in girls with early menarche.

[Acute renal failure in the allogeneic transplantation of hemopoietic progenitors. The clinical characteristics in a series of 92 patients]. / Fracaso renal agudo en el trasplante alogénico de progenitores hemopoyéticos. Características clínicas en una serie de 92 pacientes.

BACKGROUND: Analysis of clinical characteristics of acute renal failure (ARF) after allogeneic bone marrow transplantation (BMT). PATIENTS AND METHODS: Analysis of 92 patients who developed ARF of 260 patients following BMT. RESULTS: ARF incidence was 35.4%. Sixty three percent of ARF occurred before day 20 after BMT. Duration of ARF was less of 10 days in 72.8%. ARF was non oliguric in the 80.4% of cases. Most common ARF etiologies were: multifactorial (37%), nephrotoxicity (NPH) (33.7%) and veno-occlusive disease of the liver (VOD) (14.1%). ARF secondary to VOD was the most severe: and the longest, where the secondary to NPH was less lever and shorter. Hemodialysis (HD) was necessary in 22.8% of ARF. Mortality in ARF group was 45.6%, higher in HD group (80.9%) than in non-HD group (35.2%) (p < 0.0002). CONCLUSIONS: ARF is a frequent complication following BMT. It occurs early, has short duration, is non oliguric, mainly hemodynamic and carries a whose prognosis.

Nephroprotective effect of cilastatin in allogeneic bone marrow transplantation. Results from a retrospective analysis.

Cilastatin, an inhibitor of the tubular brush border enzyme dehydropeptidase-I, is added in a fixed combination to imipenem. Cilastatin has been demonstrated in different animal models and in one clinical trial, to reduce the nephrotoxicity associated with cyclosporin A. To evaluate a possible nephroprotective effect of cilastatin following allogeneic BMT we conducted a retrospective analysis of 104 patients transplanted in our BMT Unit from January 1991 to January 1995. Imipenem/cilastatin (I/C) was used in a non-randomized manner in 64 patients during this period. Acute renal failure (ARF) was diagnosed in 32 patients (30%). ARF was not associated with gender, sepsis, conditioning regimen, underlying disease, bilirubin, or age. VOD occurred in 12/32 (37.5%) of patients with ARF whereas it occurred in only 7/72 (9.7%) of patients without ARF (P < 0.0007). ARF was not correlated with use of aminoglycosides, vancomycin, ciprofloxacine, ceftazidime or amphotericin-B. However, 13 patients of 64 exposed to I/C (20.3%) developed ARF vs 19 of 40 patients (47.5%) who were not exposed to I/C (P < 0.003; OR 0.28). Stratified analysis and multiple logistic regression confirmed the I/C nephroprotective action. The mean cyclosporin A levels in the I/C group were significantly decreased (208.6 +/- 64.9) vs the non-I/C group (265 +/- 118). We conclude that these results suggest I/C may counteract acute cyclosporin A nephrotoxicity following BMT and further prospective clinical trials are needed to confirm if routine administration of cilastatine confers benefit in the BMT setting.

Influence of body mass index and slimming habits on menstrual pain and cycle irregularity.

Using a cross-sectional sample of 1147 urban adolescents, aged between 14 and 20 years, the variability of some menstrual cycle indicators was related to weight loss. Nearly 40% of the adolescents tried to lose weight and the results showed that attempting to lose weight is significantly associated with increased prevalence of menstrual irregularity and menstrual pain. This finding is independent of body mass index.

Microscopic polyangiitis. A systemic vasculitis with a positive P-ANCA.

A young girl presented with a purpuric rash on lower limbs, fever, eosinophilia, peripheral neuropathy and progressive renal insufficiency. She developed vesicles, purpuric macules and papules on the head, several nodules on the palmar sides of hands and fingers, splinter haemorrhages, and a disfiguring, facial oedema. A renal biopsy specimen disclosed a focal and segmental necrotizing glomerulonephritis with crescents. Peripheral ANCA with antimyeloperoxidase specificity [P-ANCA (MPO)] was positive and cytoplasmic ANCA with PR3 specificity was negative. Treatment with prednisone and cyclophosphamide was started with a good clinical response, stabilization of renal insufficiency and disappearance of P-ANCA (MPO). Our case fulfils the diagnostic criteria for microscopic polyangiitis (microscopic polyarteritis, MPA), namely a segmental necrotizing and crescentic glomerulonephritis associated with extrarenal vasculitis involving small-sized vessels, without granulomas or asthma. This is a rare disease, which has a poor prognosis in the absence of aggressive therapy, and is infrequently reported in dermatological journals.

Acute renal failure in patients following bone marrow transplantation: prevalence, risk factors and outcome.

To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 275 patients was undertaken. ARF was diagnosed in 72 patients (26%) and occurred in 81.9% within the first month. The three main clinical causes were multifactorial (36%), nephrotoxic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prevalence was higher in allogeneic BMT (36%) than in autologous BMT (6.5%). Risk factors related to the development of ARF wee preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT confirmed this association (VOD, odds ratio 3.8; age offer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, conditioning therapy, and sex were not associated with ARF. Seventeen cases of ARF required hemodialysis (24%) mainly in association with VOD (70.5%). The overall morality from ARF was 45.8%, the dialyzed group having the highest mortality (88%). Survival in the ARF group was continuously worse up to 3 months and the actuarial survival at 10 years was 29.7 versus 53.2%. We conclude that ARF is a common complication mainly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.