RESUMO
Thrombotic microangiopathies represent a group of particularly serious pathologies that can cause a rapid worsening of renal function, especially in young subjects. Through the clinical case described, we will focus our attention on the clinical and laboratory manifestations of the pathology, on the diagnostics and on the therapies to be used. Recent therapeutic innovations for the treatment of this pathology will also be analysed.
Assuntos
Síndrome Hemolítico-Urêmica Atípica , Cefaleia , Hipertensão , Humanos , Síndrome Hemolítico-Urêmica Atípica/complicações , Síndrome Hemolítico-Urêmica Atípica/diagnóstico , Cefaleia/etiologia , Hipertensão/complicações , Hipertensão/etiologia , Masculino , FemininoRESUMO
Through a clinical case, we will describe the difficulties associated with providing transplantation opportunities to highly immunized patients. We will therefore focus on new desensitization therapies and their pharmacological effects with the consequent improvement in clinical outcomes. The main desensitization strategies in use and the main future therapeutic prospects will also be discussed.
Assuntos
Transplante de Rim , Humanos , Dessensibilização Imunológica , Antígenos HLA , Rejeição de Enxerto/prevenção & controleRESUMO
Mushroom poisoning can represent an acute event which the clinical nephrologist must deal with and which often leads to the need for emergency dialysis treatment. Through the exposed clinical case, we describe the secondary clinical manifestations of an acute intoxication sustained by Amanita Echinocephalae, and we will provide an overview of the main fungal intoxications of renal interest, the clinical presentation, the diagnostic strategies, and the subsequent treatment.
Assuntos
Injúria Renal Aguda , Intoxicação Alimentar por Cogumelos , Humanos , Amanita , Intoxicação Alimentar por Cogumelos/complicações , Intoxicação Alimentar por Cogumelos/terapia , Intoxicação Alimentar por Cogumelos/diagnóstico , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/terapia , Diálise Renal/efeitos adversos , Ingestão de AlimentosRESUMO
IgG4 related renal disease represents a frequent manifestation of the wider IgG4 related disease, a fibroinflammatory disorder with a not fully understood etiology that affects several organs. Through the clinical case presented, we will focus attention on this pathology and on the diagnostic difficulties that may arise, and on the investigations necessary for the diagnosis. Finally, the main therapeutic options will be discussed.
Assuntos
Imunoglobulina G , Nefropatias , Humanos , Rim/patologia , Nefropatias/patologiaRESUMO
Alport syndrome is a hereditary clinical condition characterized by multisystemic changes (sensorineural and ocular deafness) associated with hematuria and proteinuria. Due to its genetic variability and multiple symptoms, it is often diagnosed by chance and too late. The present work focuses on this pathology through a clinical case report. It also mentions the new therapeutic possibilities relating to this disease.
Assuntos
Nefrite Hereditária , Feminino , Hematúria/etiologia , Humanos , Nefrite Hereditária/complicações , Nefrite Hereditária/diagnóstico , Nefrite Hereditária/genética , Proteinúria/etiologiaRESUMO
We report the case of a patient with rheumatoid arthritis (RA) who developed a membranous nephropathy (MN) with nephrotic syndrome while receiving etanercept, a fusion protein that binds specifically to TNFalpha and blocks its interaction with TNFalpha receptors. A 62-year-old man with RA treated with etanercept was admitted to our unit in March 2008 because of a full-blown nephrotic syndrome. Renal biopsy showed a typical MN. Since no improvement of proteinuria was observed after withdrawal of etanercept, we administered rituximab (1 g two weeks apart repeated after 6 months). The signs and symptoms of RA improved and proteinuria decreased from 7.2 g/24h to 2.3 g/24h. MN is an immunological glomerulonephritis that may complicate other immune-mediated diseases or may be triggered by a number of drugs. The clinical improvement of both RA and MN after rituximab may indirectly confirm the role of antibodies in the pathogenesis of these diseases, although the mechanisms of action of this drug in immunological disorders remain to be elucidated.