RESUMO
[Figure: see text].
Assuntos
Hipertensão Renal , Rim , Nefrite , Óxido Nítrico , Simpatectomia/métodos , Animais , Pressão Sanguínea/fisiologia , Hipertensão Renal/metabolismo , Hipertensão Renal/cirurgia , Rim/inervação , Rim/metabolismo , Testes de Função Renal/métodos , Nefrite/metabolismo , Nefrite/cirurgia , Óxido Nítrico/análise , Óxido Nítrico/metabolismo , Ovinos , Resultado do TratamentoRESUMO
The increasing incident of chronic kidney disease (CKD) in recent years might be related to a change in dietary habits, known as excessive salt intake. Given excessive salt promotes pathogenic T cells responses. Since the importance of macrophage in the development of CKD, we addressed the effect of high salt loading on in a rat CKD model. We observed that 5/6Nx rats receiving a high salt diet showed strongly enhanced macrophage infiltration and activation in the renal tissue accompanied by deteriorated renal inflammation. Then we used the microarray expression profiling to detect the effect of additional Nacl on peritoneal macrophage derived from 5/6Nx. The NaCl treatment of macrophage extracted from 5/6Nx rat elicited a strong pro-inflammatory phenotype characterized by enhanced proinflammatory cytokine production, increased expression of molecules mainly involved in immune response process. This NaCl-induced pro-inflammatory macrophage phenotype was accompanied by increased phosphorylation of STAT1. Taken together, our study demonstrated that high salt intake promotes immune activation of macrophages through the STAT1 independently and exacerbates the kidney accompanied by promotion of inflammation. Thus, changes in diet may provide a novel strategy for the prevention or amelioration of CKD.
Assuntos
Mediadores da Inflamação/metabolismo , Inflamação/patologia , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Nefrectomia/efeitos adversos , Nefrite/patologia , Cloreto de Sódio/toxicidade , Animais , Regulação da Expressão Gênica , Inflamação/induzido quimicamente , Inflamação/metabolismo , Macrófagos/metabolismo , Masculino , Nefrite/induzido quimicamente , Nefrite/metabolismo , Nefrite/cirurgia , Ratos , Ratos Sprague-DawleyRESUMO
RATIONALE: A horseshoe kidney is the most common congenital fusion abnormality in the kidney, occurring in approximately 1 in 400 live births. Several complications including renal malignancies, ureteropelvic junction obstruction, urolithiasis, vesicoureteral reflux, and hydronephrosis can occur in this patient population. PATIENT CONCERNS: A 28-year-old woman was admitted to hospital because of chronic left low back pain. Microscopic hematuria was not seen. Computed tomography showed the horseshoe kidney and left hydronephrosis. DIAGNOSES: On the basis of these findings and clinical manifestations, the final diagnosis was the horseshoe kidney with left renal hydronephrosis and inflammation. INTERVENTIONS: A retroperitoneoscopic nephrectomy on the left kidney was performed. OUTCOMES: Histopathological examination of the specimen confirmed massive dilatation of the pelvicaliceal system and chronic pyelonephritic inflammation. The patient was discharged on the 7th postoperative day with no complications and no back pain. She remained well at 3 months with normal activity and good cosmetic result. LESSONS: Retroperitoneoscopic nephrectomy can be a safe and minimally invasive surgery for horseshoe kidney treatment.
Assuntos
Rim Fundido/cirurgia , Hidronefrose/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Nefrite/cirurgia , Adulto , Feminino , Rim Fundido/complicações , Humanos , Hidronefrose/etiologia , Nefrite/etiologia , Espaço Retroperitoneal/cirurgiaRESUMO
ABSTRACT Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Pielonefrite/cirurgia , Tuberculose Renal/cirurgia , Pionefrose/cirurgia , Laparoscopia Assistida com a Mão/efeitos adversos , Nefropatias/cirurgia , Nefrectomia/métodos , Nefrite/cirurgia , Pielonefrite Xantogranulomatosa/cirurgia , Reprodutibilidade dos Testes , Perda Sanguínea Cirúrgica , Fístula Intestinal/cirurgia , Doenças do Colo/cirurgia , Duração da Cirurgia , Fístula/cirurgia , Tempo de Internação , Pessoa de Meia-Idade , Nefrectomia/efeitos adversosAssuntos
Abscesso/etiologia , Aspergilose/etiologia , Aspergillus fumigatus/isolamento & purificação , Transplante de Fígado , Nefrite/etiologia , Infecções Oportunistas/etiologia , Complicações Pós-Operatórias/etiologia , Abscesso/microbiologia , Abscesso/cirurgia , Adulto , Aspergilose/cirurgia , Hepatite Autoimune/cirurgia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Nefrectomia , Nefrite/microbiologia , Nefrite/cirurgia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/cirurgia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
OBJECTIVES: This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. MATERIALS AND METHODS: Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. RESULTS: Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. CONCLUSIONS: In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.
Assuntos
Laparoscopia Assistida com a Mão , Nefropatias/cirurgia , Nefrectomia/métodos , Nefrite/cirurgia , Pielonefrite/cirurgia , Pionefrose/cirurgia , Tuberculose Renal/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Doenças do Colo/cirurgia , Feminino , Fístula/cirurgia , Laparoscopia Assistida com a Mão/efeitos adversos , Humanos , Fístula Intestinal/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Pielonefrite Xantogranulomatosa/cirurgia , Reprodutibilidade dos TestesRESUMO
We encountered a patient with infantile nephrotic syndrome associated with a dense interstitial inflammatory infiltrate and prominent extramedullary hematopoiesis. Immunohistochemical analysis revealed numerous terminal deoxynucleotidyl transferase (TdT)-positive cells, which may raise concern for lymphoblastic lymphoma. Thus, we further characterized a group of pediatric kidneys with inflammation. TdT-positive nuclei were quantitated, and dual immunostains for TdT/CD79a, TdT/CD3, and TdT/CD43 were performed in a subset of cases; flow cytometry was performed in 1 case. TdT-positive nuclei were present in inflamed pediatric kidneys in 40 of 42 patients. TdT counts (average of 3 maximal high-power fields) ranged from 1 to >200, with a mean of 47. The presence and number of TdT-positive nuclei showed a strong association with younger patient age. Extramedullary hematopoiesis was identified in 11/42 patients, all under the age of 1. The presence of extramedullary hematopoiesis did not correlate with TdT count (P=0.158). Dual immunostaining and flow cytometric analysis in 1 case showed weak expression of B-cell markers and favored normal precursor B cells. Although TdT is a common marker of lymphoblastic lymphoma, we have demonstrated that TdT-positive cells may be part of the inflammatory milieu in infant kidneys. Together with cytologic, architectural, and clinical features, these data can help to avoid misinterpretation of involvement by lymphoblastic lymphoma/leukemia.
Assuntos
DNA Nucleotidilexotransferase/análise , Rim/química , Nefrite/metabolismo , Síndrome Nefrótica/metabolismo , Adolescente , Biomarcadores/análise , Biópsia , Complexo CD3/análise , Antígenos CD79/análise , Criança , Pré-Escolar , Diagnóstico Diferencial , Citometria de Fluxo , Hematopoese Extramedular , Humanos , Imuno-Histoquímica , Lactente , Recém-Nascido , Rim/patologia , Rim/cirurgia , Leucossialina/análise , Masculino , Nefrectomia , Nefrite/diagnóstico , Nefrite/cirurgia , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/cirurgia , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Valor Preditivo dos Testes , Adulto JovemAssuntos
Estado Terminal , Mucormicose/diagnóstico , Nefrite/microbiologia , Idoso , Anfotericina B/uso terapêutico , Anemia/etiologia , Anemia/terapia , Antifúngicos/uso terapêutico , Transfusão de Sangue , Terapia Combinada , Comorbidade , Cistoscopia , Humanos , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Nefrectomia , Nefrite/diagnóstico , Nefrite/tratamento farmacológico , Nefrite/cirurgia , Prostatectomia , Tomografia Computadorizada por Raios X , UreterostomiaRESUMO
Candida parapsilosis is an emerging pathogen worldwide. It commonly causes soft tissue infection; however, to our knowledge there has been no previous report of monomicrobial necrotizing soft tissue infection (NSTI) secondary to C. parapsilosis. We report the first case of NSTI caused by C. parapsilosis in an immunocompromised renal transplant patient, with the diagnosis proven both histologically and microbiologically. Our patient required aggressive surgical intervention and antifungal therapy, with postoperative survival at 90 days.
Assuntos
Antifúngicos/uso terapêutico , Candida/patogenicidade , Candidíase Cutânea/microbiologia , Fasciite Necrosante/microbiologia , Terapia de Imunossupressão/efeitos adversos , Transplante de Rim/efeitos adversos , Amputação Cirúrgica , Antifúngicos/administração & dosagem , Candida/isolamento & purificação , Caspofungina , Equinocandinas/administração & dosagem , Equinocandinas/uso terapêutico , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Hipertensão Renal/cirurgia , Hospedeiro Imunocomprometido , Perna (Membro)/cirurgia , Lipopeptídeos/administração & dosagem , Lipopeptídeos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Nefrite/cirurgiaRESUMO
BACKGROUND: IgG4-related kidney disease is a comprehensive term for renal lesions associated with IgG4-related disease, which mainly manifests as plasma cell-rich tubulointerstitial nephritis with increased IgG4+ plasma cells and fibrosis. IgG4-related kidney disease in the renal pelvis is rare. CASE PRESENTATION: We describe a 53-year-old Asian woman who was referred to our hospital with a space-occupying renal lesion discovered by medical examination. A physical examination and laboratory evaluation revealed no significant abnormalities. Computed tomography scans showed a soft-tissue mass with an irregular border and mild homogeneous enhancement in the right renal pelvis and calyces. A positron emission tomography/computed tomography scan revealed soft-tissue density shadows with increased radionuclide uptake. To investigate a suspected pelvic carcinoma, a right ureteronephrectomy was performed. A pathologic examination of the renal sections showed a dense lymphoplasmacytic infiltrate rich in IgG4+ plasma cells, with fibrosis beneath the urothelial epithelium of the renal pelvis. Postoperatively, the serum IgG4 level was significantly elevated. The patient was diagnosed with IgG4-related kidney disease. CONCLUSION: We present a case of IgG4-related kidney disease mimicking urothelial carcinoma in the renal pelvis. When a buried and solitary hypovascular tumor is detected in the kidney, we must consider IgG4-related kidney disease as a differential diagnosis. Accordingly, elevated serum IgG4, radiologic findings, and pathologic examination may improve the diagnosis.
Assuntos
Carcinoma de Células de Transição/patologia , Imunoglobulina G/imunologia , Neoplasias Renais/patologia , Pelve Renal/patologia , Nefrite/diagnóstico , Nefrite/imunologia , Biópsia por Agulha , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina G/sangue , Imuno-Histoquímica , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Pelve Renal/diagnóstico por imagem , Pessoa de Meia-Idade , Nefrectomia/métodos , Nefrite/cirurgia , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
The Nephrology Quiz and Questionnaire remains an extremely popular session for attendees of the Annual Kidney Week Meeting of the American Society of Nephrology. Once again, the conference hall was overflowing with audience members and eager quiz participants. Topics covered by the expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories along with single best answer questions were prepared and submitted by the panel of experts. Before the meeting, program directors of United States nephrology training programs and nephrology fellows answered the questions through an internet-based questionnaire. During the live session, members of the audience tested their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They compared their answers in real time using audience response devices with the answers of the nephrology fellows and training program directors. The correct and incorrect answers were then discussed after the audience responses and the results of the questionnaire were displayed. As always, the audience, lecturers, and moderators enjoyed this educational session. This article recapitulates the session and reproduces its educational value for the readers of CJASN. Enjoy the clinical cases and expert discussions.
Assuntos
Anemia/virologia , Transplante de Rim/efeitos adversos , Nefrologia/educação , Infecções por Parvoviridae/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Inibidores de Calcineurina/efeitos adversos , Feminino , Humanos , Hipertensão Renal/cirurgia , Terapia de Imunossupressão/efeitos adversos , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrite/cirurgia , Neuroimagem , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Radiografia , Inquéritos e Questionários , Tacrolimo/efeitos adversosRESUMO
Resistant hypertension poses significant health concerns. There are strong demands for new and safe therapies to control resistant hypertension while addressing its common causes, specifically poor compliance to lifelong polypharmacy, lifestyle modifications, and physician inertia. The sympathetic nervous system plays a significant pathophysiological role in hypertension. Surgical sympathectomy for blood pressure reduction is an old but extremely efficacious therapeutic concept, now abandoned with the dawn of a safer contemporary pharmacology era. Recently, clinical studies have revealed promising results for safe and sustained blood pressure reduction with percutaneous renal sympathetic denervation. This is a novel, minimally invasive, device-based therapy, specifically targeting and ablating the renal artery nerves with radiofrequency waves without permanent implantation. There are also reported additional benefits in related comorbidities, such as impaired glucose metabolism, renal impairment, left ventricular hypertrophy, heart failure, and others. This review focuses on how selective renal sympathetic denervation works, its present and potential therapeutic indications, and its future directions.
Assuntos
Hipertensão/cirurgia , Artéria Renal/inervação , Simpatectomia/métodos , Sistema Vasomotor/cirurgia , Ablação por Cateter , Resistência a Medicamentos , Insuficiência Cardíaca/cirurgia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão Renal/cirurgia , Nefrite/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Simpatectomia/efeitos adversos , Simpatectomia/instrumentação , Sistema Vasomotor/fisiopatologiaRESUMO
A 55-year-old male patient suffered from severe high-voltage electric burn with an area of 20%TBSA full-thickness injury. The injury involved the distal end of left upper limb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perforation of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was performed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin grafting. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppressive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocutaneous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.
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Traumatismos Abdominais/cirurgia , Queimaduras por Corrente Elétrica/cirurgia , Vasculite por IgA/cirurgia , Nefrite/cirurgia , Traumatismos Torácicos/cirurgia , Cavidade Abdominal , Traumatismos Abdominais/complicações , Queimaduras por Corrente Elétrica/complicações , Humanos , Vasculite por IgA/complicações , Masculino , Pessoa de Meia-Idade , Nefrite/complicações , Cavidade Torácica , Traumatismos Torácicos/complicaçõesRESUMO
OBJECTIVE: To evaluate the effect of mesenchymal stem cells (MSCs) in rats with anti-Thy1,1 nephritis. METHODS: Female albino rats were divided into three groups, control group, anti-Thy1,1 group and treatment with i.v. MSCs group. MSCs were derived from bone marrow of male albino rats, Y-chromosome gene was detected by polymerase chain reaction in the kidney. Serum urea and creatinine were estimated for all groups. Kidney of all studied groups was examined histologically and histochemically (total carbohydrates and total proteins). DNA fragmentation and expression of α-SMA were detected. RESULTS: Kidney of animals injected with anti-Thy1,1 showed inflammatory leucocytic infiltration, hypertrophied glomeruli, tubular necrosis and congestion in the renal blood vessels. The kidney tissue also showed reduction of carbohydrates and total proteins together with increase in apoptosis and in expression of α-SMA. Moreover, the levels of urea and creatinine were elevated. Treating animals with MSCs revealed that kidney tissue displayed an improvement in the histological and histochemical changes. Apoptosis and α-SMA expression were decreased, and the levels of urea and creatinine decreased. CONCLUSIONS: The obtained results demonstrated the potential of MSCs to ameliorate the structure and function of the kidney in rats with anti-Thy1,1 nephritis possibly through the release of paracrine growth factor(s).
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Isoanticorpos/toxicidade , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , Nefrite/cirurgia , Animais , Feminino , Masculino , Nefrite/induzido quimicamente , RatosRESUMO
BACKGROUND: Bariatric surgery improves arterial hypertension and renal function; however, the underlying mechanisms and effect of different surgical procedures are unknown. In the present prospective study, we compared the 12-month follow-up results after Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy on weight loss, hypertension, renal function, and inflammatory status. METHODS: A total of 34 morbidly obese patients were investigated before, one and 12 months after Roux-en-Y gastric bypass (n = 10), laparoscopic adjustable gastric banding (n = 13), and laparoscopic sleeve gastrectomy (n = 11) for hypertension, kidney function, urinary and serum cytokine levels of macrophage migration inhibitory factor, monocyte chemotactic protein-1, and chemokine ligand-18. RESULTS: At 12 months after surgery, the patients in all 3 treatment arms showed a significant decrease in the mean body mass index, mean arterial pressure, and urinary and serum inflammatory markers (all P < .001). The reduction in urinary and serum cytokine levels correlated directly with body weight loss (P < .05). Patients with impaired renal function at baseline (corresponding to serum cystatin C >.8 mg/L) had a marked improvement in renal function 12 months after surgery (P < .05). CONCLUSION: Surgically induced weight loss is associated with a marked decrease in renal and systemic inflammation and arterial hypertension and improvement in renal function in patients with pre-existing renal impairment. These effects appear to be independent of surgical procedure. The improvement in renal inflammation could be 1 of the mechanisms contributing to the beneficial effects of bariatric surgery on arterial blood pressure, proteinuria, and renal function.
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Gastrectomia/métodos , Derivação Gástrica/métodos , Gastroplastia/métodos , Hipertensão/cirurgia , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Adulto , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Creatinina/metabolismo , Cistatina C/metabolismo , Citocinas/metabolismo , Feminino , Humanos , Inflamação/fisiopatologia , Inflamação/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrite/fisiopatologia , Nefrite/cirurgia , Obesidade Mórbida/fisiopatologia , Estudos Prospectivos , Redução de Peso/fisiologiaRESUMO
Recent evidence indicates that bone marrow-derived mesenchymal stem cells (BM-MSCs) possess immunosuppressive properties both in vitro and in vivo. We have previously demonstrated that transplantation of human MSCs can significantly improve the autoimmune conditions in MRL/lpr mice. The current study aimed to determine the mechanisms by which murine BM-MSC transplantation (MSCT) ameliorates nephritis in MRL/lpr mice. In this study, we found that MSCT can significantly prolong the survival of MRL/lpr mice. Eight weeks after transplantation, MSCT-treated mice showed significantly smaller spleens than control animals, with fewer marginal zones (MZs), T1, T2, activated B-cells, and plasma cells. Moreover, serum levels of B-cell activating factor (BAFF) and IL-10 in MSCT-treated mice decreased significantly compared to those in the control group, while levels of serum TGF-ß were increased. Notably, decreased BAFF expression in both spleen and kidney was accompanied by decreased production of anti-dsDNA autoantibodies and proteinuria in MSCT-treated mice. Since BAFF is mainly expressed by T-cells and dendritic cells, we incubated BM-MSCs and DCs together and found that the production of BAFF by DCs was suppressed by MSCs. Thus, our findings suggest that MSCT may suppress the excessive activation of B-cells via inhibition of BAFF production in MRL/lpr mice.
Assuntos
Linfócitos B/imunologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Nefrite/terapia , Animais , Autoanticorpos/imunologia , Autoanticorpos/metabolismo , Fator Ativador de Células B/sangue , Linfócitos B/metabolismo , Células da Medula Óssea/citologia , Células Cultivadas , Feminino , Interleucina-10/sangue , Rim/metabolismo , Rim/patologia , Ativação Linfocitária , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos MRL lpr , Nefrite/metabolismo , Nefrite/patologia , Nefrite/cirurgia , Proteinúria/diagnóstico , Baço/metabolismo , Baço/patologia , Linfócitos T/imunologia , Linfócitos T/metabolismo , Fator de Crescimento Transformador beta/sangue , Transplante HomólogoRESUMO
Henoch-Schönlein purpura (HSP) is a systemic disorder characterized by leukocytoclastic vasculitis involving the capillaries and the deposition of IgA immune complexes. Renal involvement is the principal cause of morbidity and mortality in children with HSP. We report here a 13-year-old girl with Henoch-Schönlein purpura nephritis (HSPN) of International Study of Kidney Disease in Children (ISKDC) grade VI and persistent nephrotic syndrome despite receiving conventional therapy, such as prednisolone, methylprednisolone and urokinase pulse therapy and plasmapheresis (PP). The patient was treated with tonsillectomy, which subsequently decreased proteinuria, induced the disappearance of microscopic hematuria, and improved renal pathological findings. A regimen of methylprednisolone and urokinase pulse therapy plus PP with tonsillectomy may be an effective and useful therapy for some children with severe HSPN children of ISKDC grade VI and persistent nephrotic syndrome.
Assuntos
Vasculite por IgA/cirurgia , Nefrite/cirurgia , Síndrome Nefrótica/cirurgia , Tonsilectomia , Adolescente , Feminino , Humanos , Vasculite por IgA/tratamento farmacológico , Metilprednisolona/administração & dosagem , Nefrite/tratamento farmacológico , Síndrome Nefrótica/tratamento farmacológico , Plasmaferese , Proteinúria/tratamento farmacológico , Proteinúria/cirurgia , Pulsoterapia , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagemRESUMO
BACKGROUND: Henoch-Schönlein nephritis (HSN) is a rare condition resulting in end-stage renal disease. Therefore, graft outcomes and recurrence rates after transplantation are not well studied. Also, the effect of donor type on graft outcome has not been evaluated thoroughly. METHODS: The graft outcome and recurrence rate in 20 kidney recipients with HSN were compared with age-, sex-, and donor source-matched controls (control A, primary immunoglobulin A nephropathy; control B, other causes; 40 recipients per group). To assess the effect of donor type, we pooled our data with two previous cohort studies where donor type had been described in detail. RESULTS: Overall graft survival rates were 87.7% at 10 years. The overall recurrence rate of HSN was 15.4% over 10 years. Graft survival and recurrence rates in the HSN group were similar to those of control A and control B. The pooled data showed a 29.4% incidence rate for recurrent HSN. Living related donor transplantation showed a trend of higher recurrence compared with recipients with nonrelated grafts, although it was marginally significant (P=0.059). However, the graft survival rate in related-donor recipients was not inferior to that in the unrelated-donor recipients. CONCLUSIONS: Long-term graft survival and recurrence rates in kidney recipients with HSN were comparable to those of recipients with primary immunoglobulin A nephropathy. The type of donor did not significantly affect long-term graft survival.