RESUMO
There is fast-emerging, cumulative clinical data on coronavirus disease 2019 (COVID-19) in kidney transplant recipients. Although respiratory tract symptoms are often the initial presentation among kidney transplant recipients who contract COVID-19, other clinical features which may indicate underlying SARS-CoV-2-related inflammation, such as gastrointestinal symptoms, are not uncommon. Hyponatremia can develop and may reflect underlying inflammation. Interferon-6 is an important pro-inflammatory cytokine involved in the pathogenesis of severe COVID-19 complications and may play a role in the inappropriately higher secretion of antidiuretic hormone leading to hyponatremia. This pathway is the so-called immuno-neuroendocrine interface. Hyponatremia in COVID-19 has been reported in a few case series of non-kidney transplant patients and only one reported kidney transplant recipient. However, the clinical course and prognostic value of hyponatremia in this population are not described in detail. We report a kidney transplant recipient who was infected with COVID-19 and exhibited severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion. Hyponatremia is one of the clinical presentations of COVID-19, although less common, and may occur more frequently in kidney transplant recipients. Thus, the possible underlying immuno-neuroendocrine relationship related to the inflammatory process of COVID-19 leading to hyponatremia and its prognostic value are reviewed.
Assuntos
COVID-19/imunologia , Hiponatremia/imunologia , Imunossupressores/uso terapêutico , Síndrome de Secreção Inadequada de HAD/imunologia , Transplante de Rim , COVID-19/metabolismo , Feminino , Rejeição de Enxerto/prevenção & controle , Humanos , Hiponatremia/metabolismo , Síndrome de Secreção Inadequada de HAD/metabolismo , Pessoa de Meia-Idade , Neuroimunomodulação/imunologia , Sistemas Neurossecretores/imunologia , SARS-CoV-2RESUMO
The objective of this study was to analyze the frequency of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with positive aquaporin-4 (AQP4) antibodies and evaluate the relationship between SIADH and hypothalamic lesions in patients with NMO and NMO spectrum disorder (NMOSD). AQP4 antibodies were tested by an indirect immunofluorescence assay employing HEK-293 cells transfected with recombinant human AQP4. Clinical data of patients were analyzed retrospectively. In total, 192 patients with AQP4 antibodies were certified, of which 41 patients (21.4 %) were included in the present study. Six patients (14.6 %, 6/41) met the criteria of SIADH, of which hyponatremia was mild in one patient, and severe in five. Five patients experienced confusion or decreased consciousness. Four patients were diagnosed with NMO and two were diagnosed with recurrent optic neuritis. Magnetic resonance imaging showed 11 of 41 patients (26.8 %) had hypothalamic lesions. All patients with SIADH had hypothalamic abnormalities. Hyponatremia resolved in all patients after intravenous methylprednisolone and intravenous immunoglobulin therapy. SIADH is not rare in patients with NMO/NMOSD, especially in patients with lesions close to the hypothalamus.
Assuntos
Aquaporina 4/imunologia , Autoanticorpos , Hipotálamo/patologia , Síndrome de Secreção Inadequada de HAD/patologia , Neuromielite Óptica/patologia , Adulto , Autoanticorpos/sangue , Autoanticorpos/líquido cefalorraquidiano , Feminino , Células HEK293 , Humanos , Síndrome de Secreção Inadequada de HAD/imunologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuromielite Óptica/imunologia , Adulto JovemAssuntos
Ataxia/complicações , Autoanticorpos/sangue , Gangliosídeos/imunologia , Síndrome de Guillain-Barré/complicações , Síndrome de Secreção Inadequada de HAD/imunologia , Ataxia/imunologia , Ataxia/fisiopatologia , Autoanticorpos/análise , Progressão da Doença , Feminino , Síndrome de Guillain-Barré/imunologia , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Sistema Hipotálamo-Hipofisário/imunologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Secreção Inadequada de HAD/fisiopatologia , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/imunologia , Transtornos da Motilidade Ocular/fisiopatologia , Nervos Periféricos/imunologia , Nervos Periféricos/patologia , Nervos Periféricos/fisiopatologia , Polirradiculoneuropatia/complicações , Polirradiculoneuropatia/imunologia , Polirradiculoneuropatia/fisiopatologia , Recidiva , Transtornos de Sensação/imunologia , Transtornos de Sensação/fisiopatologia , Síndrome , Resultado do TratamentoAssuntos
Anticorpos Antifosfolipídeos/efeitos adversos , Diabetes Insípido Neurogênico/imunologia , Síndrome de Secreção Inadequada de HAD/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Anticorpos Anticardiolipina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Autoanticorpos/sangue , Doenças Autoimunes/diagnóstico , Hipotermia/imunologia , Encefalite Límbica/diagnóstico , Canais de Potássio de Abertura Dependente da Tensão da Membrana/imunologia , Doenças Autoimunes/imunologia , Diagnóstico Diferencial , Humanos , Hipotálamo/imunologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Síndrome de Secreção Inadequada de HAD/imunologia , Encefalite Límbica/imunologiaRESUMO
A patient was admitted for fever and acute respiratory failure (ARF), rapidly progressive tetraparesis, delirium, behavioral abnormalities, and diplopia. Leukocytosis and a rise in C-reactive protein were present. A syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was also diagnosed. Lumbar puncture yielded colorless CFS with mononuclear pleocytosis and protein rise. Electrodiagnosis revealed demyelinating polyneuropathy and axonal degeneration. Serum IgG and IgM for mycoplasma pneumoniae (MP) was consistent with acute infection, and erythromycin was started with rapid resolution of symptoms. Contrarily to most reports, an associated respiratory disease was not present and SIADH in association with MP has been reported only once, in a patient without direct central nervous system (CNS) involvement. Differential diagnosis and possible pathogenic mechanisms are discussed.
Assuntos
Doenças Desmielinizantes/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Secreção Inadequada de HAD/diagnóstico , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/diagnóstico , Degeneração Retrógrada/diagnóstico , Adulto , Proteína C-Reativa/metabolismo , Doenças Desmielinizantes/tratamento farmacológico , Doenças Desmielinizantes/imunologia , Eritromicina/uso terapêutico , Febre de Causa Desconhecida/etiologia , Febre de Causa Desconhecida/imunologia , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/imunologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Síndrome de Secreção Inadequada de HAD/tratamento farmacológico , Síndrome de Secreção Inadequada de HAD/imunologia , Masculino , Mycoplasma pneumoniae/imunologia , Exame Neurológico/efeitos dos fármacos , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/imunologia , Quadriplegia/etiologia , Quadriplegia/imunologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/imunologia , Degeneração Retrógrada/tratamento farmacológico , Degeneração Retrógrada/imunologiaRESUMO
A 52-year-old man presented with vomiting, general fatigue and hyponatremia. His symptoms and signs were consistent with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Endocrine studies revealed hypopituitarism and administration of hydrocortisone resulted in a marked polyuria. The patient was diagnosed as masked diabetes insipidus. The lymphocytic hypophysitis was also diagnosed on the basis of MRI findings and anti-pituitary antibody. Six months later, these abnormalities disappeared. Diabetes insipidus may exist in a case of hyponatremia due to contrastive SIADH. Such patients may recover spontaneously and careful follow-up is required, avoiding a long-term treatment by monotonous continuation of hormonal replacement.