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1.
Clin Exp Nephrol ; 19(5): 804-14, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25500737

RESUMO

BACKGROUND: The soluble urokinase receptor (suPAR) has been implicated as a cause of primary focal segmental glomerulosclerosis (FSGS). However, the clinical significance of suPAR in glomerular diseases currently remains unclear. METHODS: In this retrospective single-center cohort study, we investigated serum (s-) and urinary (u-) suPAR in patients with primary nephrotic syndrome (NS) (serum/urine: 37/32 cases) and MPO-ANCA-associated glomerulonephritis (ANCA-GN) (serum/urine: 13/11 cases). RESULTS: In pretreatment s- and u-suPAR, no significant differences were observed between the primary NS and ANCA-GN groups or among the pathological types of primary NS. An inverse correlation was noted between pretreatment s-suPAR and eGFR in the primary NS and ANCA-GN groups. A positive correlation was noted between pretreatment u-suPAR and proteinuria in the primary NS group. Furthermore, time-course changes in s- and u-suPAR over 2 months after therapy were associated with the therapeutic responsiveness of primary NS, particularly the differentiation of MCNS from FSGS (s-suPAR: AUC-ROC = 0.905, p = 0.007; u-suPAR: AUC-ROC = 0.816, p = 0.048). In the ANCA-GN group, a positive correlation was found between pretreatment s-suPAR and clinical severity or crescent formation, whereas u-suPAR was not correlated with these parameters. CONCLUSION: S- and u-suPAR after therapy may serve as clinical markers to judge the treatment response of untreated NS and differentiate MCNS from FSGS, but not in pretreatment patients. S-, but not u-suPAR may predict the severity of and crescent formation in ANCA-GN.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/genética , Glomerulonefrite/genética , Glomerulonefrite/metabolismo , Síndrome Nefrótica/genética , Síndrome Nefrótica/metabolismo , Peroxidase/genética , Peroxidase/metabolismo , Receptores de Ativador de Plasminogênio Tipo Uroquinase/genética , Receptores de Ativador de Plasminogênio Tipo Uroquinase/metabolismo , Adulto , Idoso , Povo Asiático , Estudos de Coortes , Progressão da Doença , Feminino , Glomerulonefrite/patologia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/patologia , Estudos Retrospectivos
2.
Nephron Clin Pract ; 121(1-2): c16-24, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23075624

RESUMO

BACKGROUND: Interstitial fibrosis in chronic allograft injury has been suggested as a major cause of the loss of allograft. METHODS: To clarify the involvement of circulating fibrocytes (CF) and α-smooth muscle actin (SMA)-positive cells in renal allograft injury, we investigated 36 renal transplanted cases at 0 h, 1 h, 2-4 weeks, 4-8 weeks, and 1 year, and 5 normal controls. Double immunofluorescence analysis for both COL1 and CD45 indicating CF (/mm(2)), and the positive area (%) of α-SMA and Masson trichrome (MT) stain were detected by an image analyzing system. RESULTS: The mean number of CF was 0 in controls and 4.0 in total transplanted specimens (p < 0.05). CF correlated with the α-SMA-positive area in the graft (R(2) = 0.39, p < 0.01), but not with Banff 2005 scores. The number of CF increased in 2-4 weeks; however, decreased 1 year after transplantation. α-SMA-positive area gradually increased at 1 year concomitant with the increase of MT-positive area. A similar phenomenon was observed in a case of primary nonfunction kidney from 0 h to 6 weeks after transplantation. The electron microscopy score of fibrosis around peritubular capillaries was correlated positively with COL1-positive area (R(2) = 0.72, p < 0.01), but negatively with infiltrated CF (R(2) = 0.25, p < 0.05). CONCLUSION: CF were transiently induced, probably due to ischemia-reperfusion injury, but fibrosis only slightly progressed in this process. The α-SMA-positive myofibroblasts may accelerate the expansion of fibrosis around peritubular capillaries in chronic allograft injury.


Assuntos
Actinas/metabolismo , Fibroblastos , Transplante de Rim/patologia , Rim/patologia , Traumatismo por Reperfusão/complicações , Adulto , Idoso , Capilares/patologia , Contagem de Células , Colágeno Tipo I/metabolismo , Feminino , Fibroblastos/metabolismo , Fibrose , Sobrevivência de Enxerto , Humanos , Rim/irrigação sanguínea , Rim/metabolismo , Antígenos Comuns de Leucócito/metabolismo , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Miofibroblastos/metabolismo , Estatísticas não Paramétricas , Fatores de Tempo
3.
Clin Transplant ; 24 Suppl 22: 35-8, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20590692

RESUMO

We reported a 40-year-old female case of second renal transplantation with antibody-mediated rejection (AMR) complicated by BK virus nephropathy. She started hemodialysis (HD) at the age of 17 because of IgA nephropathy. At the age of 18, she underwent living-donor kidney transplantation from her father, but two and a half years after transplantation, she developed chronic rejection. This time, she received cadaveric renal transplantation under the negative cross-match (AHG-LCT), and HLA-AB 1 mismatch and -DR 1 mismatch. Immunosuppressive therapy was initiated using the following four immunosuppressants: methylprednisolone, mycophenolate mofetil, cyclosporine, and basiliximab. However, renal graft showed delayed function, the biopsy showed glomerulitis (g2), endarteritis (v1), and cellular infiltration (ptc3) consisting mainly of mononuclear cells in the peritubular capillary with diffusely positive C4d and anti-SV 40 large T-antigen-positive renal tubular epithelial cells on post-operative day 19. The donor-specific antibody for HLA-B46 was proven by the LAB screen method. We performed plasma exchange three times and administered immunoglobulin (15 g in total). Then, methylprednisolone pulse therapy was added, and the serum creatinine (SCr) levels gradually decreased. On post-operative day 44, the patient was removed from HD and was discharged with SCr level of 3.3 mg/dL.


Assuntos
Vírus BK/patogenicidade , Rejeição de Enxerto/imunologia , Antígenos HLA-B/imunologia , Imunoglobulina G/imunologia , Transplante de Rim , Nefrite Intersticial/cirurgia , Infecções por Polyomavirus/cirurgia , Infecções Tumorais por Vírus/cirurgia , Adulto , Feminino , Humanos , Imunossupressores/uso terapêutico , Doadores Vivos , Nefrite Intersticial/imunologia , Nefrite Intersticial/virologia , Infecções por Polyomavirus/imunologia , Infecções por Polyomavirus/virologia , Reoperação , Resultado do Tratamento , Infecções Tumorais por Vírus/imunologia , Infecções Tumorais por Vírus/virologia , Replicação Viral
4.
Nihon Jinzo Gakkai Shi ; 51(1): 44-50, 2009.
Artigo em Japonês | MEDLINE | ID: mdl-19238908

RESUMO

UNLABELLED: To clarify the outcomes of patients with lupus glomerulonephritis (LGN), we performed a retrospective study of 31 patients (27 females and 4 males) with LGN between January 1975 and June 2006. All these 31 patients fulfilled the SLE criteria of the American College of Rheumatology evaluated by pathohistological diagnosis using renal biopsies. According to 2003 ISN/RPS classification, we reclassified all initial renal biopsies as class II 16%, class III 16%, class IV 48%, and class V 19.5%. Activity and chronicity indices were also calculated according to the scores proposed by Austin et al. All patients were treated by oral corticosteroids in induction therapy, then subsequeatly 18 patients (61%) were treated with intravenous methylprednisolone pulse therapy, and 16 patients with immunosuppressive agents (58%). Clinical remission rate was 94% by induction therapy and 13% by recurrence rate. Patient survival rate was 85% at 10 years and 76% at 20 years. Renal survival rate was 96% at 10 years and 86% at 20 years, 100% at 10 years and 80% at 20 years in ClassIV-G. In the multivariate Cox hazard analysis of the clinicopathologic factors, serum creatinine was selected as the most significant risk factor for death and/or end-stage renal failure (p=0.036). In addition, the chronicity index was also a significant risk factor for renal survival of LGN. CONCLUSION: This retrospective analysis of LGN showed better outcomes than expected. Overall, early diagnosis and suitable initial therapy may improve the renal survival of LGN in both groups of patients.


Assuntos
Nefrite Lúpica/diagnóstico , Adolescente , Corticosteroides/administração & dosagem , Adulto , Idoso , Criança , Creatinina/sangue , Feminino , Humanos , Imunossupressores/administração & dosagem , Rim/patologia , Nefrite Lúpica/classificação , Nefrite Lúpica/mortalidade , Nefrite Lúpica/terapia , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
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