RESUMO
BACKGROUND: There have been some shifts in the frequency and distribution of biopsy-proven renal diseases in China over recent years. The aim of the study was to investigate the changing spectrum of renal diseases from the view of kidney biopsy data in a single center of China. METHODS AND RESULTS: A total of 10,996 cases of native renal biopsies from patients aged ≥15 years old in Huashan Hospital, Fudan University, between 2008 and 2018 were analyzed retrospectively. The results showed that primary glomerular nephropathy (PGN) remained the most common biopsy-proven renal disease (69.42% of total), with IgA nephropathy (IgAN) accounting for 44.40% of PGN, membranous nephropathy (MN) for 28.55%, minimal change disease (MCD) for 13.26% and focal segmental glomerulosclerosis (FSGS) for 8.00%. During the study period, the proportion of MN in PGN appeared an increasing tendency, while that of IgAN and MCD remained stable and that of FSGS showed a decline. Secondary glomerular nephropathy (SGN) constituted 21.54% of total cases, among which the leading two diseases were lupus nephritis (LN) and Henoch-Schonlein purpura nephritis (HSN) which accounted for 41.08% and 19.11% respectively. CONCLUSIONS: The 11-year retrospective study revealed that PGN was the predominant histologic diagnosis among patients undergoing renal biopsy and the most frequent type of PGN remained to be IgAN, followed by MN which increased dramatically.
Assuntos
Glomerulonefrite por IGA , Glomerulonefrite Membranosa , Glomerulosclerose Segmentar e Focal , Rim , Nefrose Lipoide , Humanos , China/epidemiologia , Masculino , Estudos Retrospectivos , Adulto , Feminino , Pessoa de Meia-Idade , Biópsia/estatística & dados numéricos , Glomerulonefrite Membranosa/patologia , Glomerulonefrite Membranosa/epidemiologia , Glomerulonefrite por IGA/patologia , Glomerulonefrite por IGA/epidemiologia , Glomerulosclerose Segmentar e Focal/patologia , Glomerulosclerose Segmentar e Focal/epidemiologia , Adulto Jovem , Nefrose Lipoide/patologia , Nefrose Lipoide/epidemiologia , Rim/patologia , Adolescente , Nefrite Lúpica/patologia , Nefrite Lúpica/epidemiologia , Idoso , Vasculite por IgA/patologia , Vasculite por IgA/epidemiologia , Vasculite por IgA/diagnóstico , Glomerulonefrite/patologia , Glomerulonefrite/epidemiologia , Nefropatias/patologia , Nefropatias/epidemiologia , Nefropatias/diagnósticoRESUMO
Immunoglobulin A vasculitis (IgAV) is the most common vasculitis of childhood. Disordered immune responses play important roles in its pathogenesis, but the comprehensive immune profile of the disease and the underlying mechanisms are still largely unknown. Here we found a potential disease biomarker cold inducible RNA binding protein (CIRP) in our pediatric IgAV cohort. Serum CIRP level in these patients were elevated and positively correlated with the increased early memory (CD45RA+CD62L+CD95+) T cells revealed using multicolor flow cytometry. Immune phenotyping of the patients showed they had more activated T cells with higher IL6Ra expression. T cell culture experiment showed CIRP further activated both human CD4+ and CD8+ T cells as indicated by increased perforin secretion and phosphorylation of STAT3. Blockade of IL6Rα attenuated CIRP-induced T cell toxicity in vitro. RNA-sequencing data further supported CIRP stimulation promoted human T cell activation and migration, fueled inflammation through the JAK-STAT signaling pathway. Therefore, IL6Ra-mediated T cell activation by extracellular CIRP may contribute to pathogenesis of IgAV in children, both CIRP and IL6Ra could be new therapeutic targets for IgAV.
Assuntos
Ativação Linfocitária , Proteínas de Ligação a RNA , Receptores de Interleucina-6 , Fator de Transcrição STAT3 , Adolescente , Criança , Feminino , Humanos , Masculino , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Receptor Celular 2 do Vírus da Hepatite A , Vasculite por IgA/imunologia , Vasculite por IgA/patologia , Vasculite por IgA/metabolismo , Ativação Linfocitária/imunologia , Receptores de Interleucina-6/metabolismo , Receptores de Interleucina-6/genética , Receptores de Interleucina-6/imunologia , Proteínas de Ligação a RNA/genética , Proteínas de Ligação a RNA/metabolismo , Proteínas de Ligação a RNA/imunologia , Transdução de Sinais , Fator de Transcrição STAT3/metabolismo , Fator de Transcrição STAT3/imunologia , Linfócitos T/imunologia , Linfócitos T/metabolismoRESUMO
Hemophilia A and B are one of the most common hereditary bleeding disorders. Patients are predisposed to bleeding spontaneously or after minor trauma in different areas such as the skin, gastrointestinal, or joints. COVID-19 infection has been associated with various clinical manifestations and complications including rarely triggering IgA vasculitis. We report a 23-year-old man who was previously diagnosed with severe hereditary hemophilia A. He presented to our hospital with classic symptoms of IgA vasculitis, complaining of petechiae and purpura in his limbs, fatigue, body aches, poor oral intake, abdominal pain, and watery non-bloody diarrhea. He did not present with respiratory symptoms or fever typical of COVID-19 infection. Abnormal blood tests were mildly elevated C-reactive protein, elevated d-dimers, and low Factor VIII activity. Extensive immunological tests were negative. CT abdomen with contrast was unremarkable. A skin biopsy strongly indicated IgA vasculitis. COVID-19 test came back positive. The patient was managed symptomatically and with glucocorticosteroids which significantly improved his symptoms. The available literature on clinical features, laboratory tests, and management of COVID-19-associated IgA vasculitis is discussed. However, there is no case reported on the associations between hemophilia, COVID-19 infection, and IgA vasculitis. This is the first case of atypical COVID-19 infection masquerading as de novo IgA vasculitis in an adult patient with underlying hemophilia. Our case contributes to the growing body of literature about hemophilia being a possible predisposing factor that a COVID-19 virus relies on to amplify immune dysregulation resulting in IgA vasculitis.
Assuntos
COVID-19 , Hemofilia A , Vasculite por IgA , Masculino , Adulto , Humanos , Adulto Jovem , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/patologia , Hemofilia A/complicações , Hemofilia A/diagnóstico , Hemofilia A/patologia , COVID-19/complicações , COVID-19/diagnóstico , Pele/patologia , Trato GastrointestinalRESUMO
PURPOSE OF REVIEW: To present findings indicating the value of kidney biopsy in assessing prognosis and guiding clinical approach to patients with IgA vasculitis nephritis (IgAVN), including a recent international study examining the value of the Oxford (MEST-C) classification. RECENT FINDINGS: Historically, kidney biopsies with IgAVN are scored using the International Society for Kidney Diseases in Children (ISKDC) classification. However, this classification has limited prognostic value, and most biopsies fall into just two of the six ISKDC grades. There are few studies examining the clinical value of the Oxford classification, which is well documented to be predictive of kidney outcomes in IgA nephropathy, in IgAVN. However, a recent study of 361 biopsied patients with IgAVN showed that endocapillary hypercellularity (Oxford E1) predicted a subclass of patients showing initial improvement in kidney function with immunosuppressive treatment, followed by a later decline. SUMMARY: Kidney outcome in patients with biopsied IgAVN treated with immunosuppression is determined by clinical factors and endocapillary hypercellularity. The latter is not part of the ISKDC classification and supports including MEST-C scores in biopsy reports of IgAVN. Even patients showing a good initial response to immunosuppression require long-term follow-up due to risk of subsequent kidney function decline.
Assuntos
Glomerulonefrite por IGA , Vasculite por IgA , Nefrite , Criança , Humanos , Vasculite por IgA/diagnóstico , Vasculite por IgA/patologia , Rim/patologia , Glomerulonefrite por IGA/tratamento farmacológico , BiópsiaRESUMO
BACKGROUND: Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. METHODS: Biopsies from 262 children and 99 adults with IgA vasculitis nephritis ( N =361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients ( N =309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. RESULTS: M, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N =91) and another with stable eGFR (class 2, N =218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2. CONCLUSIONS: Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.
Assuntos
Glomerulonefrite por IGA , Vasculite por IgA , Nefrite , Adulto , Criança , Humanos , Masculino , Adolescente , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/tratamento farmacológico , Glomerulonefrite por IGA/patologia , Vasculite por IgA/complicações , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Taxa de Filtração Glomerular , Rim/patologia , Nefrite/complicações , Proteinúria/etiologia , Biópsia , Estudos RetrospectivosRESUMO
BACKGROUND: Henoch-Schonlein purpura (HSP) is an IgA-mediated systemic small-vessel vasculitis (IgAV) that typically presents with a variable tetrad of symptoms. HSP if often preceded by respiratory tract infections, vaccinations, drugs or malignancies. During the recent COVID-19 pandemic multiples cases of HSP have been described after both infection and vaccination for SARS-CoV2. This study aims to perform a systematic review of literature and describe an additional complicated case of de-novo HSP appeared after the administration of the third dose of a mRNA-SARS-CoV2 vaccination. METHODS: Electronic bibliographic research was performed to identify all the original reports describing cases of de-novo HSP or IgAV appeared after respiratory infection or vaccine administration for SARS-CoV2. We included all case series or case reports of patients who respected our inclusion and exclusion criteria. RESULTS: Thirty-eight publications met our pre-defined inclusion criteria, for an overall number of 44 patients. All patients presented with palpable purpura variable associated with arthralgia, abdominal pain or renal involvement. Increased levels of inflammation markers, mild leukocytosis and elevated D-dimer were the most common laboratory findings. Up to 50% of patients presented proteinuria and/or hematuria. Almost all skin biopsies showed leukocytoclastic vasculitis, with IgA deposits at direct immunofluorescence in more than 50% of cases. CONCLUSIONS: Our results suggest that the immune response elicited by SARS-CoV2 vaccine or infection could play a role in the development of HSP. Current research suggests a possible role of IgA in immune hyperactivation, highlighted by early seroconversion to IgA found in some COVID-19 patients who develop IgA vasculitis.
Assuntos
COVID-19 , Vasculite por IgA , Vacinas , Humanos , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/patologia , RNA Viral , Pandemias , COVID-19/complicações , SARS-CoV-2 , Imunoglobulina ARESUMO
BACKGROUND Immunoglobulin A (IgA) vasculitis is a small-vessel vasculitis characterized by the deposition of IgA immune complexes primarily in the skin, kidneys, and gastrointestinal tract. While it predominantly affects children, cases in adults are associated with more severe manifestations. Evidence suggests that infectious triggers play a pivotal role in its etiology. Often, it follows a self-limiting course and doesn't necessitate intervention. CASE REPORT We present the case of a 51-year-old man who presented with a maculopapular rash, arthralgia, and abdominal pain. An examination revealed a purpuric rash on lower extremities and abdomen. A lower extremity duplex ultrasound identified deep vein thrombosis (DVT) in the right leg. Skin biopsy of the rash confirmed the diagnosis of IgA vasculitis, demonstrating perivascular neutrophilic infiltrate and IgA complex deposition. Stool studies revealed co-infection with Cryptosporidium and Giardia. The patient was treated with a prednisone taper with significant improvement in symptoms. CONCLUSIONS This case highlights the potential role of Cryptosporidium as a trigger for IgA vasculitis. The presence of concurrent infections underscores the complex interplay between infections and the development of IgA vasculitis. The co-infection with Giardia suggests that a secondary infection may be involved, further complicating the disease's etiology. The observation of DVT suggests a possible link between IgA vasculitis and a prothrombotic state. This report serves to expand the knowledge of IgA vasculitis triggers and associated complications, guiding clinicians in diagnosing and managing similar cases while emphasizing the importance of vigilance in adults with these symptoms.
Assuntos
Coinfecção , Criptosporidiose , Cryptosporidium , Exantema , Vasculite por IgA , Vasculite , Masculino , Adulto , Criança , Humanos , Pessoa de Meia-Idade , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/patologia , Giardia , Criptosporidiose/complicações , Imunoglobulina A , Vasculite/complicações , Vasculite/diagnósticoRESUMO
PURPOSE: To compare uric acid levels in children with Henoch-Schonlein purpura (HSP)without nephritis and with renal damage, and at different pathological grades. METHODS: A total of 451 children were enrolled in this study, including 64 with HSP without nephritis and 387 HSP with kidney damage. Age, gender, uric acid, urea, creatinine and cystatin C levels were reviewed. Pathological findings of those with renal impairment were also reviewed. RESULTS: Among the HSP children with renal damage, 44 were grade I, 167 were grade II and 176 were grade III. There were significant differences in age, uric acid, urea, creatinine and cystatin C levels between the two groups (p<0.05, all). Correlation analysis showed that uric acid levels in children with HSP without nephritis were positively correlated with urea and creatinine levels (p<0.05). Uric acid levels in HSP children with renal damage was positively correlated with age, urea, creatinine and cystatin C levels (p<0.05, all). Regression analysis found that, without adding any correction factors, there were significant differences in uric acid levels between the two groups; however, after adjusting for pathological grade, there was no longer a significant difference. CONCLUSIONS: There were significant differences of uric acid levels in children with HSP without nephritis and with renal impairment. Uric acid levels in the renal impairment group were significantly higher than that in the HSP without nephritis group. Uric acid levels were related to only the presence or absence of renal damage, not to the pathological grade.
Assuntos
Vasculite por IgA , Nefrite , Ácido Úrico , Criança , Feminino , Humanos , Masculino , Creatinina/metabolismo , Cistatina C/metabolismo , Vasculite por IgA/epidemiologia , Vasculite por IgA/metabolismo , Vasculite por IgA/patologia , Nefrite/epidemiologia , Nefrite/metabolismo , Nefrite/patologia , Medição de Risco , Ureia/metabolismo , Ácido Úrico/metabolismoRESUMO
OBJECTIVE: Bowman's capsule rupture (BCR) is a glomerular pathological change, but it is still not well recognized in immunoglobulin A vasculitis nephritis (IgAV-N). The Oxford MEST-C score is a classification for IgA nephropathy; however, its clinical correlation and prognostic value in adult patients with IgAV-N are unclear. METHODS: A retrospective study of 145 adult patients with IgAV-N diagnosed by renal biopsy was conducted. Clinical manifestations, pathological changes and the prognosis of IgAV-N patients were compared depending on the presence or absence of BCR, International Study of Kidney Disease in Children (ISKDC) classification and MEST-C score. The primary endpoint events were end-stage renal disease, renal replacement therapy and all-cause death. RESULTS: In total, 51 of 145 (35.17%) patients with IgAV-N presented with BCR. Patients with BCR had more proteinuria, lower serum albumin, and more crescents. Compared with IgAV-N patients with crescents only, 51/100 patients with crescents combined with BCR had a higher proportion of crescents in all glomeruli (15.79% vs. 9.09%; p = 0.003). Patients with higher ISKDC grades had more severe clinical presentation, but it did not reflect the prognosis. However, the MEST-C score not only reflected clinical manifestations but also predicted prognosis (p < 0.05). BCR contributed to the effectiveness of the MEST-C score in predicting the prognosis of IgAV-N (C-index: 0.845 to 0.855). CONCLUSIONS: BCR is associated with clinical manifestations and pathological changes in patients with IgAV-N. The ISKDC classification and MEST-C score are related to the patient's condition, but only the MEST-C score is correlated with the prognosis of patients with IgAV-N, while BCR can improve its predictive ability.
BCR was associated with clinical manifestations and pathological changes in patients with IgAV-N, particularly crescents.The ISKDC classification was related to clinical manifestations of patients with IgAV-N, but it wasn't associated with prognosis.The Oxford MEST-C score was correlated to clinical presentations and prognosis of patients with IgAV-N, while BCR can improve its predictive ability.
Assuntos
Cápsula Glomerular , Vasculite por IgA , Humanos , Adulto , Cápsula Glomerular/patologia , Rim/patologia , Rim/fisiopatologia , Estudos Retrospectivos , Vasculite por IgA/patologia , Masculino , Feminino , Esclerose/patologia , Inflamação/patologia , Prognóstico , Análise de SobrevidaRESUMO
BACKGROUND: IgA vasculitis (IgAV) is the most common vasculitis in children. IgAV long-term prognosis depends on kidney involvement or IgA vasculitis with nephritis (IgAVN). To date, steroid treatment (oral steroids or methylprednisolone pulses) has not proven to be formally efficient. This study aimed to assess the role of steroids on IgAVN outcome. METHODS: All children with IgAVN diagnosed 2000-2019 in 14 French pediatric nephrology units with minimal follow-up of 6 months were retrospectively included. Outcomes of patients treated with steroids were compared with those of a control group of untreated patients matched for age, sex, proteinuria, eGFR, and histological features. The primary endpoint was IgAVN remission defined as urine protein-to-creatinine ratio < 20 mg/mmol without impaired eGFR one year after disease onset. RESULTS: A total of 359 patients with IgAVN were included with a median follow-up time of 249 days (range 43-809). One hundred eight (30%) patients received oral steroids alone, 207 (51%) patients received three methylprednisolone pulses followed by oral steroids, and 44 patients (12.5%) did not receive steroids. Thirty-two children treated with oral steroids alone were compared with 32 matched control patients who did not receive steroids. One year after disease onset, IgAVN remission proportion was not different between these two groups: 62% versus 68%, respectively. Ninety-three children treated with oral steroids alone were compared with 93 matched patients treated with three methylprednisolone pulses followed by oral corticosteroids. IgAVN remission proportion was not different between these two groups: 77% versus 73%, respectively. CONCLUSION: The benefit of oral steroids alone and methylprednisolone pulses could not be established based on this observational study. Randomized controlled trials are thus required to determine the efficacy of steroids in IgAVN. A higher resolution version of the Graphical abstract is available as Supplementary information.
Assuntos
Vasculite por IgA , Nefrite , Humanos , Criança , Vasculite por IgA/complicações , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Estudos Retrospectivos , Nefrite/patologia , Rim/patologia , Metilprednisolona , Imunoglobulina ARESUMO
OBJECTIVE: IgA vasculitis (IgAV) (formerly Henoch-Schönlein Purpura, HSP) rarely causes severe skin lesions in children. The purpose of the research was to determine whether severe skin manifestations were associated with a more severe disease course. METHODS: Severe cutaneous manifestations were defined as presence of hemorrhagic vesicles, bullae, ulcerations and/or necroses. Data were collected retrospectively from 12 international tertiary university medical centers. RESULTS: A total of 64 patients with the most severe skin changes in IgAV/HSP and median (Q1, Q3) age of 8.08 (5.08, 11.92) years at the disease onset were compared with 596 IgAV/HSP patients without these manfiestations and median (Q1, Q3) age of 6.33 (4.50, 8.92) years. The patients with severe cutaneous manifestations were older in comparison to other patients with IgAV/HSP (p<0.001), they developed nephritis more frequently (40.6% vs. 20.6%, p = 0.001) with worse outcome of renal disease (p = 0.001). This group of patients also had higher frequencies of severe gastrointestinal complications like hematochezia, massive bleeding and/or intussusception (29.3% vs. 14.8%, p<0.001). d-dimer concentrations were significantly higher in these patients (4.60 mg/L vs. 2.72 mg/L, p = 0.003) and they had more frequent need for treatment with systemic glucocorticoids (84.4% vs. 37.2%, p<0.001) in comparison with the control group. Further multivariate analysis showed that severe cutaneous changes were associated with higher risk of developing nephritis [OR=3.1 (95%CI 1.04-9.21), p = 0.042] and severe gastrointestinal complications [OR=3.65 (95%CI 1.08-12.37), p = 0.038]. CONCLUSION: Patients with IgAV/HSP and severe skin manifestations had a more severe clinical course and more frequently required glucocorticoids compared to classic IgAV/HSP patients.
Assuntos
Gastroenteropatias , Vasculite por IgA , Nefrite , Humanos , Criança , Vasculite por IgA/complicações , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Estudos Retrospectivos , Glucocorticoides/uso terapêutico , Nefrite/complicações , Nefrite/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Resultado do Tratamento , Imunoglobulina A/uso terapêuticoRESUMO
A 78-year-old man with lung cancer underwent concurrent chemoradiotherapy followed by durvalumab for 24 cycles. After 6 months, he presented with anorexia and palpable purpura of the lower extremities, with increased proteinuria, hematuria, and elevated creatinine levels. Skin and kidney biopsies suggested a diagnosis of IgA vasculitis. No evidence of cancer progression was found; moreover, no infection or drug could be identified as the cause. Therefore, he was diagnosed with IgA vasculitis as an immune-related adverse event (irAE) caused by durvalumab. Because immune checkpoint inhibitors can cause vasculitis, clinicians should be cautious during their administration and after their discontinuation.
Assuntos
Vasculite por IgA , Neoplasias Pulmonares , Neoplasias Cutâneas , Masculino , Humanos , Idoso , Vasculite por IgA/diagnóstico , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Anticorpos Monoclonais/uso terapêutico , Neoplasias Pulmonares/complicaçõesRESUMO
BACKGROUND: Immunoglobulin A vasculitis (IgA vasculitis) is one of the most common forms of vasculitis in children. It rarely occurs in adults. It is a systemic vasculitis with IgA deposition and is characterized by the classical tetrad of purpura, arthritis/arthralgia, gastrointestinal and renal involvement. Certain types of infections, and pharmacological agents have been reported to be associated with IgA vasculitis. Here, we describe a case of IgA vasculitis triggered by infective endocarditis in a patient undergoing maintenance hemodialysis. CASE PRESENTATION: A 70-year-old man undergoing hemodialysis was admitted because of skin purpura, abdominal pain, diarrhea, and lower back pain. We suspected him as IgA vasculitis based on the clinical features and skin biopsy findings. Transesophageal echocardiography revealed infective endocarditis, which predisposed him to IgA vasculitis. He was treated with antibiotics and low-dose corticosteroids, which led to resolution of vasculitis. CONCLUSIONS: This is the first case of IgA vasculitis triggered by infective endocarditis in a patient undergoing hemodialysis. Patients undergoing hemodialysis are at a high risk of infection because of immune dysfunction and frequent venipuncture. The incidence of infective endocarditis associated with IgA vasculitis is very low, but it has been repeatedly reported. Therefore, it is necessary to consider infective endocarditis in patients with clinical features that indicate IgA vasculitis.
Assuntos
Endocardite/complicações , Vasculite por IgA/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Glucocorticoides/uso terapêutico , Humanos , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Masculino , Staphylococcus aureus Resistente à Meticilina , Metronidazol/uso terapêutico , Prednisolona/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêuticoRESUMO
Leukocytoclastic vasculitis has been reported in the setting of COVID-19 infection and post-COVID-19 vaccination. We report a case of IgA vasculitis (IgAV) post-COVID-19 vaccination, with immunoglobulin A (IgA) immune deposits in the skin and renal involvement. SARS-CoV spike protein immunohistochemical staining was negative. IgAV with skin and renal involvement is a potential reaction to COVID-19 vaccination.
Assuntos
Vacinas contra COVID-19/efeitos adversos , Vasculite por IgA/etiologia , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Humanos , Vasculite por IgA/patologia , Imuno-Histoquímica/métodos , MasculinoRESUMO
OBJECTIVE: We aimed to investigate levels of interleukin-17 (IL-17) and oxidative stress in the active phase of immunoglobulin A vasculitis (IgAV) and determine whether a relationship exists among IL-17, oxidative stress, and system involvement. METHOD: Patients diagnosed with IgAV, who were not given non-steroidal anti-inflammatory or steroidal drugs within a month, were enrolled. Blood samples were taken in the active and remission phases of the disease. Malondialdehyde (lipid peroxidation marker), 8-hydroxydeoxyguanosine (DNA oxidation marker), total oxidant status (TOS) and total antioxidant status (TAS) levels for oxidative stress, and IL-17 levels were measured. RESULTS: Forty-four patients aged 1.91-15.41 years were enrolled. IL-17 and TAS levels were significantly higher in the active phase of the disease than in the remission phase. 8-Hydroxydeoxyguanosine levels were higher in patients with gastrointestinal involvement than in patients without involvement in the active phase of the disease. A moderate positive correlation was observed between IL-17 and TAS in both active and remission phases. CONCLUSION: Our results showed increased DNA oxidation in patients with gastrointestinal involvement in the active phase of IgAV, for the first time. Higher IL-17 and TAS levels in the active phase of the disease and positive correlations of TAS and IL-17 in both active and remission phases suggest that IL-17 and oxidative stress may be related.
Assuntos
Vasculite por IgA , Interleucina-17 , 8-Hidroxi-2'-Desoxiguanosina , Antioxidantes/metabolismo , Criança , Humanos , Vasculite por IgA/metabolismo , Vasculite por IgA/patologia , Imunoglobulina A , Interleucina-17/metabolismo , Estresse OxidativoRESUMO
Endocapillary proliferation occurs in various types of glomerulonephritis (GN), with varying prognoses. We examined 42 renal biopsy samples representing endocapillary proliferative lesions from post-streptococcal acute GN (PSAGN), Henoch-Schönlein purpura nephritis (HSPN), and lupus nephritis (LN). In PSAGN, the glomerular capillary network was maintained, although severe lesions displayed dots or short, curved lines, indicating CD34-positive capillaries and suggesting capillary obstruction. Conversely, patients with LN and HSPN displayed obstruction of CD34-positive capillaries with dissociation from the glomerular basement membrane even in mild lesions. According to computer-assisted morphologic analysis, the cell density did not differ between the diseases. However, in PSAGN, the number of capillary loops was significantly increased, with a larger glomerular capillary luminal area than in the other groups. In addition, the number and frequency of CD163-positive cells (M2 macrophages) tended to be higher in PSAGN, while there were no significant differences in the number of CD68-positive (total) macrophages. These results indicate that in PSAGN, endothelial cell damage is less severe, and angiogenesis may be promoted. The severity of endothelial cell injury in each disease may be associated with differences in infiltrating inflammatory cell phenotypes.
Assuntos
Capilares/patologia , Células Endoteliais/patologia , Glomerulonefrite Membranoproliferativa/patologia , Glomérulos Renais/patologia , Macrófagos/patologia , Doença Aguda , Adolescente , Adulto , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Capilares/metabolismo , Criança , Células Endoteliais/metabolismo , Feminino , Glomerulonefrite Membranoproliferativa/metabolismo , Humanos , Vasculite por IgA/metabolismo , Vasculite por IgA/patologia , Glomérulos Renais/metabolismo , Nefrite Lúpica/metabolismo , Nefrite Lúpica/patologia , Macrófagos/metabolismo , Masculino , Pessoa de Meia-Idade , Prognóstico , Receptores de Superfície Celular/metabolismo , Adulto JovemRESUMO
Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood and affects the small blood vessels, leading to arthritis, abdominal pain, and renal involvement. However, scrotal involvement is a rare complication of HSP and scrotal pain. Swelling is the most frequent clinical presentation and can be easily confused with testicular torsion. If not treated in time, the scrotal inflammation will result in irreversible testicular necrosis. We report a 6-year-old male with HSP and scrotal involvement, characterized by swelling and pain on the left side of the scrotum, rashes on both lower extremities, and epididymitis. He was treated with conservative care, corticosteroids, and antibiotic therapy. We were able to avoid surgical intervention. On the 10 days of treatment, he recovered sufficiently well and was discharged. We have reviewed the literature related to HSP with scrotal involvement, identified 21 cases, and revealed that steroid therapy and/or antibiotics are the first-line of therapy in children with scrotal involvement. Vasculitis in the scrotum may predispose to testicular torsion, which is a complication that should not be overlooked. Clinicians should be aware of the atypical types of HSP. Timely diagnosis and appropriate treatment are essential for achieving the best results.
Assuntos
Vasculite por IgA/patologia , Escroto/patologia , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Criança , Humanos , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/tratamento farmacológico , Masculino , Escroto/efeitos dos fármacos , Torção do Cordão Espermático/etiologiaRESUMO
OBJECTIVE: IgA nephropathy (IgAN) and IgA vasculitis with nephritis (IgAV-N) are related diseases. Galactose-deficient IgA1 (Gd-IgA1) plays an important role in the pathology of IgAV-N and IgAN, so we aim to compare the serum levels of Gd-IgA1 in Chinese pediatric patients with IgAN, IgAV-N, and IgAV. METHODS: We retrospectively enrolled 52 patients with IgAN, 57 patients with IgAV-N, 26 patients with IgAV, and 40 healthy children. The serum levels of Gd-IgA1 were measured at the time of biopsy using a lectin-based ELISA method. RESULTS: Gd-IgA1 levels in IgAV-N patients and IgAN patients were higher than in healthy controls (303.94 ± 39.37 U/ml, 314.91 ± 47.79 U/ml vs. 273.57 ± 48.29 U/ml, P < 0.001), and Gd-IgA1 levels in IgAV-N patients were higher than in IgAV patients (303.94 ± 39/ml vs. 286. 21 ± 38.81 U/ml, P = 0.059), but the latter result is not statistically significant. The Gd-IgA1 levels in IgAV patients were comparable with those in healthy controls (286.21 ± 38.81 U/ml vs. 273.57 ± 48.29 U/ml, P = 0.267). Among the four groups, we did not observe significant correlations of Gd-IgA1 levels with eGFR, proteinuria, or the MEST-C score. CONCLUSION: Serum Gd-IgA1 maybe involved in the pathogenesis of the IgAV-N and IgAN. However, we found no statistically significant correlation between Gd-IgA1 levels and clinical and pathological features.
Assuntos
Glomerulonefrite por IGA/sangue , Vasculite por IgA/sangue , Nefrite/sangue , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , China , Feminino , Glomerulonefrite por IGA/tratamento farmacológico , Glomerulonefrite por IGA/patologia , Humanos , Vasculite por IgA/complicações , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Masculino , Nefrite/tratamento farmacológico , Nefrite/etiologia , Nefrite/patologia , Esteroides/uso terapêuticoRESUMO
BACKGROUND: In present study we investigated expression pattern of the special tissue markers. SATB1 and PTEN to evaluate possible influence in pathophysiology and development of various biopsy proven kidney diseases. METHODS: The 32 kidney biopsy samples were analysed using light, immunofluorescence and electron microscopy. There were 19 samples in proliferative and 13 samples in non- proliferative group of renal diseases. As control group, 9 specimens of healthy kidney tissue taken after surgery of kidney tumour were used. SATB1 and PTEN markers were used for immunofluorescence staining. Analysed tissue structures were glomeruli, proximal convoluted tubules (PCT) and distal convoluted tubules (DCT). The number of SATB1 and PTEN cells were calculated and the data compared between kidney structures, disease groups and control specimens. RESULTS: Both markers were positive in all investigated kidney structures, with expression generally, more prominent in tubular epithelial cells than in glomeruli, with the highest staining intensity rate as well as highest rate of both markers in DCT of proliferative diseases group (SATB1 64.5 %, PTEN 52 %). There was statistically significant difference in SATB1 expression in all tissue structures of interest in proliferative as well as non- proliferative group compared to control group (pâ¯<â¯0.01-pâ¯<â¯0.0001). PTEN expression were found significantly decreased in PCT of both disease groups in regard to control (PTEN 25.3 % and 23.8 % vs. 41.1 % (pâ¯<â¯0.01 and pâ¯<â¯0.001 respectively). CONCLUSION: SATB1 and PTEN could be considered as markers influenced in kidney disease development. SATB1/PTEN expression should be further investigated as useful markers of kidney disease activity as well as potential therapeutic target.
Assuntos
Glomerulonefrite por IGA/genética , Glomerulonefrite Membranoproliferativa/genética , Glomerulonefrite Membranosa/genética , Glomerulosclerose Segmentar e Focal/genética , Vasculite por IgA/genética , Proteínas de Ligação à Região de Interação com a Matriz/genética , Nefrite/genética , PTEN Fosfo-Hidrolase/genética , Amiloidose/diagnóstico , Amiloidose/genética , Amiloidose/metabolismo , Amiloidose/patologia , Biomarcadores/metabolismo , Biópsia , Estudos de Casos e Controles , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/metabolismo , Glomerulonefrite por IGA/patologia , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulonefrite Membranoproliferativa/metabolismo , Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/metabolismo , Glomerulonefrite Membranosa/patologia , Glomerulosclerose Segmentar e Focal/diagnóstico , Glomerulosclerose Segmentar e Focal/metabolismo , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Vasculite por IgA/diagnóstico , Vasculite por IgA/metabolismo , Vasculite por IgA/patologia , Imuno-Histoquímica , Glomérulos Renais/metabolismo , Glomérulos Renais/patologia , Túbulos Renais Distais/metabolismo , Túbulos Renais Distais/patologia , Túbulos Renais Proximais/metabolismo , Túbulos Renais Proximais/patologia , Proteínas de Ligação à Região de Interação com a Matriz/metabolismo , Nefrite/diagnóstico , Nefrite/metabolismo , Nefrite/patologia , Nefrite Hereditária/diagnóstico , Nefrite Hereditária/genética , Nefrite Hereditária/metabolismo , Nefrite Hereditária/patologia , PTEN Fosfo-Hidrolase/metabolismoRESUMO
Henoch-Schönlein purpura (HSP) is a small vessel vasculitis characterized by the presence of vascular immunoglobulin A deposition that usually presents as non-thrombocytopenic palpable purpura. It primarily affects children and is less common in adults. The incidence of hemorrhagic necrotic skin lesions increases with age, similarly to renal involvement. Warfarin is a widely used oral anticoagulant drug that has rarely been associated with leukocytoclastic vasculitis and allergic interstitial nephritis. We report a patient with HSP who presented with cutaneous ulcerative plaques and proteinuria in the setting of warfarin therapy. We would like to raise the awareness of this potential adverse effect of warfarin for prompt diagnosis.