Mayo Clinic Consensus Report on Membranous Nephropathy: Proposal for a Novel Classification.

Membranous nephropathy (MN) is a pattern of injury caused by autoantibodies binding to specific target antigens, with accumulation of immune complexes along the subepithelial region of glomerular basement membranes. The past 20 years have brought revolutionary advances in the understanding of MN, particularly via the discovery of novel target antigens and their respective autoantibodies. These discoveries have challenged the traditional classification of MN into primary and secondary forms. At least 14 target antigens have been identified, accounting for 80%-90% of cases of MN. Many of the forms of MN associated with these novel MN target antigens have distinctive clinical and pathologic phenotypes. The Mayo Clinic consensus report on MN proposes a 2-step classification of MN. The first step, when possible, is identification of the target antigen, based on a multistep algorithm and using a combination of serology, staining of the kidney biopsy tissue by immunofluorescence or immunohistochemistry, and/or mass spectrometry methodology. The second step is the search for a potential underlying disease or associated condition, which is particularly relevant when knowledge of the target antigen is available to direct it. The meeting acknowledges that the resources and equipment required to perform the proposed testing may not be generally available. However, the meeting consensus was that the time has come to adopt an antigen-based classification of MN because this approach will allow for accurate and specific MN diagnosis, with significant implications for patient management and targeted treatment.

Mayo Clinic consensus report on membranous nephropathy: proposal for a novel classification.

Membranous nephropathy (MN) is a pattern of injury caused by autoantibodies binding to specific target antigens, with accumulation of immune complexes along the subepithelial region of glomerular basement membranes. The past 20 years have brought revolutionary advances in the understanding of MN, particularly via the discovery of novel target antigens and their respective autoantibodies. These discoveries have challenged the traditional classification of MN into primary and secondary forms. At least 14 target antigens have been identified, accounting for 80%-90% of cases of MN. Many of the forms of MN associated with these novel MN target antigens have distinctive clinical and pathologic phenotypes. The Mayo Clinic consensus report on MN proposes a 2-step classification of MN. The first step, when possible, is identification of the target antigen, based on a multistep algorithm and using a combination of serology, staining of the kidney biopsy tissue by immunofluorescence or immunohistochemistry, and/or mass spectrometry methodology. The second step is the search for a potential underlying disease or associated condition, which is particularly relevant when knowledge of the target antigen is available to direct it. The meeting acknowledges that the resources and equipment required to perform the proposed testing may not be generally available. However, the meeting consensus was that the time has come to adopt an antigen-based classification of MN because this approach will allow for accurate and specific MN diagnosis, with significant implications for patient management and targeted treatment.

Pacientes em hemodiálise: estado inflamatório emassa magra corporal / Hemodialysis patients: inflammatory status and lean body mass

Objetivos: Investigar a relação do estado inflamatório com a massa magra corporal de pacientes em hemodiálise.Métodos: Um estudo transversal observacional incluiu pacientes em hemodiálise há pelo menos três meses. A análise da composição corporal foi realizada por bioimpedância segmentar multi-frequência (InBody 520®). O estado nutricional associado à inflamação foi avaliado usando o instrumento que computa o Escore Desnutrição-Inflamação.Resultados: A amostra incluiu 59 indivíduos, sendo 30 mulheres. A idade média foi de 58,7±14,4 anos, a mediana do tempo em hemodiálise foi de 24 (9-49) meses, a média do peso seco estimado foi 67,0±14,7 kg e a média de massa magra foi 29,7±5,5 kg. A mediana do nível sérico de proteína C-reativa ultrassensível foi 8,6 (3,9-18,0) mg/L e acima do limite normal (≤ 5,0 mg/L), sugerindo a presença de inflamação.O escore desnutrição-inflamação teve mediana de 4 (2-6). Houve correlação significativa entre o escore desnutrição-inflamação e a idade(rs=0,350, p menor do que 0,01) e com o tempo em diálise: (rs=0,320, p menor do que 0,05). Inflamação avaliada pelo nível de proteína C-reativa ultrassensível foi significativamente associada à massa magra (rs=-0,283, p menor do que 0,05).Conclusões: O aumento do tempo em hemodiálise e a idade aumentada estiveram associados com pior estado nutricional. Nesta população, aparentemente quanto menor a massa magra corporal maior o nível de proteína C-reativa ultrassensível, sugerindo uma possível associação entre a inflamação e a massa magra corporal nestes pacientes...

AIMS: To investigate the relationship of the inflammatory status with the lean body mass in hemodialysis patients.METHODS: A cross-sectional observational study included patients on hemodialysis for at least three months. The body composition analysis was performed by segmental multi-frequency bioimpedance (InBody 520�). The nutritional status associated with inflammation was evaluated using the instrument that computes the Malnutrition-Inflammation Score.RESULTS: The sample included 59 subjects, 30 were female. The mean age was 58.7 � 14.4 years, the median time on dialysis was 24 (9-49) months, the mean estimated dry weight was 67.0 � 14.7 kg and mean lean body mass was 29.7 � 5.5 kg. The median serum level of ultrasensitive C-reactive protein was 8.6 (3.9 to 18.0) mg / L and above the normal limit (equal or less than 5.0 mg / L), suggesting the presence of inflammation. The malnutrition-inflammation score had a median of 4 (2-6). There was a significant correlation between the score malnutrition-inflammation and age (rs = 0.350, p less than 0.01) and with time on dialysis: (rs = 0.320, p less than 0.05). Inflammation assessed by the level of ultrasensitive C-reactive protein was significantly associated with lean body mass (rs = - 0.283, p less than 0.05).CONCLUSIONS: The increased time on dialysis and increased age were associated with poorer nutritional status. In this population, apparently the lower lean body mass the higher level of ultrasensitive C-reactive protein, suggesting a possible association between inflammation and lean body mass in these patients...

Insuficiência renal aguda tratada por diálise em unidade de tratamento intensivo (análise de 124 pacientes consecutivos) / Acute kidney failure treated by dialysis in intensive care unit: analysis of 124 consecutive patients

Insuficiência Renal Aguda (IRA) ainda apresenta elevada mortalidade, especialmente associada a outras falências orgânicas. O presente trabalho: 1) analisa o aspecto clínico de pacientes adultos com IRA internados em Unidade de Tratamento Intensivo (UTI); 2) determina condiçöes prévias, circunstâncias evolutivas e formas de intervençäo associadas a mau prognóstico; 3) tenta prever "desfecho" com índice de "gravidade de doença" reconhecido (APACHE II) e; 4) cria índice prognóstico local. Os prontuários de 124 pacientes consecutivos com IRA em UTI, submetidos a diálise, foram examinados. Variáveis clínicas e demográficas, circunstânciais evolutivas e modalidades de intervençäo foram analisadas, além de permanência em UTI e em diálise. Dois grupos - "sobreviventes" e "nao sobreviventes" - comparados, e as variáveis submetidas a análise univariada e por regressäo logística multivariada. A mortalidade hospitalar foi 81 por cento. Associaram-se à evoluçäo desfavorável: 1. Doença hepática ou biliar, antecedendo; 2; Indice APACHE II ao iniciar; 3. Ventilaçäo mecânica, drogas vasoativas, choque e funçäo renal substituída por método "lento", durante. Idade näo influenciou prognóstico. A mortalidade aumentou com o número de órgäos em falência, näo havendo sobreviventes com mais de três falências, além de IRA. Indice local, com as variáveis selecionadas, permitiria prever "desfecho" em mais de 93 por cento dos pacientes.