ABSTRACT
A Hepatite C é um problema de saúde mundial. Uma associação entre infecção pelo vírus da hepatite C (HCV) e crioglobulinemia mista com doença renal tem sido descrita, sendo a glomerulonefrite membranopoliferativa (GNMP) tipo I o acometimento renal mais comum. A GNMP é frequentemente associada com a crioglobulinemia mista tipo II. Esse relato de caso objetiva descrever fatores clínicos dos pacientes com crioglobulinemia mista, a qual é uma manifestação extra-hepática da infecção por HCV, assim como discutir a sua fisiopatologia e tratamento, baseado no relato de caso. (AU)
Hepatitis C is a public health concern worldwide. An association of hepatitis C virus (HCV) infection with mixed cryoglobulinemia and renal disease has been described, and type I membranoproliferative glomerulonephritis (MPGN) is the most common. MPGN is often associated with type II mixed cryoglobulinemia. This case report aimed to describe the clinical features of patients with mixed cryoglobulinemia, a major extrahepatic manifestation of HCV infection, and to discuss its pathophysiology and treatment of HCV infection based on the case report. (AU)
Subject(s)
Humans , Male , Middle Aged , Glomerulonephritis, Membranoproliferative/complications , Glomerulonephritis, Membranoproliferative/drug therapy , Cryoglobulinemia/physiopathology , Cryoglobulinemia/drug therapy , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/diagnosisABSTRACT
BACKGROUND: In China, mesangial proliferative glomerulonephritis (MsPGN) is one of the most common kidney diseases. In this study, we treated a rat model of chronic anti-Thy-1 MsPGN with Shenhua Tablet and evaluated whether the tablet was able to protect the kidney function. Thirty-six Wistar rats were randomly divided into six groups: (1) Sham surgery (Sham); (2) anti-Thy-1 nephritis model (Thy-1); (3) anti-Thy-1 nephritis model + irbesartan-treated (Irb); (4) anti-Thy-1 nephritis model + low-dose of Shenhua Tablet (SHL); (5) anti-Thy-1 nephritis model + medium-dose of Shenhua Tablet (SHM); (6) anti-Thy-1 nephritis model + high-dose of Shenhua Tablet (SHH). RESULTS: Thirteen weeks after drug treatment, urinary proteins were quantified and renal pathological changes were thoroughly examined at the time point of 24 h. Meanwhile, the expression levels of p-Erk1/2, cyclin D1 and p21 at the renal cortex were also tested. The levels of urinary proteins and total cholesterol in the blood were significantly reduced in rats treated with any drug tested in this study. The level of triglyceride was significantly reduced in all three Shenhua Tablet-treated groups. Renal pathomorphological scores were significantly improved in groups of Irb, SHM and SHH. Mesangial cell proliferation was significantly inhibited in any drug-treated group. p-Erk1/2 and cyclin D1 were downregulated whereas p21 was upregulated in the renal cortex. CONCLUSIONS: Our study indicated that Shenhua Tablet is able to inhibit the abnormal proliferation of mesangial cells and to prevent kidney damage, which is likely associated with downregulation of p-Erk1/2 and reduced activity of its downstream target-cyclin D1.
Subject(s)
Animals , Male , Drugs, Chinese Herbal/pharmacology , Glomerulonephritis, Membranoproliferative/drug therapy , Cell Proliferation/drug effects , Mesangial Cells/drug effects , Isoantibodies , Time Factors , Serum Albumin/analysis , Drugs, Chinese Herbal/therapeutic use , Glomerulonephritis, Membranoproliferative/pathology , Chronic Disease , Reproducibility of Results , Rats, Wistar , Mitogen-Activated Protein Kinase 1/analysis , Cyclin D1/analysis , Computers, Handheld , p21-Activated Kinases/analysisSubject(s)
Adolescent , Cyclosporine/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Follow-Up Studies , Glomerulonephritis, Membranoproliferative/drug therapy , Humans , Male , Methylprednisolone/administration & dosage , Proteinuria/drug therapy , IgA Vasculitis/complications , Recurrence , Severity of Illness Index , Treatment Outcome , UrinalysisABSTRACT
A 46 years male presented with skin rash and acute nephritic syndrome. He had history of jaundice four months back. Rheumatoid factor and cryoglobulins were present in the serum. Although anti-HCV antibodies were negative, HCV RNA was detected by polymerase chain reaction. Kidney biopsy showed membranoproliferative glomerulonephritis and thrombi in the lumen of the glomerular capillary loops. His renal functions improved with steroids.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Biopsy , Cryoglobulinemia/drug therapy , Follow-Up Studies , Glomerulonephritis, Membranoproliferative/drug therapy , Hepacivirus/genetics , Hepatitis C/complications , Humans , Kidney/pathology , Male , Middle Aged , Polymerase Chain Reaction , Prednisolone/administration & dosage , RNA, Viral/analysis , Time FactorsABSTRACT
Intrarenal hemodynamic and tubular function has been assessed in 16 patients who presented clinically with hypertension, hematuria and severe renal functional impairment. Twelve of these 16 patients had histopathologic classification as DPGN (3 cases), MPGN (3 cases) and FSGS (6 cases). The initial assessment of intrarenal hemodynamics in 11 patients revealed strikingly increased afferent (RA) and efferent arterioles (RE), filtration fraction (FF), intraglomerular capillary hydrostatic pressure (PG), whereas, there was marked reduction in renal plasma flow (RPF), in ultrafiltration coefficient (KFG) and in glomerular filtration rate (GFR). Tubular transporting defect as being reflected by enhanced fractional excretions of solutes was also observed. Both enhanced TXB2 production and diminished PGI2 may be in part responsible for the marked reduction of RPF and elevated intrarenal resistance. In light of the preceding intrarenal hemodynamics alteration, therapeutic intervention with vasodilators consisting of dipyridamole, calcium channel blocker and angiotensin convertase inhibitor has been accomplished with clinical improvement in glomerular and tubular functions following the improvement in intrarenal hemodynamics. Thus, this abnormal intrarenal hemodynamics renders a supportive view of the hemodynamically mediated glomerulo-tubulo-interstitial injury to be central to the pathogenetic mechanism.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Glomerulonephritis/drug therapy , Glomerulonephritis, Membranoproliferative/drug therapy , Glomerulosclerosis, Focal Segmental/drug therapy , Hemodynamics/drug effects , Humans , Kidney/physiopathology , Male , Renal Circulation/drug effects , Vasodilator Agents/therapeutic useABSTRACT
Se realiza un análisis de la presentación clínica, de la evolución y del pronóstico de la glomerulonefritis membrano-proliferativa o mesangio-capilar definida como una glomerulopatía crónica con proliferación de las células mesangiales y engrosamiento de la pared capilar glomerular. Se distinguen tres tipos y se considera que la tipo II o enfermedad por depósitos densos es una entidad independiente. Se refiere que la frecuencia entre las glomerulopatías primarias del adulto en nuestro medio es de 9 por ciento y se confirma la disminución de la incidencia en los últimos años. Se analizan las características clínicas de 19 pacientes asistidos en el Hospital de Clínicas en el período 1976-1989. Las formas de presentación clínica son el síndrome nefrótico, el síndrome nefrítico agudo y la proteinuria asintomática. La hipocomplementemia es un hallazgo frecuente. El pronóstico es severo y la mitad de los pacientes se hallan en insuficiencia renal terminal a los diez años. Los tratamientos ensayados no han modificado esta evolución