RESUMEN
ABSTRACT Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.
RESUMO A Glomerulonefrite Rapidamente Progressiva (GNRP) é um padrão de doença renal com amplo diagnóstico diferencial. O caso reporta uma paciente de 55 anos com deterioração aguda e progressiva da função renal após quadro de piodermite em membro inferior com diagnóstico concomitante de hanseníase. Associação da hanseníase com doença renal é bem descrita, sendo a GN a forma de acometimento renal mais comum. As glomerulonefrites pós-infecciosas (GNPIs) em adultos ocorrem devido a um grande número de patógenos, nos mais diversos sítios. A paciente do caso relatado apresentava quadro de GNRP e achados de biópsia que sugerem GNPI com marcação de C3 e IgA na imunofluorescência, sugestiva de lesão renal secundária a infecção recente por Staphylococcus, uma manifestação bem descrita de doença renal em pacientes com hanseníase.
Asunto(s)
Humanos , Persona de Mediana Edad , Complemento C3/metabolismo , Lepra Multibacilar/diagnóstico , Lesión Renal Aguda/diagnóstico , Glomerulonefritis por IGA/diagnóstico , Rifampin/uso terapéutico , Biopsia , Nitrógeno de la Urea Sanguínea , Técnica del Anticuerpo Fluorescente , Clofazimina/uso terapéutico , Creatinina/sangre , Dapsona/uso terapéutico , Diagnóstico Diferencial , Lesión Renal Aguda/tratamiento farmacológico , Glomerulonefritis por IGA/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéuticoRESUMEN
Rapidly progressive glomerulonephritis (RPGN) is a renal disease with an extensive differential diagnosis. This paper reports the case of a 55-year-old female patient diagnosed with Hansen's disease with acute progressive renal impairment after developing lower limb pyoderma. The association between Hansen's and kidney disease has been well documented, with glomerulonephritis (GN) ranked as the most common form of renal involvement. Post-infectious glomerulonephritis (PIGN) in adults has been associated with a number of pathogens occurring in diverse sites. The patient described in this case report had RPGN and biopsy findings suggestive of PIGN with C3 and IgA detected on immunofluorescence and kidney injury secondary to recent infection by Staphylococcus, a well-documented manifestation of renal impairment in patients with Hansen's disease.
Asunto(s)
Lesión Renal Aguda/diagnóstico , Complemento C3/metabolismo , Glomerulonefritis por IGA/diagnóstico , Inmunoglobulina A/metabolismo , Lepra Multibacilar/diagnóstico , Lesión Renal Aguda/tratamiento farmacológico , Biopsia , Nitrógeno de la Urea Sanguínea , Clofazimina/uso terapéutico , Creatinina/sangre , Dapsona/uso terapéutico , Diagnóstico Diferencial , Femenino , Técnica del Anticuerpo Fluorescente , Glomerulonefritis por IGA/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Riñón/patología , Leprostáticos/uso terapéutico , Persona de Mediana Edad , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Diálisis Renal , Rifampin/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Functional and morphological renal lesions have been widely described in leprosy for decades. Nevertheless few studies have assessed renal function pre- and during treatment after the advent of multidrug therapy (MDT). METHODS: This is a prospective study involving 189 consecutive patients, with all forms of leprosy (Ridley-Jopling scale). Laboratory (serum urea and creatinine, estimated GFR, urinalysis, microalbuminuria, urinary RBP) and clinical features of renal disease were evaluated previously and after onset (3 and 8 months later) of MDT. RESULTS: One hundred and eighty-nine patients (M 1.8: F 1; mean age 44 ± 16 years) were included just after diagnosis of leprosy and before the introduction of MDT. Mean time until manifestation of symptoms and/or signs of leprosy was 29 ± 56 months (25 days-480 months). Microhematuria and microalbuminuria were detected in 7.5% and 9.6% of the cases, respectively. Elevated serum creatinine was detected in 34% pre-MDT; this was statistically more frequent in males, hypertensive and frequent users of non-steroidal anti-inflammatory drugs (NSAID), as well as in patients with erythema nodosum lepromatosum, 45.5% by the time of diagnosis, 18% after 3 months and 9% after 8 months of MDT (p = 0.039). CONCLUSIONS: Our results suggest that functional renal lesions in leprosy are currently mild and predominantly of glomerular origin, in opposition to the severe involvement described in the past. This improved outcome of renal disease secondary to leprosy is possibly due to the advent of MDT and effective treatment of episodes of reaction, leading to shorter periods of active infectious disease.
Asunto(s)
Creatinina/sangre , Glomerulonefritis/sangre , Fallo Renal Crónico/sangre , Riñón/fisiopatología , Lepra/complicaciones , Lepra/diagnóstico , Mycobacterium leprae/patogenicidad , Adolescente , Adulto , Anciano , Brasil , Niño , Quimioterapia Combinada/métodos , Femenino , Tasa de Filtración Glomerular , Humanos , Lepra/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Urinálisis , Adulto JovenRESUMEN
INTRODUCTION: Despite rehabilitation programmes offered to all patients with newly diagnosed type 2 diabetes in Denmark, a number of patients either never accomplish good diabetes regulation or the regulation deteriorates with time. Therefore, new approaches are needed. The aim of the present study is to examine whether telemedicine conferences with a nurse can contribute to achieving good diabetes control among patients with poorly regulated type 2 diabetes. MATERIAL AND METHODS: A total of 165 patients with type 2 diabetes who have formerly undergone a rehabilitation programme are randomized to either telemedicine intervention or usual care. The intervention lasts for 32 weeks and consists of monthly videoconferences with a nurse from a health-care centre as an add-on to usual care. Blood sugar, blood pressure and weight are regularly self-monitored and measurements are automatically transferred to a database. Glycaemic control (HbA1c level) is examined at baseline, 16 weeks, 32 weeks and 58 weeks (six months post intervention). Blood pressure, weight, waist/hip ratio, quality of life, physical activity, lipids, creatinine and haemoglobin are examined at baseline and after 32 weeks. CONCLUSION: The study will examine whether telemedicine technology can contribute to achieving good diabetes regulation. FUNDING: The City of Copenhagen and the Prevention Fund of the Capital Region of Denmark funded the project. Also "Smedemester Niels Hansen og Hustru Johanne F. Frederiksens Legat" has supported the study. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT01688778.
Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Pautas de la Práctica en Enfermería , Telemedicina , Comunicación por Videoconferencia , Adulto , Anciano , Glucemia/metabolismo , Presión Sanguínea , Peso Corporal , Creatinina/sangre , Dinamarca , Diabetes Mellitus Tipo 2/sangre , Hemoglobina Glucada/metabolismo , Hemoglobinas/metabolismo , Humanos , Lípidos/sangre , Persona de Mediana Edad , Actividad Motora , Calidad de Vida , Proyectos de Investigación , Relación Cintura-CaderaRESUMEN
We have evaluated laboratory and clinical manifestations of renal disease in 96 patients with leprosy, looking for a sensitive and early marker for detection and possibly follow-up of nephropathy in these patients. Microscopic hematuria was observed in 21.9% of the cases (with dysmorphic erythrocytes in 71.4% of them). Abnormal microalbuminuria and urinary beta 2-microglobulin were found in 15.8 and 19.8% of the cases, respectively. We have observed a high frequency of hematuria, abnormal microalbuminuria and elevation of urinary beta 2-microglobulin in these patients still with normal serum creatinine.
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Enfermedades Renales/etiología , Lepra/complicaciones , Adolescente , Adulto , Anciano , Albuminuria/etiología , Biomarcadores/orina , Niño , Creatinina/sangre , Femenino , Hematuria/etiología , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/orina , Lepra/sangre , Lepra/orina , Masculino , Persona de Mediana Edad , Microglobulina beta-2/orinaRESUMEN
Renal functional status was evaluated in 122 patients with lepromatous leprosy. Renal functions were found to be markedly impaired in patients with erythema nodosum leprosum (ENL) in the active or quiescent phases. Although uncomplicated lepromatous leprosy patients did show significant renal impairment as compared to healthy controls, the degree of impairment was less than that of the reactive cases. Diminished endogenous creatinine clearance and proteinuria were the common abnormalities detected. Serum creatinine was significantly increased only in reactive cases. Blood urea was found to be marginally increased in a few patients although not to a statistically significant degree. Renal involvement did not bear any relation to the duration of illness or to the Bacteriological Index.
Asunto(s)
Riñón/fisiopatología , Lepra/fisiopatología , Adolescente , Adulto , Anciano , Niño , Creatinina/sangre , Eritema Nudoso/fisiopatología , Hematuria/etiología , Humanos , Persona de Mediana Edad , Proteinuria/etiología , Urea/sangreRESUMEN
The febrile responses of 73 bacteremic patients were retrospectively studied using peak temperatures and 24-hour areas under the fever curve on the day of the positive cultures. These responses were compared to their respective creatinine clearances calculated with the Nielsen-Hansen nomogram. Patients with clearances greater than or equal to 80 ml/min had a significantly greater febrile response than those with clearances less than or equal to 29 ml/min (P less than .025). Patients with clearances between these groups had responses that were in a mid position but not significantly different from either group. We conclude that patients with impaired renal function do manifest fever in response to infection, but that it is quantitatively less than those with normal renal function. Because of this blunted response, minimal elevations of temperature in such patients warrant a diligent search for the presence of infection.
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Fiebre/fisiopatología , Riñón/fisiopatología , Sepsis/fisiopatología , Adolescente , Adulto , Factores de Edad , Anciano , Creatinina/sangre , Infecciones por Escherichia coli/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sepsis/etiología , Sepsis/microbiología , Infecciones Estafilocócicas/complicacionesAsunto(s)
Glomerulonefritis/etiología , Lepra/complicaciones , Adolescente , Adulto , Anciano , Biopsia , Creatinina/sangre , Eritema Nudoso/complicaciones , Glomerulonefritis/sangre , Glomerulonefritis/patología , Hematuria/etiología , Humanos , Riñón/patología , Lepra/tratamiento farmacológico , Lepra/inmunología , Lepra/patología , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Proteinuria/etiología , Piuria/etiología , TaiwánRESUMEN
Although Mycobacterium leprae does not invade the reanl parenchyma, there are many reports of nephritis in patients leprosy. Glomerulonephritis has been observed in autopsy studies, but the relationship to leprosy has never been clearly estabilished. In the present study, we found urinary abnormalities consistent with glomerulonephritis in 11 of 636 leprosarium inhabitants; there was a strong correlation with a history aof erythema nodosum leprosum (ENL). Seven of 8 noninstitutionalizes patients with active ENL aldo had urinary findings suggestive of glomerunephritis. In 2 patients with ENL, 1 of whom had alterations of serum complement suggestive of complement consumption, renal biopsies revealed proliferative glomerulonephritis. ENL has been considered to reflect, in part, the deposition of circulating immune complexes throught the body. These studies suggest that patients with lepromatous leprosy may expreience glomerulonephritis as one manifestation of ENL, and are consistent with recent observations of immne complex deposition in the glomerular capillary walls of the kidneys of patients with leprosy.