RESUMEN
In light chain amyloidosis (LA), the massive glomerular and vascular amyloid deposition leading to interstitial fibrosis/tubular atrophy (IFTA) is thought to be responsible for renal failure. The amyloid deposition in the interstitium and the tubular basement membrane (TBM) has received less attention in the study of LA. We, therefore, collected clinical and laboratory data on patients diagnosed with LA in our Nephrology Department and studied amyloid deposition in the TBM. Twelve LA patients were diagnosed by renal biopsy during a seven-year period. In 4 of the 12, amyloid deposition could also be detected in the TBM. In our first case of a patient with diabetes mellitus, non-amyloid fibrils resembling 'diabetic fibrillosis' were also seen by electron microscopy. Despite the double damage, IFTA was negligible, blood vessels were unaffected, and the glomerular deposition was segmental. In the other three cases, significant (>50%) IFTA and a severely reduced estimated glomerular filtration rate were already detected at the time of diagnosis and amyloid deposition was also observed in the blood vessels. These findings indicate the importance of TBM amyloid deposition in the progression of renal disease. This may represent a late-stage presentation of the disease with a heavy LC burden.
Asunto(s)
Amiloidosis , Enfermedades Renales , Humanos , Riñón/patología , Amiloidosis/diagnóstico , Amiloidosis/patología , Enfermedades Renales/diagnóstico , Enfermedades Renales/patología , Glomérulos Renales/patología , Membrana Basal/patologíaRESUMEN
Duchenne muscular dystrophy (DMD) is the most common inherited muscle dystrophy. Patients are characterized by muscle weakness, gross motor delay, and elevated serum creatinine kinase (CK) levels. The disease is caused by mutations in the DMD gene located on the X chromosome. Due to the X-linked recessive inheritance pattern, DMD most commonly affects males, who are generally diagnosed between the age of 3-5 years. Here we present an ultra-rare manifestation of DMD in a female patient. Cytogenetic examination showed that she has a t(X;10)(p21.1;p12.1) translocation, which turned out to affect the DMD gene with one of the breakpoints located in exon 54 (detected by genome sequencing). The X-inactivation test revealed skewed X-inactivation (ratio 99:1). Muscle histology and dystrophin immunohistochemistry showed severe dystrophic changes and highly reduced dystrophin expression, respectively. These results, in accordance with the clinical picture and a highly elevated serum CK, led to the diagnosis of DMD. In conclusion, although in very rare cases, DMD can manifest in female patients as well. In this case, a balanced X-autosome reciprocal translocation disrupts the DMD gene and skewed X-inactivation leads to the manifestation of the DMD phenotype.
Asunto(s)
Distrofina , Distrofia Muscular de Duchenne , Masculino , Femenino , Humanos , Distrofina/genética , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/patología , Inactivación del Cromosoma X , Cromosoma X , MutaciónRESUMEN
The introduction of Bruton's tyrosine kinase inhibitor ibrutinib has made a significant progress in the treatment of chronic lymphocytic leukemia and other B-cell malignancies. Due to the reduction of cytokine release, it is effective in chronic graft-versus-host disease, and its use has also been suggested in autoimmune diseases and in prevention of COVID-19-associated lung damage. Despite this effect on the immune response, we report a severe hypersensitivity reaction in a 76-year-old male patient diagnosed with prolymphocytic leukemia. Four weeks after the ibrutinib start, non-oliguric acute kidney injury with proteinuria and microscopic hematuria developed and that was accompanied by lower limb purpuras and paresthesia. Renal biopsy revealed acute interstitial nephritis. Employing 1 mg/kg methylprednisolone administration, serum creatinine decreased from 365 µmol/L to 125 µmol/L at 11 days and the proteinuria-hematuria as well as the purpura, paresthesia resolved. Three months later at stabile eGFR of 56 ml/min/1.73 m2 methylprednisolone was withdrawn and a rituximab-venetoclax treatment was initiated without side effects. We conclude that despite the beneficial effect on cytokines response in Th1 direction, ibrutinib can cause acute interstitial nephritis. Early detection, discontinuation of ibrutinib, glucocorticoid administration may help to better preserve renal function, thereby lowering the risk of potential subsequent kidney injury.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Adenina/análogos & derivados , Nefritis Intersticial/inducido químicamente , Piperidinas/efectos adversos , Proteinuria/inducido químicamente , Lesión Renal Aguda/tratamiento farmacológico , Adenina/efectos adversos , Anciano , Citocinas/efectos de los fármacos , Glucocorticoides/uso terapéutico , Humanos , Riñón/patología , Leucemia Prolinfocítica/tratamiento farmacológico , Masculino , Nefritis Intersticial/tratamiento farmacológico , Inhibidores de Proteínas Quinasas , Proteinuria/tratamiento farmacológicoRESUMEN
BACKGROUND: Arteriovenous fistulae impair the distal circulation, but their effects at the microcirculatory level are not well understood. This study presents the carotid-jugular fistula (CJF) as a model to evaluate fistula-related microcirculatory and systemic changes. MATERIALS AND METHODS: Female Wistar rats were anesthetized and divided into a fistula group (FG, n = 10) and a sham group (SG, n = 6). End-to-end anastomosis was performed between the right carotid artery and the jugular vein in the FG. The hemodynamic status was followed for 6 weeks. On the sixth postoperative week, liver and kidney microcirculation was measured using laser Doppler; then microcirculatory changes were assessed after occlusion of the carotid artery. At the end of the experiment, histological samples were taken and the weights of the organs were measured. RESULTS: The heart rate and systolic blood pressure decreased significantly due to the CJF. Laser Doppler showed a reduction in liver blood flow units (BFU) in the FG in comparison with the SG (p = 0.01), and they increased (p < 0.01) after occlusion of the fistula. Kidney BFU showed slight changes only. The comparative morphological study revealed significant increases in heart weight (p < 0.001) and left ventricular hypertrophy (p = 0.008) in the FG. CONCLUSION: Beside hemodynamic and morphologic changes, a CJF causes a deterioration in the microcirculation of the liver rather than of the kidney, but occlusion of the CJF immediately reverses these changes.
Asunto(s)
Fístula Arteriovenosa/fisiopatología , Arteria Carótida Común/fisiopatología , Hemodinámica , Venas Yugulares/fisiopatología , Riñón/irrigación sanguínea , Circulación Hepática , Hígado/irrigación sanguínea , Microcirculación , Circulación Renal , Animales , Velocidad del Flujo Sanguíneo , Arteria Carótida Común/cirugía , Modelos Animales de Enfermedad , Femenino , Venas Yugulares/cirugía , Flujometría por Láser-Doppler , Flujo Sanguíneo Regional , Factores de Tiempo , Grado de Desobstrucción VascularRESUMEN
BACKGROUND/AIMS: The pathogenesis of the human polyomavirus (PyV) KI, WU, MW, and STL has not been elucidated yet. Respiratory transmission is suggested, but the site of the replication, tissue, and cell tropism is not clarified. KIPyV and WUPyV DNA and/or antigen were detected in normal lung tissues previously by others. In fact, a KIPyV DNA sequence was found in lung cancer samples. Up to date, there is no publication about the DNA prevalence of MWPyV and STLPyV neither in normal nor in cancerous lung tissues. The aim of the present study was to examine the DNA prevalence of these polyomaviruses in cancerous and non-cancerous lung tissue samples, in order to study the possible site for viral replication and/or persistence, and the potential association of these viruses with lung carcinogenesis as well. METHODS: 100 cancerous and 47 non-cancerous, formalin-fixed paraffin-embedded lung tissue samples were studied for KIPyV, WUPyV, MWPyV, and STLPyV by real-time PCR. RESULTS AND CONCLUSION: Neither of the viruses was found in samples from small-cell, non-small-cell (adenocarcinoma, squamous-cell carcinoma and large-cell neuroendocrine lung cancer), mixed-type and non-differentiated lung carcinoma, and non-cancerous lung tissues (from patients with pneumonia, emphysema and fibrosis).
Asunto(s)
Adenocarcinoma/virología , Enfisema/virología , Fibrosis/virología , Neoplasias Pulmonares/virología , Neumonía/virología , Infecciones por Polyomavirus/virología , Poliomavirus/aislamiento & purificación , Adenocarcinoma del Pulmón , Adulto , Anciano , Femenino , Humanos , Pulmón/virología , Masculino , Persona de Mediana Edad , Poliomavirus/genética , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Antibody-mediated rejection (ABMR) is one of the factors affecting the long-term graft survival after kidney transplantation (KT). Two kidney transplant centres (University of Debrecen and University of Pécs) followed up their data of cadaveric KTs that had been performed between 2013 and 2017, and reviewed the literature. There were 454 KTs in the mentioned period, 18 cases (4%) were recognised as ABMRs. Biopsy has been performed in all cases. 22% were primary, and 78% retransplanted patients. The average age was 51.2 ± 6 years. ABMR occurred 15.4 ± 22.1 months after KT. Histology showed C4d positivity in 39% of the cases. The treatment was steroid bolus + intravenous immunoglobulin (IVIG) + plasma exchange (PE) in 16 cases, rituximab was additionally given in 5 cases. 47.4% of the patients are alive with a functioning graft, four (21%) died, and 31% of the patients had a graft loss due to ABMR. ABMR is a dangerous complication after KT. Diagnostic criteria has been unclear for years. Gold standard is the histology, however, accelerated ABMR may occur even in C4d negative cases. The exposed group includes young, retransplanted patients, having a preformed donor-specific antibody (DSA), and receiving a graft from an EC donor. The occurrence of de novo DSA and the kinetics of mean fluorescence intensity (MFI) of existing ones can be a signal for the risk of an ABMR. The effectiveness of rituximab is not proven, there is a lack of long-term controlled trials for new drugs. Our results of over 40% recovery is an extensively good result. Orv Hetil. 2018; 159(46): 1913-1929.
Asunto(s)
Anticuerpos/inmunología , Rechazo de Injerto/terapia , Supervivencia de Injerto/inmunología , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/cirugía , Trasplante de Riñón/tendencias , Adulto , Femenino , Rechazo de Injerto/epidemiología , Rechazo de Injerto/inmunología , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Donantes de TejidosRESUMEN
BACKGROUND/AIMS: The oncogenic potential of human polyomaviruses (HPyVs) has been proposed, but so far only Merkel cell carcinoma polyomavirus seems to be associated with a human tumour. The role of BK polyomavirus (BKPyV) in human tumourigenesis remains controversial. BKPyV establishes persistent infection in the urinary tract, and renal and bladder neoplasms have been studied extensively, but conflicting prevalence data are reported. KI, WU and HPyV9 were detected in urine samples suggesting that these viruses may also infect the urinary tract, but their presence in urinary tract tumours has not been studied. The aim of this work was to examine the prevalence of KIPyV, WUPyV, HPyV9 and BKPyV by PCR in renal and bladder neoplasms. METHODS: A total of 190 formalin-fixed paraffin-embedded renal neoplasms, bladder cancer and kidney biopsy samples were analysed for the presence of BKPyV, KIPyV, WUPyV and HPyV9 DNA by real-time and nested PCR. RESULTS: Amplifiable DNA was extracted from all the samples, but none of the studied viruses were detected in benign renal neoplasia (0/23), malignant renal tumours (0/89) or bladder cancer (0/76). CONCLUSION: Our study did not find any evidence that BKPyV, KIPyV, WUPyV or HPyV9 are associated with bladder and renal tumours.
Asunto(s)
Neoplasias Renales/virología , Infecciones por Polyomavirus/virología , Poliomavirus/aislamiento & purificación , Infecciones Tumorales por Virus/virología , Neoplasias de la Vejiga Urinaria/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , ADN Viral/análisis , Femenino , Humanos , Riñón/virología , Masculino , Persona de Mediana Edad , Poliomavirus/genética , Prevalencia , Vejiga Urinaria/virología , Adulto JovenRESUMEN
Primary angiosarcoma of the pancreas is an extremely rare neoplasm that often mimicks severe acute pancreatitis. A 58-year-old man was admitted with clinical and laboratory signs of severe acute pancreatitis. Contrast enhanced CT scan demonstrated haemorrhagic necrotizing inflammation of the pancreas involving the pancreatic tail, splenic hilum and small bowels with multiple peripancreatic and free abdominal fluid collection. Percutaneous drainage was performed. After 13 days, laparotomy was indicated because of persistent intra-abdominal bleeding, fever and a palpable, rapidly growing mass in the left upper quadrant of the abdomen. During the operation a necrotic, haemorrhagic mass was found in the pancreatic tail; a frozen section showed malignancy, although the tumour was unresectable. Despite all conservative and surgical therapeutic attempts, the patient died within four weeks after diagnosis. Final histology justified primary angiosarcoma of the pancreas. If a patient with signs of severe acute pancreatitis has fever without elevated PCT, the presence of a malignant tumour of the pancreas should be considered.
Asunto(s)
Hemangiosarcoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pancreatitis Aguda Necrotizante/diagnóstico , Diagnóstico Diferencial , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The onset of proteinuria in renal allograft recipients is frequently associated with an increased risk for both graft failure and mortality. We investigated the risk associated with post-transplant proteinuria and its time-dynamics in a select group treated for biopsy proven antibody-mediated rejection (ABMR). METHODS: Eighty-five patients who underwent transplantation were enrolled in our study and followed up from transplantation until October 31, 2020, death, or the date of the return to dialysis. We created two main groups: the ABMR group (n = 19) and an ABMR-negative control group with stable kidney function (n = 52) without donor-specific antibodies (DSA) and a subgroup with DSAs but stable graft function (n = 14) without ABMR. Differences in patient, donor, and transplant graft characteristics between the groups were assessed by Fisher's exact test for categorical variables. Death-censored graft loss was evaluated with the help of Kaplan-Meier analysis using log risk statistics. RESULTS: Proteinuria decreased after treatment in the ABMR group (P < .0009). Pre-treatment every 10 mg/mmol increase in proteinuria was associated with a 7% increase in the risk for graft failure in the ABMR group. The estimated 3-year graft survival was 87.5% in the ABMR group, compared to 93% in the group without ABMR but with pre-formed DSA, and 100% in the DSA negative subgroup (log-rank probe P < .0666). CONCLUSION: Proteinuria is an independent predictor for graft failure, can be lowered by treatment for ABMR but ABMR is associated with lower graft survival in our study population.
RESUMEN
Prostate cancer stands as the most prevalent malignant tumor among men; with its incidence increasing with advancing age. The spectrum of patient care options for this disease is broad, encompassing approaches such as "active surveillance," definitive radiation therapy, robot-assisted surgery, among others. These diverse modalities afford opportunities for cure or successful management in the majority of cases. It is paramount to underscore that optimal treatment hinges upon a multidisciplinary framework, wherein the coordinated efforts of allied healthcare professionals yield the highest standard of patient care. Hence, it is imperative for pathologists to keep abreast of contemporary processing and specimen collection protocols, as well as the potential necessity of supplementary investigations and their clinical significance. The latest Hungarian guideline on prostate cancer care features a dedicated chapter delineating the pivotal role and responsibilities of pathologists. Through this discourse, we aim to consolidate and disseminate pertinent insights, thereby fostering the continuing enhancement of pathologists' knowledge and elucidating the intricacies of histological processing to our clinical counterparts.
Asunto(s)
Neoplasias de la Próstata , Manejo de Especímenes , Humanos , Masculino , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Hungría , Biopsia/normas , Biopsia/métodos , Manejo de Especímenes/normas , Manejo de Especímenes/métodos , Próstata/patología , Próstata/cirugía , Patólogos , Prostatectomía/métodos , Guías de Práctica Clínica como AsuntoRESUMEN
Herpes simplex virus encephalitis (HSVE) is a rare and life-threatening infection. The clinical signs are diverse and often misleading regarding the aetiology. However, focal seizure with fever and typical CT/MRI finding should always raise the possibility of HSVE as early diagnosis and antiviral therapy is crucial. Before the advent of molecular techniques and high-tech imaging histological examination from multiple brain biopsies were often necessary. Although nowadays PCR and other molecular methods may provide an aetiological diagnosis some cases need neuropathological verification. Due to the high IgG seropositivity rate in the population the plasma IgG titer is not diagnostic and elevation of its plasma level requires several weeks. We report the case of a 25-years old male patient who initially presented with epileptic seizures. There was no final diagnosis and no causal treatment in the district general hospital. The patient was admitted to our institution in comatose state on day 9; the initiated diagnostic tests and therapy could not save the patient who died next day. The autopsy and subsequent neuropathological examination revealed HSVE. We present a flowchart on diagnostic work-up and special techniques to aid diagnosis in suspected viral encephalitis.
Asunto(s)
Antivirales/administración & dosificación , Líquido Cefalorraquídeo/virología , Encefalitis por Herpes Simple/diagnóstico , Encefalitis por Herpes Simple/tratamiento farmacológico , Simplexvirus/aislamiento & purificación , Lóbulo Temporal/virología , Adulto , Algoritmos , Hemorragia Cerebral/virología , Diagnóstico Tardío , Diagnóstico Diferencial , Encefalitis por Herpes Simple/complicaciones , Encefalitis por Herpes Simple/patología , Resultado Fatal , Fiebre/virología , Humanos , Inmunohistoquímica , Comunicación Interdisciplinaria , Imagen por Resonancia Magnética , Masculino , Necrosis/virología , Reacción en Cadena de la Polimerasa , Convulsiones/virología , Simplexvirus/inmunología , Lóbulo Temporal/patología , Factores de TiempoRESUMEN
Assessing the accurate Grade Group of a prostate needle biopsy specimen is essential for choosing the adequate therapeutic modality for prostate cancer patients. However, it is well-known that biopsy Grade Group tends to up- or downgrade significantly at radical prostatectomy. We aimed to investigate the correlation between accuracy and biopsy core number, performed immunohistochemical staining (IHC) or prostatectomy specimen sampling, with the latest also being correlated with higher detection rates of adverse pathological features, e.g., positive surgical margins, higher pathological stage or presence of perineural invasion (PnI status). The study cohort consisted of 315 consecutive patients diagnosed with prostate adenocarcinoma via transrectal ultrasound-guided needle biopsy who later underwent radical prostatectomy. We grouped and compared patients based on Grade Group accuracy, presence of IHC on biopsy, margin status, pathological stage, and PnI status. Inter-observer reproducibility was also calculated. Statistical analyzes included ANOVA, Tukey's multiple comparisons post hoc test, Chi-squared test, and Fleiss kappa statistics. Undergraded cases harboured a significantly lower number of biopsy cores (p < 0.05), than accurately graded cases. Using IHC did not affect grading accuracy significantly, nor did the number of slides from prostatectomy specimens. The mean number of slides was virtually identical when margin status, pathological stage and PnI status of prostatectomy specimens were compared. Inter-observer reproducibility at our institute was calculated as fair (overall kappa = 0.29). Grade Group accuracy is significantly improved by obtaining more cores at biopsy but is unrelated to performed IHC. The extent of sampling prostatectomy specimens, however, did not affect accuracy and failed to significantly improve detection of adverse pathological features.
Asunto(s)
Próstata , Neoplasias de la Próstata , Masculino , Humanos , Próstata/cirugía , Próstata/patología , Inmunohistoquímica , Reproducibilidad de los Resultados , Valor Predictivo de las Pruebas , Biopsia , Prostatectomía , Neoplasias de la Próstata/patología , Estadificación de NeoplasiasRESUMEN
Background: Splanchnic vein thrombosis due to co-existing metastatic pancreatic neuroendocrine tumour (pNET) and JAK2V617F mutation is a rare condition. Case report: Here we present a case of a young woman with complete remission of a non-functioning grade 2 pNET with unresectable liver metastases, coexisting with JAK2V617F mutation. Splenectomy and distal pancreatectomy were performed. Neither surgical removal, nor radiofrequency ablation of the liver metastases was possible. Therefore, somatostatin analogue (SSA) and enoxaparine were started. Peptide receptor radionuclide therapy (PRRT) was given in 3 cycles 6-8 weeks apart. Genetic testing revealed no multiple endocrine neoplasia type 1 (MEN-1) gene mutations. After shared decision making with the patient, she gave birth to two healthy children, currently 2 and 4 years old. On pregnancy confirmation, SSA treatment was interrupted and resumed after each delivery. Ten years after the diagnosis of pNET, no tumour is detectable by MRI or somatostatin receptor scintigraphy. PRRT followed by continuous SSA therapy, interrupted only during pregnancies, resulted in complete remission and enabled the patient to complete two successful pregnancies.
Asunto(s)
Adenoma de Células de los Islotes Pancreáticos , Neoplasias Hepáticas , Neoplasias Primarias Secundarias , Tumores Neuroectodérmicos Primitivos , Tumores Neuroendocrinos , Neoplasias Pancreáticas , Trombosis , Femenino , Humanos , Embarazo , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/secundario , Tumores Neuroectodérmicos Primitivos/complicaciones , Tumores Neuroendocrinos/complicaciones , Tumores Neuroendocrinos/terapia , Tumores Neuroendocrinos/patología , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/diagnóstico , Vena Porta , SomatostatinaRESUMEN
BACKGROUND: One of the most important possible complications determining long-term graft survival after kidney transplant is antibody-mediated rejection (ABMR). The criterion standard approach to recognize ABMR is currently the kidney biopsy with histopathologic analysis. However, this test has limitations because of difficulties in timing of sampling, the evaluability of histology because of the questionable representativeness of specimens, and the limited number of this intervention. Hence, new reliable, noninvasive biomarkers are required to detect the development of ABMR in time. METHODS: In this study, we analyzed the clinical data of 45 kidney transplant patients (mean age of 44.51 years, 20 male and 25 female subjects). These participants were recruited into 5 subcohorts based on their clinical status, histologic findings, and level of donor-specific anti-HLA antibodies. Circulating microRNAs (miR-21, miR-181b, miR-146a, miR-223, miR-155, miR-150) in plasma samples were quantified by quantitative polymerase chain reaction and their levels were correlated with the clinical characteristics in different subgroups. RESULTS: The relative expression of plasma miR-155 (P = .0003), miR-223 (P = .0316), and miR-21 (P = .0147) were significantly higher in patients who had subsequent histology-approved ABMR with donor-specific anti-HLA antibody positivity (n = 10) than in the "triple negative" group (n = 21), and miR-155 showed the highest sensitivity (90%) and specificity (81%) to indicate ABMR development based on receiver operating characteristic analysis. CONCLUSIONS: According to our preliminary data, plasma miR-155, miR-21, and miR-223 can indicate the development of ABMR after kidney transplant in correlation with classic clinical parameters. However, future studies with larger number of participants are necessary to further evaluate the diagnostic properties of blood miRNAs in prediction of this life-threatening condition.
Asunto(s)
MicroARN Circulante , Rechazo de Injerto , Trasplante de Riñón , Adulto , Femenino , Humanos , Masculino , Aloinjertos , Anticuerpos/inmunología , Anticuerpos/metabolismo , MicroARN Circulante/sangre , MicroARN Circulante/química , Rechazo de Injerto/genética , Rechazo de Injerto/metabolismo , Isoanticuerpos , Trasplante de Riñón/efectos adversos , MicroARNs/sangre , MicroARNs/químicaRESUMEN
Összefoglaló. Bevezetés: A kis méretu vesedaganatok között lényegesen gyakoribbak a benignus elváltozások, és a kis malignus tumorok biológiai tulajdonságai is kedvezobbek, mint a nagyobb daganatokéi. Célkituzés: Szerzok a kis méretu vesetumorok tulajdonságait vizsgáltuk különbözo alcsoportokban. Módszer: 2000. január 1. és 2015. január 1. között 1272 beteg esetén végeztünk mutétet vesedaganat miatt. Közülük 496 betegnek volt kis méretu vesetumora. A betegek átlagéletkora 59 ± 12 év volt. A betegeket a tumorméret alapján három csoportba osztottuk. Az 1. csoportban a daganat mérete ≤4 cm, a 2. csoportban ≤3 cm és a 3. csoportban ≤2 cm volt. Eredmények: Az eltávolított daganat nagysága átlagosan 29 ± 8 mm volt. A szövettan 418 esetben (84%) malignus, míg 78 alkalommal (16%) benignus elváltozást mutatott. A 2 cm-nél kisebb daganatoknál malignitás csak az esetek 73,2%-ában fordult elo. A malignus és a benignus tumorok méretében szignifikáns eltérés volt (p = 0,008). Rosszul differenciált daganat - grade 3. és 4. - az esetek 10,8%-ában, 14,4%-ában, illetve 20,7%-ában volt jelen, amikor a tumorméret kisebb mint 2 cm, 2,1-3 cm, illetve 3,1-4,0 cm volt. A vesecarcinomáknál az átlagosan 10 éves utánkövetési ido alatt progresszió az esetek 5,5%-ában fordult elo. Következtetés: A kis méretu vesetumor az összes vesedaganat 39%-át tette ki. Ezek nagy része malignus volt, és benignus elváltozás az esetek 16%-ában fordult elo. A malignitás elofordulása a 2 cm-nél kisebb tumoroknál volt a legalacsonyabb. A tumorméret szoros összefüggést mutatott a malignitás gyakoriságával és a daganat differenciáltságával. A kedvezo patológiai és biológiai eredmények alapján a 2 cm alatti daganatoknál felmerül annak lehetosége, hogy esetükben az aktív követés vagy minimálisan invazív kezelés alkalmazása kerüljön elotérbe. Orv Hetil. 2021; 162(42): 1693-1697. INTRODUCTION: The incidence of benign lesions is more common in small renal masses (SRMs) and biological behavior of small malignancies is better compared to larger ones. OBJECTIVE: The authors measured the characteristics of SRMs in different subgroups. METHOD: From January 1, 2000 to January 1, 2015, 1272 patients underwent surgery for renal tumors. In 496 of the 1272 cases, the patients had SRMs. The mean age of the patients was 59 ± 12 years. Based on the sizes, the SRMs were divided into three groups. The sizes of the renal tumors were ≤4 cm in Group 1, ≤3 cm in Group 2 and ≤2 cm in Group 3. RESULTS: The mean diameter of the removed SRMs was 29 ± 8 mm. Histology confirmed renal cell carcinoma in 418 cases (84%), while benign tumor was present in 78 patients (16%). However, with the tumor size ≤2 cm, malignancy was detected in 73.2% of the cases. There was a significant difference in the sizes of the malignant and the benign masses (p = 0.008). Grade 3 or 4 tumors were present in 10.8%, 14.4% and 20.7% when the tumor size was ≤2 cm, 2.1 to 3 cm, and 3.1 to 4 cm in diameter, respectively. During the mean 10-year follow-up period, tumor progression was detected only in 5.5% of malignancies. CONCLUSION: In 39% of all cases, the patients had SRMs. The majority of SRMs were malignant, and benign lesion occurred only in 16% of the cases. The incidence of malignant tumors was the lowest when the size of SRMs was ≤2 cm. The size of the tumor was highly associated with probability of malignancy and tumor grading. Based on the favorable pathological and biological results in tumors below 2 cm, active surveillance or minimally invasive treatment could be the preferred management. Orv Hetil. 2021; 162(42): 1693-1697.
Asunto(s)
Neoplasias Renales/patología , Anciano , Humanos , Incidencia , Persona de Mediana EdadRESUMEN
Összefoglaló. Bevezetés: Az antitest közvetítette kilökodés a graftvesztés gyakori oka a vesetranszplantáltak körében. Célkituzés: Célul tuztük ki, hogy ismertetjük a centrumunkban biopsziával igazolt humorális kilökodéssel rendelkezo betegeknek a kezelésre (standard kezelés: plazmaferézis, immunglobulin, rituximab) adott válaszát, valamint hogy vizsgáljuk a proteinuria grafttúlélésre kifejtett hatását és azt, hogy ezt a DSA-tól függetlenül teszi-e. Vizsgáltuk az eGFR-, a DSA-MFI-értéknek az antirejekciós terápia hatására bekövetkezo változásait is. Módszer: 85 beteg retrospektív analízisét végeztük el. A szövettani elemzésben a Banff-klasszifikációt vettük alapul. A csoportok összehasonlításához kategorikus változók esetén a Fisher-féle egzakt próbát, folyamatos változók esetén a Kruskal-Wallis-próbát használtuk. Eredmények: A biopsziával igazolt humorális rejekciós csoportba (ABMR-csoport) 19, a DSA-pozitív csoportba 14, a DSA-negatív csoportba 52 beteget választottunk be. A DSA-érték az ABMR-csoportban 61,16%-kal csökkent, a DSA-pozitív csoportban 42,86%-kal redukálódott (Fisher-féle egzakt: p = 0,1). Az ABMR-csoportban 9 betegnek a jelentos, 4-nek a nephroticus mértéku proteinuriája csökkentheto volt (az ABMR-csoport 68%-a). A legjobb grafttúlélés a legalacsonyabb fehérjeürítésnél adódott. Az antirejekciós terápiát követoen készült biopsziákban: a glomerulitis, az interstitialis gyulladás, az arteritis mértéke csökkent az antihumorális kezelés hatására, azonban krónikus elváltozások jelentek meg. Következtetés: Az ABMR-csoportban az antirejekciós terápiát követoen a fehérjeürítés monitorizálása javasolt, hiszen becsülheto vele a grafttúlélés. Orv Hetil. 2021; 162(26): 1029-1037. INTRODUCTION: Antibody-mediated rejection is a common cause of graft loss among kidney transplant recipients. OBJECTIVE: We aimed to describe the response of patients with biopsy-proven humoral rejection to treatment (standard treatment: plasmapheresis, immunoglobulin, rituximab) in our center. We also analyzed the effect of proteinuria on graft survival and whether this effect is independent of donor-specific antibodies (DSAs). Changes of eGFR and level of DSA following rejection treatment were examined. METHOD: In this study, laboratory data of 85 patients were analysed. Histological analysis was based on the Banff classification. Fisher's exact test was used for statistical analysis, and Kruskal-Wallis test was used to compare patient groups per variable. RESULTS: Data from 85 patients were processed retrospectively. 19 patients were selected for the biopsy-confirmed humoral rejection group (ABMR group), 14 for the DSA-positive group, and 52 for the DSA-negative group. DSA titer decreased by 61.16% in the ABMR group after treatment and by 42.86% in the DSA-positive group (Fisher's exact test: p = 0.1). In the ABMR group, significant nephrotic proteinuria in 4 patients and severe proteinuria in 9 patients were reduced (68% of ABMR group). The patients with the lowest protein excretion had the best graft survival. In biopsies performed after antirejection therapy, the extent of glomerulitis, interstitial inflammation, arteritis decreased with antihumoral treatment, but chronic lesions appeared. CONCLUSION: Following treatment of biopsy-proven ABMR, reduction of proteinuria predicts graft survival and should be monitored as an important factor-predicting prognosis. Orv Hetil. 2021; 162(26): 1029-1037.
Asunto(s)
Trasplante de Riñón , Humanos , Inmunoglobulinas , Pronóstico , Estudios RetrospectivosRESUMEN
The most serious complication of novel influenza virus (H1N1) infections is the progressive respiratory insufficiency caused by diffuse alveolar damage (DAD) which can be overinfected by opportunistic pathogens. Clinically manifest acute respiratory distress syndrome leads to death in the most severe forms of the disease. However, despite the H1N1 positivity determined by RT-PCR, signs of virus pneumonia could not be demonstrated in several cases belonging to the high-risk patient group, therefore, the role of the virus infection in the course of the disease remained unclear. In this paper, a case with a complicated, partially organized hemorrhagic pneumonia and DAD is presented in a patient with H1N1 virus positivity, which can be referred as a classical pulmonary change. In order to obtain correct statistical data on virus related mortality, only unambiguous cases with clear virus associated morphological changes should be considered.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/complicaciones , Neumonía Viral/diagnóstico , Alveolos Pulmonares/virología , Atelectasia Pulmonar/virología , Síndrome de Dificultad Respiratoria/virología , Anciano , Resultado Fatal , Femenino , Humanos , Gripe Humana/patología , Gripe Humana/terapia , Gripe Humana/virología , Neumonía Viral/patología , Neumonía Viral/terapia , Neumonía Viral/virología , Alveolos Pulmonares/patología , Atelectasia Pulmonar/patología , Insuficiencia Respiratoria/virología , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
BACKGROUND: Chronic kidney disease (CKD) models are known to study pathophysiology and various treatment methods. Renal dysfunction could influence erythrocytes through several pathways. However, hemorheological and microcirculatory relation of CKD models are not completely studied yet. OBJECTIVE: To evaluate erythrocyte micro-rheology, microcirculatory and structural compensatory mechanisms in a rat model of CKD. METHODS: Female Sprague-Dawley rats were subjected to nephrectomy group (NG, nâ=â6) or sham-operated group (SG, nâ=â6). NG rats were subjected to 5/6 nephrectomy in two stages. In SG no intervention was made on kidneys. Hemorheological and hematological measurements were carried out after each stage, and 5 weeks after the last operation. Histological and microcirculatory studies were done on the remaining kidney and compared with sham rats. RESULTS: Serum creatinine increased in NG (pâ=â0.008), accompanied with decrease of red blood cell count (pâ=â0.028) and hemoglobin (pâ=â0.015). Erythrocyte aggregation parameters slightly increased in NG, while the elongation index didn't show significant changes. Microcirculation was intact in the remnant kidney of NG. However, in comparison with SG, the diameter of glomeruli increased significantly (pâ<â0.01). CONCLUSIONS: Erythrocyte mass was influenced more than micro-rheological properties in this model. The main compensation mechanism was rather structural than at microcirculatory level.
Asunto(s)
Microcirculación/inmunología , Insuficiencia Renal Crónica/patología , Reología/métodos , Animales , Modelos Animales de Enfermedad , Femenino , Ratas , Ratas Sprague-DawleyRESUMEN
BACKGROUND: The optimal timing of remote ischemic preconditioning (RIPC) in renal ischemia-reperfusion (I/R) injury is still unclear. We aimed to compare early- and delayed-effect RIPC with hematological, microcirculatory and histomorphological parameters. METHODS: In anesthetized male CrI:WI Control rats (nâ=â7) laparotomy and femoral artery cannulation were performed. In I/R group (nâ=â7) additionally a 45-minute unilateral renal ischemia with 120-minute reperfusion was induced. The right hind-limb was strangulated for 3×10 minutes (10-minute intermittent reperfusion) 1 hour (RIPC-1 group, nâ=â7) or 24 hour (RIPC-24 group, nâ=â6) prior to the I/R. Hemodynamic, hematological parameters and organs' surface microcirculation were measured. RESULTS: Control and I/R group had the highest heart rate (pâ<â0.05 vs base), while the lowest mean arterial pressure (pâ<â0.05 vs RIPC-1) were found in the RIPC-24 group. The highest microcirculation values were measured in the I/R group (liver: pâ<â0.05 vs Control). The leukocyte count increased in I/R group (base: pâ<â0.05 vs Control), also this group's histological score was the highest (pâ<â0.05 vs Control). The RIPC-24 group had a significantly lower score than the RIPC-1 (pâ=â0.0025 vs RIPC-1). CONCLUSION: Renal I/R caused significant functional and morphological, also in the RIPC groups. According to the histological examination the delayed-effect RIPC method was more effective.
Asunto(s)
Hemodinámica/genética , Precondicionamiento Isquémico/métodos , Riñón/patología , Daño por Reperfusión/tratamiento farmacológico , Animales , Masculino , Ratas , Daño por Reperfusión/patologíaRESUMEN
BACKGROUND: Ischemia reperfusion (I/R) injury remains one of the most challenging fields of organ transplantation. It is highly associated with the use of expanded criteria donors that might conclude to delayed graft function or early or late graft failure. OBJECTIVE: To investigate the metabolic, microcirculatory parameters, and histologic changes under the effect of N,N-dimethyltryptamine (DMT) in a renal I/R model in rats. METHOD: In 26 anesthetized rats both kidneys were exposed. In the control group (n = 6) no other intervention happened. In 20 other animals, the right renal vessels were ligated, and after 60 minutes the right kidney was removed. The left renal vessels were clamped for 60 minutes then released, followed by 120 minutes of reperfusion. In the I/R group (n = 10), there was no additive treatment, while in I/R + DMT group (n = 10) DMT was administered 15 minutes before ischemia. Blood samples were taken, laser Doppler measurement was performed, and both kidneys were evaluated histologically. RESULTS: Microcirculation (blood flux units [BFU]) diminished in all groups, but remarkably so in the I/R + DMT group. This group compensated better after the 30th minute of reperfusion. The control and I/R + DMT groups had similar BFUs after 120 minutes of reperfusion, but in the I/R group BFU was higher. Tubular necrosis developed in the I/R and I/R + DMT groups too; it was moderated under DMT effect, and severe without. Histologic injuries were less in I/R + DMT Group compared to non-treated animals. CONCLUSION: Histologic changes characteristic to I/R injuries were reversible and microcirculation recovered at the end of 120 minutes reperfusion under the administration of DMT. DMT can be used for renoprotection in kidney transplantation.