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1.
J Chin Med Assoc ; 85(5): 584-596, 2022 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-35385419

RESUMEN

BACKGROUND: Magnolol is a component of the bark of Magnolia officinalis, which is a traditional herbal remedy used in China. In this study, we investigated whether magnolol can reduce myocardial injury induced by renal ischemia and reperfusion (I/R). METHODS: Renal I/R was elicited by a 60-minute occlusion of the bilateral renal arteries and a 24-hour reperfusion in Sprague-Dawley rats. Magnolol was administered intravenously 10 minutes before renal I/R to evaluate its effects on myocardial injury induced by renal I/R. RESULTS: Renal I/R significantly increased the serum levels of creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and cardiac troponin I and caused myocardial damage. The terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive nuclei and caspase-3 activation was significantly increased in the myocardium, indicating increase of apoptosis. Echocardiography revealed left ventricular dysfunction, as evidenced by reduction of left ventricular ejection fraction and left ventricular fractional shortening. Furthermore, serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, and IL-6 were significantly elevated, while the IL-10 level was suppressed. However, intravenously, pretreatment with magnolol at doses of 0.003 and 0.006 mg/kg 10 minutes before renal I/R significantly prevented the increases of CPK, LDH, and cardiac troponin I levels, as well as the histological damage and the apoptosis in the myocardium. Echocardiography showed significant improvement of left ventricular function. Furthermore, the increases in TNF-α, IL-1ß, and IL-6 and the decrease in IL-10 were significantly limited, while Bcl-2 was increased and Bax was decreased in the myocardium. Phosphorylation of Akt and extracellular signal-regulated kinases 1 and 2 was increased, while phosphorylation of p38 and c-Jun N-terminal kinase was reduced. CONCLUSION: Magnolol reduces myocardial injury induced by renal I/R. The underlying mechanisms for this effect might be related to modulation of the production of pro- and anti-inflammatory cytokines and the limiting of apoptosis.


Asunto(s)
Daño por Reperfusión Miocárdica , Daño por Reperfusión , Animales , Apoptosis , Compuestos de Bifenilo , Interleucina-10/farmacología , Interleucina-6 , Isquemia/patología , Lignanos , Daño por Reperfusión Miocárdica/tratamiento farmacológico , Daño por Reperfusión Miocárdica/prevención & control , Miocardio/patología , Ratas , Ratas Sprague-Dawley , Reperfusión , Volumen Sistólico , Troponina I , Factor de Necrosis Tumoral alfa , Función Ventricular Izquierda
2.
Am J Chin Med ; 45(7): 1421-1439, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28946769

RESUMEN

Magnolol, a constituent of the bark of Magnolia officinalis, has been reported to decrease myocardial stunning and infarct size. In this study, we investigated whether magnolol can reduce renal ischemia and reperfusion (I/R) injury. Renal I/R, induced by a 60-min occlusion of bilateral renal arteries and a 24-h reperfusion, significantly increased blood urea nitrogen (BUN) and creatinine levels, and caused histological damage to the kidneys of rats. Apoptosis, as evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining and caspase-3 activation, was significantly increased in the kidneys. Furthermore, serum levels of tumor necrosis factor-[Formula: see text] (TNF-[Formula: see text]), interleukin-1ß (IL-1ß), and interleukin-6 (IL-6) were significantly elevated, while the interleukin-10 (IL-10) level was suppressed. However, intravenous pretreatment with magnolol at doses of 0.003[Formula: see text]mg/kg and 0.006[Formula: see text]mg/kg 10[Formula: see text]min before renal I/R significantly limited the increases of BUN, creatinine, the histological damage, and apoptosis in the kidneys. The increases in TNF-[Formula: see text], IL-1ß, and IL-6, and the decrease in IL-10 were also significantly inhibited. Additionally, magnolol increased Bcl-2 and decreased Bax in the kidneys. Phosphorylation of the prosurvival kinases, including Akt and extracellular signal-regulated kinases 1 and 2 (ERK1/2), was elevated, while phosphorylation of the pro-apoptotic mitogen-activated protein kinases, including p38 and c-Jun N-terminal kinase (JNK), was suppressed. In conclusion, magnolol reduces renal I/R injury. The underlying mechanisms for this effect might be related to the prevention of apoptosis, possibly via the inhibition of both extrinsic and intrinsic apoptotic pathways, including the reduction of TNF-[Formula: see text] production and the modulation of pro- and anti-apoptotic signaling elements.


Asunto(s)
Apoptosis/efectos de los fármacos , Compuestos de Bifenilo/administración & dosificación , Compuestos de Bifenilo/farmacología , Isquemia/tratamiento farmacológico , Riñón/irrigación sanguínea , Riñón/patología , Lignanos/administración & dosificación , Lignanos/farmacología , Fitoterapia , Daño por Reperfusión/tratamiento farmacológico , Animales , Nitrógeno de la Urea Sanguínea , Creatinina/sangre , Relación Dosis-Respuesta a Droga , Infusiones Intravenosas , Interleucina-10/sangre , Interleucina-1beta/sangre , Interleucina-6/sangre , Isquemia/sangre , Proteínas Quinasas JNK Activadas por Mitógenos/metabolismo , Riñón/metabolismo , Masculino , Proteína Quinasa 3 Activada por Mitógenos/metabolismo , Fosforilación/efectos de los fármacos , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Ratas Sprague-Dawley , Daño por Reperfusión/sangre , Transducción de Señal/efectos de los fármacos , Factor de Necrosis Tumoral alfa/sangre , Proteína X Asociada a bcl-2/metabolismo
3.
Am J Chin Med ; 45(4): 791-811, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28521514

RESUMEN

Baicalein is an active component of Scutellaria baicalensis Georgi, which has traditionally been used to treat cardiovascular diseases in China. In this study, we investigated if treatment with baicalein can attenuate the lung injury induced by myocardial ischemia and reperfusion (I/R). Myocardial I/R, induced by a 40-min occlusion of the left anterior descending coronary artery and a 3-h reperfusion, significantly increased histological damage and the wet-to-dry weight ratio of lungs in rats. The terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive nuclei and caspase-3 activation was significantly increased in the lungs. Serum and bronchoalveolar lavage fluid levels of tumor necrosis factor-[Formula: see text] (TNF-[Formula: see text]), interleukin-1[Formula: see text] (IL-1[Formula: see text]), and interleukin-6 (IL-6) were significantly elevated, as were TNF-[Formula: see text] levels in the lung. Intravenous administration with baicalein at doses of 3, 10, and 30[Formula: see text]mg/kg for ten minutes before myocardial I/R significantly reduced histological damage, the wet-to-dry weight ratio, and apoptosis in the lung. Baicalein also significantly inhibited the increase in levels of TNF-[Formula: see text], IL-1[Formula: see text], and IL-6. Moreover, baicalein increased Bcl-2 and decreased p53, Bax, and cytochrome [Formula: see text] in lungs. Phosphorylation of the prosurvival kinases, including Akt and extracellular signal-regulated kinases 1 and 2 (ERK1/2), was increased, while the phosphorylation of the pro-apoptotic mitogen-activated protein kinases, including p38 and c-Jun N-terminal kinase (JNK), was decreased. In conclusion, treatment with baicalein attenuates the lung injury induced by myocardial I/R. The mechanisms might be related to the limiting of apoptosis, possibly via the inhibition of both the extrinsic and intrinsic pathways of apoptosis, including the inhibition of TNF-[Formula: see text] production and modulation of pro- and anti-apoptotic signaling elements.


Asunto(s)
Apoptosis/efectos de los fármacos , Flavanonas/uso terapéutico , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/etiología , Isquemia Miocárdica/complicaciones , Reperfusión Miocárdica/efectos adversos , Fitoterapia , Scutellaria baicalensis/química , Animales , Apoptosis/genética , Caspasa 3/metabolismo , Citocinas/metabolismo , ADN Nucleotidilexotransferasa/metabolismo , Nucleótidos de Desoxiuracil/metabolismo , Flavanonas/administración & dosificación , Flavanonas/aislamiento & purificación , Infusiones Intravenosas , Pulmón/metabolismo , Enfermedades Pulmonares/metabolismo , Enfermedades Pulmonares/prevención & control , Masculino , Ratas Sprague-Dawley
4.
Am J Chin Med ; 44(3): 531-50, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27109160

RESUMEN

Baicalein is a component of the root of Scutellaria baicalensis Georgi, which has traditionally been used to treat liver disease in China. In the present study, we investigated baicalein' ability to reduce the liver injury induced by myocardial ischemia and reperfusion (I/R). Myocardial I/R was induced in this experiment by a 40[Formula: see text]min occlusion of the left anterior descending coronary artery and a 3[Formula: see text]h reperfusion in rats. The induced myocardial I/R significantly increased the serum levels of aspartate transaminase (AST) and alanine transaminase (ALT), indicating the presence of liver injury. Hepatic apoptosis was significantly increased. The serum levels of tumor necrosis factor-[Formula: see text] (TNF-[Formula: see text]), interleukin-1[Formula: see text] (IL-1[Formula: see text]), and interleukin-6 (IL-6) were significantly elevated, as was the TNF-[Formula: see text] level in the liver. Intravenous pretreatment with baicalein (3, 10, or 30[Formula: see text]mg/kg) 10[Formula: see text]min before myocardial I/R significantly reduced the serum level increase of AST and ALT, apoptosis in the liver, and the elevation of TNF-[Formula: see text], IL-1[Formula: see text], and IL-6 levels. Moreover, baicalein increased Bcl-2 and decreased Bax in the liver. Phosphorylation of the prosurvival kinases, including Akt and extracellular signal-regulated kinases 1 and 2 (ERK1/2), was also increased. In conclusion, we found that baicalein can reduce the liver injury induced by myocardial I/R. The underlying mechanisms are likely related to the inhibition of the extrinsic and intrinsic apoptotic pathways, possibly via the inhibition of TNF-[Formula: see text] production, the modulation of Bcl-2 and Bax, and the activation of Akt and ERK1/2. Our findings may provide a rationale for the application of baicalein or traditional Chinese medicine containing large amounts of baicalein to prevent liver injury in acute myocardial infarction and cardiac surgery.


Asunto(s)
Flavanonas/uso terapéutico , Hepatopatías/tratamiento farmacológico , Hepatopatías/etiología , Isquemia Miocárdica/complicaciones , Daño por Reperfusión Miocárdica/complicaciones , Fitoterapia , Alanina Transaminasa/sangre , Animales , Apoptosis , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Modelos Animales de Enfermedad , Flavanonas/administración & dosificación , Flavanonas/aislamiento & purificación , Flavanonas/farmacología , Infusiones Intravenosas , Interleucina-1beta/sangre , Interleucina-6/sangre , Hepatopatías/diagnóstico , Hepatopatías/patología , Masculino , Proteína Quinasa 3 Activada por Mitógenos , Extractos Vegetales/química , Proteínas Proto-Oncogénicas c-bcl-2 , Ratas Sprague-Dawley , Scutellaria baicalensis , Factor de Necrosis Tumoral alfa/sangre
5.
Planta Med ; 82(3): 181-9, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26550790

RESUMEN

Acute kidney injury is a common and severe complication of acute myocardial infarction and cardiac surgery. It results in increased mortality, morbidity, and duration of hospitalization. Baicalein is a component of the root of Scutellaria baicalensis, which has traditionally been used to treat cardiovascular and liver diseases in Asia. In this study, we investigated whether baicalein can attenuate kidney injury induced by myocardial ischemia and reperfusion in rats. Myocardial ischemia and reperfusion, induced by a 40-minute occlusion and a 3-hour reperfusion of the left anterior descending coronary artery, significantly increased blood urea nitrogen and creatinine levels in addition to causing histological changes in the kidneys. Kidney apoptosis was also significantly increased. Furthermore, myocardial ischemia and reperfusion significantly increased the serum levels of tumor necrosis factor-α, interleukin-1, and interleukin-6 as well as the tumor necrosis factor-α levels in the kidneys. Intravenous pretreatment with baicalein (in doses of 3, 10, or 30 mg/kg), however, significantly reduced the increases in the creatinine level, renal histological damage, and apoptosis induced by myocardial ischemia and reperfusion. In addition, the increases in the serum levels of tumor necrosis factor-α, interleukin-1, and interleukin-6, and of tumor necrosis factor-α in the kidneys were significantly reduced. Western blot analysis revealed that baicalein significantly increased Bcl-2 and reduced Bax in the kidneys. The phosphorylation of Akt and extracellular signal-regulated kinases 1 and 2 was also significantly increased. In conclusion, baicalein significantly attenuates kidney injury induced by myocardial ischemia and reperfusion. The underlying mechanisms might be related to the inhibition of apoptosis, possibly through the reduction of tumor necrosis factor-α production, the modulation of Bcl-2 and Bax, and the activation of Akt and extracellular signal-regulated kinases 1 and 2.


Asunto(s)
Lesión Renal Aguda/prevención & control , Flavanonas/uso terapéutico , Daño por Reperfusión Miocárdica/prevención & control , Extractos Vegetales/uso terapéutico , Scutellaria baicalensis/química , Animales , Apoptosis/efectos de los fármacos , Masculino , Proteína Quinasa 1 Activada por Mitógenos/metabolismo , Proteína Quinasa 3 Activada por Mitógenos/metabolismo , Proteínas Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Ratas , Ratas Sprague-Dawley , Proteína X Asociada a bcl-2/metabolismo
6.
Eur J Cardiothorac Surg ; 48(3): 382-91, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25475946

RESUMEN

OBJECTIVES: Acute kidney injury is a common and serious complication of cardiac surgery. Because its underlying mechanisms are unclear, there is no specific therapy to prevent or treat it. A regional transient ischaemia and reperfusion (I/R) may provide protection to distant tissue or organs, a phenomenon known as remote preconditioning. In this study, we investigated whether myocardial preconditioning (MPC) would reduce kidney injury and apoptosis induced by myocardial I/R, as well as the mechanisms involved. METHODS: Myocardial I/R was induced by a 40-min occlusion of the left anterior descending artery and a 3-h reperfusion in anaesthetized Sprague-Dawley rats. MPC was elicited by two 10-min coronary artery occlusions and two 10-min reperfusions. A sham group received the same surgical procedures without coronary artery occlusion and reperfusion. RESULTS: Compared with the sham group, myocardial I/R significantly increased the serum creatinine levels (1.15 ± 0.44 vs 0.54 ± 0.23 mg/dl, P < 0.05, mean ± standard deviation) and renal histological damage, indicating increased kidney injury. Kidney apoptosis was also significantly increased, as evidenced by the increase in the terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate (dUTP) nick-end labelling (TUNEL)-positive nuclei, clear DNA laddering and increased caspase-3 activation. Serum levels of tumour necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) were significantly elevated, as were TNF-α levels in the kidneys. MPC significantly decreased myocardial infarct size (18.5 ± 3.1 vs 25.6 ± 2.1% of area at risk, P < 0.001). Additionally, MPC significantly reduced the serum creatinine level (0.65 ± 0.19 mg/dl, P < 0.05), renal histological damage and apoptosis. The increase in the serum levels of TNF-α, IL-1 and IL-6, and of TNF-α in the kidneys, was significantly inhibited. Western blot analysis found that MPC significantly increased Bcl-2 and decreased Bax in the kidneys. Phosphorylation of Akt and extracellular signal-regulated kinases 1 and 2 (ERK1/2) was significantly increased. Haemodynamics, area at risk and mortality did not differ significantly among the groups. CONCLUSIONS: MPC significantly reduces kidney injury and apoptosis induced by myocardial I/R. The underlying mechanisms might be related to inhibition of both the extrinsic and intrinsic pathways of apoptosis, possibly via inhibition of TNF-α production, modulation of Bcl-2 and Bax and activation of Akt and ERK1/2.


Asunto(s)
Lesión Renal Aguda/prevención & control , Apoptosis/fisiología , Precondicionamiento Isquémico Miocárdico , Isquemia Miocárdica/complicaciones , Daño por Reperfusión Miocárdica/complicaciones , Lesión Renal Aguda/patología , Animales , Caspasa 3/análisis , Interleucina-1/sangre , Interleucina-6/sangre , Riñón/química , Riñón/patología , Masculino , Proteínas Proto-Oncogénicas c-akt/análisis , Proteínas Proto-Oncogénicas c-bcl-2/análisis , Ratas , Ratas Sprague-Dawley , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/sangre , Proteína X Asociada a bcl-2/análisis
7.
Am J Dermatopathol ; 29(3): 274-8, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17519626

RESUMEN

Apocrine fibroadenoma (AFA), considered a counterpart of fibroadenoma of breast, is a rare cutaneous apocrine neoplasm occurring almost exclusively in women. We describe a 75-year-old man who presented with a red dome-shaped papule near the nasal bridge. The tumor was composed of numerous tubular, cystic, and partially branching lumina and struts of epithelial cells oriented perpendicular to the skin surface, with which it connected through infundibula. The epithelial strands were embedded in fibrocollagenous stroma. These histopathological features are consistent with AFA. The cytokeratin profiles of our case were similar to those of apocrine or eccrine neoplasms. Progesterone and estrogen receptors (PR/ER) were not expressed. The stroma cells were stained strongly positive for vimentin, but nonreactive for alpha-smooth muscle actin, S-100 protein, or glial fibrillary acidic protein. To the best of our knowledge, this is the first report of facial AFA in man. Different from a more common anogenital AFA, this neoplasm might represent a second type of AFA with unique histopathologic and immunopathological features.


Asunto(s)
Glándulas Apocrinas/patología , Fibroadenoma/patología , Neoplasias de las Glándulas Sudoríparas/patología , Anciano , Glándulas Apocrinas/química , Glándulas Apocrinas/cirugía , Biomarcadores de Tumor/análisis , Fibroadenoma/química , Fibroadenoma/cirugía , Humanos , Inmunohistoquímica , Masculino , Neoplasias de las Glándulas Sudoríparas/química , Neoplasias de las Glándulas Sudoríparas/cirugía , Resultado del Tratamiento
8.
Ann Surg Oncol ; 14(7): 2121-7, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17431724

RESUMEN

BACKGROUND: Occult insulinomas remain a clinical challenge. Specifically designed protocols are necessary to aid detection and facilitate a focused pancreatic exploration. METHODS: Seventeen non-multiple endocrine neoplasia (non-MEN) patients referred to this medical center in the past 10 years because of equivocal diagnosis, failure of previous operation or difficulty in localization for insulinomas were studied. A routine intra-arterial calcium stimulation test with venous sampling (IACS test) was done for lesion localization. An exploratory laparotomy with intraoperative ultrasound (IOUS) examinations was performed. RESULTS: Preoperative imaging (sonography, high-resolution computed tomography scan, and magnetic resonance imaging) found six insulinomas, and IOUS found an additional six in the pancreatic regions; all were compatibly indicated by the IACS test. The remaining five patients with occult lesions by IOUS were treated by 40% (1) or 60-70% (4) distal pancreatectomies when insulin gradients were demonstrated on calcium stimulation to the splenic or to the superior mesenteric artery, respectively, and nesidioblastosis was found in each pathology examination. There were no complications related to the arterial stimulation and venous sampling (ASVS) test. No patient had recurrent hyperinsulinism, permanent morbidity, or mortality from surgery. CONCLUSIONS: IACS test helps in the diagnosis of equivocal pancreatogenous hypoglycemia, indicating the pancreatic region of priority exploration and guiding a pancreatic resection.


Asunto(s)
Gluconato de Calcio , Insulina/sangre , Insulinoma/diagnóstico , Nesidioblastosis/cirugía , Neoplasias Pancreáticas/diagnóstico , Adulto , Anciano , Gluconato de Calcio/administración & dosificación , Femenino , Venas Hepáticas , Humanos , Inyecciones Intraarteriales , Insulinoma/cirugía , Masculino , Persona de Mediana Edad , Nesidioblastosis/diagnóstico , Nesidioblastosis/patología , Pancreatectomía , Neoplasias Pancreáticas/cirugía , Ultrasonografía Intervencional
9.
Am J Med Sci ; 331(5): 284-7, 2006 May.
Artículo en Inglés | MEDLINE | ID: mdl-16702801

RESUMEN

A 42-year-old woman underwent hemodialysis secondary to diabetic nephropathy. Total parathyroidectomy with forearm autograft was performed due to secondary hyperparathyroidism (HPT) complicated with calciphylaxis. Rapidly progressive enlargement of autograft with unusual "gourd-shape" developed, and then it was removed. Pathologic examination of the autograft disclosed multinodular hyperplasia. Residual parathyroid gland in the retrothyroid region was found later. Rapidly recurrent HPT originating from both the residual parathyroid tissues and the enlarged autograft within such short time after parathyroidectomy is rare in the literature. The multinodular hyperplasia pattern of the parathyroid gland may be a major factor for such rapid recurrence. In addition to good control of calcium and phosphate, regular follow-up of parathyroid hormone level and imaging studies of not only autografted gland at the forearm but also possibly residual parathyroid tissues at the neck are important for monitoring recurrence in maintenance hemodialysis patients after parathyroidectomy with forearm autograft, especially in those with pathologic type of nodular hyperplasia and calciphylaxis.


Asunto(s)
Calcifilaxia/complicaciones , Hiperparatiroidismo Secundario/diagnóstico , Fallo Renal Crónico/terapia , Glándulas Paratiroides/patología , Paratiroidectomía , Adulto , Calcio/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Antebrazo/patología , Humanos , Hiperparatiroidismo Secundario/sangre , Hiperparatiroidismo Secundario/etiología , Hiperplasia/complicaciones , Fallo Renal Crónico/complicaciones , Cuello/patología , Glándulas Paratiroides/trasplante , Hormona Paratiroidea/sangre , Fosfatos/sangre , Recurrencia , Diálisis Renal , Trasplante Autólogo
10.
J Chin Med Assoc ; 67(4): 193-6, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15244019

RESUMEN

We report a rare case with acquired Fanconi syndrome caused by mixed Chinese herbs, initially presenting as waddling gait and lower limb muscle atrophy. From a series of investigations, proximal renal tubule injury with functional defects and Chinese herb nephropathy were discovered. Hypophosphatemic osteomalacia and type II muscle fiber atrophy shown in muscle biopsy of left quadriceps may be associated with the sequelae of ingestion of mixed crude Chinese herbs. Aggressive and early alkali treatment with supplementation of phosphate and Vitamin D restored the patient's metabolic and musculoskeletal abnormalities.


Asunto(s)
Síndrome de Fanconi/etiología , Debilidad Muscular/inducido químicamente , Plantas Medicinales/efectos adversos , Adulto , Biopsia , Humanos , Riñón/patología , Enfermedades Renales/inducido químicamente , Enfermedades Renales/patología , Masculino
11.
Am J Med Sci ; 327(6): 358-61, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15201652

RESUMEN

The authors report a 49-year-old woman who had been treated with diclofenac for her back pain. Nephrotic syndrome followed by occlusion of the right profound femoral and popliteal arteries occurred. Successful thrombectomy was performed. Another nonsteroidal anti-inflammatory drug (NSAID) was administered by injection during hospitalization. Renal biopsy showed minimal change glomerulopathy (MCG). Remission was delayed despite large-dose steroid administration. The delayed remission in this patient may be caused by impaired renal function and the possible effect of a second period of NSAID administration. The authors present the first case of femoral arterial thrombosis associated with nephrotic syndrome secondary to NSAID-associated MCG. Careful history-taking and physical examination may detect early causes and complications of nephrotic syndrome. Any rechallenge of NSAID should be avoided.


Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Arteria Femoral/patología , Síndrome Nefrótico/inducido químicamente , Trombosis/inducido químicamente , Femenino , Arteria Femoral/efectos de los fármacos , Glomerulonefritis Membranosa/inducido químicamente , Glomerulonefritis Membranosa/patología , Humanos , Persona de Mediana Edad , Síndrome Nefrótico/patología , Trombosis/patología
12.
J Nephrol ; 16(4): 580-5, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-14696762

RESUMEN

BACKGROUND: Tacrolimus is an effective organ transplantation immunosuppressant. Hemolytic uremic syndrome (HUS) is a rare but severe complication of tacrolimus. METHODS: We report a case of tacrolimus-associated HUS and review the 15 previously reported cases. RESULTS: The results of the 16 cases indicated that tacrolimus-associated HUS is more frequent in females (56.3%), with the mean age at onset of 41.3 years. Forty-four percent of cases received renal transplantations. The average time from the first tacrolimus dose to HUS onset was 7.1 months. Prevalence was between 0.14.7%. The tacrolimus trough level did not predict the prognosis. Seven patients (43.7%) had improved graft function after treatment, including anticoagulation and antiplatelet therapy, reduction or discontinuation of tacrolimus, switch to cyclosporine (CyA), plasma exchange (PE) and dialysis. Five patients (31.3%) died and four patients (25%) lost their graft in spite of the above treatment. Mortality risk factors for transplant recipients with tacrolimus-associated HUS included: (1) non-renal transplant recipients (100% vs. 36.4%, p = 0.034); (2) lower peak serum Cr (2.58 +/- 1.23 vs. 6.16 +/- 1.96, p < 0.002); (3) liver dysfunction (60% vs. 0, p < 0.02); (4) higher serum lactate dehydrogenase (LDH) level (3119 +/- 1019 vs. 982 +/- 522, p < 0.001). A lower platelet count carried borderline mortality risk (29500 +/- 14480 vs. 59625 +/- 25584, p = 0.057). CONCLUSIONS: HUS should be included in the differential diagnosis of renal function deterioration in patients on tacrolimus post-organ transplantation. Frequent renal function monitoring and appropriate treatment should be performed aggressively to decrease morbidity and mortality, especially in patients with risk factors.


Asunto(s)
Síndrome Hemolítico-Urémico/inducido químicamente , Síndrome Hemolítico-Urémico/patología , Trasplante de Riñón/efectos adversos , Infecciones Estafilocócicas/tratamiento farmacológico , Tacrolimus/efectos adversos , Adulto , Biopsia con Aguja , Estudios de Seguimiento , Rechazo de Injerto , Síndrome Hemolítico-Urémico/terapia , Humanos , Inmunohistoquímica , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Masculino , Diálisis Peritoneal Ambulatoria Continua/métodos , Complicaciones Posoperatorias/tratamiento farmacológico , Reoperación , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tacrolimus/uso terapéutico , Resultado del Tratamiento
13.
Am J Kidney Dis ; 42(3): 586-90, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12955689

RESUMEN

A 38-year-old woman presented with muscle cramping of 4 extremities and paralysis for months. Laboratory results showed an elevated antinuclear antibody titer; antibodies to the ribonucleoprotein antigen Ro; hypokalemia; hypomagnesemia with hyperreninemia, but abnormally high urine potassium and magnesium levels and low urine calcium levels; and a blunted diuretic effect to thiazide, but not furosemide, which met the criteria for Gitelman's syndrome (GS) and led to the diagnosis of primary Sjögren's syndrome (pSS). She received medical treatment, including a potassium supplement and aldosterone antagonist. GS as a presentation of pSS has never been reported in the literature. The features of renal diseases related to SS are reviewed. SS is the underlying cause of GS, which may precede the onset of the well-known sicca complex.


Asunto(s)
Alcalosis/etiología , Autoantígenos , Enfermedades Autoinmunes/complicaciones , Hipopotasemia/etiología , Nefritis Intersticial/etiología , Parálisis/etiología , ARN Citoplasmático Pequeño , Síndrome de Sjögren/complicaciones , Adulto , Aldosterona/sangre , Alcalosis/sangre , Alcalosis/orina , Anticuerpos Antinucleares/sangre , Benzotiadiazinas , Calcio/orina , Diuresis/efectos de los fármacos , Diuréticos/farmacología , Femenino , Furosemida/farmacología , Humanos , Magnesio/sangre , Magnesio/orina , Parálisis/sangre , Potasio/orina , Renina/sangre , Ribonucleoproteínas/inmunología , Síndrome de Sjögren/etiología , Inhibidores de los Simportadores del Cloruro de Sodio/farmacología , Síndrome
14.
J Nephrol ; 16(1): 154-8, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12649548

RESUMEN

Selective immunoglobulin A (IgA) deficiency may result in a predisposition to recurrent sinopulmonary infection and allergic diseases. IgA deficiency may also play a role in the development of autoimmune disorders. Selective IgA deficiency associated with glomerulonephritis was rare, while the clinical presentation in IgA deficiency-associated glomerulonephritis was variable. We report an 83 year-old male with selective IgA deficiency associated with membranous glomerulonephritis. He presented with nephrotic syndrome. Percutaneous renal needle biopsy showed diffuse global thickening and rigidity of glomerular capillary walls, mildly diffuse segmental expansion of mesangial matrix, focal and cortical scar with segmental obsolescence of glomeruli. Heavy IgG and moderate C3 deposits were found on immunofluorescence. We also review the previous cases of IgA deficiency with glomerulonephritis. Several clues were rendered to establish the association between IgA deficiency and membranous glomerulonephritis.


Asunto(s)
Glomerulonefritis Membranosa/complicaciones , Glomerulonefritis Membranosa/patología , Deficiencia de IgA/complicaciones , Síndrome Nefrótico/etiología , Síndrome Nefrótico/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Estudios de Seguimiento , Humanos , Deficiencia de IgA/diagnóstico , Inmunohistoquímica , Masculino , Microscopía Electrónica , Medición de Riesgo , Índice de Severidad de la Enfermedad
15.
Nephrology (Carlton) ; 8(5): 243-7, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15012711

RESUMEN

Clinically relevant renal lesions in rheumatoid arthritis (RA) are not common. More often renal involvement is related to complications of therapy than the disease itself. The most common forms of primary renal disease in RA are membranous glomerulonephropathy and a pure mesangial proliferative glomerulonephritis. Some studies have described the association between crescentic glomerulonephritis (crescentic GN) and RA, but they were all found to be perinuclear antineutrophil cytoplasmic antibody (p-ANCA) positive. However, RA associated with ANCA negative pauci-immue crescentic GN has not been reported. This is a case report of a 37-year-old female with RA who initially presented with general oedema and acute deterioration of renal function. The renal biopsy revealed ANCA negative pauci-immune crescentic GN. The patient was treated with steroid pulse and plasmapheresis, but not cyclophosphamide because of severe urosepsis. Despite the use of aggressive therapy, her renal function was not improved and she underwent maintenance haemodialysis thereafter. Because ANCA negative crescentic GN may occur in RA patients without frank systemic vasculitis, but with severe clinical manifestation, a heightened suspicion for a relatively 'silent' crescentic GN would have led to the correct diagnosis and appropriate treatment.


Asunto(s)
Lesión Renal Aguda/etiología , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Artritis Reumatoide/complicaciones , Glomerulonefritis/diagnóstico , Lesión Renal Aguda/inmunología , Lesión Renal Aguda/patología , Lesión Renal Aguda/terapia , Adulto , Artritis Reumatoide/inmunología , Artritis Reumatoide/patología , Artritis Reumatoide/terapia , Errores Diagnósticos/prevención & control , Edema/etiología , Edema/inmunología , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/etiología , Glomerulonefritis/inmunología , Glomerulonefritis/patología , Glomerulonefritis/terapia , Glucocorticoides/administración & dosificación , Humanos , Riñón/inmunología , Riñón/patología , Metilprednisolona/administración & dosificación , Plasmaféresis , Quimioterapia por Pulso , Diálisis Renal
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