The aging kidney: structural changes.

A number of structural changes occur in the kidney with aging. The aging kidney is characterized by loss of renal mass, arterial sclerosis, arteriolar hyalinosis, an increased number of sclerotic glomeruli, loss of tubules and interstitial fibrosis. The pathogenesis of aging-associated structural changes is not completely understood. Both genetic background and hemodynamic factors have been associated with progression of age-related morphological changes. The structural changes of aging kidney are nonspecific and can be seen in many conditions, including diabetes and hypertension, and, as such, arterionephrosclerosis of aging is a diagnosis of exclusion.

Clinical and histological features of lupus nephritis induced by anti-TNFα therapy.

It is known that anti-TNFα therapy has opened a new era in treatment of rheumatoid arthritis, and it is emerging as a new successful treatment in the current rheumatologic practice. Besides, there is evidence that this therapy is an important cause of iatrogenic autoimmune disease. Several studies reported the possible onset of lupus syndrome that can be resolved with withdrawal of anti-TNFα drugs. Our report describes the first lupus nephritis case developing in a rapidly progressive renal failure that required haemodialysis treatment in a patient affected with rheumatoid arthritis, treated with anti-TNFα therapy. So, we confirm the importance of a careful clinic and immunologic evaluation before starting anti-TNFα therapy.

End-stage renal disease secondary to IgA nephropathy in recessive dystrophic epidermolysis bullosa: a case report.

Epidermolysis bullosa (EB) consists of a group of dominant or recessive autosomal diseases characterised by skin and mucosa fragility. The lesions leave erosions and scars that, in turn, can cause stenosis of tracheal, oesophageal, and genitourinary tract mucosae. The significantly increased survival of EB patients has determined the onset of complications never observed before, including genitourinary disorders such as hydroureteronephrosis, recurrent urinary tract infections, renal amyloidosis, IgA nephropathy and post-infectious glomerulonephritis. A 6-year-old boy diagnosed with recessive dystrophic EB Hallopeau-Siemens type (RDEB-HS) was referred to our clinic because of microhaematuria that evolved into intra-infectious macrohaematuria. Renal biopsy revealed an increase in both extracellular matrix and mesangial cells, with a focal segmental glomerulosclerosis with severe chronic tubulointerstitial damage. Immunofluorescence showed IgA mesangium deposits. Five years later, he was started on haemodialysis, because of worsening renal function. This is a rare case of a child with EB who was successfully treated with haemodialysis. The pertinent literature has been reviewed.

Microscopic polyangiitis associated with primary biliary cirrhosis.

We describe a patient with microscopic polyangiitis and primary biliary cirrhosis (PBC) who presented with a non-erosive polyarthritis followed by pulmonary and renal involvement and signs of liver disorder. Detection of pANCA and antimitochondrial antibodies with results of renal and liver biopsies allowed a diagnosis of microscopic polyangiitis and PBC. To our knowledge, this is the first report of an association between the 2 diseases.

Preeclampsia and fetal triploidy: a rarely reported association in nephrologic literature.

We report a case of a healthy woman - whose previous pregnancy was uncomplicated - with early onset of hypertension, proteinuria and edema, during her second pregnancy. Ultrasound examination at 19th week of amenor rhea showed a fetus with growth retardation, corresponding to 17 weeks' gestation, ascites, cardiomegaly with serious multiple congenital anomalies. Amniocentesis for fetal karyotyping revealed 69, XXX. Because of continued elevated blood pressure, increasing proteinuria and severe lethal fetal anomalies, interruption of pregnancy was suggested. It was subsequently carried out by surgery. The patient underwent renal biopsy 10 days post-partum: histology showed the presence of the characteristic pathologic renal changes of preeclampsia. A year later, she became pregnant by the same partner. The third pregnancy was uneventful. The combination of fetal triploidy and preeclampsia may suggest a causative relationship. Clinically, most cases manifest as severe early-onset preeclampsia and must be differentiated from essential hypertension and a chronic glomerulonephritis (GN), which becomes symptomatic during pregnancy. When a fetus has triploidy, the counseling should stress the high incidence of preeclampsia; particularly when fetal anomaly is not compatible with life, it is well known that delivery of the fetus is curative in this syndrome. This information is important in counseling patients who are hesitant to terminate the pregnancy purely for a fetal abnormality, even if lethal.