ABSTRACT
A common criticism of the classification of lupus nephritis is the relative scarcity of information regarding tubular, interstitial, and vascular changes compared to the available information regarding glomerular changes, even though their potential for independent progression is known. This study reviewed the importance of less explored lesions by the current and widely used 2003 classification of lupus nephritis of the International Society of Nephrology/Renal Pathology Society (ISN/RPS), with emphasis on the tubulointerstitial, podocyte, and vascular lesions, increasingly recognised as being important in the pathogenesis and prognosis of the disease. Recognition of these lesions can help with therapeutic decision-making, thereby allowing better results for patients with systemic lupus erythematosus.
ABSTRACT
Collapsing glomerulopathy (CG) is a clinicopathologic entity characterized by segmentar or global collapse of the glomerulus and hypertrophy and hyperplasia of podocytes. The Columbia classification of 2004 classified CG as a histological subtype of focal segmental glomerulosclerosis (FSGS). A growing number of studies have demonstrated a high prevalence of CG in many countries, especially among populations with a higher proportion of people with African descent. The present study is a narrative review of articles extracted from PubMed, Medline, and Scielo databases from September 1, 2020 to December 31, 2021. We have focused on populational studies (specially cross-sectional and cohort articles). CG is defined as a podocytopathy with a distinct pathogenesis characterized by strong podocyte proliferative activity. The most significant risk factors for CG include APOL1 gene mutations and infections with human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2. CG typically presents with more severe symptoms and greater renal damage. The prognosis is notably worse than that of other FSGS subtypes.
ABSTRACT
Resumo: Introdução: O ensino híbrido pode ser utilizado como recurso pedagógico às formas tradicionais de ensinar. A ausência de um laboratório de patologia renal pode gerar uma lacuna na formação de médicos residentes em nefrologia. Este estudo descreve como a complementação do conteúdo com o uso de um atlas on-line de patologia renal foi descrita por médicos residentes. Relato de experiência: Um atlas virtual de patologia renal elaborado por preceptores das residências médicas de nefrologia e patologia foi apresentado a oito médicos residentes matriculados no serviço, que, durante 15 dias, incluíram os estudos desse conteúdo em suas atividades. Os residentes avaliaram a experiência de ensino-aprendizagem por meio de um grupo focal. Discussão: Estratégias de ensino on-line podem ser utilizadas para complementar o conhecimento adquirido durante a residência médica. No entanto, é importante que essa etapa da estratégia de ensino híbrido seja motivadora na visão do estudante e se adapte ao momento vivenciado pelos médicos residentes, os quais já possuem carga de trabalho determinada. Esses pontos estiveram entre os temas emergentes na análise temática do conteúdo do grupo focal, que também incluiu sugestões dos alunos em como modificar a apresentação do conteúdo. Conclusão: A inserção de estratégias de ensino híbrido pode auxiliar a formação dos médicos residentes, bem como abrir espaço para a produção discente. Parcerias interinstitucionais devem ser desenvolvidas para suprir barreiras à elaboração de e-learning pelos formadores médicos.
Abstract: Introduction: Blended Learning can be used as a pedagogical resource to the traditional ways of teaching. The lack of a Renal Pathology laboratory can result in a gap in the training of resident physicians in Nephrology. This study describes how complementing the content with the use of an online Renal Pathology atlas was described by resident physicians. Experience report: A virtual atlas of Renal Pathology prepared by preceptors of the Medical Residencies of Nephrology and Pathology was presented to eight resident physicians enrolled in the service, who, for fifteen days, included the studies of this content in their activities. The residents evaluated the teaching-learning experience through a focus group. Discussion: Online teaching strategies can be used to complement the knowledge acquired during Medical Residency. However, it is important that this stage of the blended learning strategy be motivating in the students' view, adapting to the moment experienced by resident physicians, who already have a pre-determined workload. These points were among the emerging topics in the thematic analysis of the content of the focus group, which also included suggestions from the students on how to modify the content presentation. Conclusion: The inclusion of blended learning strategies can help the training of resident physicians, as well as open space for student production. Inter-institutional partnerships should be developed to overcome barriers to e-learning development by medical trainers.
ABSTRACT
Abstract Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.
Resumo O lúpus eritematoso sistêmico (LES) é uma doença inflamatória crônica autoimune multissistêmica. Alguns pacientes, contudo, podem exibir um padrão histológico de lesão renal, com características indistinguíveis da nefrite lúpica, porém sem apresentar quaisquer sintomas extrarrenais ou sorologias sugestivas de LES. Tal acometimento tem sido recentemente denominado nefropatia "full-house" não relacionada ao lúpus. O objetivo é relatar uma série de casos clínicos encaminhados ao Laboratório da Universidade Federal do Maranhão que receberam o diagnóstico de nefropatia "full-house" não relacionada ao lúpus à imunofluorescência e discutir sua evolução e desfechos. A nefropatia "full-house" não relacionada ao lúpus representa um desafio diagnóstico e terapêutico por ser uma entidade nova, que ainda necessita de maiores estudos e pode ser a manifestação inicial do LES, manifestação isolada do LES ou uma patologia nova não relacionada ao LES.
Subject(s)
Humans , Lupus Nephritis/diagnosis , Kidney Diseases , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Fluorescent Antibody Technique , KidneyABSTRACT
Anti-brush border antibody (ABBA) disease, also called anti-low-density lipoprotein receptor-related protein 2 (anti-LRP2) nephropathy, occurs due to the formation of antibodies against brush border antigens of the renal proximal convoluted tubule. We report a case of ABBA disease in a male farmer in his 30s who presented with 2 years of polyuria, dysuria, nocturia, and urinary urgency. He described a history of long-term occupational exposure to pesticides and silica, evolving into possible pneumoconiosis, and prior pulmonary tuberculosis. At presentation, he had reduced kidney function (serum creatinine 3.6 mg/dL) with hyponatremia, hypokalemia, hypophosphatemia, a normal anion gap, metabolic acidosis, and respiratory acidosis, and 2.2 g/day of urine proteinuria. The kidney biopsy was consistent with ABBA, showing amorphous immune-deposits in the tubular basement membrane and strong positivity on indirect immunofluorescence in the brush border of the proximal tubules. The trigger for production of ABBA is still unknown, but it may be associated with chronic conditions such as pulmonary tuberculosis and occupational exposures such as silica and pesticides, as seen in the patient in this report. Most cases do not respond to immunosuppression, and the prognosis is poor.
ABSTRACT
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.
Subject(s)
Kidney Diseases , Lupus Erythematosus, Systemic , Lupus Nephritis , Fluorescent Antibody Technique , Humans , Kidney , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Nephritis/diagnosisABSTRACT
Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2.
ABSTRACT
Abstract Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.
Resumo Introdução: O acesso vascular (AV) para hemodiálise (HD) é crucial para os pacientes portadores de doença renal crônica (DRC) estágio V. Infelizmente, com o passar dos anos, um percentual não desprezível desses enfermos evolui para falência de AV por diversos motivos, o que impossibilita a confecção de novas fístulas arteriovenosas (FAV) ou o implante de cateteres venosos centrais nos sítios de punções tradicionais. Nesse cenário, o implante de cateteres translombares para hemodiálise (CTLHD) em veia cava inferior ganha destaque como medida salvadora. Objetivos: Relatar uma série de 12 casos de implante de CTLHD, sua técnica de implante, patência e complicações. Métodos: Estudo retrospectivo que analisou 12 implantes de CTLHD por radiologista intervencionista no setor de hemodinâmica do Hospital Universitário da Universidade Federal do Rio Grande do Norte (UFRN), no período de janeiro/2016 a outubro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxa de sucesso, complicações observadas, sobrevida dos pacientes, patência do cateter e desfechos clínicos. Resultados: Todos os 12 CTLHD foram implantados e utilizados com sucesso; ocorreram apenas 2 complicações associadas ao procedimento (sangramento e falha na extubação); 41,6% dos pacientes apresentaram infecção relacionada ao cateter após 98 ± 72,1 dias (6-201 dias), mas não houve necessidade de remoção; e a patência foi de 315,5 cateteres-dia (65-631 dias). Conclusão: O CTLHD é uma opção para pacientes com falência de acesso vascular, prolongando a sobrevida dos pacientes e atuando como ponte para o transplante renal.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vascular Diseases/etiology , Vena Cava, Inferior/surgery , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Renal Dialysis , Central Venous Catheters/adverse effects , Kidney Failure, Chronic/therapy , Lumbosacral Region/blood supply , Fluoroscopy , Feasibility Studies , Retrospective Studies , Arteriovenous Fistula/complications , Kidney Transplantation , Treatment Outcome , Hemorrhage/etiologyABSTRACT
INTRODUCTION: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. OBJECTIVES: To describe placement technic, complications, and patency of 12 TLDC. METHODS: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. RESULTS: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. CONCLUSION: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.
