Asunto(s)
Enfermedades Renales , Riñón , Biopsia , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/terapiaAsunto(s)
Hidrotórax/terapia , Diálisis Peritoneal/efectos adversos , Anciano , Humanos , Hidrotórax/etiología , MasculinoAsunto(s)
Biopsia Guiada por Imagen/efectos adversos , Enfermedades Renales/patología , Riñón/patología , Ultrasonografía Intervencional/efectos adversos , Humanos , Biopsia Guiada por Imagen/instrumentación , Biopsia Guiada por Imagen/métodos , Agujas , Seguridad del Paciente , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de RiesgoAsunto(s)
Lesión Renal Aguda/diagnóstico , Riñón/patología , Nefritis Intersticial/diagnóstico , Lesión Renal Aguda/etiología , Lesión Renal Aguda/patología , Lesión Renal Aguda/terapia , Corticoesteroides/uso terapéutico , Anciano , Biopsia , Humanos , Masculino , Nefritis Intersticial/etiología , Nefritis Intersticial/patología , Nefritis Intersticial/terapia , Valor Predictivo de las Pruebas , Diálisis Renal , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Glomerulonefritis/terapia , Granulomatosis con Poliangitis/terapia , Síndrome Hemolítico-Urémico/terapia , Plasmaféresis , Femenino , Glomerulonefritis/etiología , Humanos , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/terapia , Masculino , Plasmaféresis/efectos adversos , Plasmaféresis/métodos , Esteroides/uso terapéuticoRESUMEN
Acute crescentic transformation is a rare but well described event in patients with membranous glomerulonephritis. We report our experience with a 66-year-old Caucasian man presented for rapid decline in renal function. For nearly 10 years, he was suffering from hypertension and mixed sensori-motor polyneuropathy. He performed therapy with prednisone and azathioprine, suspended 1 year before presentation. Moreover, six months before presentation, laboratory tests showed a serum creatinine concentration 220 mol/L and a 24-h protein excretion 0,75 g/d. The physical examination showed oedema and severe hypertension; the 24-h protein excretion was 1,1 gr/d and creatinine concentration was 550.8 mol/L; ANCA and other immunological tests were negative. There was no evidence of SLE, infection or malignancy. The kidney biopsy highlighted a membranous GN with crescentic overlap. The patient was treated with steroid and cyclophosphamide. Because there was no sign of improvement after 2 months, we stopped the cyclophosphamide therapy and the patient started chronic haemodialysis treatment. Unlike membranous nephropathy, patients with superimposed crescentic glomerulonephritis appear to have a more aggressive clinical course. The importance of recognizing this group of patients with membranous nephropathy and crescentic glomerulonephritis is that immunosuppressive therapy may ameliorate the progression of renal damage and in some cases early treatment was associated with useful recovery of renal function.
Asunto(s)
Glomerulonefritis Membranoproliferativa/complicaciones , Glomerulonefritis Membranosa/complicaciones , Anciano , Glomerulonefritis Membranoproliferativa/patología , Glomerulonefritis Membranosa/patología , Humanos , MasculinoRESUMEN
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