RESUMEN
Xanthogranulomatous pyelonephritis (XGP) is a rare chronic granulomatous destructive process of the renal parenchyma. It is caused by a chronic inflammatory process due to recurrent urinary tract infections and/or obstructing renal calculi. Rarely, it presents with advanced complications including abscesses and fistula formations. In this article, we report a unique presentation of XGP with simultaneous upper and lower gastrointestinal bleeding in the setting of XGP with reno-gastric and reno-colic fistulas.
Asunto(s)
Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/cirugía , Pielonefritis Xantogranulomatosa/diagnóstico por imagen , Pielonefritis Xantogranulomatosa/cirugía , Diagnóstico Diferencial , Endoscopía Gastrointestinal , Femenino , Humanos , Fístula Intestinal/etiología , Laparotomía , Persona de Mediana Edad , Nefrectomía , Esplenectomía , Tomografía Computarizada por Rayos X , Fístula Urinaria/etiologíaRESUMEN
The advent of biologic therapy has enhanced our ability to augment disease in an increasingly targeted manner. The use of biologics in cardiovascular disease (CVD) has steadily increased over the past several decades. Much of the early data on biologics and CVD were derived from their use in rheumatologic populations. Atherosclerosis, myocardial infarction, and heart failure have been closely linked to the inflammatory response. Accordingly, cytokines such as tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 have been targeted. Noninflammatory mediators, such as proprotein convertase subtilisin kexin type 9 (PCSK9), have been selected for therapeutic intervention as well. Furthermore, RNA interference (RNAi) therapy has emerged and may serve as another targeted therapeutic mechanism. Herein, we will review the history, obstacles, and advances in using biologic therapy for CVD.