Analysis of glomerular deposition of IgM and C3 in patients with podocytopathies.

Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are the main causes of nephrotic syndrome in the world. The complement system appears to play an important role in the pathogenesis of these diseases. To evaluate the deposition of immunoglobulins and particles of the complement system in renal biopsies of patients with FSGS and MCD and relate to laboratory data, we selected 59 renal biopsies from patients with podocytopathies, 31 from patients with FSGS and 28 with MCD. Epidemiological, clinical, laboratory information and the prognosis of these patients were evaluated. Analysis of the deposition of IgM, IgG, C3, C1q and C4d in renal biopsies was performed. We related IgM and C3 deposition with laboratory parameters. Statistical analysis was performed using GraphPad Prism version 7.0. Glomerular deposition of IgM was significantly higher in the FSGS group, as was codeposition of IgM and C3. The clinical course of patients and laboratory data were also worse in cases of FSGS, with a higher percentage progressing to chronic kidney disease and death. Patients with C3 deposition had significantly higher mean serum creatinine and significantly lower eGFR, regardless of disease. Patients with FSGS had more IgM and C3 deposition in renal biopsies, worse laboratory data and prognosis than patients with MCD. C3 deposition, both in FSGS and MCD, appears to be related to worsening renal function.

Analysis of serum inflammatory mediators in type 2 diabetic patients and their influence on renal function.

AIM: To evaluate the serum concentrations of inflammatory mediators in patients with type 2 diabetes mellitus (T2DM) with or without renal alteration (RA) function. METHODS: Serum samples from 76 patients with T2DM and 24 healthy individuals were selected. Patients with T2DM were divided into two groups according to eGFR (> or < 60mL/min/1.73m2). Cytokines, chemokines and adipokines levels were evaluated using the Multiplex immunoassay and ELISA. RESULTS: TNFR1 and leptin were higher in the T2DM group with RA than in the T2DM group without RA and control group. All patients with T2DM showed increased resistin, IL-8, and MIP-1α compared to the control group. Adiponectin were higher and IL-4 decreased in the T2DM group with RA compared to the control group. eGFR positively correlated with IL-4 and negatively with TNFR1, TNFR2, and leptin in patients with T2DM. In the T2DM group with RA, eGFR was negatively correlated with TNFR1 and resistin. TNFR1 was positively correlated with resistin and leptin, as well as resistin with IL-8 and leptin. CONCLUSION: Increased levels of TNFR1, adipokines, chemokines and decrease of IL-4 play important role in the inflammatory process developed in T2DM and decreased renal function. We also suggest that TNFR1 is a strong predictor of renal dysfunction in patients with T2DM.

Mast cells in the kidney biopsies of pediatric patients with lupus nephritis.

INTRODUCTION: Mast cells may be involved in inflammation and contribute to the onset of fibrosis in lupus nephritis (LN). OBJECTIVE: This study aimed to correlate the presence of mast cells in kidney biopsy specimens of pediatric patients with LN with activity (AI) and chronicity (CI) indices and assess how effectively mast cells may be used as a prognostic factor. METHOD: The study included 40 patients aged 6-18 years diagnosed with LN at the Renal Disease Service of the Federal University of Triângulo Mineiro between 1996 and 2015. Workup and epidemiological data were evaluated vis-à-vis AI, CI, and mast cell counts (MCC). RESULTS: Significant positive correlations were found between mast cell counts (MCC) and AI (p = 0.003; r: 0.66) and MCC and CI (p = 0.048; r: 0.48). The ROC curve showed that mast cells were highly sensitive and specific in the differentiation of patients with an AI > 12 from individuals with an AI ≤ 12. Serum creatinine levels were higher in individuals with class IV LN than in patients with class V disease [1.50 (0.40-20.90) vs. 0.70 (0.62-0.90), p = 0.04]. Blood urea nitrogen had a positive significant correlation with MCC (p = 0.002; r: 0.75). A trend toward a negative correlation was observed between MCC and serum albumin (p = 0.06; r: -0.5459). Kidney biopsies of patients with nephrotic syndrome had higher MCC [2.12 (0.41-5.140) vs. 0.53 (0.0-3.94), p = 0.07]. CONCLUSION: Inflammatory cell infiltration and morphological differences between cell types in the inflammatory infiltrate are relevant factors in the assessment of the LN. Mast cell analysis and AI/CI assessment may be relevant prognostic indicators for pediatric patients with LN.

Is it possible to predict parameters of the Oxford classification of primary IgA Nephropathy from clinical laboratory data? Focus on the role of segmental glomerulosclerosis subtypes.

INTRODUCTION: IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world and has a broad range of histological and clinical manifestations, ranging from morphologically normal to globally sclerotic glomeruli with clinical manifestations varying from isolated hematuria to end stage renal disease. This study aims to assess sensitivity, specificity and accuracy of clinical data at the time of biopsy in predicting 2017 updated Oxford classification parameters and to investigate if subtypes of segmental sclerosis (FSGS) influence clinical presentation. MATERIAL AND METHODS: Renal biopsies from 103 patients with IgAN were analyzed. Oxford classification was updated and FSGS lesions were subclassified. ROC curves, univariate and multivariate logistic regression were used. RESULTS: In Oxford classification, the majority of patients had mesangial hypercellularity in less than a half of glomeruli (M0), did not have endocapillary hypercellularity (E0), had segmental glomerulosclerosis (S1), had interstitial fibrosis and tubular atrophy in more than a half of the sample (T2) and had no crescents (C0). Hypertension increases the chance of M1 in 2.54x (p = 0.02). For each unit of increased creatinine, 2.6x more chances of E1 (p = 0.001). S1 is predicted by proteinuria with 75% sensitivity and 90.9% specificity (p < 0.0001). For each unit of increase in GFR, there is a reduction of 6% in the chance of T2 in relation to T0 (p = 0.0001). If hypertension, there is 5x more chances of T2 than T0 (p = 0.01). For each unit of increase in creatinine, there are 2.8x more chances of crescents- C (p = 0.003). Creatinine also showed 75.8% sensitivity and 75% specificity for prediction of C (p = 0.002). Inversely, for each unit of GFR, the chance of C is reduced by 4% (p = 0.007). Other clinical data related with C are hypertension (p = 0.03) and proteinuria (p = 0.02). To determine the role of FSGS subtypes in clinical presentation, we divided patients in S0 and S1 groups. Proteinuria was the only clinical parameter with significative difference, respectively, 0.3 (0-2.1) and 1.6 (0.02-16.2) g/24 h (p < 0.0001). FSGS subtypes related to proteinuria were cellular (p = 0.03) and peri-hilar (p = 0.02). Subtypes classically related to podocytopathies showed no correlation with clinical data. CONCLUSION: In the future, with noninvasive methods for diagnosis of IgAN, it will be essential to predict Oxford classification parameters using clinical laboratory data for establishment of prognosis and therapeutics. We showed that Oxford classification parameters correspond to some clinical laboratory data, making this approach possible. FSGS lesions not specifically related to podocytopathies may also influence clinical parameters that affect renal disease progression.

Podocin and uPAR are good biomarkers in cases of Focal and segmental glomerulosclerosis in pediatric renal biopsies.

There are controversies whether Minimal Change Disease (MCD) and Focal and Segmental Glomerulosclerosis (FSGS) are distinct glomerular lesions or different manifestations within the same spectrum of diseases. The uPAR (urokinase-type plasminogen activator receptor) and some slit diaphragm proteins may be altered in FSGS glomeruli and may function as biomarkers of the disease in renal biopsies. Thus, this study aims to evaluate the diagnostic potential of uPAR and glomerular proteins for differentiation between MCD and FSGS in renal pediatric biopsy. Renal biopsies from 50 children between 2 and 18 years old were selected, with diagnosis of MCD (n = 29) and FSGS (n = 21). Control group consisted of pediatric autopsies (n = 15) from patients younger than 18 years old, with no evidences of renal dysfunction. In situ expressions of WT1, nephrin, podocin and uPAR were evaluated by immunoperoxidase technique. Renal biopsy of patients with MCD and FSGS expressed fewer WT1 (p≤0.0001, F = 19.35) and nephrin (p<0.0001; H = 21.54) than patients in the control group. FSGS patients expressed fewer podocin than control (p<0.0359, H = 6.655). FSGS cases expressed more uPAR than each of control and MCD (p = 0.0019; H = 12.57) and there was a positive and significant correlation between nephrin and podocin (p = 0.0026, rS = 0.6502) in these cases. Podocin had sensitivity of 73.3% and specificity of 86.7% (p = 0.0068) and uPAR had sensitivity of 78.9% and specificity of 73.3% (p = 0.0040) for diagnosis of FSGS patients. The main limitation of the study is the limited number of cases due to the difficulty in performing biopsy in pediatric patients. Podocin and uPAR are good markers for FSGS and differentiate these cases from MCD, reinforcing the theory of distinct glomerular diseases. These findings suggest that podocin and uPAR can be used as biomarkers in the routine analysis of renal biopsies in cases of podocytopathies when the lesion (sclerosis) is not sampled.

Evaluation of topical corticosteroids in children with phimosis through morphological and immunohistochemical analyses of the foreskin.

INTRODUCTION: Histopathological analysis of the foreskin has become more common in the last two decades. OBJECTIVES: This study aims to analyze the morphology of the foreskin and determine the effects of topical corticosteroid therapy on this tissue. MATERIALS AND METHODS: We retrospectively evaluated forty foreskin samples from children aged from 2 years to 15 years with phimosis undergoing circumcision at our institution over a 2-year period. In the foreskin samples, we analyzed the elastic fibers (Verhoeff), epidermal thickness (hematoxylin and eosin), and Annexin 1 and Langerhans cells (LCs) (immunohistochemistry). RESULTS: In the present study, 18 (45%) patients made use of topical corticosteroids, and 22 (55%) did not, while 4 (10%) had a history of balanoposthitis as previous complication. Forty patients were divided according to the parameter analyzed: with or without previous complication and with or without previous topical corticotherapy. Annexin 1 expression was significantly higher in group with a history of complications when compared with group without complications (P = 0.024) and lower in the group of those who used corticosteroids when compared with those who did not used corticosteroids (P = 0.364). In the analysis of all samples, the density of mature LCs was significantly higher when compared with immature LCs (P < 0.0001). The density of immature LCs was significantly higher in patients without previous complications when compared with group with complications (P = 0.028). CONCLUSIONS: These findings contribute to a better understanding of the histopathological aspects of previous complications and of treatment with corticosteroids in children with phimosis.

Pulmonary coinfection by Pneumocystis jiroveci, Cryptococcus neoformans and cytomegalovirus in hiv patient without antiretroviral treatment

Pulmonary diseases are among the main causes of morbidity and mortality in HIV patients. Here, we present the fatal case of a 30 year-old AIDS patient, who did not undergo antiretroviral treatment, presenting pulmonary coinfection by Pneumocystis jiroveci, Cryptococcus neoformans and cytomegalovirus diagnosed in the postmortem histological examination. Concurrent pulmonary infection by these three agents is not common and, to date, apparently had not been reported in the literature.

Intrauterine infection, immune system and premature birth.

Preterm birth accounts for nearly one million deaths among children under five years of age, and although its etiopathogenesis is not fully elucidated, ascending intrauterine infection and fetal inflammatory response seem to be the main triggers. The intense inflammatory response mediated by IL-1ß, TNF-α, PAF, IFN-γ and IL-6, PGE2 and MMP-1 and MMP-9 causes fetal membrane damage and rupture, increased uterine contractions and biochemical and structural changes in the cervix. Furthermore, preterm neonates have deficient innate and adaptive immune responses characterized by reduced levels of IgG, opsonization and phagocytosis, as well as increased activation of Th1 cells in relation to Th2 cells. Therefore, this triad is favors the occurrence of neonatal complications, such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Due to serious maternal and child health complications of intrauterine infection, several studies have tried to identify biomarkers for the early diagnosis of this entity. This literature review aims to discuss the main scientific findings regarding the association between ascending intrauterine infection, immune system and preterm birth.

Angiogenic and antiangiogenic factors in preeclampsia.

BACKGROUND: Pre-eclampsia is a multifactorial hypertensive disorder that is triggered by placental insufficiency and that accounts for up to 15% of maternal deaths. In normal pregnancies, this process depends on the balance between the expression of angiogenic factors and antiangiogenic factors, which are responsible for remodeling the spiral arteries, as well as for neoangiogenesis and fetal development. PURPOSE: The aim of this review is to discuss the main scientific findings regarding the role of angiogenic and antiangiogenic factors in the etiopathogenesis of preeclampsia. METHODS: An extensive research was conducted in the Pubmed database in search of scientific manuscripts discussing potential associations between angiogenic and antiangiogenic factors and preeclampsia. Ninety-one papers were included in this review. RESULTS: There is an increased expression of soluble fms-like tyrosine kinase receptor and soluble endoglin in pre-eclampsia, as well as reduced placental expression of vascular endothelial growth factor and placental growth factor. Systemic hypertension, proteinuria and kidney injury - such as enlargement and glomerular fibrin deposit, capillary occlusion due to edema, and hypertrophy of endocapillary cells - are some of these changes. The complex etiopathogenesis of preeclampsia instigates research of different biomarkers that allow for the early diagnosis of this entity, such as vascular endothelial growth factor, placental growth factor, soluble fms-like tyrosine kinase receptor, soluble endoglin, placental glycoprotein pregnancy-associated plasma protein-A and protein 13. CONCLUSION: Even though it is possible to establish an efficient and effective diagnostic tool, three key principles must be observed in the management of preeclampsia: prevention, early screening and treatment.

Influence of the Expression of Inflammatory Markers on Kidney after Fetal Programming in an Experimental Model of Renal Failure.

Objective. To evaluate the expression of inflammatory markers in experimental renal failure after fetal programming. Methods. The offspring aged two and five months were divided into four groups: CC (control dams, control offspring); DC (diabetic dams, control offspring); CFA (control dams, folic acid offspring, 250 mg/Kg); and DFA (diabetic dams, folic acid offspring). Gene expression of inflammatory markers MCP-1, IL-1, NOS3, TGF-ß, TNF-α, and VEGF was evaluated by RT-PCR. Results. MCP-1 was increased in the CFA and DFA groups at two and five months of age, as well as in DC5 when compared to CC5. There was a higher expression of IL-1 in the CFA2, DFA2, and DC2 groups. There was a decrease in NOS3 and an increase in TNF-α in DFA5 in relation to CFA5. The gene expression of TGF-ß increased in cases that had received folic acid at two and five months, and VEGF decreased in the CFA5 and DFA5 groups. DC5 showed increased VEGF expression in comparison with CC5. Conclusions. Gestational diabetes mellitus and folic acid both change the expression of inflammatory markers, thus demonstrating that the exposure to harmful agents in adulthood has a more severe impact in cases which underwent fetal reprogramming.

Epithelial-mesenchymal transition in pediatric nephropathies.

INTRODUCTION: Epithelial-mesenchymal transition (EMT) is a process in which epithelial cells may express mesenchymal cell markers with subsequent change in their functions, and it may be part of the etiopathogenesis of kidney disease. OBJECTIVE: The aim of this study was to evaluate the immunexpression of some EMT inducers and markers in frequent nephropathies in pediatric patients. METHODS: 59 patients aged 2-18 years old were selected and divided into 6 groups of frequent nephropathies in children and adolescents, as well as one control group. Urea and creatinine data of the patients were recorded. TGF-ß3, fibronectin, α-SMA and vimentin were evaluated by immunohistochemistry. RESULTS: Glomerular TGF-ß3 was higher in the Lupus Nephritis and Acute Diffuse Glomerulonephritis (ADGN) groups than in the control group. Glomerular fibronectin was higher in the Podocytopathy, Lupus Nephritis, ADGN and Membranous Glomerulopathy patients than in control subjects. The expression of α-SMA was higher in the tubulointerstitial compartment of ADGN and Membranous Glomerulopathy groups than in the control group. Glomerular α-SMA was higher in ADGN patients than in control and Berger's Disease groups. Glomerular vimentin was higher in individuals with ADGN than in those with Podocytopathy, Lupus Nephritis, Berger's Disease and Thin Basement Membrane Disease/Alport Syndrome. There was a positive correlation between fibronectin in the tubulointerstitial compartment and creatinine levels, between α-SMA and vimentin in both tubulointerstitial and glomerular compartments, and between urea and creatinine levels of patients, regardless of their nephropathy (p<0.05 for all results). CONCLUSION: These markers may possibly be used as indicators of renal functional impairment in various nephropathies in pediatric patients.

Giant Condyloma (Buschke-Loewenstein Tumor) in a 16-year-old Patient: Case Report.

The Buschke-Loewenstein tumor is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It is considered benign despite the high rate of recurrence and the possibility of malignant transformation. It is commonly associated with subtypes 6 and 11 of the human papillomavirus (HPV), and host's immunity plays an important role in the development of the disease. Surgical excision is the recommended treatment in most cases. We present the case of a 16 years old female patient with extensive vulvar lesions successfully treated surgically.

Diagnosis of congenital and infantile nephrotic syndromes in renal biopsies in Minas Gerais, Brazil: Six case reports.

Congenital or infantile nephrotic syndromes (CNS/INS) correspond to a heterogeneous group of rare diseases in which glomerular renal dysfunction and proteinuria are prominent. The aim of this study is to present six cases of possible CNS/INS with diagnoses based on clinical findings and especially histological, ultrastructural, and immunohistochemical characteristics of renal biopsies. Four cases are presented with diffuse mesangial sclerosis, one of them possibly part of Denys-Drash syndrome and two cases with CNS probably of the Finnish type in patients between 3 months old and 13 years old. The study focuses on the late evolution of Denys-Drash syndrome to end-stage renal disease in a 13-year-old patient and the diagnosis of diffuse mesangial sclerosis in an 8-year-old patient. Thus, it contributes to a better epidemiological characterization of these syndromes, demonstrating cases of CNS/INS in infrequent age groups.

Giant Condyloma (Buschke-Loewenstein Tumor) in a 16-year-old Patient: Case Report / Condiloma gigante (tumor de Buschke-Loewenstein) em uma paciente de 16 anos: relato de caso

Abstract The Buschke-Loewenstein tumor is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It is considered benign despite the high rate of recurrence and the possibility of malignant transformation. It is commonly associated with subtypes 6 and 11 of the human papillomavirus (HPV), and host 's immunity plays an important role in the development of the disease. Surgical excision is the recommended treatment in most cases. We present the case of a 16 years old female patient with extensive vulvar lesions successfully treated surgically.

Resumo O tumor de Buschke-Loewenstein se caracteriza pelo crescimento excessivo de lesões verrucosas na região genital e/ou perianal. É considerado benigno apesar da elevada taxa de recorrência e da possibilidade de transformação maligna. Está comumente associado aos sorotipos 6 e 11 do papiloma vírus humano (HPV) e a imunidade do hospedeiro tem importante papel no desenvolvimento da doença. A excisão cirúrgica é o tratamento recomendado na maioria dos casos. Apresentamos o caso de uma paciente do sexo feminino, de 16 anos, com lesão vulvar de grande extensão tratada cirurgicamente com sucesso.

Contribution of glomerular morphometry to the diagnosis of pediatric nephropathies.

Only a few studies describe histopathological changes in renal biopsies performed in pediatric patients. This study was conducted to identify an association between morphometric data in renal biopsies and renal function of these patients. Fifty-nine individuals with ages between 2 and 18 years old were selected, who were divided into six groups consisting of frequent nephropathies in children and adolescents and one control group. Proteinuria, urea, and creatinine values of the patients were recorded. Interactive image analysis software Leica QWin[®]was used for morpho- metric analysis of Bowman's capsule, glomerular capillary tuft, and Bowman's space area. The mean glomerular tuft area was higher in the membranous glomerulopathy group than in the podo- cytopathy group (57,101 ± 25,094 vs. 27,420 c ± 6279 µm(2); P <0.05). The median of Bowman's space area was higher in the control group than in the podocytopathy group and in the thin basement membrane/Alport syndrome group [12,210 (7676-26,945) vs. 5801 (3031-7852) µm(2); P <0.01 and 12210 (7676-26,945) vs. 4183 (3797-7992) µm(2); P <0.01, respectively]. There was a positive and significant correlation between Bowman's capsule area and the levels of proteinuria, creatinine, and urea of the patients, as well as between the glomerular tuft area and the levels of proteinuria, creatinine, and urea in the patients, regardless of their nephropathy. Glomerular morphometry may contribute to the diagnosis of some glomerulopathies and the association between glomerular morphometric parameters, and laboratory data may promote a better understanding of the prognosis of these patients.

Morphological and inflammatory changes in the skin of autopsied fetuses according to the type of stress.

INTRODUCTION: The fetal skin acts on the development and activation of the immune response via immune-neuroendocrine communication coordinated by corticotropin-releasing hormone. OBJECTIVE: This study aimed to evaluate the morphological and inflammatory changes in the skin due to acute stress and chronic stress, associated with perinatal asphyxia, ascending infection and congenital malformation. METHODS: We measured dermal and epidermal thickness, the diameter of keratinocytes, and the percentage of collagen and elastic fibers. Immunohistochemistry was used to evaluate both Langerhans cell and mast cell density, and corticotropin-releasing hormone expression in the epidermis, sebaceous gland, sebaceous duct, sudoriparous gland and in the hair follicle. RESULTS: The epidermis was thinner in the cases with perinatal asphyxia, ascending infection and chronic stress. The diameter of keratinocytes was smaller in ascending infection and chronic stress. Mast cell density showed an indirect correlation with gestational age. Corticotropin-releasing hormone expression was significantly higher in ascending infection and chronic stress. CONCLUSIONS: Chronic stress is associated with immunological and morphological changes in the skin of fetuses with perinatal asphyxia and ascending infection. Thus, corticotropin-releasing hormone seems to play a vital role in the differentiation and activation of innate and adaptive immune cells of the skin of fetuses.

Morphological and functional aspects of acute kidney injury after fetal programing in the offspring of diabetic rats.

OBJECTIVE: To evaluate the effects of folic acid (FA)-induced renal failure in young offspring of diabetic mothers. METHODS: The offspring of streptozotocin-induced diabetic dams were divided into four groups: CC (controls receiving vehicle); DC (diabetics receiving vehicle); CA (controls receiving FA solution, 250 mg/kg) and DA (diabetics receiving FA solution, 250 mg/kg). Renal function tests and morphometry results were analyzed. RESULTS: An increase in creatinine and urea levels was observed in CA and DA groups at two and five months. FA administration caused a significant reduction in the number of glomeruli in the offspring of diabetic dams. The diabetes group treated with FA had fewer glomeruli compared to controls at two and five months. FA caused an increase in the area of the urinary space both in controls and offspring of diabetic dams at two and five months. The number of glomeruli and area of the urinary space at two months were negatively correlated. CONCLUSIONS: Fetal programing promotes remarkable changes in kidney morphology and function in offspring. We suggest that the morphological changes in the kidneys are more pronounced when fetal programing is associated with newly acquired diseases, e.g. renal failure induced by FA.

[Influence of cause of death on body and internal organs weight in perinatal autopsies]. / Influência da causa de morte no peso corporal e dos órgãos internos em autópsias perinatais.

PURPOSE: To evaluate changes in body and internal organ weight of autopsied children in the perinatal period and their relationship with the cause of death. METHODS: One hundred and fifty three cases of perinatal autopsies performed at a university hospital in Southeastern Brazil ere included. Information about cause of perinatal death, date of autopsy, gestational age, perinatal weight and organ weight was obtained from the autopsy protocols and medical records of the mother and/or the newborn. Four groups of causes of death were defined: congenital malformations, perinatal hypoxia/anoxia, ascending infection and hyaline membrane. Brain, liver, lungs, heart, spleen, thymus and adrenals were analyzed. RESULTS: The weight of children with perinatal hypoxia/anoxi (1,834.6±1,090.1 g versus 1,488 g), hyaline membranes (1,607.2±820.1 g versus 1,125 g) and ascending infection (1,567.4±1,018.9 g versus 1,230 g) was higher than expected for the population. Lung weight was higher in cases with ascending infection (36.6±22.6 g versus 11 g) and lower in cases with congenital malformations (22.0±9.5 g versus 40 g). Spleen weight was higher in children with ascending infection (8.6±8.9 g versus 3.75 g ) and adrenal weight was lower in cases with congenital malformations (3.9±2.1 g versus 5.5 g). Thymus weight was lower in cases with miscellaneous causes (3.7±1.2 g versus 7.5 g) and spleen weight was lower in patients with lung immaturity (0.4±0.1 g versus 1.7 g). All results showed significant differences. CONCLUSIONS: This study demonstrates that variations in the weight of children and the weight of their organs are related to the types of cause of perinatal death. These data may contribute to a better interpretation of autopsy findings and their anatomical and clinical relationship.

Influencia da causa de morte no peso corporal e dos orgaos internos em autopsias perinatais / Influence of cause of death on body and internal organs weight in perinatal autopsies

OBJETIVO: Avaliar as variações do peso corporal e dos órgãos internos de crianças autopsiadas no período perinatal e sua relação com a causa de morte. MÉTODOS: Foram incluídos 153 casos de autópsias perinatais realizadas em um hospital universitário do Sudeste do Brasil. Informações sobre causa de morte perinatal, data da autópsia, idade gestacional, peso perinatal e dos órgãos foram recuperadas dos protocolos de autópsia e do prontuário da mãe e/ou do recém-nascido. Foram definidos quatro grupos de causa de morte: malformações congênitas, hipóxia/anóxia perinatal, infecção ascendente e membrana hialina. Encéfalo, fígado, pulmões, coração, baço, timo e suprarrenais foram analisados. RESULTADOS: O peso das crianças com hipóxia/anóxia perinatal (1.834,6±1.090,1 g versus 1.488 g), membrana hialina (1.607,2±820,1 g versus 1.125 g) e infecção ascendente (1.567,4±1.018,9 g versus 1.230 g) foi maior do que o esperado para a idade gestacional. O peso dos pulmões foi maior nos casos com infecção ascendente (36,6±22,6 g versus 11 g) e menor nos casos com malformação congênita (22,0±9,5 g versus 40 g). O peso do baço foi maior nos casos que apresentaram infecção ascendente (8,6±8,9 g versus 3,75 g ). O peso das suprarrenais foi menor nos casos com malformação congênita (3,9±2,1 g versus 5,5 g), o do timo foi menor nos casos com miscelânea (3,7±1,2 g versus 7,5 g) e o do baço foi menor nos casos com imaturidade pulmonar (0,4±0,1 g versus 1,7 g). Todos esses resultados apresentaram diferenças significativas. CONCLUSÕES: Este estudo demonstra que as variações do peso das crianças e de seus órgãos ...

PURPOSE: To evaluate changes in body and internal organ weight of autopsied children in the perinatal period and their relationship with the cause of death. METHODS: One hundred and fifty three cases of perinatal autopsies performed at a university hospital in Southeastern Brazil ere included. Information about cause of perinatal death, date of autopsy, gestational age, perinatal weight and organ weight was obtained from the autopsy protocols and medical records of the mother and/or the newborn. Four groups of causes of death were defined: congenital malformations, perinatal hypoxia/anoxia, ascending infection and hyaline membrane. Brain, liver, lungs, heart, spleen, thymus and adrenals were analyzed. RESULTS: The weight of children with perinatal hypoxia/anoxi (1,834.6±1,090.1 g versus 1,488 g), hyaline membranes (1,607.2±820.1 g versus 1,125 g) and ascending infection (1,567.4±1,018.9 g versus 1,230 g) was higher than expected for the population. Lung weight was higher in cases with ascending infection (36.6±22.6 g versus 11 g) and lower in cases with congenital malformations (22.0±9.5 g versus 40 g). Spleen weight was higher in children with ascending infection (8.6±8.9 g versus 3.75 g ) and adrenal weight was lower in cases with congenital malformations (3.9±2.1 g versus 5.5 g). Thymus weight was lower in cases with miscellaneous causes (3.7±1.2 g versus 7.5 g) and spleen weight was lower in patients with lung immaturity (0.4±0.1 g versus 1.7 g). All results showed significant differences. CONCLUSIONS: This study demonstrates that variations in the weight of children and the weight of their organs are related to the types of cause of perinatal death. These data may contribute to a better interpretation of autopsy findings and their anatomical and clinical relationship. .

The importance of C4d in biopsies of kidney transplant recipients.

Antibody-mediated rejection (AMR) is highly detrimental to the prolonged survival of transplanted kidneys. C4d has been regarded as a footprint of AMR tissue damage, and the introduction of C4d staining in daily clinical practice aroused an ever-increasing interest in the role of antibody-mediated mechanisms in allograft rejection. Despite the general acceptance of the usefulness of C4d in the identification of acute AMR, the data for C4d staining in chronic AMR is variable. The presence of C4d in the majority of the biopsies with features of chronic antibody-mediated rejection is reported, but this rejection without C4d staining is observed as well, suggesting that C4d is specific but not sensitive. Further studies on AMR with positive C4d staining in biopsy specimens are really important, as well as the study of novel routine markers that may participate in the pathogenesis of this process.