RESUMO
We present a the case of 58-year old man who was admitted to hospital with typical clinical features (bloody nasal discharge, arthralgia, acute kidney injury with a nephritic syndrome) consisting with Wegeners granulomatosis (WG). CT-scan showed pulmonary nodules and antineutrophil cytoplasmatic antibodies (ANCA) were elevated. A kidney biopsy showed a crescentic glomerulonephritis, but not pauci-immune-immune with a histopathological staining of a mesangioproliferative IgA-glomerulonephritis. The patient was put on prednisolone and i.v. cyclophosphamid (CYCLOPS-protocol (1). The anti-proteinase-3 antibody titer decreased and the CT-scan showed decreased activity of Wegener's granulomatosis (BVAS 26 dropped to 2) and the patient`s serum creatinine level was stable. The exact nosological relation of mesangial IgA-nephropathy to WG is still unclear. This case underlines that knowledge of renal histology is essential in the management of patients with renal disease, especially in patients with hematuria and/or proeinuria with positive ANCA.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/imunologia , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/imunologia , Imunoglobulina A/sangue , Fatores Imunológicos/sangue , Biomarcadores/sangue , Ciclofosfamida/uso terapêutico , Quimioterapia Combinada , Seguimentos , Glomerulonefrite por IGA/sangue , Glomerulonefrite por IGA/tratamento farmacológico , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The use of mesh has become essential in the repair of abdominal wall incisional hernias. Suture techniques, reapplied after failure of a primary repair, are characterized by recurrence rates of up to 50 percent, whereas the reinforcement of the abdominal wall with surgical mesh has significantly decreased these rates to <10 percent. This article describes the background for the development of mesh with lightweight construction and physiological biomechanical performance.