RESUMO
In this study, we assessed the association between single-nucleotide polymorphisms (SNPs) in seven candidate genes involved in orchestrating the immune response against cytomegalovirus (CMV) and the 12-month incidence of CMV infection in 315 CMV-seropositive kidney transplant (KT) recipients. Patients were managed either by antiviral prophylaxis or preemptive therapy. CMV infection occurred in 140 patients (44.4%), including 13 episodes of disease. After adjusting for various clinical covariates, patients harboring T-allele genotypes of interleukin-28B (IL28B) (rs12979860) SNP had lower incidence of CMV infection (adjusted hazard ratio [aHR]: 0.66; 95% confidence interval [CI]: 0.46-0.96; p-value = 0.029). In the analysis restricted to patients not receiving prophylaxis, carriers of the TT genotype of toll-like receptor 9 (TLR9) (rs5743836) SNP had lower incidence of infection (aHR: 0.61; 95% CI: 0.38-0.96; p-value = 0.035), whereas the GG genotype of dendritic cell-specific ICAM 3-grabbing nonintegrin (DC-SIGN) (rs735240) SNP exerted the opposite effect (aHR: 1.86; 95% CI: 1.18-2.94; p-value = 0.008). An independent association was found between the number of unfavorable SNP genotypes carried by the patient and the incidence of CMV infection. In conclusion, specific SNPs in IL28B, TLR9 and DC-SIGN genes may play a role in modulating the susceptibility to CMV infection in CMV-seropositive KT recipients.
Assuntos
Infecções por Citomegalovirus/genética , Imunidade Inata/genética , Falência Renal Crônica/cirurgia , Transplante de Rim , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Alelos , Moléculas de Adesão Celular/genética , Infecções por Citomegalovirus/sangue , Feminino , Genótipo , Humanos , Incidência , Interferons , Interleucinas/genética , Falência Renal Crônica/sangue , Falência Renal Crônica/genética , Lectinas Tipo C/genética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Prospectivos , Receptores de Superfície Celular/genética , TransplantadosRESUMO
Publicamos un caso de un paciente de 30 años que acude al servicio de Urgencias con dolor abdominal, fiebre, inestabilidad hemodinámica, hepatoesplenomegalia, fracaso renal agudo anúrico, linfadenopatías latero-cervicales, anemia y trombocitopenia. El paciente fue tratado con antibióticos empíricos, esteroides, gammaglobulinas, noradrenalina y hemodiálisis intermitente diaria con buena respuesta. La biopsia renal mostró datos de microangiopatía trombótica y tras la biopsia de una adenopatía se diagnosticó de enfermedad de Castleman. La enfermedad de Castleman, también conocida como hiperplasia nodular linfática gigante o angiofolicular, es una entidad clínico-patológica de etiología desconocida. La afectación renal és heterogénea y frecuente (AU)
We report a case of a 30-year-old man presenting with abdominal pain, fever, homodynamic instability, hepatosplenomegaly, acute renal failure, cervical lymph nodes, anaemia and thrombocytopenia. The patient was treated with empiric antibiotics, high dose corticosteroids, gammaglobulins, noradrenalin and diary intermittent haemodialysis, with an excellent response. The renal biopsy showed a thrombotic microangiopathy, the lymph node biopsy showed a Castlemans disease.Castlemans disease (also known as giant lymph node hyperplasia or angiofollicular lymph node hyperplasia) is a clinicopathological entity of unknown aetiology. A number of renal alterations have been described in association with the Castlemans disease (AU)
Assuntos
Humanos , Masculino , Adulto , Hiperplasia do Linfonodo Gigante/complicações , Púrpura Trombocitopênica Trombótica/complicações , Hiperplasia do Linfonodo Gigante/diagnóstico , Trombocitopenia/etiologia , Hemodinâmica , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Púrpura Trombocitopênica Trombótica/diagnósticoRESUMO
We report a case of a 30-year-old man presenting with abdominal pain, fever, homodynamic instability, hepatosplenomegaly, acute renal failure, cervical lymph nodes, anaemia and thrombocytopenia. The patient was treated with empiric antibiotics, high dose corticosteroids, gammaglobulins, noradrenalin and diary intermittent haemodialysis, with an excellent response. The renal biopsy showed a thrombotic microangiopathy, the lymph node biopsy showed a Castleman s disease. Castleman s disease (also known as giant lymph node hyperplasia or angiofollicular lymph node hyperplasia) is a clinicopathological entity of unknown aetiology. A number of renal alterations have been described in association with the Castleman s disease.
