Thrombotic microangiopathy and accelerated hypertension after treatment with interferon beta / Microangiopatía trombótica e hipertensión acelerada tras tratamiento con interferón beta

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Recomendaciones y sugerencias a 4 preguntas clave en nefropatía lúpica: Extracto de la guía de práctica clínica 2015 / Hot topics in lupus nephropathy: Responses from a new 2015 Spanish guideline

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Chlorambucil-induced cytomegalovirus infection: a case report.

INTRODUCTION: Chlorambucil is an alkylating agent used in combination with prednisolone for the treatment of idiopathic membranous nephropathy. Although chlorambucil is generally well-tolerated, it is a myelosuppresive drug that can cause several infections. CASE PRESENTATION: We report the case of an 81-year-old Caucasian male presenting with idiopathic membranous nephropathy who developed fever, cough, dyspnea, pulmonary infiltrates, and abdominal pain shortly after the initiation of treatment with chlorambucil and corticosteroids for nephropathy. Virology tests for infectious diseases revealed a recent cytomegalovirus infection. Antiviral treatment (ganciclovir) resulted in full remission. CONCLUSIONS: Cytomegalovirus infection should be considered in the differential diagnosis of respiratory symptoms and pulmonary infiltrates in patients treated with chlorambucil for nephrotic syndrome.

Tratamiento con adalimumab en la amiloidosis secundaria a artritis reumatoide: a propósito de dos casos / Treatment with adalimumab in amyloidosis secondary to rheumatoid arthritis: two case reports

Las patologías reumatológicas, y en primer lugar la artritis reumatoidea (AR), siguen siendo unas de las principales causas de amiloidosis secundaria. La aparición de agentes biológicos como el adalimumab en el tratamiento precoz de la AR puede ser una alternativa eficaz para frenar el desarrollo y la progresión de la amiloidosis secundaria. No todos los pacientes responderán igual al tratamiento; debemos considerar la comorbilidad asociada, los factores de mal pronóstico para predecir la repuesta terapéutica y los posibles efectos adversos. Dentro de los efectos adversos de las terapias biológicas, hay que destacar el aumento de la tasa de infecciones letales y cuadros de insuficiencia cardíaca. Presentamos dos casos clínicos con amiloidosis renal secundaria a AR que han seguido un curso clínico diferente: nuestro primer caso tuvo una buena repuesta al adalimumab, mientras que el segundo caso evolucionó desfavorablemente después del inicio del tratamiento, falleciendo por complicaciones cardiovasculares (AU)

Rheumatological diseases and, firstly, rheumatoid arthritis (RA) remain a major cause of secondary amyloidosis. The emergence of biological agents such as adalimumab in the early treatment of RA can be an effective alternative to stop the development and progression of secondary amyloidosis. Not all patients will respond the same way to treatment; we must consider associated comorbidity, the poor prognosis factors for predicting therapeutic response and possible adverse effects. In the adverse effects of biological therapies, there has been an increase in the rate of lethal infections and congestive heart failure. We present two cases with renal amyloidosis secondary to RA who had a different clinical course: our 1st case had a good response to Adalimumab while the 2nd case evolved unfavourably after treatment, and died from cardiovascular complications (AU)

Espondilodiscitis, experiencia en nefrología / Spondylodiscitis, nephrology department's experience

La espondilodiscitis es una infección del cuerpo vertebral y los discos adyacentes, cuya forma de diseminación más frecuente es la vía hematógena. Se trata de una entidad rara pero con una incidencia global en aumento, debido principalmente al incremento de bacteriemias en portadores de dispositivos intravasculares, como el utilizado en pacientes en tratamiento renal sustitutivo con hemodiálisis. Su diagnóstico es difícil por presentarse con síntomas inespecíficos, por lo que para un diagnóstico precoz y preciso es necesario el uso de la resonancia magnética. El tratamiento antibiótico empírico temprano y el abordaje multidisciplinario mejoran el pronóstico de esta infección potencialmente grave. Presentamos una serie de casos diagnosticados de espondilodiscitis en nuestra Sección de Nefrología (AU)

Spondylodiscitis is an infection of the vertebral body and adjacent intervertebral discs, in which hematogenous spread is by far the most common cause. This is a rare disease but its overall incidence is increasing, due mainly to increased bacteremia in patients with intravascular catheter as it is used in hemodialysis, being Staphylococcus aureus the most common organism. The diagnosis is difficult because of nonspecific symptoms. The use of magnetic resonance imaging allows an early and accurate diagnosis. The early empirical antibiotic treatment may improve the outcome of this potentially catastrophic infection, so it requires the collaboration of a multidisciplinary team of physicians to optimal therapy. We report a case series of spondylodiscitis diagnosed in our Nephrology Unit (AU)

Spondylodiscitis, nephrology department's experience.

Spondylodiscitis is an infection of the vertebral body and adjacent intervertebral discs, whose most common means of spreading is the haematogenous route. It is a rare disease but its overall incidence is increasing, mainly due to increased bacteraemia in patients with intravascular devices, such as that used in patients on renal replacement therapy with haemodialysis. Its diagnosis is difficult due to non-specific symptoms and as such, for early and accurate diagnosis, MRI is necessary. The early empirical antibiotic treatment and the multidisciplinary approach may improve the prognosis of this potentially serious infection. We report a series of cases diagnosed with spondylodiscitis in our Nephrology Unit.

Treatment with adalimumab in amyloidosis secondary to rheumatoid arthritis: two case reports.

Rheumatological diseases and, firstly, rheumatoid arthritis (RA) remain a major cause of secondary amyloidosis. The emergence of biological agents such as adalimumab in the early treatment of RA can be an effective alternative to stop the development and progression of secondary amyloidosis. Not all patients will respond the same way to treatment; we must consider associated comorbidity, the poor prognosis factors for predicting therapeutic response and possible adverse effects. In the adverse effects of biological therapies, there has been an increase in the rate of lethal infections and congestive heart failure. We present two cases with renal amyloidosis secondary to RA who had a different clinical course: our 1st case had a good response to Adalimumab while the 2nd case evolved unfavourably after treatment, and died from cardiovascular complications.