RESUMO
A 78-year-old male was admitted to the hospital with acute renal failure and generalized erythema after starting dapagliflozin 10 mg/day for chronic kidney disease (CKD). A skin biopsy revealed superficial perivascular dermatitis with eosinophils. A renal biopsy revealed lymphocytic and eosinophilic infiltration of the interstitium, and focal tubulitis. The patient was diagnosed with a dapagliflozin-induced drug reaction with eosinophilia and systemic symptoms (DRESS), followed by acute interstitial nephritis (AIN), and prednisolone therapy was therefore initiated. The patient's renal function improved, and erythema disappeared. To our knowledge, this is the first report of DRESS caused by dapagliflozin, and the patient was successfully treated with prednisolone.
RESUMO
A 70-year-old woman with acute kidney injury, a high serum Creatinine (Cr) level (3.91 mg/dL), and proteinuria (protein/Cr ratio 1.59 g/gCr) was admitted. Serum IgG λ-type and urinary λ-type M proteins were observed. A bone marrow examination indicated monoclonal gammopathy of undetermined significance (MGUS). A renal biopsy showed distended proximal tubular cells, and immunofluorescence identified tissue positive for proximal tubular cell λ light chains. Electron microscopy identified fibril-like structures in the lysosomes. The patient was diagnosed with light chain proximal tubulopathy without crystals in IgG λ-type MGUS and treated with bortezomib and dexamethasone therapy, which improved her renal function.
Assuntos
Nefropatias , Gamopatia Monoclonal de Significância Indeterminada , Paraproteinemias , Feminino , Humanos , Idoso , Bortezomib/uso terapêutico , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Paraproteinemias/complicações , Paraproteinemias/tratamento farmacológico , Dexametasona/uso terapêutico , Imunoglobulina GAssuntos
Sensibilização do Sistema Nervoso Central , Etanol/farmacologia , Mesencéfalo/metabolismo , Morfina/farmacologia , Núcleo Accumbens/metabolismo , Simportadores/metabolismo , Consumo de Bebidas Alcoólicas , Animais , Locomoção , Mesencéfalo/efeitos dos fármacos , Mesencéfalo/fisiologia , Camundongos , Camundongos Endogâmicos ICR , Núcleo Accumbens/efeitos dos fármacos , Núcleo Accumbens/fisiologia , Simportadores/genéticaRESUMO
RATIONALE: Both the acute and chronic consumption of ethanol have been reported to modify several molecular events in the central nervous system, and the endogenous µ-opioid receptor system is involved in the reinforcing/rewarding effects of ethanol. OBJECTIVES: The present study was designed to clarify the effects of chronic ethanol treatment on cellular processes involving µ-opioid receptor and the development of morphine-induced rewarding effects. METHODS: Male C57BL/6J mice were continuously treated with a liquid diet containing 3.0 w/v ethanol. The direct involvement of µ-opioid receptor functions in the activation of G-proteins and changes in protein levels in the lower midbrain of mice after chronic treatment with ethanol were investigated by a [(35)S] GTPγS binding assay and Western blotting, respectively. The rewarding effects of morphine (5 mg/kg) under treatment with ethanol were measured by the conditioned place preference paradigm. RESULTS: The function of µ-opioid receptor was increased by treatment with ethanol in the lower midbrain using [(35)S] GTPγS binding assay. Furthermore, the GRK2 protein level was significantly increased by treatment with ethanol. Chronic treatment with ethanol enhanced the rewarding effects of morphine. On the other hand, this enhancement of the rewarding effects of morphine by ethanol treatment was significantly inhibited by the GRK2 inhibitor ß-adrenergic receptor kinase 1 inhibitor. CONCLUSIONS: The present study demonstrated that chronic treatment with ethanol enhanced the rewarding effects of morphine by up-regulating functional changes in µ-opioid receptor, mediated by GRK2.
