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1.
Cesk Patol ; 57(2): 109-112, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34275321

RESUMO

Inflammatory bowel disease (IBD) is a group of chronic relapsing intestinal inflammatory processes primarily represented by ulcerative colitis (UC) and Crohn´s disease (CD). Nearly half of IBD cases are followed by extraintestinal complications and renal involvement can occur independatly or along with other complications and are described with the patients sufferring from UC or CD. Most frequent renal involvement is nephrolithiasis, tubulointerstinal nephritis, different kinds of glomerulonephritis and AA amyloidosis. We are presenting an unusal form of renal involvement of a young female patient with a severe form of Crohn´s disease treated with recombinant monoclonal antibodies.


Assuntos
Colite Ulcerativa , Doença de Crohn , Glomerulonefrite , Doenças Inflamatórias Intestinais , Doença de Crohn/complicações , Feminino , Humanos , Recidiva
2.
Tuberk Toraks ; 69(2): 237-241, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256514

RESUMO

Nocardia species are opportunistic bacteria that are frequently contagious by inhalation. Recently, Nocardia abscessus has been described as a different species. We report a 54-year-old male who presented with acute pleuritic chest pain, mimicking pulmonary thromboembolism on the 5th day of discharge from the hospital. The patient was receiving immunosuppressive therapy for newly diagnosed atypical anti-glomerular basement membrane disease. Thorax computed tomography revealed a 17x19 mm soft tissue lesion in the lateral segment of the middle lobe of the right lung. After further examinations, a biopsy decision was made and Nocardia abscessus was isolated in the aerobic culture of the aspiration material.


Assuntos
Glomerulonefrite/complicações , Nocardiose/diagnóstico , Embolia Pulmonar/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Nocardia/isolamento & purificação , Nocardiose/diagnóstico por imagem , Nocardiose/microbiologia , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Zhonghua Nei Ke Za Zhi ; 60(6): 589-592, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34058821

RESUMO

Onset with fever and back pain, an 81-year-old man had sudden oliguria and progressively elevated serum creatine from normal range to 660 µmol/L within 1 week after receiving contrast agents, various antibiotics, and several nonsteroidal anti-inflammation drugs. Urine output recovered after supportive treatment. However, his serum creatinine level rose again soon after a temporary decline accompanied by gross hematuria with almost normal morphology, nephrotic proteinuria, and hypoalbuminemia. Renal biopsy revealed necrotizing glomerulonephritis. Methylprednisolone was intravenously administrated 500 mg per day for 3 days, followed by oral glucocorticoids and cyclophosphamide. Gradually the patient's serum creatinine descended to 144 µmol/L.


Assuntos
Injúria Renal Aguda , Glomerulonefrite , Síndrome Nefrótica , Injúria Renal Aguda/tratamento farmacológico , Idoso de 80 Anos ou mais , Hematúria , Humanos , Masculino , Síndrome Nefrótica/complicações , Síndrome Nefrótica/tratamento farmacológico , Proteinúria
4.
BMJ Case Rep ; 14(6)2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130975

RESUMO

We present a case of antineutrophil cytoplasmic antibodies (ANCA)-associated rapidly progressive glomerulonephritis in the context of treatment of pulmonary tuberculosis (TB). A 42-year-old woman was treated for drug-susceptible pulmonary TB and represented with paradoxical worsening of symptoms and radiological features. She was HIV negative. A severe acute kidney injury with features of glomerulonephritis was evident on admission. Perinuclear ANCA and antimyeloperoxidase antibodies were present in serum and renal biopsy was consistent with ANCA-associated vasculitis. The patient was successfully treated with both antituberculous therapy and immunosuppression (corticosteroids and mycophenolate mofetil) with subsequent clinical improvement and amelioration of renal function. We propose this is the first case that describes the association between paradoxical reactions during TB treatment and ANCA-associated glomerulonephritis.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Glomerulonefrite , Tuberculose , Adulto , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Anticorpos Anticitoplasma de Neutrófilos , Feminino , Glomerulonefrite/complicações , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Humanos , Peroxidase
6.
Wiad Lek ; 74(4): 1024-1031, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34156024

RESUMO

The article presents two clinical cases of microscopic polyangiitis in patients with symptoms of glomerulonephritis with renal failure, which were preceded by such nonspecific symptoms as: abdominal syndrome, high blood pressure, arthralgia, myalgia, weight loss, uveitis, shortness of breath, general weakness. Clinical and laboratory-instrumental aspects of diseases are analyzed. Emphasized the feasibility of early diagnosis, adequate therapy appointment. The aim of the article is to show that only with timely prescribing of pathogenetic therapy it is possible to achieve clinical and laboratory remission and, even, to cease hemodialysis sessions. It was described two clinical cases of microscopic polyangiitis in patients with symptoms of glomerulonephritis with renal failure. Approaches to complex treatment of patients with the use of pathogenetic and the possibility of using renal replacement therapy were discussed. After verifying the diagnosis, all patients started immunosuppression with corticosteroids and cytostatics. It is shown that only with timely prescribing of pathogenetic therapy it is possible to achieve clinical and laboratory remission. Clinical examples demonstrate to physicians that systemic vasculitis can often hide under the «mask¼ of other diseases and require timely diagnosis and immediate pathogenetic treatment.


Assuntos
Glomerulonefrite , Poliangiite Microscópica , Corticosteroides , Glomerulonefrite/complicações , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Humanos , Poliangiite Microscópica/complicações , Poliangiite Microscópica/diagnóstico , Poliangiite Microscópica/tratamento farmacológico , Nefrologistas , Diálise Renal
7.
BMJ Case Rep ; 14(6)2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1270884

RESUMO

We present a case of antineutrophil cytoplasmic antibodies (ANCA)-associated rapidly progressive glomerulonephritis in the context of treatment of pulmonary tuberculosis (TB). A 42-year-old woman was treated for drug-susceptible pulmonary TB and represented with paradoxical worsening of symptoms and radiological features. She was HIV negative. A severe acute kidney injury with features of glomerulonephritis was evident on admission. Perinuclear ANCA and antimyeloperoxidase antibodies were present in serum and renal biopsy was consistent with ANCA-associated vasculitis. The patient was successfully treated with both antituberculous therapy and immunosuppression (corticosteroids and mycophenolate mofetil) with subsequent clinical improvement and amelioration of renal function. We propose this is the first case that describes the association between paradoxical reactions during TB treatment and ANCA-associated glomerulonephritis.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Glomerulonefrite , Tuberculose , Adulto , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Anticorpos Anticitoplasma de Neutrófilos , Feminino , Glomerulonefrite/complicações , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Humanos , Peroxidase
8.
BMJ Case Rep ; 14(6)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158330

RESUMO

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is included in the group of dysproteinaemias causing renal disease. Only a minority of cases are associated with a haematological malignancy. Two cases have been linked to acute parvovirus B19 infections. We report a 36-year-old African-American woman who presented with renal dysfunction, proteinuria, haematuria and a kidney biopsy reported as PGNMID with IgG3-kappa deposits. Her evaluation for a haematological malignancy was unrevealing. Her parvovirus IgM and IgG levels were positive. The patient was initially treated with an ACE inhibitor and spontaneously remitted with minimal proteinuria after 1 month. Repeat parvovirus B19 serologies 6 months later showed persistent IgG and DNA by PCR positivity but IgM negativity. Given the clinical scenario, we believe that her PGNMID was induced by acute parvovirus B19 infection, which appeared to resolve once her acute infection abated. In this report, we describe our latest understanding of PGNMID.


Assuntos
Glomerulonefrite , Infecções por Parvoviridae , Parvovirus B19 Humano , Adulto , Anticorpos Monoclonais , Feminino , Glomerulonefrite/tratamento farmacológico , Humanos , Imunoglobulina G , Imunoglobulina M , Infecções por Parvoviridae/complicações , Infecções por Parvoviridae/diagnóstico
9.
Adv Exp Med Biol ; 1306: 81-99, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33959907

RESUMO

Chronic glomerulonephritis (CGN) is a disease with a steady progressive course that involves the development of nephrosclerosis, which is especially evident in clinical courses with incidences of high proteinuria (PU). Currently, proteinuria is considered the main laboratory feature (sign) of CGN activity and progression because proteinuria is closely related to the process of tubulointerstitial fibrosis, which is correlated with the grade of renal insufficiency. The injury to podocytes, which are key components of the filtration barrier, plays a central role in proteinuria development. The detachment of podocytes from the glomerular basement membrane leading to podocytopenia is suggested to induce glomerulosclerosis and hyalinosis with obliteration of capillary loops and the progression of chronic kidney disease. Urinary markers of podocyte dysfunction could serve as useful tools while monitoring the activity and prognosis of CGN. In this chapter, the most important mechanisms of podocyte loss and urinary markers of this process are discussed.


Assuntos
Glomerulonefrite , Podócitos , Biomarcadores , Doença Crônica , Humanos , Proteinúria
10.
BMJ Case Rep ; 14(5)2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039551

RESUMO

IgA nephropathy (IgAN) is commonly associated with psoriasis; however, psoriasis presenting with crescentic IgAN is uncommon. A 49-year-old man with erythrodermic psoriasis with arthritis and stage 2 chronic kidney disease presented to the emergency department with worsening peripheral oedema and difficulty breathing. The patient had been hospitalised previously for a psoriasis flare. He was found to have an acute kidney injury on chronic kidney disease and was diagnosed with crescentic IgA glomerulonephritis on his first hospitalisation. He was treated with corticosteroids and was discharged stable with a plan to start cyclophosphamide in the outpatient setting. On his current hospitalisation, cyclophosphamide was added to his corticosteroids. Crescentic IgAN is rare. Its management has been based largely on observational studies. Our case highlights the importance of starting combined corticosteroids and cyclophosphamide early in crescentic IgAN and that corticosteroid monotherapy is insufficient in controlling disease progression.


Assuntos
Injúria Renal Aguda , Glomerulonefrite por IGA , Glomerulonefrite , Psoríase , Ciclofosfamida/uso terapêutico , Glomerulonefrite/complicações , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/tratamento farmacológico , Humanos , Imunoglobulina A , Masculino , Pessoa de Meia-Idade , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/tratamento farmacológico
11.
Medicine (Baltimore) ; 100(20): e26022, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011106

RESUMO

ABSTRACT: Fibrillary glomerulonephritis (FGN) is a diverse glomerular disease with poor renal prognosis. The optimal therapeutic approach remains undetermined, as treatment outcomes vary across different studies.We retrospectively reviewed the medical data of 10 patients diagnosed with biopsy-proven FGN at our center between 2004 and 2019. Clinical and histological features, as well as therapeutic regimens and treatment response, are reported.The patients were predominantly men (2.5/1 men-female ratio) with a mean age at diagnosis of 46.5 years (IQR: 41.5-59.5). The median proteinuria and creatinine levels at presentation were 2.55 g/day (IQR: 0.4-8.9) and 1.35 mg/dl (IQR: 0.94-1.88), respectively. Four out of 10 patients presented with nephrotic syndrome, 5 patients with nephritic syndrome and 1 with isolated microscopic hematuria. Light microscopy showed mesangial proliferative (n = 7), membranoproliferative-like (n = 2), and diffuse sclerosing patterns (n = 1). Rituximab was used in 7/10 patients, either as monotherapy (n = 3) or combined with cyclophosphamide and corticosteroids (n = 4). Patients who were treated with immunosuppression had higher median levels of creatinine (1.40 mg/dl) and proteinuria (3.5 g/d) compared to those who received supportive treatment alone (0.94 mg/dl and 0.6 g/d, respectively). After a median follow-up of 30 months (IQR:18-66.5), 4 out of 7 patients (57%) treated with immunosuppression achieved a clinical response, 1 had persistent renal dysfunction and 2 patients progressed to end-stage renal disease.The present case series extends the existing literature on the clinical features and outcomes of FGN, as well as the use of rituximab-based regimens for the treatment of the disease. Further research is needed to establish the proper management of the disease.


Assuntos
Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/patologia , Adulto , Idoso , Ciclofosfamida/uso terapêutico , Feminino , Glomerulonefrite/complicações , Humanos , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rituximab/uso terapêutico , Resultado do Tratamento
12.
Front Immunol ; 12: 656362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33936084

RESUMO

Since March 2020, the outbreak of Sars-CoV-2 pandemic has changed medical practice and daily routine around the world. Huge efforts from pharmacological industries have led to the development of COVID-19 vaccines. In particular two mRNA vaccines, namely the BNT162b2 (Pfizer-BioNTech) and the mRNA-1273 (Moderna), and a viral-vectored vaccine, i.e. ChAdOx1 nCoV-19 (AstraZeneca), have recently been approved in Europe. Clinical trials on these vaccines have been published on the general population showing a high efficacy with minor adverse events. However, specific data about the efficacy and safety of these vaccines in patients with immune-mediated inflammatory diseases (IMIDs) are still lacking. Moreover, the limited availability of these vaccines requires prioritizing some vulnerable categories of patients compared to others. In this position paper, we propose the point of view about the management of COVID-19 vaccination from Italian experts on IMIDs and the identification of high-risk groups according to the different diseases and their chronic therapy.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/complicações , COVID-19/prevenção & controle , Doenças do Sistema Imunitário/virologia , Vacinação/métodos , Diabetes Mellitus/imunologia , Diabetes Mellitus/virologia , Europa (Continente) , Prova Pericial , Glomerulonefrite/complicações , Glomerulonefrite/imunologia , Glomerulonefrite/virologia , Humanos , Inflamação/imunologia , Inflamação/virologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/virologia , Pneumopatias/complicações , Pneumopatias/imunologia , Pneumopatias/virologia , Pandemias/prevenção & controle , Doenças Reumáticas/complicações , Doenças Reumáticas/imunologia , Doenças Reumáticas/virologia , Dermatopatias/complicações , Dermatopatias/imunologia , Dermatopatias/virologia , Uveíte/complicações , Uveíte/imunologia , Uveíte/virologia
13.
Am J Case Rep ; 22: e931263, 2021 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-33993184

RESUMO

BACKGROUND Hydralazine, a potent vasodilator widely used to treat hypertension, has been implicated in an increasing number of cases of drug-induced autoimmune diseases in recent years. However, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis secondary to hydralazine use has rarely been described and most reported cases involved multi-organ-related vasculitis, including skin and lung-kidney manifestations. ANCA-associated vasculitis is an immune-inflammatory condition characterized by necrotizing vasculitis with few or no immune deposits, predominantly affecting small vessels. The fact that the vasculitis is associated with hydralazine use and improves with discontinuation of hydralazine supports the diagnosis of hydralazine-induced disease. The case we report is a hydralazine-induced, ANCA-associated, pauci-immune crescentic glomerulonephritis with a presentation limited to the kidneys. CASE REPORT A 66-year-old woman was admitted to the hospital for worsening renal function over a month with no symptoms. Serology work-up was significantly positive for antinuclear, perinuclear ANCA, anti-histone, anti-double-stranded DNA, anti-cardiolipin, and anti-myeloperoxidase antibodies. The patient ultimately underwent a kidney biopsy, which revealed pauci-immune crescentic glomerulonephritis. Her kidney function improved with cessation of hydralazine as well as therapy with pulse steroids. CONCLUSIONS Hydralazine is commonly prescribed to treat hypertension. Healthcare providers should be aware of potentially severe hydralazine-induced ANCA-associated vasculitis, which can present with various clinical manifestations. Serologic studies have indicated that it has features that overlap with lupus. Biopsy is helpful for making a definitive diagnosis and developing individual treatment plans. Early diagnosis, cessation of the offending drug, and initiation of immunosuppressive therapy are key for favorable prognosis.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Glomerulonefrite , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/induzido quimicamente , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Anticorpos Anticitoplasma de Neutrófilos , Feminino , Humanos , Hidralazina/efeitos adversos , Rim
14.
Cell Prolif ; 54(6): e13055, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33987885

RESUMO

OBJECTIVES: We aimed to investigate the underlying mechanism of endothelial cells (ECs) proliferation in anti-Thy-1 nephritis. MATERIALS AND METHODS: We established anti-Thy-1 nephritis and co-culture system to explore the underlying mechanism of ECs proliferation in vivo and in vitro. EdU assay kit was used for measuring cell proliferation. Immunohistochemical staining and immunofluorescence staining were used to detect protein expression. ELISA was used to measure the concentration of protein in serum and medium. RT-qPCR and Western blot were used to qualify the mRNA and protein expression. siRNA was used to knock down specific protein expression. RESULTS: In anti-Thy-1 nephritis, ECs proliferation was associated with mesangial cells (MCs)-derived vascular endothelial growth factor A (VEGFA) and ECs-derived angiopoietin2 (Angpt2). In vitro co-culture system activated MCs-expressed VEGFA to promote vascular endothelial growth factor receptor2 (VEGFR2) activation, Angpt2 expression and ECs proliferation, but inhibit TEK tyrosine kinase (Tie2) phosphorylation. MCs-derived VEGFA stimulated Angpt2 expression in ECs, which inhibited Tie2 phosphorylation and promoted ECs proliferation. And decline of Tie2 phosphorylation induced ECs proliferation. In anti-Thy-1 nephritis, promoting Tie2 phosphorylation could alleviate ECs proliferation. CONCLUSIONS: Our study showed that activated MCs promoted ECs proliferation through VEGFA/VEGFR2 and Angpt2/Tie2 pathway in experimental mesangial proliferative glomerulonephritis (MPGN) and in vitro co-culture system. And enhancing Tie2 phosphorylation could alleviate ECs proliferation, which will provide a new idea for MPGN treatment.


Assuntos
Células Endoteliais/patologia , Glomerulonefrite/patologia , Glomérulos Renais/patologia , Células Mesangiais/patologia , Transdução de Sinais , Antígenos Thy-1/antagonistas & inibidores , Angiopoietina-2/metabolismo , Animais , Anticorpos , Proliferação de Células , Modelos Animais de Doenças , Células Endoteliais/metabolismo , Glomerulonefrite/induzido quimicamente , Glomerulonefrite/metabolismo , Glomérulos Renais/metabolismo , Masculino , Células Mesangiais/metabolismo , Ratos , Ratos Wistar , Receptor TIE-2/metabolismo , Antígenos Thy-1/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo
15.
Front Immunol ; 12: 656362, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1211814

RESUMO

Since March 2020, the outbreak of Sars-CoV-2 pandemic has changed medical practice and daily routine around the world. Huge efforts from pharmacological industries have led to the development of COVID-19 vaccines. In particular two mRNA vaccines, namely the BNT162b2 (Pfizer-BioNTech) and the mRNA-1273 (Moderna), and a viral-vectored vaccine, i.e. ChAdOx1 nCoV-19 (AstraZeneca), have recently been approved in Europe. Clinical trials on these vaccines have been published on the general population showing a high efficacy with minor adverse events. However, specific data about the efficacy and safety of these vaccines in patients with immune-mediated inflammatory diseases (IMIDs) are still lacking. Moreover, the limited availability of these vaccines requires prioritizing some vulnerable categories of patients compared to others. In this position paper, we propose the point of view about the management of COVID-19 vaccination from Italian experts on IMIDs and the identification of high-risk groups according to the different diseases and their chronic therapy.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/complicações , COVID-19/prevenção & controle , Doenças do Sistema Imunitário/virologia , Vacinação/métodos , Diabetes Mellitus/imunologia , Diabetes Mellitus/virologia , Europa (Continente) , Prova Pericial , Glomerulonefrite/complicações , Glomerulonefrite/imunologia , Glomerulonefrite/virologia , Humanos , Inflamação/imunologia , Inflamação/virologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/virologia , Pneumopatias/complicações , Pneumopatias/imunologia , Pneumopatias/virologia , Pandemias/prevenção & controle , Doenças Reumáticas/complicações , Doenças Reumáticas/imunologia , Doenças Reumáticas/virologia , Dermatopatias/complicações , Dermatopatias/imunologia , Dermatopatias/virologia , Uveíte/complicações , Uveíte/imunologia , Uveíte/virologia
16.
Medicina (Kaunas) ; 57(3)2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33799854

RESUMO

Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.


Assuntos
Injúria Renal Aguda/patologia , COVID-19/patologia , Glomerulonefrite/patologia , Rim/patologia , Microangiopatias Trombóticas/patologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/imunologia , Imunidade Adaptativa/imunologia , Arteriosclerose/imunologia , Arteriosclerose/patologia , COVID-19/sangue , COVID-19/imunologia , Citocinas/imunologia , Glomerulonefrite/imunologia , Glomerulonefrite por IGA/imunologia , Glomerulonefrite por IGA/patologia , Glomerulosclerose Segmentar e Focal/imunologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Imunidade Inata/imunologia , Infarto/imunologia , Infarto/patologia , Rim/irrigação sanguínea , Rim/imunologia , Necrose do Córtex Renal/imunologia , Necrose do Córtex Renal/patologia , Nefrite Intersticial/imunologia , Nefrite Intersticial/patologia , Nefrose Lipoide/imunologia , Nefrose Lipoide/patologia , Rabdomiólise , SARS-CoV-2 , Trombofilia/sangue , Microangiopatias Trombóticas/imunologia
17.
BMJ Case Rep ; 14(4)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846189

RESUMO

We describe a case of a 48-year-old woman who presented with acute respiratory failure due to diffuse alveolar haemorrhage and acute renal failure due to pauci-immune glomerulonephritis consistent with a new diagnosis of microscopic polyangiitis (MPA). The patient had a recent SARS-CoV-2 infection 6 weeks before MPA diagnosis and had stopped immunosuppression for her rheumatoid arthritis (RA) at that time. The patient was treated with pulse intravenous steroids, plasma exchange therapy and rituximab, which induced remission of her illness. This case highlights a timely dilemma of holding immunosuppression in a RA patient with low disease activity on combination therapy with SARS-CoV-2 infection, and the potential risk of developing an additional autoimmune disease, such as vasculitis, given their existing autoimmunity due to RA.


Assuntos
Artrite Reumatoide/tratamento farmacológico , COVID-19/complicações , Imunossupressores/administração & dosagem , Vasculite/etiologia , Suspensão de Tratamento , Injúria Renal Aguda , Artrite Reumatoide/complicações , Diagnóstico Diferencial , Feminino , Glomerulonefrite , Hemorragia , Humanos , Pneumopatias , Poliangiite Microscópica , Pessoa de Meia-Idade , Troca Plasmática , Indução de Remissão , Síndrome do Desconforto Respiratório , Rituximab/uso terapêutico
18.
J Med Case Rep ; 15(1): 186, 2021 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-33810799

RESUMO

BACKGROUND: Immune checkpoint inhibitors and mitogen-activated protein kinase inhibitors have become the standard of care in patients with advanced melanoma bearing V600 mutations. However, little is known about their nephrotoxicity. To date, only two cases of anti-glomerular basement membrane glomerulonephritis after exposure to checkpoint inhibitors have been documented. Herein, we report the first case of a patient with metastatic melanoma who developed linear Immunoglobulin G 3+, Immunoglobulin A 2+, kappa 2+, lambda 1+ anti-glomerular basement membrane glomerulonephritis with negative serology following treatment with checkpoint inhibitors and subsequently mitogen-activated protein kinase inhibitors. CASE PRESENTATION: A 58-year-old Caucasian male was referred to our outpatient nephrology clinic with acute kidney injury and proteinuria. He had received three cycles of ipilimumab and nivolumab for recurrent melanoma positive for the BRAF V600E mutation with metastasis to the lungs. Immunotherapy had been discontinued in the setting of severe adverse effects including dermatitis, colitis, and hepatitis. Because of persistent bilateral lung metastases and left pleural metastases, the patient had been initiated on dabrafenib and trametinib until his presentation to our clinic 6 months later. On presentation, his blood pressure was 172/89 mm/Hg and had 2+ edema bilaterally. His creatinine level was 2.4 mg/dL from a previous normal baseline with a urinary protein-to-creatinine ratio of 2 g/g. His urinalysis showed dysmorphic erythrocytes and red blood cell casts. Serologic testing was negative for antineutrophilic cytoplasmic antibodies, proteinase 3 antigen, myeloperoxidase, and anti-glomerular basement membrane antibody. Complement levels were normal. A renal biopsy showed focal crescentic (2 of 15 glomeruli with cellular crescents), proliferative, and sclerosing glomerulonephritis with diffuse linear staining of glomerular capillary loops dominant for IgG (3+), IgA (2+), kappa (2+), and lambda (1+) minimal changes. He was initiated on oral cyclophosphamide and pulse intravenous methylprednisolone followed by oral prednisone for 6 months, which stabilized his renal function until reinitiation of immunotherapy. CONCLUSIONS: Acute kidney injury is an increasingly reported adverse effect of both drug classes, mostly affecting the tubulointerstitial compartment and infrequently the glomerulus. Although the biologic effect of these drugs on immune cells is not entirely understood, it is possible that BRAF-induced podocyte injury in combination with direct T-cell-mediated glomerular injury facilitated by checkpoint inhibitors led to the unmasking of cryptic antigens, loss of self-tolerance, and autoimmunity. More importantly, we show that treatment with corticosteroids and cyclophosphamide was able to improve and stabilize our patient's renal function until the reinitiation of immunotherapy.


Assuntos
Doença Antimembrana Basal Glomerular , Glomerulonefrite , Melanoma , Autoanticorpos , Humanos , Inibidores de Checkpoint Imunológico , Masculino , Melanoma/tratamento farmacológico , Pessoa de Meia-Idade , Proteínas Quinases Ativadas por Mitógeno , Recidiva Local de Neoplasia
19.
BMJ Case Rep ; 14(4)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827879

RESUMO

Calciphylaxis is commonly associated with end-stage renal disease (ESRD) and renal transplant. We present a rare case of early onset calciphylaxis in a patient presenting with acute kidney injury (AKI) secondary to anti-glomerular basement membrane (anti-GBM) antibody disease. A 65-year-old obese Caucasian woman with type 2 diabetes mellitus and hypertension presented with a 1-month history of painless gross haematuria and worsening lower extremity oedema. Laboratory results indicated AKI and nephrotic-range proteinuria. Anti-glomerular antibodies were elevated. Renal biopsy revealed focal crescentic glomerulonephritis with linear capillary immunoglobulin G staining consistent with anti-GBM antibody disease. She was treated with haemodialysis, plasmapheresis, steroids, bumetanide and cyclophosphamide. Two months later, she developed necrotic lesions on bilateral thighs. Wound biopsy was consistent with calciphylaxis. This case highlights that calciphylaxis, usually seen in patients with chronic kidney disease or ESRD, can manifest in patients with AKI as well.


Assuntos
Injúria Renal Aguda , Doença Antimembrana Basal Glomerular , Calciofilaxia , Diabetes Mellitus Tipo 2 , Glomerulonefrite , Injúria Renal Aguda/etiologia , Idoso , Doença Antimembrana Basal Glomerular/complicações , Autoanticorpos , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Feminino , Hemorragia , Humanos , Pneumopatias
20.
Clin Exp Rheumatol ; 39 Suppl 129(2): 27-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886460

RESUMO

OBJECTIVES: We have recently described the frequency of Bowman's capsule (BC) rupture in a considerable subset of patients with antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN). Interestingly, recent reports established a better performance of glomerulocentric ANCA scoring systems after adding BC rupture to these classification systems, suggesting that characteristics of this lesion are independent from glomerular lesions. Since BC rupture may link glomerular damage to tubulointerstitial lesions via direct interaction with the surrounding interstitium, we here aimed to expand our current knowledge of this distinct lesion by a systematic description of tubulointerstitial lesions analogous to the Banff classification in association with the presence of BC rupture in ANCA GN. METHODS: A total number of 44 kidney biopsies with confirmed renal involvement of ANCA GN were retrospectively included between 2015 till 2020 in a single-centre observational study. RESULTS: We here show that presence of BC rupture was associated with severe deterioration of kidney function at disease onset, similar to previous findings regarding long-term renal survival. Furthermore, BC rupture in ANCA GN was associated with tubulointerstitial inflammation and ultrastructural analysis revealed direct cellular exchange between Bowman's space and the interstitium, potentially contributing to the observed deterioration of kidney function and worse renal outcome in ANCA GN. CONCLUSIONS: BC rupture is associated with renal outcome in ANCA GN, therefore underscoring the need for further studies with regard to the glomerular-tubulointerstitial interaction in this disease.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos , Glomerulonefrite , Cápsula Glomerular , Humanos , Inflamação , Rim , Estudos Retrospectivos
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