[MALT B cell lymphoma with kidney damage and monoclonal gammopathy: a case study and literature review]. / Linfoma de células B tipo MALT con afectación renal y gammapatía monoclonal: presentación de un caso y revisión de la literatura.

We report a case of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) involving the left kidney and simultaneous onset of a monoclonal gammopathy IgM kappa. No predisposing local inflammatory condition was identified. Following left nephrectomy, the renal specimen showed the centrocyte like cells and lymphoid cells in the lymphoepithelial lesions were positive for CD20 and CD79α. The neoplastic cells expressed monotypic cytoplasmic IgM kappa. The demonstration of bone marrow cells of B-lineage expressing the same monoclonal protein as the tumor suggested bone marrow involvement, even in the absence of identical morphology. Despite chemotherapy and rituximab treatment, clinical follow-up showed right kidney extension with high-grade transformation, and finally systemic dissemination. This case illustrates that the kidney is among the sites that may be involved by MALT B-cell lymphomas in a primary or secondary fashion, and the need for expanded investigation of the possible dissemination. We review the literature on this unusual extranodal lymphoma.

[Utility of cystatin-C in hospitalized patients. Comparing with different methods of assessing renal function]. / Utilidad de la cistatina-C en el ámbito hospitalario. Comparación con los distintos métodos de valoración renal.

Serum creatinine is the most widely use parameter to assessing renal function, even though limitations, some time is necessary measure 24 h creatinine clearance (CLcr), or estimate Cockroft-Gault (C-G) or MDRD formulas. Different methods can offer different results, and cause confusion in clinicians. Using Cystatin-C as new parameter of renal function could suppose an important improvement. The objective of our study was to compare the different methods from renal evaluation and establish the utility of cistatina-C in the hospital area. In the study were included 70 patients (44 men) selected of random way, predominate patients with kidney disease and diabetics, which was made CLcr and calculated C-G and MDRD formulas. The mean age of the patients was 66+/-14 years, mean weight 73+/-17 Kg, creatinine 2,14+/-1,77 mg/dL, cystatin-c 1,77+/-1,18 mg/L, CLcr 54,39+/-36,2 mL/min. The correlation of 1/Crea with the Clcr, C-G and MDRD formulas was respectively: 0,7735, 0.8269 and 0.9613, (p< 0.0001). The correlation of 1/Cist with the Clcr, C-G and MDRD was respectively: 0,836, 0.8142 and 0.832, (p<0,0001). By Bland-Altman graphs the average of the difference between CLcr with CG and MDRD was 2,8 mL/min and -1,5 mL/min respectively. Comparing CG with MDRD was 1,7 mL/min. The average of the observed absolute differences between CLcr with CG and MDRD was 13.5 mL/min and 17.1 mL/min respectively. Between this formulas the average was 12.5 mL/min. Statistically significant differences between the different methods from renal evaluation do not exist (p>0,05). In conclusion, most of the urine collections could be avoided with the use of the formulas. Cystatin-c is far beyond the creatinine, mainly to detect slight renal alteration (sensitivity 80,4% U.S. 44,7% in men) becoming a promising alternative, that could reduce considerably hidden renal insufficiency (non detected by creatinine), although more studies are needed to confirm.

Sequential development of pulmonary hemorrhage with MPO-ANCA complicating anti-glomerular basement membrane antibody-mediated glomerulonephritis.

We report a case of rapidly progressive glomerulonephritis caused by anti-glomerular basement membrane (anti-GBM) antibodies that progressed to end-stage renal disease in a 67-year-old woman with diabetes. Intensive combined immunosuppressive therapy with methylprednisolone bolus, oral prednisone, and cyclophosphamide led to negativity of anti-GBM antibodies but was not able to restore renal function. After 28 months of hemodialysis, the patient suddenly presented with pulmonary hemorrhage. In this setting, high levels of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) and negative anti-GBM antibodies were found. Therapy with oral prednisone and cyclophosphamide led to resolution of pulmonary hemorrhage and negativity of MPO-ANCA.

Left atrial calcification in a hemodialysis patient with cor triatriatum.

Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.

[Arterial hypertension and renal vascular disease: nephroangiosclerosis]. / Hipertensión arterial y enfermedad vascular renal: nefroangioesclerosis.

Nephroangiosclerosis and nephrosclerosis are terms used to define the renal disease induced by essential hypertension. The predominant histologic changes occur in the preglomerular microvasculature. Epidemiological data about the risk of hypertensive patients from developing renal failure offer conflicting results. Nevertheless, renal vascular disease, including nephroangiosclerosis and/or ischemic nephropathy, appears to be an important cause of end-stage renal disease. Presumably, nephrosclerosis is the renal expression of systemic atherosclerosis: male sex, age > 55-60 years, black race, high serum cholesterol and/or uric acid levels, and coronary heart disease, peripheral artery disease, and/or cerebrovascular disease are common associations with the renal alteration. Treatment strategy should include an intensive blood pressure control, probably below 130/80 mmHg, together with antiplatelet and lipid-lowering agents when necessary. Although specific studies are lacking, ACE inhibitors and angiotensin II antagonists may offer additional benefits in slowing the renal disease progression.

[Massive inferior vena cava thrombosis in a patient with autosomal dominant polycystic hepatorenal disease]. / Trombosis masiva de la vena cava inferior en un paciente con poliquistosis hepatorrenal autosómica dominante.

We report a 68-year-old man with autosomal dominant polycystic kidney disease, who developed multiple venous thromboses (inferior vena cava, left renal vein and iliofemoral veins) caused by local compression of the intrahepatic inferior vena cava by hepatic cysts. To our knowledge this is the first reported case of inferior vena cava thrombosis caused by hepatic cysts compression. Doppler ultrasound, computed tomography, and magnetic resonance imaging were effective in documenting the venous thromboses and the underlying lesions non-invasively. Long-term anticoagulation was an efficient and safe treatment.

Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis.

We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol.

Control of cytomegalovirus disease in renal transplant patients treated with prednisone, azathioprine and cyclosporine using intensive monitoring and decreased immunosuppression.

BACKGROUND: The aim of this trial was to study the effectiveness of intensive monitoring, together with an early decrease in immunosuppression, in reducing the prevalence of CMV disease in renal transplant recipients treated with prednisone, azathioprine and cyclosporine. METHODS: From 1/95 to 11/97 a prospective, longitudinal study was conducted among 146 consecutive, unselected, renal transplant patients in our unit. Only 96 patients whose immunosuppressive regimens consisted of prednisone, azathioprine and cyclosporine and whose follow-up period was greater than 4 months were included in the study. Preemptive therapy was administered to 27 high-risk patients. CMV antigenemia (CMV-AG) and other virological tests were performed weekly for the first 4 posttransplant months. The immunosuppression was decreased when the first positive CMV-AG was detected. Azathioprine was completely withdrawn when the CMV-AG count was greater than 10 cells per 10(5) PBLs. The cyclosporine dose was gradually decreased in the next 4 weeks, but it was not withdrawn in any patient. The prednisone dose was modified according to the immunosuppressive protocol. RESULTS: 53% (51/96) of the patients had positive CMV-AG on at least one occasion. The dose of azathioprine was decreased after CMV-AG detection in 41/51 (80.4%) patients and it was completely withdrawn in 23 of these (45%). The mean decrease in the dose of azathioprine was 73 +/- 31 (25-175) mg, a mean percentage decrease of 76 +/- 27% (25-100%). The dose of cyclosporine was progressively decreased during the 4 weeks after detection of the first CMV-AG (mean cyclosporine levels: 210 +/- 66, 196 +/- 54 and 164 +/- 36 ng/ml at the time of first CMV-AG detection, 2 and 4 weeks respectively, p < 0.0001, repeated measures analysis of variance). None of the 45 patients without CMV-AG and only 2 of 51 (3.9%) patients with CMV-AG developed symptomatic CMV disease (2% of the total). CMV disease was of moderate intensity in both patients. Only 3/51 (5.8%) patients developed acute rejection after the first CMV-AG detection in the 4 posttransplant months. CONCLUSION: The results of this study suggest that intensive monitoring and an early reduction of immunosuppression, together with preemptive therapy in high-risk patients, is effective in diminishing the prevalence and severity of CMV disease.