ABSTRACT
Nephrotic syndrome is the most common clinical presentation of glomerular disease in elderly patients, and renal biopsy is an important diagnostic resource. The aim of this study was to describe nephrotic syndrome among elderly patients in Brazil, focusing on tubulointerstitial and vascular involvement. This was a retrospective study of patients over 65 years of age with nephrotic syndrome who underwent renal biopsy between January 2012 and December 2019. Of the 123 renal biopsies that occurred during the study period, 44 (35.8%) were performed for the investigation of nephrotic syndrome. Among those 44 cases, the main etiologies were membranous nephropathy in 13 cases (29.5%), amyloidosis in ten (22.7%), non-collapsing focal segmental glomerulosclerosis (FSGS) in four (9.1%), and collapsing FSGS in four (9.1%). Patients with minimal change disease (MCD) had the lowest degree of interstitial fibrosis compared with the other glomerulopathies, and histological signs of acute tubular necrosis (ATN) were less common among those with amyloidosis than among those with membranous nephropathy, FSGS, or MCD (P=0.0077). Of the patients with ATN, the frequency of acute kidney injury (AKI) was highest in those with MCD (P<0.001). All patients had some degree of vascular involvement, regardless of the type of glomerulopathy. In conclusion, the second most common cause of nephrotic syndrome in this population was amyloidosis, and acute interstitial tubule involvement was more marked in MCD. Vascular involvement is something that cannot be dissociated from the age of the patient and is not only due to the underlying glomerulopathy.
ABSTRACT
Glomerular crescents were analyzed as a prognostic factor in retrospectively reviewed data from 144 patients with biopsy-proven IgA nephropathy. Crescents were found in 26 (18 percent) patients, and detected in 2 to 100 percent of glomeruli in each specimen. In 5 percent of the patients more than 50 percent of the glomeruli were affected. Thirty patients with IgA nephropathy without crescents were studied as a control group. Mean age was 30.3 ± 9.4 and 30.2 ± 12.0 years for the patients with and without crescents, respectively, and males prevailed in both groups. The length of follow-up was 23.2 ± 41.6 months for patients with crescents and 29.3 ± 35.3 months for patients without crescents. Eighty percent of the patients with crescents were hypertensive, compared to 27 percent of the non-crescent control group (P < 0.05). Mean serum creatinine at the time of diagnosis was 3.9 ± 2.9 and 1.9 ± 2.1 mg/dl for the patients with and without crescents, respectively. Initial urinary protein excretion was higher in patients with crescents (4.6 ± 3.5 vs 1.2 ± 0.9 g/day; P < 0.05). At the end of follow-up 17 patients (77.3 percent) from the crescent group and 3 (11.1 percent) from the non-crescent group had end-stage renal disease (P < 0.0001). The presence of crescents was associated with higher levels of initial serum creatinine and urinary protein excretion, and a higher frequency of hypertension and progression to end-stage renal disease.
Subject(s)
Humans , Male , Female , Glomerulonephritis, IGA , Kidney Failure, Chronic , Kidney Glomerulus , Biomarkers , Case-Control Studies , Creatinine/blood , Follow-Up Studies , Hypertension , Prognosis , Proteinuria , Retrospective StudiesABSTRACT
Objetivo: A nefropatia primária da IgA (NIgA) e adeficiência de IgA (DIgA) constituem as formas maiscomuns de glomerulonefrite e de deficiência primáriade anticorpos, respectivamente, despertando interesseespecial o fato de ambas envolverem distúrbios contrastantes da produção da IgA. O objetivo deste trabalho foi comparar os níveis de citocinas possivelmente implicadas na produção da IgA (IL-4, IL-5, IL-6, IL-10) em pacientes com NIgA ou DIgA. Casuística e Métodos: Foram estudados 18 pacientes com NIgA (hematúria microscópica e proteinúria persistente ou intermitente e biópsia renal percutânea com depósito de IgA em mesângio glomerular detectado por imunofluorescência), sendo nove do gênero masculino e nove do feminino, com média de idade de 33,2 anos; 17 pacientes com DIgA (níveis séricos de IgA menores do que 7 mg/dL e níveis normais ou elevados de IgG e IgM), sendo 13 do gênero masculino e quatro do feminino, com média de idade de 25,5 anos; dez voluntários sadios (dois do gênero masculino e oito do feminino com média de idade de 30,7 anos). As citocinas foram quantificadas por método imunoenzimático em sobrenadante de cultura de PMBC após 48 horas de estímulo com fitohemaglutinina . Resultados: Foram observados: 1) níveis elevadosde IL-5 e de IL-10 e baixos de IL-6 em pacientes com NIgA em relação aos pacientes com DIgA e controlessadios; 2) níveis semelhantes de IL-4 em ambos gruposde pacientes e mais elevados na NIgA em comparaçãoaos controles sadios; 3) níveis similares de todasas citocinas testadas em pacientes com DIgA e controlessadios. Conclusões: Os níveis elevados de IL-5 encontrados na NIgA reforçam a importância desta citocina na síntese de IgA, cujos níveis séricos estão aumentados em aproximadamente 50 per cent dos casos; os níveis elevados de IL-4 e IL-5 encontrados nestes pacientes sugerem que estas duas citocinas possam estar envolvidas na glicosilação da IgA e seu conseqüente depósito em mesângio renal; os níveis elevados de IL-10 e baixos de IL-6 observados em pacientes com NIgA reforçam a hipótese de que a IL-10 esteja implicada na síntese da IgA em humanos e sugerem que esta citocina possa desempenhar um papel regulador sobre a produção deIL-6.
Subject(s)
Humans , Male , Female , Adult , Cytotoxicity Tests, Immunologic , Glomerulonephritis, IGA , In Vitro TechniquesABSTRACT
There are doubts about the presence of glycosuria and the progress of glomerular disease. Some reports suggest that glycosuria could be an index of a more severe tubulointerstitial lesion. We investigated the presence of glycosuria in 60 patients with primary glomerular diseases: 17 patients (28 percent) and glycosuria and 43 patients (72 percent) were glycosuria free. The two groups were similar in age, arterial pressure and sex. Serum creatinine was higher in patients with glycosuria (2.0 + 1.7 vs 1.3 + 0.9 mg/dl, P<0.05). The protein excretion rate was 7.5 + 3.7 vs 5.3 + 4.2g/day (P>0.05) in patients with and without glycosuria, respectively, while serum albumin was lower in patients with glycosuria (1.7 + 0.6 vs 2.7 + 1.0 g/dl, P<0.05). Several histological forms were present in the group with glycosuria, with membranous glomerulonephritis being the most frequent. Histological evidence of tubular atrophy and interstitial fibrosis prevailed in patients with glycosuria, suggesting a poor prognosis for these patients. We may conclude that the presence of glycosuria in patients with glomerular disease is associated with more pronounced tubular atrophy and interstitial fibrosis and therefore imply a poorer prognosis.