Progress on the roles of adipokines in sepsis organ injury / 中国小儿急救医学

Sepsis is a serious life-threatening organ dysfunction disease caused by the body′s response to infection, which is the main cause of death in patients admitted to ICU.The occurrence, development and prognosis of sepsis are closely related to metabolism and regulation of inflammatory response.Adipose tissue not only participates in energy storage and metabolism, but also, as an important endocrine organ, secretes a variety of adipokines with pro-inflammatory or anti-inflammatory activities, and thus participates in the occurrence and development of sepsis.There are many kinds of adipokines, and different adipokines play different roles in sepsis and sepsis-related organ damage.Some adipokines such as adiponectin, adipokine complement Clq/tumor necrosis factor-associated protein 3, vaspin, irisin and Apelin are closely related with the pathogenesis and prognosis of organ injury in sepsis.

Nefropatía C1q en un paciente de 17 años: caso clínico / C1q nephropathy: report ofone case

Clq nephropathy (Clq N) is an infrequent disease and only about 100 cases have been reponed. It is defined by a pattern of immunofluorescense (IF) with dominant or co-dominant complement Clq with electrondense deposits in the mesangium, without clinical or serological features of Lupus Nephritis. The most common histopathological findings of ClqN are focal segmental glomerulosclerosis and Minimal Change Disease. We repon a 17 year-old male patient with an isolated selective proteinuría found in a routine study. He had normal renal function and uriñe culture was negative. Serum lipids, liver enzymes an complement were all normal. Serum antinuclear and anti-DNA antibodies, antineutrophil cytoplasmic antibodies (ANCA), HIV, Hepatitis B and C serology, were negative. Renal and abdominal ultrasonography was normal. The histopathological study revealed segmental glomerular sderosis, modérate increase of mesangial matrix, Bowmann capsule adhesions and fucsinophil deposits in mesangium. The IF was positive (dominant) for Clq (+++) and IgA, IgG, IgM, C3++, all of them with a granular mesangial distribution. Ultrastructural findings were pedicelar effacement and paramesangial electrondense deposits. Tubular reticular inclusions (TRI) were not found. Remission of proteinuría was reached after 18 months of treatment with enalapril and losartan. The patient remains with normal renal function. Clinical findings, negative serology for Lupus, light microscopy IFwith dominant positivity for Clq, absence of TRI and paramesangial electrondense deposits in electron microscopy lead us to the diagnosis of ClqN. A poor response to steroid therapy was described in ClqN. Thus it was worthwhile to differentiate it from lupus nephritis, that is responsive to steroids.