Daño hepatocelular, proteinuria y autoinmunidad: ¿enfermedad multisistémica o coincidencia de enfermedades? Caso clínico / Hepatocellular damage, proteinuria and autoimmunity: multisystemic disorder or coexistence of diseases?

We report a 19 years old male presenting with knee pain, elevated liver enzymes and proteinuria. Further investigation found positive antinuclear and anti-smooth muscle antibodies and a liver biopsy revealed the presence of an autoimmune hepatitis. Treatment with corticosteroids and azathioprine was started, resulting in normalization of liver enzymes but proteinuria persisted and a kidney biopsy disclosed a focal segmental glomerulosclerosis. The use of lisinopril resulted in a significative reduction of proteinuria and, after 30 months of follow up, he continues with azathioprine, lisinopril and a low prednisone dose without evidence of liver or kidney disease activity.

Immunoexpression of gelatinase and apolipoprotein E in induced glomerulosclerosis in adult male albino rat

Introduction: The abnormal expressions of gelatinase are implicated in the pathogenesis of extracellular matrix accumulation in glomerulosclerosis [GS]. Apolipoprotein E [apoE] is an important plasma protein in cholesterol that plays a key role in the progression of GS

Aim: The aim of this work was to study the immunoexpression of gelatinases and apoE in experimentally induced GS

Materials and methods: Twenty male rats were divided into two equal groups: a control group and a GS model group [each n=10]. The GS was induced by an injection of adriamycin [5 mg/kg]. At the end of 4 weeks, the 10 rats in each group were killed and kidney specimens were processed for [histological and immunohistochemical study] biochemical studies

Results: Serum total protein and serum albumin in the GS group were reduced compared with those of the control group [P<0.01]. Compared with the control group, the values of 24-h urine total protein, 24-h urine excretion for albumin, blood urea nitrogen, serum creatinine, and GS index in the GS group were significantly increased [P<0.01]. In the GS group, there was glomerular hypercellularity and hypertrophy with focal obliteration of some capillaries. Interstitial fibrosis and inflammation were detected. The immunostaining for gelatinase was decreased, whereas apoE, transforming growth factor-beta1, and alpha-smooth muscle actin were increased

Conclusion: In induced GS, an increased expression of apoE was associated with decreased expression of gelatinase and this led to accumulation of extracellular material in glomeruli

Schistosomal glomerulopathy and changes in the distribution of histological patterns of glomerular diseases in Bahia, Brazil

Distinct patterns of glomerular lesions, including membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis, are associated with infection by Schistosoma mansoni or Schistosoma japonicum. Evidence suggests that immune complex deposition is the main mechanism underlying the different forms of schistosomal glomerulonephritis and that immune complex deposition may be intensified by portal hypertension. The relationship between focal segmental glomerulosclerosis and schistosomiasis remains poorly understood. A clinicopathologic classification of schistosomal glomerulopathies was proposed in 1992 by the African Association of Nephrology. In Brazil, mass treatment with oral medications has led to a decrease in the occurrence of schistosomal glomerulopathy. In a survey of renal biopsies performed in Salvador, Brazil, from 2003-2009, only 24 (4 percent) patients were identified as positive for S. mansoni infection. Among these patients, only one had the hepatosplenic form of the disease. Focal segmental glomerulosclerosis was found in seven patients and membranoproliferative glomerulonephritis was found in four patients. Although retrospective studies on the prevalence of renal diseases based on kidney biopsies may be influenced by many patient selection biases, a change in the distribution of glomerulopathies associated with nephrotic syndrome was observed along with a decline in the occurrence of severe forms of schistosomiasis.