ABSTRACT
ABSTRACT Tubulointerstitial nephritis and uveitis syndrome is a rare and probably underdiagnosed condition. Renal and ocular manifestations may not occur simultaneously, making the diagnosis more difficult. Nephritis may be asymptomatic; therefore, renal function evaluation is essential for diagnosis. Urinary β2-microglobulin levels may be particularly useful. Uveitis, mostly anterior, nongranulomatous and bilateral, occurs usually after the onset of nephritis. Treatment includes corticosteroids and, eventually, other immunosuppressant agents. Renal disease is usually benign and resolves spontaneously or after treatment with systemic corticosteroids. Uveitis, however, may be chronic or recurrent. The authors described the cases of three pediatric patients diagnosed with tubulointerstitial nephritis and uveitis syndrome. The goal of this paper was to warn the medical community over the need to screen patients with uveitis for renal disease.
RESUMO A síndrome nefrite tubulointersticial e uveíte é uma doença rara, provavelmente subdiagnosticada. As manifestações renais e oculares podem não ocorrer simultaneamente, tornando o diagnóstico mais difícil. A nefrite é geralmente assintomática, tornando fundamental a avaliação da função renal em doentes com uveíte. O doseamento da excreção urinária de β2-microglobulina é particularmente útil para o diagnóstico. A uveíte, tipicamente anterior, não granulomatosa e bilateral, manifesta-se após a nefrite na maioria dos casos. O tratamento inclui corticoides e, por vezes, outros imunossupressores. A doença renal tem evolução benigna, resolvendo-se espontaneamente ou com terapêutica com corticoides sistêmicos na maioria dos casos, no entanto, a uveíte pode ser crônica ou recorrente. Os autores descrevem três casos de síndrome nefrite tubulointersticial e uveíte, diagnosticados em idade pediátrica, e pretendem alertar para a necessidade de pesquisar sempre alterações renais nos doentes com uveíte.
Subject(s)
Humans , Female , Child , Adolescent , Uveitis/diagnosis , Uveitis/drug therapy , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/drug therapyABSTRACT
Resumen Introducción: La nefritis tubulointersticial aguda (NTIA) es infrecuente en la edad pediátrica. Se caracteriza por la infiltración del parénquima renal por células mononucleares y/o polinucleares con afectación secundaria de los túbulos sin lesión glomerular, y puede ser producida por infecciones, enfermedades inmunológicas, fármacos, o ser de origen idiopático. Objetivo: Describir un caso de NTIA secundario a antiinflamatorios no esteroidales (AINE) en un lactante, con énfasis en esta aso ciación para ser considerada por los pediatras. Caso clínico: Lactante de 10 meses, sin antecedentes previos, trasladada a nuestro hospital por daño renal agudo estadio 3, clasificación KDIGO 2012. Los tres días previos recibió tratamiento con amoxicilina e ibuprofeno por otitis media aguda. En la exploración física destacaba leve edema palpebral con presión arterial normal. En la orina presentaba proteinuria no nefrótica con componente tubular, microhematuria y leucocituria. La ecografía renal no mostraba alteraciones. Ante la sospecha de NTIA se cambió el antibiótico a cefotaxima intrave nosa y se suspendió el ibuprofeno realizándose manejo conservador del daño renal agudo. Presentó aumento de la creatinina (4.14 mg/dL) y eosinofilia, siendo el estudio inmunológico negativo. Se trató con metilprednisolona, con normalización de la función renal. Conclusión: La NTIA se puede producir por cualquier medicamento mediante una reacción inmunológica idiosincrásica. Entre los medicamentos responsables se identifican fármacos de uso frecuente en la edad pediátrica, como los AINEs, por lo que se necesita una alta sospecha diagnóstica por parte de los pediatras.
Abstract Introduction: Acute tubulointerstitial nephritis (ATIN) is a rare entity in the pediatric age. It is de fined by the infiltration of the renal parenchyma by mononuclear and/or polynuclear cells with se condary involvement of the tubules, without glomerular injury. It can be triggered by infections or immunological diseases, drugs like NSAIDs or be of idiopathic origin. Objective: To raise awareness among pediatricians about the prescription of NSAIDs, especially to patients of less than a year old, since they can provoke renal damage. Case report: A ten month old child, with no nephrological an tecedents of interest, was transferred to our hospital due to acute renal failure stage 3 KDIGO 2012. The three previous days received treatment with amoxicillin and ibuprofen for acute otitis media. Physical examination revealed mild eyelid edema with normal blood pressure. In the urine analysis, there were non-nephrotic proteinuria with tubular component, microhematuria and leukocyturia. Renal ultrasound showed no abnormalities. ATIN was suspected and so the antibiotic was changed to intravenous cefotaxime and ibuprofen was discontinued, opting for conservative management of acute renal damage. There was an increase in the number of creatinine up to 4.14 mg/dL and eosinophilia, with the immunological study being negative. Treatment with methylprednisolone was initiated, achieving normalization of renal function. Discussion: NTIA can be produced by any me dication through an idiosyncratic immune reaction. Among the responsible drugs, there are ones commonly used in the pediatric age, such as NSAIDs. Therefore, the pediatricians should pay special attention during prescriptions and have a high diagnostic suspicion of this disease.
Subject(s)
Humans , Female , Infant , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Ibuprofen/adverse effects , Acute Kidney Injury/chemically induced , Nephritis, Interstitial/chemically induced , Acute Kidney Injury/diagnosis , Nephritis, Interstitial/diagnosisSubject(s)
Humans , Female , Adult , Young Adult , Lupus Nephritis/diagnosis , Nephritis, Interstitial/diagnosis , Nephrotic Syndrome/diagnosis , Blood Pressure , Lupus Nephritis/pathology , Serum Albumin/analysis , Blood Proteins/analysis , Image-Guided Biopsy , Kidney Glomerulus/pathology , Nephritis, Hereditary/diagnosis , Nephritis, Hereditary/genetics , Nephritis, Interstitial/pathology , Nephrotic Syndrome/pathologyABSTRACT
IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease.
Subject(s)
Humans , Male , Middle Aged , Autoimmune Diseases/complications , Immunoglobulin G , Hemoptysis/etiology , Nephritis, Interstitial/complications , Nephritis, Interstitial/diagnosis , Recurrence , Autoimmune Diseases/diagnosis , Diagnosis, Differential , Hemoptysis/diagnosisABSTRACT
La uveítis intermedia es una enfermedad ocular caracterizada por la inflamación de la úvea, principalmente el vítreo anterior, la retina periférica y la pars plana. Diversas etiologías de carácter infeccioso, inflamatorio sistémico y local pueden asociarse a dicho fenómeno. Un cuadro infrecuente es el síndrome de nefritis túbulo-intersticial aguda asociado a uveítis. Presentamos el caso de una mujer de 64 años con antecedente de tiroiditis de Hashimoto, que desarrolló pérdida brusca de la agudeza visual en contexto de falla renal aguda. Se trata de una paciente con nefritis túbulo-intersticial aguda asociada a uveítis.
Intermediate uveitis is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. It is a subset of uveitis where the vitreous is the major site of damage. It has been reported to be associated with many local and systemic inflammatory and infectious diseases. An infrequent cause is the tubulointerstitial nephritis and uveitis syndrome. We report a case of an acute visual acuity loss related with renal failure in a 64 years old woman with Hashimoto disease. It was an acute tubulointerstitial nephritis and uveitis syndrome case.
Subject(s)
Humans , Male , Female , Middle Aged , Uveitis/complications , Blindness/etiology , Nephritis, Interstitial/complications , Syndrome , Uveitis/diagnosis , Visual Acuity , Blindness/diagnostic imaging , Acute Disease , Ultrasonography , Hashimoto Disease , Nephritis, Interstitial/diagnosisABSTRACT
Resumo A Doença relacionada a IgG4 (IgG4RD) é um processo inflamatório recente de etiologia supostamente autoimune, que se caracteriza por níveis séricos elevados de IgG4, um denso infiltrado mononuclear rico em plasmócitos IgG4 positivos e fibrose estoriforme. A nefrite túbulo-intersticial é a manifestação renal mais comum, com diferentes graus de disfunção renal e achados clínicos variáveis. Aqui, os autores descrevem um novo caso de nefrite túbulo-intersticial associada a IgG4 (NTIgG4), e discutem critérios clínicos e patológicos. Paciente masculino, 72 anos, foi admitido no serviço hospitalar com queixa clínica de astenia, perda de força, emagrecimento e anosmia. A história prévia incluía Diabetes mellitus tipo 2. Os dados laboratoriais incluíam anemia normocrômica, proteinúria e elevação da creatinina. A ultrassonografia/tomografia computadorizada renal bilateral revelou um parênquima heterogêneo, com zonas densas e difusas irregulares, áreas de fibrose nos polos superiores e hidronefrose. A biópsia renal mostrou um infiltrado mononuclear intersticial denso, com mais de 50 plasmócitos por campo de grande aumento, áreas irregulares de fibrose fibroblástica e colagênica, tubulite focal e glomérulos normais. A imunofluorescência revelou deposição granular leve de IgG e C3c na membrana basal tubular. A imuno-histoquímica foi positiva para CD138, cadeias leves Kappa e lambda, e IgG4 (cerca de quarenta e cinco plasmócitos IgG4 positivos por campo de grande aumento). O nível sérico de IgG4 estava aumentado. O diagnóstico de NTIgG4 foi então estabelecido. O paciente recebeu corticoterapia e controle rigoroso da glicemia com insulina, com melhoria significativa dos sintomas e dos níveis de creatinina.
Abstract IgG4-related disease (IgG4RD) is a recent inflammatory process of supposed autoimmune etiology, which is characterized by elevated serum IgG4 levels, dense lymphoplasmacytic infiltration rich in IgG4-positive plasma cells and storiform fibrosis. Tubulointerstitial nephritis is the most common renal manifestation, with different degrees of kidney dysfunction and variable clinical findings. Herein, the authors describe a new case of IgG4 tubulointerstitial nephritis (IgG4TN), and discuss clinic and pathologic criteria. Male patient, 72 years-old, was admitted on hospital service with clinical complaint of asthenia, loss of strength, emaciation, and anosmia. Previous history included type 2 diabetes mellitus. Laboratorial data included normochromic anemia, proteinuria, and creatinine elevation. Bilateral kidney ultrassonography/computed tomography revealed a heterogenous parenchyma, with diffuse irregular dense zones, areas of fibrosis on upper poles, and hydronephrosys. Kidney biopsy showed a dense interstitial lymphoplasmacytic infiltrate, with more than 50 plasma cell per high power field, irregular areas of fibroblastic and collagenous fibrosis, focal tubulitis, and normal glomeruli. Immunofluorescence revealed mild granular deposition of C3c and IgG in the tubular basement membrane. Immunohistochemestry was positive for CD138, lambda and Kappa light chains, and IgG4 (around forty five IgG4 positive plasma cells per high power field). IgG4 serum level was increased. The diagnosis of IgG4TN was then established. The patient received corticotherapy and strict control of glycemia with insulin, with marked improvement of symptoms and creatinine levels.
Subject(s)
Humans , Male , Aged , Immunoglobulin G , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/immunology , BrazilABSTRACT
Resumo Introdução: A síndrome nefrite tubulointersticial e uveíte (síndrome TINU) é uma entidade clínica incomum e a maioria dos pacientes são adolescentes e mulheres jovens. O caso relatado a seguir refere-se a uma paciente idosa com manifestações oftalmológicas que antecederam às renais, sendo provavelmente o primeiro caso descrito no Brasil. Relato de Caso: Paciente feminina, 60 anos, procurou atendimento médico por queixa de "olhos vermelhos". Três meses após o primeiro episódio do quadro ocular, a paciente cursou com sintomas sistêmicos e disfunção renal. A biópsia renal evidenciou nefrite tubulointersticial com sinais de atividade. Discussão: A fisiopatologia da síndrome TINU permanece pouco entendida, provavelmente envolvendo a imunidade celular e humoral. Essa síndrome pode ser diferenciada de condições sistêmicas associadas à uveíte e à nefrite, sendo necessária a exclusão de outras doenças antes de se confirmar seu diagnóstico, especialmente na presença de achados oftalmológicos. Conclusão: A suspeição clínica e o conhecimento do manejo desta patologia por nefrologistas, internistas e oftalmologistas são mandatórios no tratamento do paciente com Síndrome TINU.
Abstract Introduction: Tubulointerstitial nephritis and uveitis syndrome (TINU Syndrome) is an uncommon clinical entity, and the majority of patients are adolescents and young women. The case reported refers to an elderly patient with ophthalmologic symptoms detected earlier than kidney manifestations, being probably the first case described in Brazil. Case Report: Female patient, 60 years-old, sought medical attention for complaints of "red eye". Three months after the first episode of eye manifestation, the patient presented with systemic symptoms and renal dysfunction. Renal biopsy showed tubulointerstitial nephritis with signs of activity. Discussion: The pathophysiology of TINU Syndrome remains poorly understood, probably involving both cellular and humoral immunity. This syndrome can be differentiated from systemic conditions associated with nephritis and uveitis, and prior exclusion of other diseases is necessary to confirm diagnosis, especially in the presence of ophthalmologic findings. Conclusion: The clinical suspicion and the knowledge of the management of the disease by nephrologists, internists and ophthalmologists is mandatory in the treatment of patients with TINU Syndrome.
Subject(s)
Humans , Female , Middle Aged , Uveitis/diagnosis , Nephritis, Interstitial/diagnosis , Syndrome , Brazil , Kidney/physiopathologyABSTRACT
INTRODUCCIÓN: la fracción de excreción de los electrólitos puede constituir un marcador temprano de daño renal en las glomerulopatías. OBJETIVO: identificar la posible relación existente entre variables clínicas, fracción de excreción de magnesio y estado del túbulo-intersticio, en pacientes con proteinuria nefrótica a los que se les realizó biopsia renal en el Instituto de Nefrología entre abril de 2012 y junio de 2013. MÉTODOS: se realizó un estudio observacional analítico, transversal, en el que se excluyeron los pacientes con factores que modificaran la fracción de excreción de magnesio. A los 40 pacientes incluidos en el estudio se les recogieron datos antropométricos, demográficos y clínicos, se les midió la fracción de excreción de magnesio, se les practicó biopsia renal y se les cuantificó el porcentaje de fibrosis con el programa Image J. La información fue procesada mediante el paquete estadístico SPSS 15.0. Se utilizó la técnica estadística de análisis de distribución de frecuencias, en las variables cuantitativas se calcularon estadígrafos descriptivos. Fueron empleados los tests de Wilcoxon, de Kruskal Wallis y el coeficiente de correlación de Spearman's-rho, en las pruebas de hipótesis. RESULTADOS: se encontró correlación estadísticamente significativa de la fibrosis intersticial con la fracción de excreción de magnesio (rsp= 0,37, p= 0,02) y con la tasa de filtración glomerular (rsp= -0,56, p= 0,00). No fue encontrada asociación de la fracción de excreción de magnesio con el empleo de medicamentos, ni con el antecedente de hipertensión arterial. CONCLUSIÓN: la fibrosis intersticial se relaciona con la fracción de excreción de magnesio y con la tasa de filtración glomerular en pacientes con proteinuria nefrótica.
INTRODUCTION: fractional excretion of electrolytes can be used as an early marker of renal damage in glomerulopathies. OBJECTIVE: to identify the possible relationship between some clinical variables, the fractional excretion of magnesium and the tubulointerstitial status in patients with nephrotic proteinuria assisted at The National Institute of Nephrology from April 2012 to June 2013. METHODS: an observational analytical study was conducted. Patients with conditions that modify the fractional excretion of magnesium were excluded. 40 patients were included in this study at the Institute of Nephrology from April 2012 until June 2013, and their demographic, anthropometric and clinical data were collected; the fractional excretion of magnesium was measured as well. Renal biopsies were practiced to all patients and the percent of fibrosis was measured with the aid of image J program. Data were processed with Statistical package for Social Science (SPSS) version 15.0. The statistical technique of frequency distribution analysis was used; quantitative variables descriptive statistics were calculated. Wilcoxon tests, Kruskal Wallis and correlation coefficient Spearman's- rho were used in hypothesis tests. RESULTS: the percent of interstitial fibrosis was related to fractional excretion of magnesium (rsp= 0,37, p= 0,02) and glomerular filtration rate (rsp= -0,56, p= 0,00). No association of the fractional excretion of magnesium with the use of drugs or with history of hypertension was found. CONCLUSIONS: tubulointerstitial fibrosis is related to the fractional excretion of magnesium and glomerular filtration rate in patients with nephrotic proteinuria.
Subject(s)
Humans , Proteinuria/pathology , Magnesium , Nephritis, Interstitial/diagnosis , Nephrotic Syndrome/diagnosis , Modalities, Secretion and ExcretionABSTRACT
Infliximab is a chimeric anti-tumor necrosis factor-alpha monoclonal antibody. Infusion related reactions and infection are well known side effects of infliximab; however, renal complications have not been well recognized. We report on a patient with late onset-acute tubulointerstitial nephritis (ATIN) after treatment with infliximab and mesalazine for Crohn's disease. A 25-year-old woman was admitted with a purpuric rash on both lower extremities and arthralgia. She had been diagnosed with Crohn's disease 5.6 years previously and had been treated with mesalazine and infliximab. Serum creatinine level, last measured one year ago, was elevated from 0.6 mg/dL to 1.9 mg/dL. Results of urinalysis, ultrasound, and serologic examinations were normal. With a tentative diagnosis of Henoch-Schonlein purpura, oral prednisolone was given, and serum creatinine decreased to 1.46 mg/dL, but was elevated to 2.6 mg/dL again at two months after discontinuation of prednisolone. Renal biopsy indicated that ATIN was probably induced by drug, considering significant infiltration of eosinophils. Concomitant use of infliximab with mesalazine was supposed to trigger ATIN. Oral prednisolone was administered, and serum creatinine level showed partial recovery. Thus, ATIN should be suspected as a cause of renal impairment in Crohn's disease even after a long period of maintenance treatment with infliximab and mesalazine.
Subject(s)
Female , Humans , Adalimumab/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Creatine/blood , Crohn Disease/drug therapy , Drug Therapy, Combination , Eosinophils/immunology , Infliximab/adverse effects , Kidney/pathology , Mesalamine/adverse effects , Nephritis, Interstitial/diagnosis , Prednisolone/therapeutic useABSTRACT
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease entity usually occurring in children. In the present study a case of TINU syndrome in an elderly patient is described and relevant literature is reviewed. A 61-year-old man presented with bilateral flank pain, urinary frequency, and foamy urine. A kidney ultrasonography revealed an increase in kidney parenchyma echogenicity. Following a kidney biopsy, the patient was diagnosed with acute tubulointerstitial nephritis. An ophthalmology examination initially performed for floater symptoms, revealed anterior uveitis in both eyes. Acute tubulointerstitial nephritis and anterior uveitis in both eyes responded to treatment with oral prednisolone, furosemide, carvedilol, and a topical steroid. TINU syndrome can occur in the elderly and should be part of the differential diagnosis when seeing a patient who has uveitis in association with renal disease; any therapy should be managed by both an internist and an ophthalmologist.
Subject(s)
Humans , Male , Middle Aged , Biopsy , Diagnosis, Differential , Glucocorticoids/therapeutic use , Nephritis, Interstitial/diagnosis , Uveitis/diagnosisABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Cytomegalovirus Infections/diagnosis , Graft Rejection/diagnosis , Kidney Transplantation/adverse effects , Nephritis, Interstitial/diagnosis , Ureteral Obstruction/diagnosisABSTRACT
We report a case of acute tubulointerstitial nephritis and uveitis syndrome (TINU syndrome) in an elderly Indian woman. TINU is one of the rare causes of acute tubulo interstitial nephritis and is likely to be missed as there is often temporal gap between the appearance of the renal and ocular manifestations. ©
Subject(s)
Female , Humans , Middle Aged , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/therapy , Syndrome , Uveitis/diagnosis , Uveitis/therapyABSTRACT
The acute interstitial nephritis is an important cause of acute renal failure and even the cause could be idiopathic, the most important cause is asociaded to the use of drugs, immunological disorders, neoplasic disease or infections. Clinical features are essentially those of acute renal failure form any cause, and apart from a history of new illness or medication exposure, there are no specific history, physical examination, or laboratory findings that distinguish acute interstitial nephritis from other causes of acute renal failure. Classic finding of fever, rash, and arthralgias may be absent in up to two thirds patients. The AIN associated to drugs could present symptoms days ore even months after the intake. Renal biopsy is the only definitive method of establishing the diagnosis of AIN; this step usually is undertaken when the diagnosis is unclear and there are no contraindications for the procedure, or when the patient does not improve clinically following discontinuation of the medication suspected as the cause of AIN and renal. Others laboratory features are used to provide suggestive evidence of AIN, to guide conservative management, or to permit empiric treatment with steroid. Unfortunately, none o these test have sufficient predictive value to be diagnostically reliable. The most important treatment in drugs induced AIN is the removal of an offending agent or medication. Corticosteroids appear to provide some benefit in terms of clinical improvement and return of renal function, but no controlled clinical trials have been conducted to confirm this.
La Nefritis Intersticial Aguda (NIA) es una importante causa de insuficiencia renal aguda y, aunque puede ser idiopática, las causas más asociadas son el uso de drogas, desórdenes inmunológicos o neoplasias e infecciones. La presentación clínica es principalmente la sintomatología de la insuficiencia renal y aguda de cualquier causa, y aparte de la historia de una nueva enfermedad o la ingesta de drogas, no existen datos específicos en la anamnesis o al examen físico o exámenes de laboratorio que permitan distinguir entre NIA y otras causas de insuficiencia renal aguda. La presentación clásica de fiebre, rash y artralgia puede estar ausente en más de 2/3 de los pacientes. La NIA asociada a medicamentos puede presentar síntomas días o meses luego de la ingesta. La biopsia renal es el único método definitivo para realizar el diagnóstico de NIA, la cual se realiza habitualmente cuando la causa del cuadro clínico no es clara y no existen contraindicaciones para el procedimiento o cuando la evolución no es la esperada a pesar de suspender el agente causal. Otros hallazgos de laboratorio son usados para sospechar una NIA y permitir un tratamiento conservador y el tratamiento empírico con corticoides. Lamentablemente ninguno de estos exámenes tiene un valor predictivo que permitan un diagnóstico confiable. El principal tratamiento de la NIA inducida por medicamentos es la suspensión de la droga que se sospecha como probable causa. Aparentemente los corticoides producirían una mejoría el cuadro clínico y mejorarían la función renal, pero no existen ensayos clínicos controlados que apoyen esto.
Subject(s)
Humans , Adult , Acute Kidney Injury , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/therapy , Diagnosis, Differential , PrevalenceSubject(s)
Adult , Anemia, Aplastic/diagnosis , Antitubercular Agents/adverse effects , Colitis, Ischemic/etiology , Cryptosporidiosis/diagnosis , Fatal Outcome , Humans , Male , Nephritis, Interstitial/diagnosis , Nocardia Infections/diagnosis , Rifampin/adverse effects , Superinfection/diagnosis , Tuberculosis, Pulmonary/complicationsABSTRACT
Senior-Loken syndrome is a rare entity that combines familial juvenile nephronophthisis with retinal dystrophy. The eye disease may be congenital amaurosis of Leber type or pigmentary retinal degeneration and electroretinogram (ERG) helps in the diagnosis of these varieties. The disease progresses inexorably to chronic renal failure. Here is a case of twins with Senior-Loken syndrome emphasizing the importance of ophthalmic examination in children with renal failure, for determining a correct diagnosis.
Subject(s)
Age of Onset , Child , Diseases in Twins , Female , Humans , Kidney Diseases, Cystic/diagnosis , Kidney Failure, Chronic/etiology , Nephritis, Hereditary/diagnosis , Nephritis, Interstitial/diagnosis , Retinitis Pigmentosa/diagnosis , SyndromeABSTRACT
Alterações morfológicas de 11 casos de cães com insuficiência renal foram caracterizadas e classificadas de acordo com os padrões estabelecidos pela Organização Mundial de Saúde para seres humanos. Glomerulonefrite esclerosante difusa foi diagnosticada em 82,0 por cento dos animais e nefrite intersticial crônica nos 18,0 por cento restantes. Os tipos e freqüência das lesões identificadas foram similares às encontradas na literatura para a insuficiência renal crônica.
Morphologic alterations of 11 cases of dogs with renal failure were characterized and classified according to the patterns established by the World Health Organization for human beings. Diffuse sclerosing glomerulonephritis was diagnosed in 82.0 percent of the animals and chronic interstitial nephritis in the remaining 18.0 percent. The types and frequencies of lesions were similar to the those noticed in the literature for chronic renal failure.
Subject(s)
Animals , Male , Female , Dogs , Glomerulonephritis/classification , Glomerulonephritis/diagnosis , Renal Insufficiency, Chronic/classification , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/veterinary , Nephritis, Interstitial/classification , Nephritis, Interstitial/diagnosisABSTRACT
BACKGROUND: Tubulointerstitial fibrosis is an index of clinical severity. FE Mg has been delineated to correlate directly with the magnitude of tubulointerstitial fibrosis in clinical setting of glomerulonephropathy. A correlation between FE Mg tubulointerstitial fibrosis has never been assessed in nephritis associated with systemic lupus erythematosus. MATERIAL AND METHOD: Thirty-six patients diagnosed of having lupus nephritis were included for the determination of renal functions namely creatinine clearance, FE Mg, urinary protein. Of these 36 patients, 18 patients were associated with intact tubulointerstitial structure (group I) and 18 age matched patients were associated with tubulointerstitial fibrosis (group II) RESULTS: The mean FE Mg observed in group I was 1.5 +/- 0.3 which differed significantly from that observed in group II; 2.6 +/- 1; p = 0.006. CCr, total urinary protein, systolic and diastolic pressure were not significantly different between the two groups. CONCLUSION: FE Mg is a sensitive marker for the detection of tubulointerstitial disease in lupus nephritis. It is useful in early screening of disease severity in systemic lupus erythematosus.