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1.
Chinese Acupuncture & Moxibustion ; (12): 1216-1220, 2021.
Article in Chinese | WPRIM | ID: wpr-921035

ABSTRACT

OBJECTIVE@#To compare the effect of moxibustion combined with basic treatment and simple basic treatment on the clinical symptoms, renal function and hypercoagulable state in patients with idiopathic membranous nephropathy (IMN) of low to medium risk with spleen-kidney deficiency and blood stasis.@*METHODS@#A total of 60 patients with IMN of low to medium risk with spleen-kidney deficiency and blood stasis were randomized into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 1 case dropped off). In the control group, the conventional basic treatment of anti-hypertension, regulating blood lipid and anti-coagulation was adopted. On the basis of the control group, moxibustion was applied at Shenshu (BL 23), Pishu (BL 20), Guanyuan (CV 4), Zusanli (ST 36) and Sanyinjiao (SP 6) in the observation group, once a day, 5 days a week continuously with 2 day interval. The treatment of 6 months was required in the both groups. Before treatment and 3 and 6 months into treatment, the total TCM syndrome score, the renal function indexes (24-hour urinary protein quantity [UTP], albumin [ALB], urea nitrogen [BUN] and creatinine [Scr]), the blood coagulation indexes (fibrinogen [FIB], D-Dimer [D-D], p-selection and von Willebrand factor [vWF]), total cholesterol (TC) and triacylglycerol (TG) levels were observed, and the therapeutic efficacy was evaluated on 3 and 6 months into treatment in the two groups.@*RESULTS@#The effective rates of 3 and 6 months into treatment were 78.6% (22/28) and 89.3% (25/28) in the observation group, which were higher than 62.1% (18/29) and 75.9% (22/29) in the control group respectively (@*CONCLUSION@#Moxibustion combined with basic treatment can effectively improve the clinical symptoms, renal function and renal microcirculation in patients with idiopathic membranous nephropathy of low to medium risk with spleen-kidney deficiency and blood stasis, the therapeutic effect is superior to the simple basic treatment.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Glomerulonephritis, Membranous , Humans , Kidney/physiology , Moxibustion , Spleen
2.
Article in English | WPRIM | ID: wpr-827366

ABSTRACT

OBJECTIVES@#To evaluate the value of thrombospond in Type I domain-containing 7A (THSD7A) and M-type phospholipase A2 receptor (PLA2R) in primary membranous nephropathy (PMN) and to explore the relationship between their antibody levels and prognosis.@*METHODS@#Renal tissues in 128 patients with membranous nephropathy in the Second Xiangya Hospital of Central South University were collected from February 2015 to August 2017, including 108 patients with primary membranous nephropathy (PMN group) and 20 patients with secondary membranous nephropathy (SMN) (SMN group). Indirect immunofluorescence method was used to detect the expression of PLA2R antigen in kidney tissues,and the glomerular expression of THSD7A antigen was examined by immunohistochemistry and indirect immunofluorescence. The serum levels of anti-PLA2R antibodies and THSD7A antibodies were also detected by ELISA. According to the results of PMN examination,the patients were also divided into a PLA2R-related membranous nephropathy group and a THSD7A-related membranous nephropathy group.@*RESULTS@#The positive rate of PLA2R in the renal tissues in the PMN group was higher than that in the SMN group (78% in the PMN group, 35% in the SMN group, <0.01),while the positive rate of anti-PLA2R antibody in the PMN group was also higher than that in the SMN group (50% in the PMN group, 25% in the SMN group, <0.05).The serum level of anti-PLA2R antibody was positively correlated with 24 h urine protein (=0.254, <0.05) and negatively correlated with serum albumin (=-0.236, <0.05). The expression of THSD7A was positive in glomeruli in 7 cases of the PMN group (6%) by immuno-histochemistry, and which was positive in 1case of the SMN group (5%).The serum levels of anti-THSD7A antibody in the PMN group were higher than those in the SMN group [(0.49±0.26) pg/mL in the PMN group,(0.34±0.27) pg/mL in the SMN group, <0.05]. There was no difference in the clinical characteristics between the PLA2R-related membranous nephropathy group and the THSD7A-related membranous nephropathy group.@*CONCLUSIONS@#PLA2R and THSD7A are the target antigen of PMN, and the associated autoantibodies are helpful for the differential diagnosis of PMN. The anti-PLA2R antibody levels can reflect the severity of the disease and evaluate the effect of treatment. The incidence of THSD7A membranous nephropathy is low, and monitoring the serum anti-THSD7A antibody levels can assess patients' condition and predict disease outcome.


Subject(s)
Autoantibodies , Glomerulonephritis, Membranous , Humans , Immunohistochemistry , Receptors, Phospholipase A2 , Thrombospondins
3.
Acta méd. colomb ; 44(1): 39-42, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1019294

ABSTRACT

Resumen Antecedentes: la asociación entre glomerulopatía membranosa y glomerulonefritis necrosante crescéntica es infrecuente: 0.4%, confiriendo un escenario de peor pronóstico. Se requieren estudios que precisen el esquema de tratamiento óptimo, sin embargo, el rápido inicio de terapia inmunosupresora impacta en la preservación de la función renal. Objetivo: exponer un caso en el cual se presenta esta asociación y tiene adecuada respuesta con el tratamiento realizado. Métodos: en este artículo se presenta un caso de una mujer con síndrome nefrótico a quien se le documenta glomerulopatía membranosa con proliferación extracapilar confirmada con biopsia renal, sin evidencia de autoinmunidad, neoplasia ni proceso infeccioso. Tras el diagnóstico se inició manejo con metilprednisolona y ciclofosfamida con adecuada evolución, sin deterioro de la función renal y con mejoría de proteinuria. Conclusión: la presencia de proliferación extracapilar da peor pronóstico en los pacientes con glomerulopatía membranosa, el inicio oportuno del tratamiento es fundamental. (Acta Med Colomb 2019; 44: 39-42).


Abstract Background: the association between membranous glomerulopathy and crescentic necrotizing glomerulonephritis is infrequent: 0.4%, conferring a worst prognosis scenario. Studies that require the optimal treatment scheme are required; however, it has been described that the rapid onset of immunosuppressive therapy impacts on the preservation of renal function. Objective: to present a case in which this association is presented and has an adequate response to the performed treatment. Methods: in this article, a case of a woman with nephrotic syndrome with a documented membranous glomerulopathy with extracapillary proliferation confirmed by renal biopsy, without evidence of autoimmunity, neoplasia or infectious process is presented. After the diagnosis, treatment with methylprednisolone and cyclophosphamide was started with adequate evolution, without deterioration of renal function and with improvement of proteinuria. Conclusion: the presence of extracapillary proliferation gives worse prognosis in patients with membranous glomerulopathy. The timely initiation of treatment is essential. (Acta Med Colomb 2019; 44: 39-42).


Subject(s)
Humans , Female , Adult , Glomerulonephritis, Membranous , Kidney Diseases , Immunosuppression Therapy , Glomerulonephritis , Nephrotic Syndrome
4.
Rev. cuba. pediatr ; 91(1): e729, ene.-mar. 2019.
Article in Spanish | LILACS | ID: biblio-985596

ABSTRACT

RESUMEN Introducción: La obesidad es un problema de salud mundial y su frecuencia se está incrementando tanto en adultos como en niños. Una de sus complicaciones es la glomerulopatía asociada a la obesidad. Objetivo: Informar acerca de esta enfermedad y la actitud del pediatra para tratar de evitarla. Métodos: Revisión de la literatura médica más reciente sobre la enfermedad y el incremento de la obesidad en la edad pediátrica en las bases de datos PubMed, SciELO y LILACS. Se utilizaron las palabras clave: glomerulopatía relacionada con la obesidad, obesidad y sobrepeso en el niño, tratamiento de la obesidad. Resultados: La obesidad en el niño es en alto porcentaje de causa nutricional y en esta condición los factores ambientales y socioculturales juegan importante papel. La predisposición a padecer la glomerulopatía de la obesidad comienza desde la niñez. El tratamiento de los pediatras en estos casos estará dirigido a la prevención de la enfermedad puesto que se puede desarrollar en la adultez. Cuando fracasan las medidas preventivas, queda la posibilidad de la cirugía bariátrica con poca experiencia en la edad pediátrica y retos éticos importantes y a pesar de que pudiera ser una alternativa de tratamiento, no es aceptada hasta el presente en forma amplia. Conclusiones: La glomerulopatía de la obesidad, por lo general, no aparece hasta la adultez, pero es necesario prevenirla desde la edad pediátrica y para su prevención los pediatras deben estar atentos a los factores de riesgo que pueden aparecer desde las primeras etapas de la vida(AU)


ABSTRACT Introduction: Obesity is a global health problem and its frequency is increasing as much as in adults than in children. One of its complications is glomerulopathy associated to obesity. Objective: To inform on this disease and the attitude of pediatricians towards this trying to avoid it. Methods: Reviewing of the most recent medical literature on this disease and the increase of obesity in the pediatric age in PubMed, SCIELO and LILACS databases. The keywords used for the search were: glomerulopathy related to obesity, obesity and overweight in children, and obesity treatment. Results: Obesity in children is in a high percentage due to nutritional causes and in this disease environmental and sociocultural factors play an important role. The predisposition to suffer from glomerulopathy by obesity starts in childhood. The treatment prepared by the pediatricians in these cases will be directed to the prevention of the disease because it can be developed in adulthood. When preventive measures fail, there is the possibility of performing a bariatric surgery, having in this regard few experiences in the pediatric ages and important ethical challenges; and instead of being an alternative treatment, it is not widely accepted. Conclusions: Generally, glomerulopathy of obesity doesn't appear until adulthood, but it is necessary to prevent it since the pediatric age; and for its prevention pediatricians must be attentive to the risk factors that can appear from the earliest stages of life(AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Glomerulosclerosis, Focal Segmental/complications , Pediatric Obesity/complications , Nephrosis, Lipoid/complications , Glomerulonephritis, Membranous/prevention & control , Overweight/complications , Pediatric Obesity/epidemiology
5.
Arch. argent. pediatr ; 116(5): 688-691, oct. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-973675

ABSTRACT

La combinación de glomerulopatías es infrecuente en la población pediátrica. Su presencia debe ser sospechada en aquellos pacientes con una enfermedad glomerular de curso clínico atípico. La influencia a largo plazo sobre el deterioro funcional renal permanece incierta. Se presentan dos niños con características histológicas de glomerulopatía combinada.


Combined glomerulopathy is infrequent in pediatric patients. Its presence should be suspected in those patients with glomerulophaties with atypical course. The influence on the long-term renal impairment remains uncertain. Here we report two children with histological findings of combined glomerulopathy.


Subject(s)
Humans , Male , Female , Child, Preschool , Glomerulonephritis, Membranous/diagnosis , Glomerulonephritis, IGA/diagnosis , Glomerulonephritis, Membranous/psychology , Glomerulonephritis, IGA/physiopathology
7.
Article in English | WPRIM | ID: wpr-717222

ABSTRACT

No abstract available.


Subject(s)
Antibodies , Glomerulonephritis, Membranous
8.
Article in English | WPRIM | ID: wpr-717214

ABSTRACT

BACKGROUND: Phospholipase A2 receptor (PLA2R) has been identified as a major autoantigen in primary membranous nephropathy (MN). We evaluated the association between anti-PLA2R antibodies and clinical outcome in Korean patients with primary MN. METHODS: A total of 66 patients with biopsy-proven MN were included. Serum level of anti-PLA2R antibodies was measured by enzyme-linked immunosorbent assay. Biochemical parameters were estimated initially and at follow-up. RESULTS: Anti-PLA2R antibodies were detected in 52.1% and 27.8% of patients with primary and secondary MN, respectively. Forty-eight patients with primary MN were grouped based on presence or absence of anti-PLA2R antibodies. Proteinuria was more severe in anti-PLA2R-positive patients than in anti-PLA2R-negative patients (urine protein/creatinine ratio 7.922 ± 3.985 g/g vs. 4.318 ± 3.304 g/g, P = 0.001), and anti-PLA2R antibody level was positively correlated with proteinuria. The incidence of chronic kidney disease stage ≥ 3 was higher in anti-PLA2R-positive patients compared with anti-PLA2R-negative patients (P = 0.004). The probabilities of spontaneous remission were higher in anti-PLA2R-negative patients compared with anti-PLA2R-positive patients (P < 0.001). Multivariate analysis demonstrated that anti-PLA2R antibodies are an independent risk factor for developing chronic kidney disease stage ≥ 3 and for not reaching spontaneous remission. CONCLUSION: Detection of anti-PLA2R antibodies at diagnosis in patients with primary MN can predict prognosis and guide treatment decisions.


Subject(s)
Antibodies , Diagnosis , Enzyme-Linked Immunosorbent Assay , Follow-Up Studies , Glomerulonephritis, Membranous , Humans , Incidence , Multivariate Analysis , Prognosis , Proteinuria , Receptors, Phospholipase A2 , Remission, Spontaneous , Renal Insufficiency, Chronic , Risk Factors
9.
Article in English | WPRIM | ID: wpr-764913

ABSTRACT

BACKGROUND: Appropriate immunosuppressive therapy for patients with idiopathic membranous nephropathy (MN) remains controversial. The effect of mycophenolate mofetil (MMF) versus cyclosporine (CsA) combined with low-dose corticosteroids was evaluated in patients with idiopathic MN in a multi-center randomized trial (www.ClinicalTrials.gov NCT01282073). METHODS: A total of 39 biopsy-proven idiopathic MN patients with severe proteinuria were randomly assigned to receive MMF combined with low-dose corticosteroids (MMF group) versus CsA combined with low-dose corticosteroids (CsA group), respectively, and followed up for 48 weeks. Complete or partial remission rate of proteinuria and estimated glomerular filtration rate (eGFR) at 48 weeks were compared. RESULTS: The level of proteinuria at baseline and at 48 weeks was 8.9 ± 5.9 and 2.1 ± 3.1 g/day, respectively, in the MMF group compared to 8.4 ± 3.5 and 3.2 ± 5.7 g/day, respectively, in the CsA group. In total, 76.1% of the MMF group and 66.7% of the CsA group achieved remission at 48 weeks (95% confidence interval, −0.18 to 0.38). There was no difference in eGFR between the two groups. Anti-phospholipase A2 receptor Ab levels at baseline decreased at 48 weeks in the complete or partial remission group (P = 0.001), but were unchanged in the no-response group. There were no significant differences between the two groups in changes in the Gastrointestinal Symptom Rating Scale and Gastrointestinal Quality of Life Index scores from baseline to 48 weeks. CONCLUSION: In combination with low-dose corticosteroids, the effect of MMF may not be inferior to that of CsA in patients with idiopathic MN, with similar adverse effects including gastrointestinal symptoms. Trial registry at ClinicalTrials.gov (www.ClinicalTrials.gov NCT01282073).


Subject(s)
Adrenal Cortex Hormones , Cyclosporine , Glomerular Filtration Rate , Glomerulonephritis, Membranous , Humans , Proteinuria , Quality of Life
10.
J. bras. nefrol ; 39(4): 370-375, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-893785

ABSTRACT

Abstract Introduction: Membranous nephropathy (MN) is one of the major causes of nephrotic syndrome. The complement system plays a key role in the pathophysiology of MN. Objectives: To identify the complement pathway possibly activated in MN cases and correlate the presence of C4d with more severe clinical and histological markers. Methods: Sixty nine cases from renal biopsy with membranous nephropathy were investigated. The presence of C1q was analyzed by direct immunofluorescence; and expression of C4d by immunohistochemistry. Clinical and epidemiological data were obtained upon biopsy request. Results: The presence of focal segmental glomerulosclerosis, global glomerulosclerosis, vascular lesions and tubulointerstitial fibrosis were collected by anatomopathological report. C4d(+) was found in 58 (84%), and C1q(+) was found in 12 (17%) of the cases. Twelve patients had C4d(+)/C1q(+), 46 had C4d(+)/C1q(-), and 11 patients had C4d(-)/C1q(-), probably indicating the activation of the classical, lectin and alternative pathways, respectively. Conclusion: C4d was associated with increased interstitial fibrosis, but not with clinical markers of poor prognosis. Through the deposition of C4d and C1q we demonstrated that all complement pathways may be involved in MN, highlighting the lectin pathway. The presence of C4d has been associated with severe tubulointerstitial lesions, but not with clinical markers, or can be taken as a universal marker of all cases of MN.


Resumo Introdução: A Glomerulopatia membranosa (GM) é uma das principais causas da síndrome nefrótica. O sistema do complemento desempenha um papel chave na fisiopatologia do GM. Objetivos: Identificar a via do complemento possivelmente ativada nos casos de GM e correlacionar a presença de C4d com marcadores clínicos e histológicos mais graves. Métodos: Foram investigados 69 casos de biópsia renal com GM. A presença de C1q foi analisada por imunofluorescência direta e a expressão de C4d por imunohistoquímica. Dados clínicos e epidemiológicos foram obtidos mediante solicitação de biópsia renal. Resultados: A presença de glomerulosclerose segmentar focal, glomeruloesclerose global, lesões vasculares e fibrose tubulointersticial foi coletada por relato anatomopatológico. C4d (+) foi encontrado em 58 (84%), e C1q (+) foi encontrado em 12 (17%) casos. Doze pacientes tinham C4d (+)/C1q (+), 46 tinham C4d (+)/C1q (-) e 11 pacientes tinham C4d (-)/C1q (-), indicando provavelmente a ativação da via clássica, da lectina e da alternativa, respectivamente. Conclusão: O C4d foi associado ao aumento da fibrose intersticial, mas não com marcador clínico de mau prognóstico. Através da deposição de C4d e C1q, demonstrou-se que todas as vias do complemento podem estar envolvidas em GM, destacando a via da lectina. A presença de C4d tem sido associada a lesões tubulointersticiais graves, mas não com marcadores clínicos, ou pode ser tomada como um marcador universal de todos os casos de GM.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Complement System Proteins/biosynthesis , Glomerulonephritis, Membranous/immunology , Peptide Fragments/biosynthesis , Biomarkers , Complement C4b/biosynthesis , Complement Activation
11.
J. bras. nefrol ; 39(4): 477-480, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-893786

ABSTRACT

ABSTRACT Renal vein thrombosis (RVT) is a complication often associated with nephrotic syndrome. It occurs due to a state of hypercoagulability common in the diseases that attend to this syndromic diagnosis. It should be suspected whenever there is nephrotic syndrome associated with sudden flank pain, hematuria and worsening of proteinuria. Bilateral RVT also presents with frequently oliguric renal dysfunction. This case reports a 33-year-old patient hospitalized for a nephrotic syndrome, with etiologic investigation suggestive of primary membranous glomerulopathy, which evolved with bilateral RVT associated with deterioration of renal function and need for renal replacement therapy. He promptly performed angiography with thrombectomy and thrombolysis, evolving with recovery of renal function in two weeks.


RESUMO A trombose de veia renal (TVR) é uma complicação muitas vezes associada à síndrome nefrótica. Ocorre devido a um estado de hipercoagulabilidade comum nas enfermidades que cursam com esse diagnóstico sindrômico. Deve ser suspeitada sempre que houver síndrome nefrótica associada à dor súbita em flanco, hematúria e piora da proteinúria. TVR bilateral cursa, ainda, com disfunção renal frequentemente oligúrica. Esse caso reporta um paciente de 33 anos internado por um quadro de síndrome nefrótica, com investigação etiológica sugestiva de glomerulopatia membranosa primária, que evoluiu com TVR bilateral associada à deterioração da função renal e necessidade de terapia substitutiva renal. Realizou, prontamente, angiografia com trombectomia e trombólise, evoluindo com recuperação da função renal em duas semanas.


Subject(s)
Humans , Male , Adult , Renal Veins , Glomerulonephritis, Membranous/complications , Renal Dialysis , Venous Thrombosis/etiology , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Recovery of Function
12.
Braz. j. med. biol. res ; 50(4): e5976, 2017. tab, graf
Article in English | LILACS | ID: biblio-839282

ABSTRACT

We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4–8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Adrenal Cortex Hormones/administration & dosage , Cyclophosphamide/administration & dosage , Glomerulonephritis, Membranous/drug therapy , Immunosuppressive Agents/administration & dosage , Prednisone/administration & dosage , Tacrolimus/administration & dosage , Creatinine/blood , Drug Therapy, Combination , Follow-Up Studies , Proteinuria , Reproducibility of Results , Retrospective Studies , Serum Albumin/analysis , Time Factors , Treatment Outcome
13.
Medical Principles and Practice. 2017; 26 (4): 375-380
in English | IMEMR | ID: emr-189638

ABSTRACT

Objective: To detect urinary volatile organic compounds [VOCs] in patients with idiopathic membranous nephropathy [iMN] and normal controls, and to examine whether or not urinary VOCs can act as biomarkers for the diagnosis of iMN independent of renal biopsy


Materials and Methods: Gas chromatography/mass spectrometry [GC/MS] was used to assess the urine collected from 63 iMN patients and 15 normal controls. The statistical methods of principal component analysis and partial least squares discriminant analysis were performed to process the final data in Common Data Format which were converted from GC/MS data


Results: Six VOCs in the urine samples of iMN patients exhibited significant differences from those of normal controls: carbamic acid monoammonium salt, 2-pentanone, 2,4-di-methyl-pentanal, hydrogen azide, thiourea, and 4-hepta-none were significantly higher than in controls [p < 0.05]


Conclusions: Six urinary VOCs were isolated from patients with iMN using GC/MS. The analysis of urinary VOCs using GC/MS could be developed into a non-invasive method for the detection of iMN.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Glomerulonephritis, Membranous , Membrane Potentials , Biomarkers , Gas Chromatography-Mass Spectrometry , Urine
14.
Article in English | WPRIM | ID: wpr-205052

ABSTRACT

Particulate matter (PM) has been found to damage vital body organs, including the lungs and heart, through vascular damage and oxidative stress. Recently, renal function and chronic urologic diseases have also been found to be related to PM. To investigate this, we reviewed the characteristics of PM related to renal toxicity, including recent studies on the associations of urologic diseases with PM. PM can include constituents that cause renal toxicity, such as lead, cadmium, arsenic, and crystalline silica, which result in renal tubular or interstitial damage. Since 2008, 7 studies have evaluated the renal effects of PM. Two prospective cohort studies and a quantitative study of consecutive patients showed that PM may be related to decreased renal function, as shown by the estimated glomerular filtration rate of diseased or aged participants. Two cross-sectional studies found an association between PM and chronic kidney disease. One of those studies identified the specific renal diseases of immunoglobulin A nephropathy and membranous nephropathy. Two studies that analyzed renal cancer and PM showed no evidence that renal cancer is related to PM. Nine studies were evaluated regarding the relationship of bladder and prostate cancer with PM. The evidence for an association of PM with bladder and prostate cancer is still inconclusive. Although some recently published studies have shown a significant relationship, the causal relationship is not clear. Further well-designed studies on specific renal diseases are required.


Subject(s)
Arsenic , Cadmium , Cohort Studies , Cross-Sectional Studies , Crystallins , Environmental Exposure , Glomerular Filtration Rate , Glomerulonephritis, IGA , Glomerulonephritis, Membranous , Heart , Humans , Kidney Neoplasms , Lung , Occupational Diseases , Oxidative Stress , Particulate Matter , Prospective Studies , Prostatic Neoplasms , Renal Insufficiency, Chronic , Silicon Dioxide , Urinary Bladder , Urologic Diseases
15.
Article in English | WPRIM | ID: wpr-158108

ABSTRACT

Urticarial vasculitis is a rare disorder that principally manifests with recurrent urticarial, sometimes hemorrhagic, skin lesions and/or angioedema. Its clinical presentation is not always limited to cutaneous lesions and it can potentially affect other organs, such as the joints, lungs, kidneys, and eyes. Systemic involvement can either be present at the onset of disease or develop over time. In cases with systemic manifestations, urticarial vasculitis is more likely to be associated with a low complement level. We present the case of a teenage boy with hypocomplementemic urticarial vasculitis syndrome (HUVS) that occurred shortly following swine-origin influenza A virus infection in 2009. Afterwards, HUVS was systemically complicated with myositis and membranous nephropathy that developed several months and about 2 years after its onset, respectively. A combination of glucocorticoid and immunosuppressive agents has been used to effectively control disease activity.


Subject(s)
Angioedema , Complement System Proteins , Glomerulonephritis, Membranous , Humans , Immunosuppressive Agents , Influenza A virus , Joints , Kidney , Lung , Male , Myositis , Skin , Vasculitis
16.
Korean Journal of Medicine ; : 295-299, 2017.
Article in Korean | WPRIM | ID: wpr-189029

ABSTRACT

Membranous nephropathy is the most common pathologic lesion in adult patients with nephrotic syndrome. The cause is idiopathic, and the pathogenesis is believed to involve the deposition of immune complexes in the subepithelial tissue of the glomerular capillaries. After a period of 5 to 10 years, one-third of patients with membranous nephropathy will develop spontaneous remission, one-third will develop sustained proteinuria, and one-third will experience progression to chronic renal disease. Proteinuria may recur in patients who are in complete remission; this has been reported in approximately 26% of patients during an average of 89 months. To date, however, recurrence of membranous nephropathy has not been reported in patients who have been in complete remission for ≥ 20 years. We report herein such a case. Membranous nephropathy may recur in adult patients who are currently in the remission stage. Ongoing follow-up is therefore required, even after several years of complete remission.


Subject(s)
Adult , Antigen-Antibody Complex , Capillaries , Follow-Up Studies , Glomerulonephritis , Glomerulonephritis, Membranous , Humans , Nephrotic Syndrome , Proteinuria , Recurrence , Remission, Spontaneous , Renal Insufficiency, Chronic
17.
Chinese Medical Journal ; (24): 892-898, 2017.
Article in English | WPRIM | ID: wpr-266888

ABSTRACT

<p><b>BACKGROUND</b>According to the renal phospholipase A2 receptor (PLA2R) immunohistochemistry, idiopathic membranous nephropathy (iMN) could be categorized into PLA2R-associated and non-PLA2R-associated iMN. This study aimed to examine whether the non-PLA2R-associated iMN had any difference in clinical features compared with PLA2R-associated iMN.</p><p><b>METHODS</b>A total of 231 adult patients diagnosed as iMN were recruited to this retrospective study. Renal PLA2R expression was examined by immunofluorescence. Among these patients, 186 (80.5%) with complete baseline clinical data were used for further study. Urinary protein excretion, serum albumin, and creatinine were analyzed. For those patients with follow-up longer than 1 year, the relationship between PLA2R and response to immunosuppressants were analyzed. The t-test was used for parametric analysis and the Mann-Whitney U-test was used for nonparametric analysis. Categorical variables were described as frequencies or percentages, and the data were analyzed with Pearson's Chi-square test or Fisher's exact test.</p><p><b>RESULTS</b>Of the 231 iMN patients, 189 showed renal detectable PLA2R expression (81.8%). The baseline serum creatinine, serum albumin, and urine protein excretion were not significantly different between PLA2R-associated (n = 145) and non-PLA2R-associated iMN patients (n = 41). However, about 1/3 of the non-PLA2R-associated iMN had abnormal serological tests, significantly more common than PLA2R-associated iMN (31.7% vs. 8.3%, P = 0.000). The non-PLA2R-associated iMN had lower C4 levels compared with PLA2R-associated iMN (P = 0.004). The non-PLA2R-associated iMN patients also showed a better response to immunosuppressants (complete remission [CR] 42.9%; partial remission [PR] 14.3%) compared with PLA2R-associated iMN (CR 3.2%; PR 48.4%, P = 0.004) at the 3rd month.</p><p><b>CONCLUSIONS</b>There were no significant differences in serum creatinine, albumin, and urine protein excretion between PLA2R-associated and non-PLA2R-associated iMN, while the non-PLA2R-associated iMN patients showed more abnormal serological tests. The non-PLA2R-associated iMN seemed to respond more quickly to the immunosuppressive therapy compared with PLA2R-associated iMN.</p>


Subject(s)
Adult , Autoantibodies , Metabolism , Female , Glomerulonephritis, Membranous , Drug Therapy , Metabolism , Pathology , Urine , Humans , Immunosuppressive Agents , Therapeutic Uses , Kidney , Metabolism , Pathology , Male , Middle Aged , Receptors, Phospholipase A2 , Metabolism , Retrospective Studies
18.
Korean Journal of Medicine ; : 541-545, 2017.
Article in Korean | WPRIM | ID: wpr-103596

ABSTRACT

Heavy proteinuria in the nephrotic range is an uncommon, often unrecognized manifestation of graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation. A few isolated case reports have been published in the Korean literature involving a small number of patients who developed membranous nephropathy as GVHD after peripheral blood stem cell transplantation (PBSCT). A 17-year-old female was diagnosed with non-Hodgkin's lymphoma. Following remission, she underwent allogeneic PBSCT. Shortly thereafter, she developed acute GVHD, which was managed by medical therapy with prednisolone and cyclosporine. Approximately 13 months following PBSCT, the patient developed proteinuria without peripheral edema. Pulsed steroid therapy was initiated three times, but her condition did not improve. Twenty months after PBSCT, she developed nephrotic range proteinuria. A renal biopsy was performed, and the diagnosis was histologically consistent with membranous nephropathy. Because the response to steroids was not satisfactory, the dose of cyclosporine was increased. Approximately 3 months after renal biopsy, the proteinuria disappeared. Given the recent increase in the incidence of GVHD-mediated renal disease, in particular, renal biopsy is indispensable to the diagnosis of nephropathy and to the prevention of disease progression.


Subject(s)
Adolescent , Biopsy , Cyclosporine , Diagnosis , Disease Progression , Edema , Female , Glomerulonephritis, Membranous , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Humans , Incidence , Lymphoma, Non-Hodgkin , Peripheral Blood Stem Cell Transplantation , Prednisolone , Proteinuria , Stem Cells , Steroids
19.
Article in Korean | WPRIM | ID: wpr-178686

ABSTRACT

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated progressive or relapsing demyelinating peripheral neuropathy. Other autoimmune diseases may be associated with CIDP. A 38-year-old man developed CIDP, which was subsequently associated with membranous glomerulonephritis (MGN) and tendinitis. He was treated with intravenous immunoglobulin, rituximab, and prednisone, which resulted in improvement of the clinical symptoms. This is a case report of CIDP associated with MGN and tendinitis.


Subject(s)
Adult , Autoimmune Diseases , Glomerulonephritis , Glomerulonephritis, Membranous , Humans , Immunoglobulins , Peripheral Nervous System Diseases , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating , Prednisone , Rituximab , Tendinopathy
20.
Article in English | WPRIM | ID: wpr-633202

ABSTRACT

BACKGROUND: Acute renal infarction often presents with abdominal  pain,  nausea,  vomiting,  and  fever.With other more common illnesses presenting with the same symptoms, it is often misdiagnosed leading to delayed treatment.We present a case of a young female diagnosed to have Membranous Glomerulopathy who presented with sudden onset  flank  pain  in  whom was initially treated as urinary tract infection. CASE: A  19-year-old  female  diagnosed  with  membranous glomerulopathy presented at the Emergency Room (ER) with severe,  right  sided,  flank  pain  of  acute  onset,  associated with nausea and vomiting. No fever, dysuria, hematuria, or history of trauma. Her vital signs were within normal range. Abdominal  examination  revealed  a  distended  but  soft non-tender  abdomen  with  positive  shifting  dullness and fluid wave test. Right sided costovertebral angle tenderness was  elicited.Initial diagnostics showed leukocytosis with neutrophilic  predominance,  serum  creatinine  of  0.77mg/dL,  and  proteinuria  of  >600mg/dL.Abdominal  ultrasound showed  non-specific  findings,  thus  contrast-enhanced  computed  tomography  scan  (CT-Scan)  of  the  abdomen was  done which revealed areas of non-enhancement in the upper to middle portions of the right kidney which may relate to areas of ischemia and/or infarction, likely due to thrombosis involving the more distal portion of the right renal artery and massive ascites. Result was confirmed by computed tomography angiography (CTA) of the kidneys showing right renal artery thrombosis. Evaluations for other causes  of  renal  artery  thrombosis  aside  from  patient's concurrent  membranous  glomerulopathy  were  done  and were negative. Anti-coagulation therapy was initiated using low molecular weight heparin (LMWH) and was thereafter maintained on warfarin.CONCLUSION: A  high  index  of  clinical  suspicion  is  needed to  diagnose  acute  renal  infarction  because  of  its  non-specific symptoms which can mimic other conditions. Early diagnosis and prompt initiation of anti-coagulation therapy is  important  to  avoid  irreversible  kidney  damage.  Acute renal infarction should be considered as a cause of acute onset flank pain in patients with risk factors and normal initial screening test.


Subject(s)
Humans , Female , Adult , Glomerulonephritis, Membranous , Heparin, Low-Molecular-Weight , Warfarin , Hematuria , Creatinine , Renal Artery , Dysuria , Leukocytosis , Kidney , Kidney Diseases , Proteinuria , Urinary Tract Infections , Infarction , Flank Pain , Case Reports
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