Características clínico patológicas de la nefritis lúpica / Clinical pathological characteristics of the lupus nephritis

RESUMEN Fundamento: la nefritis lúpica es una complicación frecuente y grave asociada al lupus eritematosos sistémico. Objetivo: caracterizar la nefritis lúpica en el servicio de nefrología del Hospital Universitario Manuel Ascunce Domenech. Métodos: se realizó un estudio descriptivo, transversal y retrospectivo en el Hospital Manuel Ascunce Domenech de la provincia Camagüey entre enero de 2012 hasta diciembre de 2017. El universo estuvo formado por pacientes con nefritis lúpica que tenían biopsia renal. Como fuente se utilizaron las historias clínicas y una planilla confeccionada para vaciar los datos. Las variables fueron: edad, sexo, raza, criterios diagnósticos, estadio histopatológico, complicaciones de la enfermedad y efectos nocivos relacionados con el tratamiento. Resultados: se encontró que cuatro de cada diez pacientes estaba entre los 30 y los 44 años, mientras que seis de cada diez fueron mujeres. La cuarta parte de la muestra fue de la raza blanca. Predominaron en los pacientes los criterios renales, cutáneos y hematológicos por ese orden. Los patrones histopatológicos observados fueron la proliferación mesangial, los cambios mínimos y la glomerulopatía membranosa. Las complicaciones más frecuentes que se presentaron fueron el síndrome nefrótico y la insuficiencia renal crónica. La gran mayoría de los pacientes estudiados presentaron como efectos nocivos del tratamiento infecciones y manifestaciones cardiovasculares. Conclusiones: fue más frecuente entre 30 a 44 años, en mujeres y en la raza blanca. Se presentó más como síndrome nefrótico e insuficiencia renal crónica. Los patrones histopatológicos más observados: la proliferación mesangial, cambios mínimos y glomerulopatía membranosa.

ABSTRACT Background: the lupus nephritis is a frequent and serious complication associated to the systemic lupus erythematosus. Objective: to characterize the lupus nephritis in the nephrology service of the University Hospital Manuel Ascunce Domenech. Methods: a descriptive, transverse and retrospective study was carried out in the Hospital Manuel Ascunce Domenech of Camagüey from January, 2012 to December, 2017. The universe was constituted for patients with systemic lupus erythematosus. As source clinical charts and forms made to empty data were used. The universe was constituted by all the patients with lupus nephritis whose biopsy was useful for the diagnosis. The variables were: age, sex, race, diagnosis criteria, histopathological stage, complications of the illness and noxious effects related with the treatment. Results: was found that four of each ten patients were between the 30 and the 44 years, while six of each ten were women. The fourth part of the sample was of the white race. The renal, cutaneous and hematologic approaches prevailed in the patients in that order. The histopathological patterns observed were the mesangial proliferation, the minimum changes and the membranous glomerulonephritis. The most frequent complications that were presented were the nephrotic syndrome and the chronic renal failure. The great majority of the studied patients presented as noxious effects of the treatment infections and cardiovascular manifestations. Conclusions: it is more frequent between 30 to 44 years, in women and in the white race. It is presented more as Nephrotic syndrome and chronic renal failure. The histopathological pattern more observed: the mesangial proliferation, minimum changes and membranous glomerulonephritis.

Trombose de seios venosos em criança com síndrome nefrótica: relato de caso e revisão da literatura / Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review

A síndrome nefrótica associa-se a um estado de hipercoagulabilidade, apresentando risco aumentado de complicações tromboembólicas. A trombose dos seios venosos cerebrais é uma complicação rara da síndrome nefrótica, com poucos casos descritos na literatura, mas com diagnósticos cada vez mais frequentes. A verdadeira incidência pode estar subestimada, uma vez que muitos eventos são assintomáticos ou não são diagnosticados a tempo. Descrevemos aqui o caso de uma criança do sexo masculino, de 2 anos e 10 meses, com síndrome nefrótica, que apresentou, na evolução, cefaleia, crises epilépticas e rebaixamento sensorial, com o diagnóstico de trombose do seio sagital superior e transverso. Foi realizada revisão da literatura internacional por meio de estratégia de busca definida, nas bases de dados PubMed, SciELO e Lilacs, utilizando os termos “nephrotic syndrome” e “cerebral sinovenous thrombosis”. O diagnóstico de trombose venosa deve ser considerado em qualquer paciente com síndrome nefrótica que manifeste sinais e sintomas neurológicos, destacando que a suspeita clínica precoce tem relação com um desfecho favorável.

Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes.

Kidney Disease Complicated with Steroid-Induced Necrosis of Femoral Head: An Analysis of 62 Cases / 广州中医药大学学报

[Objective] To investigate the onset of steroid-induced necrosis of femoral head. [Methods] A retrospective study was carried out in 162 cases of kidney disease treated with steroid. Among them, 62 cases (Group A) was complicated with steroid-induced femoral head necrosis (FHN) and the others without the complication are in Group B. [Resuits] In 62 cases complicated with steroid-induced FHN, patients in the age of 20-30 accounted 93.5%; female accounted 54.8%; those with high weight index accounted 80.6% and patients complicated with blood-stasis syndrome accounted 90%; 51.6% suffered from lupus glomerulonephritis; 96.8% was given large dose of steroid (over 1 rag' kg~(-1)?d~(-1)) continuously over 2 months; 83.9% was given steroid in a total dosage of over 5000mg within one year; 54.9% has been given dexamethasone and 83.9% medicated intravenously; 67.7% has not given blood-activating stasis-removing herbal drugs (BSHD) combined with or without anticoagulation drugs (ACD). Ninety percent suffered from necrosis of bilateral hip joints and 67.7% from bilateral hip-joint disease; 68.8% suffered from FHN at the stage Ⅲ and Ⅳ. The above indexes differed from those without steroid-induced FHN. [Conclusion] The incidence of steroid -induced FHN in kidney disease is high in the female and in the cases of lupus glomerulonephritis: those who are in obesity, complicated with blood-stasis syndrome, given large-dose steroid (over 1mg?kg~(-1)?d~(-1)) continuously over 2 months or in a short term, or medicated with dexamethasone, have the high risk of steroid -induced FHN; bilateral hip-joint disease is in the majority. The combination of BSHD and ACD can decrease the incidence of steroid -induced FHN in kidney disease.