Subject(s)
Autoantibodies , Glomerulonephritis/immunology , Kidney Glomerulus , Muscular Diseases/immunology , Rectus Abdominis , Female , Hematoma , Humans , Middle AgedABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Anti-Glomerular Basement Membrane Disease/complications , Hematoma/complications , Glomerulonephritis/pathology , Biopsy , Pulmonary Embolism/complicationsABSTRACT
La nefropatía de las gammapatías monoclonales es debida principalmente al depósito de cadenas ligeras. Aunque se presenta sobre todo en cuadros malignos, también se ha descrito en pacientes cuya gammapatía es considerada «benigna». Se describen las características clínicas e histológicas de 9 casos de nefropatía por depósitos de cadenas ligeras diagnosticadas en el contexto de una gammapatía monoclonal sin datos de malignidad. Tres hombres y seis mujeres con edad media de 59,2 ± 12. Todos los pacientes presentaban al diagnóstico proteinuria y grados variables de insuficiencia renal con creatinina sérica media de 315 ±187. Dos requirieron diálisis desde el inicio. La histología renal mostró patrón nodular en 4 casos, mesangiocapilar en 3, lesiones sólo tubulares en 1 y mesangial en otro. Los depósitos renales más frecuentes fueron los constituidos por cadenas kappa (67%). Los tratamientos aplicados fueron: Prednisona en monoterapia (tres casos) o asociada aquimioterapia (melfalan, clorambucil o ciclofosfamid). En dos casos se añadieron recambios plasmáticos o autotrasplante de médula ósea, respectivamente. Tras un seguimiento medio de 4,89 ± DE: 3,69 años observamos desaparición de la proteinuria en más del 50% de los pacientes y estabilización o mejoría de la función renal en 3. Dos deellos necesitaron terapia renal substitutiva desde el inicio y existió progresión del fallo renal hasta los requerimientos dialíticos en los cuatro restantes. En caso de gammapatía monoclonal, incluso de carácter benigno, debe buscarse una posible afectación renal. La comprobación del depósito renal de cadenas ligeras debe hacer plantearse un tratamiento precoz, ya que la evolución a la insuficiencia renal terminal es frecuente (AU)
Renal involvement is observed frequently in association with malignant gammopathies, mainly those related to light chain deposition, although has also been described in non-malignant monoclonal gammopathy. This study reports the clinicopathological findings and outcome in 9 patients with nephropaty secondary to monoclonal immunoglobulin deposit in absence of malignancy. They were three men and six women and they were 59.2± 12 years old. All patients presented proteinuria and different levels of renal insufficiency (mean creatin in = 315 ± 187 micromol/L) at the moment of diagnostic. Two patients required dialysis at the time of renal biopsy. The pathology studies revealed a nodular sclerosing glomerulopathy in four cases, mesangiocapilary glomerulonephritis in three cases, only tubular lesions in one and mesangial lesions in the other one. The treatment applied was: Prednisone alone (two cases), with chemotherapy associated (melfalan in two, clorambucil in one and ciclophosphamide in another one). One patient received plasmapheresis and mycophenolate and another patient undergone a bone marrow authotransplant associated to mycophenolate and prednisone. One of the two patients who required dialysis at the moment of presentation was not treated. After a follow-up of more than 4years (4.89 ± DE: 3.69) renal function improved or remained stable in three patients and proteinuria was dissapaired in more than 50% of patients. Four patients had a worsening of renal function and they required dialysis during the time of follow-up (in 2.4 years ± DE: 4.3). In any case malignitation was observed. Chemotherapy stabilized or improved renal function in 3 of nine patients (33%) with non-malignant monoclonal gammopathy Non-malignant monoclonal gammopathy could go unnoticed. Appearance of abnormalities in renal routine tests deserves more in-depth diagnostic procedures, including renal biopsy. Evolution to end stage renal disease could probably be avoided or reduced in severity with early detection and treatment of this entity (AU)
Subject(s)
Humans , Paraproteinemias/physiopathology , Renal Insufficiency/physiopathology , Heavy Chain Disease/physiopathology , Immunoglobulin Light Chains/physiology , Renal DialysisABSTRACT
Renal involvement is observed frequently in association with malignant gammopathies, mainly those related to light chain deposition, although has also been described in non-malignant monoclonal gammopathy. This study reports the clinicopathological findings and outcome in 9 patients with nephropaty secondary to monoclonal immunoglobulin deposit in absence of malignancy. They were three men and six women and they were 59.2+/-12 years old. All patients presented proteinuria and different levels of renal insufficiency (mean creatinin = 315+/-187 micromol/L) at the moment of diagnostic. Two patients required dialysis at the time of renal biopsy. The pathology studies revealed a nodular sclerosing glomerulopathy in four cases, mesangiocapilary glomerulonephritis in three cases, only tubular lesions in one and mesangial lesions in the other one. The treatment applied was: Prednisone alone (two cases), with chemotherapy associated (melfalan in two, clorambucil in one and ciclophosphamide in another one). One patient received plasmapheresis and mycophenolate and another patient undergone a bone marrow authotransplant associated to mycophenolate and prednisone. One of the two patients who required dialysis at the moment of presentation was not treated. After a follow-up of more than 4 years (4.89 +/-DE: 3.69) renal function improved or remained stable in three patients and proteinuria was disappeared in more than 50% of patients. Four patients had a worsening of renal function and they required dialysis during the time of follow-up (in 2,4 years +/- DE: 4,3). In any case malignitation was observed. Chemotherapy stabilized or improved renal function in 3 of nine patients (33%) with non-malignant monoclonal gammopathy. Non-malignant monoclonal gammopathy could go unnoticed. Appearance of abnormalities in renal routine tests deserves more in-depth diagnostic procedures, including renal biopsy. Evolution to end stage renal disease could probably be avoided or reduced in severity with early detection and treatment of this entity.
Subject(s)
Kidney Diseases/etiology , Monoclonal Gammopathy of Undetermined Significance/complications , Female , Humans , Kidney Diseases/diagnosis , Kidney Diseases/drug therapy , Male , Middle Aged , Retrospective StudiesABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Fasciitis, Necrotizing/complications , Renal Insufficiency/complications , Glomerulonephritis, Membranoproliferative/complications , HemofiltrationSubject(s)
Acute Kidney Injury/etiology , Carnitine O-Palmitoyltransferase/deficiency , Adolescent , Humans , MaleABSTRACT
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Subject(s)
Humans , Male , Adolescent , Rhabdomyolysis/complications , Renal Insufficiency/etiology , Carnitine O-Palmitoyltransferase/deficiency , Renal DialysisABSTRACT
The role of steroid treatment in drug-induced acute interstitial nephritis (DI-AIN) is controversial. We performed a multicenter retrospective study to determine the influence of steroids in 61 patients with biopsy-proven DI-AIN, 52 of whom were treated with steroids. The responsible drugs were antibiotics (56%), non-steroidal anti-inflammatory drugs (37%) or other drugs. The final serum creatinine was significantly lower in treated patients while almost half of untreated patients remained on chronic dialysis. Among treated patients, over half showed a complete recovery of baseline renal function, whereas the rest remained in renal failure. There were no significant initial differences between these two subgroups in terms of duration or dosage of steroids. After withdrawal of the presumed causative drug, we found that when steroid treatment was delayed (by an average of 34 days) renal function did not return to baseline levels compared to those who received steroid treatment within the first 2 weeks after withdrawal of the offending agent. We found a significant correlation between the delay in steroid treatment and the final serum creatinine. Renal biopsies, including three patients who underwent a second biopsy, showed a progression of interstitial fibrosis related to the delay in steroid treatment. Our study shows that steroids should be started promptly after diagnosis of DI-AIN to avoid subsequent interstitial fibrosis and an incomplete recovery of renal function.
Subject(s)
Creatinine/blood , Nephritis, Interstitial/drug therapy , Steroids/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Biopsy , Drug Administration Schedule , Female , Humans , Kidney/pathology , Male , Middle Aged , Nephritis, Interstitial/chemically induced , Nephritis, Interstitial/pathology , Retrospective StudiesABSTRACT
La glomerulopatía por cambios mínimos también conocida como enfermedad de cambios mínimos (NCM) es la causante del 10-15% de los síndromes nefróticos de los adultos. La ausencia de lesiones histológicas con técnicas de microscopia óptica e inmunofluorescencia son características de la enfermedad junto con la evolución a curación en un buen porcentaje de casos. Las alteraciones de fusión de los pies de los podocitos en los estudios de microscopia electrónica han permitido avances en el conocimiento de la patogenia ya que es en los podocitos donde se han centrado la mayoría de los estudios de proteómica y genómica que han identificado genes y proteínas responsables de las enfermedades glomerulares encuadradas en NCM. El plan terapéutico inicial consiste en la administración de corticoides a dosis de 1 mg/kg/día , que consigue remisiones entre el 81-90%. El tiempo mínimo de administración de corticoides debe estar comprendido entre 8 y 16 semanas. En casos corticorresistentes se debe considerar la administración de un ciclo de fármacos citotóxicos , siendo el más empleado la ciclofosfamida a dosis de 2 mg/kg/día durante 8-12 semanas. Los inhibidores de la calcineurina (ciclosporina A y tacrolimus) son de gran utilidad , si bien teniendo en cuenta que la recidiva de la enfermedad es frecuente al suspender estos fármacos y que son potencialmente nefrotóxicos. El MPA puede considerarse una alternativa aunque existen pocos datos. . En casos corticodependientes o recaedores frecuentes, además de los corticoides y citotóxicos esta indicada la ciclosporina A administrada a largo plazo en dosis progresivamente decrecientes y existen cada vez más indicios de que el MPA con buen perfil de eficacia-tolerancia podría ser una opción terapéutica satisfactoria pendientes en el momento actual, de estudios controlados que acrediten grado de evidencia científica. (nivel de evidencia C)
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Subject(s)
Male , Female , Adult , Humans , Nephrosis, Lipoid/drug therapy , Nephrotic Syndrome/drug therapy , Adrenal Cortex Hormones/therapeutic use , Antibiotics, Antineoplastic/therapeutic use , Nephrosis, Lipoid/physiopathology , Nephrotic Syndrome/physiopathology , Capillary Permeability , Glomerulonephritis/physiopathologyABSTRACT
Los diuréticos y la dopamina a dosis renal, fármacos tradicionalmente utilizados en la «prevención» del FRA, han demostrado ser no efectivos e incluso deletéreos; por lo que se contraindica su utilización. En el manejo del FRA establecido los diuréticos aumentan la diuresis, pero no son beneficiosos en cuanto a la duración, necesidad de diálisis o supervivencia. Se les atribuyó un aumento de mortalidad que estudios posteriores no han confirmado. Su utilización en el tratamiento médico conservador puede considerarse después de haber conseguido un buen volumen circulante y una adecuada TA, pero obliga a una monitorización de la función renal que no difiera la consulta con el nefrólogo y el inicio de diálisis. La dopamina a dosis baja puede aumentar la diuresis en pacientes críticos, pero no previene ni mejora el FRA (puede incluso ocasionarlo en pacientes normo o hipovolémicos) por lo que su uso como renoprotector debe ser abandonado. La hipoperfusión, y en concreto la existencia de una PAM < 65 mmHg es un factor independiente asociado al riesgo de desarrolla FRA. Los vasopresores van a tener un papel importante en este contexto, pero deben iniciarse siempre después de haber asegurado un relleno vascular adecuado. En pacientes en shock séptico la noradrenalina (NA) consigue restaurar la PAM mejor que la dopamina a dosis alfa y es capaz de revertir la situación en pacientes que no han respondido a dopamina. Aunque en la actualidad no existen aun suficientes estudios controlados la vasopresina parece ser efectiva para revertir el shock cuando las catecolaminas no lo son, especialmente en el contexto séptico. Los estudios existentes han demostrado una importante mejoría hemodinámica, pero sin efecto positivo hasta la fecha en la mortalidad. El Péptido Natriurético Atrial, la Urodilatina y los bloqueantes de la endotelina demostraron eficacia en la prevención del FRA experimental, pero en los estudios clínicos randomizados son inferiores o similares al placebo por lo que actualmente se contraindica su utilización. El péptido natriurético atrial podría tener un papel en el contexto de FRA e insuficiencia cardíaca
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Subject(s)
Humans , Acute Kidney Injury/prevention & control , Diuretics/therapeutic use , Dopamine/therapeutic use , Natriuretic Peptides/therapeutic use , Norepinephrine/therapeutic use , Vasopressins/therapeutic useABSTRACT
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Subject(s)
Male , Aged , Humans , Endocarditis, Bacterial/etiology , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/therapy , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Staphylococcus/pathogenicity , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , PrognosisSubject(s)
Catheters, Indwelling/adverse effects , Endocarditis, Bacterial/epidemiology , Renal Dialysis , Staphylococcal Infections/epidemiology , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/etiology , Diabetes Complications/drug therapy , Diabetes Complications/etiology , Diabetes Complications/microbiology , Discitis/drug therapy , Discitis/etiology , Discitis/microbiology , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/microbiology , Fever/etiology , Heart Valve Prosthesis , Humans , Hyperparathyroidism, Secondary/complications , Incidence , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Lumbar Vertebrae , Methicillin Resistance , Prognosis , Rifampin/therapeutic use , Spain/epidemiology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Vancomycin/therapeutic useSubject(s)
Antibodies, Antineutrophil Cytoplasmic/immunology , Autoimmune Diseases/immunology , Vasculitis/immunology , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adult , Aged , Antibodies, Antineutrophil Cytoplasmic/analysis , Autoantigens/immunology , Autoimmune Diseases/diagnosis , Autoimmune Diseases/epidemiology , Autoimmune Diseases/therapy , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Kidney/blood supply , Middle Aged , Multicenter Studies as Topic , Myeloblastin , Neutrophils/enzymology , Neutrophils/immunology , Peroxidase/immunology , Plasmapheresis , Randomized Controlled Trials as Topic , Salvage Therapy , Serine Endopeptidases/immunology , Vasculitis/complications , Vasculitis/diagnosis , Vasculitis/epidemiology , Vasculitis/therapyABSTRACT
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Subject(s)
Vasculitis/complications , Vasculitis/epidemiology , Antibodies, Antineutrophil Cytoplasmic/analysis , Antibodies, Antineutrophil Cytoplasmic , Immunologic Factors , Consensus Development Conferences as Topic , Consensus , Histocompatibility , Histocompatibility/geneticsSubject(s)
Proteinuria/etiology , Sleep Apnea Syndromes/urine , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
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Subject(s)
Humans , Geriatrics/trends , Biomedical Research/trends , Health of the Elderly , AgingABSTRACT
Menopause is associated with the general ageing process and marks the end of follicular depletion, a process that begins in the intrauterine stage and lasts throughout the lifetime of women until their reproductive senescence. Controversy persists about whether the age at menopause is sensitive to the ecological determinants prevailing during the lifecycle or whether it has a predominantly genetic component that would allow groups of women to be characterized with respect to particular menstrual characteristics manifested throughout their fertile life. By contrast, there is a definite secular trend in age at menarche in populations that have registered improvements in their environment: sexual maturation is closely associated with the general processes of growth and development. These aspects were analysed in a sample of Spanish women, mothers and daughters, born between 1883 and 1941. The results show (a) indications--although not conclusive--of a secular trend in the age at menopause, (b) a possible association between the age at menopause of mothers and their daughters, and (c) an association at the individual level between age at menarche, particular characteristics of ovarian function (fetal loss) and age at menopause. The reproductive ageing process therefore seems to result from the expression of the influence of ecological conditions in which the lifecycle of the women develops and of a degree of heritability that affects not only the age at menopause but also a range of characteristics of ovarian function.
Subject(s)
Menopause , Mothers , Nuclear Family , Age Factors , Aged , Aging , Female , Humans , Life Style , Menopause/physiology , Middle Aged , Puberty , Socioeconomic Factors , Spain , Surveys and Questionnaires , Women's HealthABSTRACT
INTRODUCTION: Changes in dietary patterns and a decrease in physical activity have occurred in Western countries. These are factors in the variation in body composition observed in populations, characterized by a progressive accumulation of fat with age and a consequent increase in the risk of suffering from common chronic illnesses such as obesity, cardiovascular disease and cancer. OBJECTIVE: To investigate weight gain throughout the life-cycle and its relation to modifications in dietary patterns, analyzing the causes of these modifications and their implications for patterns of adult overweight and obesity. DESIGN: Cross-sectional sample of Spanish women from a socio-economically disadvantaged class. SUBJECTS: 1037 healthy perimenopausal women (age: 45-65 y). MEASUREMENTS: Juvenile body mass index (BMI), current BMI, food frequency questionnaire, retrospective food habits. RESULTS AND CONCLUSIONS: Of these women, 48.8% had changed their dietary habits during their lifetime. A change in diet due to migration or marriage occurred at approximately 20 years of age and was characterized by an increased frequency of consumption of foods rich in protein and complex carbohydrates, while a change due to illness occurred at around 50 years of age and was characterized by a decrease in the consumption of these types of food. The change in dietary behavior due to migration was associated with weight gain. Weight gain was also inversely associated with BMI during youth; women who in their youth had a BMI<18.5 kg/m2 gained an average of 21.4 kg, compared with those with a BMI>27 kg/m2 in their youth, who gained an average of 5.4 kg. International Journal of Obesity (2000)24, 14-19
