ABSTRACT
INTRODUCTION: Etanercept, a systemic inhibitor of α-TNF, is used for treatment of various autoimmune disorders. We report a case of spontaneous resolution of etanercept-induced lupus nephritis. CASE DESCRIPTION: A 57-year-old female patient taking etanercept for psoriasis presented with laboratory-and histology-confirmed lupus nephritis. After stopping etanercept, there was normalization of proteinuria, hematuria, serum complements, anti-dsDNA antibody, and resolution of the acute glomerular inflammatory process on repeat kidney biopsy. CONCLUSION: This case demonstrates serology- and biopsy-confirmed resolution of active lupus nephritis upon withdrawal of etanercept.
Subject(s)
Autoantibodies/immunology , Immunoglobulin G/adverse effects , Lupus Nephritis/chemically induced , Lupus Nephritis/pathology , Autoantibodies/drug effects , Blood Chemical Analysis , Creatine/blood , Etanercept , Female , Humans , Immunoglobulin G/therapeutic use , Kidney/ultrastructure , Microscopy, Electron , Middle Aged , Psoriasis/drug therapy , Receptors, Tumor Necrosis Factor/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , UrinalysisABSTRACT
Pseudohypertension has been described as a cause of resistant hypertension, due to medial hypertrophy of the artery from atherosclerosis. This phenomenon results in an elevated cuff pressure compared with intra-arterial measurements and is found primarily in populations with advanced age and atherosclerotic disease. The purpose of this review was to investigate the clinical picture and medical outcomes of patients with this phenomenon. We conducted a retrospective chart review between April 2009 and October 2011 of 244 patients seen in our Hypertension clinic. Baseline characteristics and outcomes of pharmacologic and lifestyle modifications were analyzed. There were 17/244 (7%) patients found to have pseudohypertension among patients enrolled. The mean number of antihypertensive medications decreased from 3.7 to 2.7, following a mean of 4.1 visits. All patients had a brachial artery bruit and triphasic blood pressure readings via Doppler. Our findings suggest that elderly patients with concomitant history of atherosclerotic disease, renal insufficiency, and diabetes mellitus have the highest risk of developing pseudohypertension. This condition should be considered in patients with resistant hypertension. Blood pressure measurement with Doppler can be considered as a noninvasive investigation. Recognition of this entity may result in potential cost reduction with fewer medications prescribed.
Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure Determination , Hypertension , Aged , Aged, 80 and over , Blood Pressure/drug effects , Blood Pressure/physiology , Brachial Artery/physiology , Comorbidity , Drug Resistance , Female , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Laser-Doppler Flowmetry , Male , Middle Aged , Prevalence , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , Risk Factors , Stroke/epidemiologyABSTRACT
BACKGROUND: The impact of bacteriuria on mortality and cardiovascular risk has not been previously reported for patients with chronic kidney disease (CKD). OBJECTIVE: To assess the relationship between outpatient episodes of bacteriuria and mortality and cardiovascular risk among women with CKD. DESIGN: Retrospective cohort study using an electronic health database from an integrated healthcare system in central Pennsylvania. SUBJECTS: Adult women with CKD receiving primary care at Geisinger Health System between January 1, 2004 and December 31, 2009 were eligible, and were followed through December 31, 2010 for study outcomes. MAIN MEASURES: The study exposure was bacteriuria, defined as an outpatient urine culture with bacterial growth of 10(4) cfu/mL. Treatment history (antibiotic prescription within 90 days) was identified. Study outcomes were death and the composite of hospitalization for myocardial infarction, congestive heart failure, or stroke. Multivariate-adjusted Cox models incorporated all bacteriuria episodes and antibiotic prescriptions in time-dependent fashion (in addition to other covariates) to account for the cumulative impact of infections, treatment, and hospitalization during follow-up. KEY RESULTS: 6807 women were followed for a median (interquartile range) of 5.2 (3.4, 5.9) years. In adjusted models, each untreated bacteriuria episode was associated with an increased risk of death (hazard ratio [HR] 1.56, 95% CI 1.35-1.81) and the composite cardiovascular outcome (HR 1.32, 95% CI 1.05-1.65); treated episodes were not associated with an increased risk of death or cardiovascular events. CONCLUSION: Among female patients with CKD, untreated bacteriuria occurring in the outpatient setting is associated with an increased risk of death and cardiovascular morbidity.
