ABSTRACT
AIM: Immune pathogenesis of nephrotic syndrome (NS) is not completely understood. We aimed to evaluate the expression of B-cell activating factor (BAFF) and its receptors in renal samples from pediatric NS patients and its relationship with renal function survival. MATERIALS AND METHODS: We conducted an ambispective study on 33 patients with pediatric NS. Immunohistochemistry for BAFF, TACI, BCMA and BR3 was performed. Markers were evaluated on podocytes and interstitial inflammatory infiltrates (III). We performed Kaplan-Meier curves to describe renal function survival according to markers' expression. RESULTS: Thirty-three NS patients were included. Minimal change disease was seen in 21 (63.6%) patients, and focal segmental glomerulosclerosis in 12 (36.4%). BAFF was found in podocytes (18.2% of samples) and III (36.4% of samples), BAFF-R in one sample, TACI in 4 (podocytes and III), and BCMA in 5 samples of podocytes and 7 of III. BAFF on podocytes and III was associated with worst renal function at follow-up; those patients had 25% probability of having GFR >90 mL/min/1.73m2, versus 84.9% when absent (p = 0.0067). Patients with BAFF in III had 42.9% probability of having GFR>90 mL/min/1.73 m2, versus 94.1% when absent (p = 0.0063). CONCLUSION: BAFF expression in renal biopsies could be a prognostic factor for renal function.
Subject(s)
B-Cell Activating Factor , Nephrotic Syndrome , Humans , Child , B-Cell Activating Factor/metabolism , Transmembrane Activator and CAML Interactor Protein/genetics , B-Cell Maturation Antigen , Interleukin-4 , Biomarkers , PrognosisABSTRACT
Hepatoid adenocarcinoma of the urachus is a rare condition. We present the case of a 51-year-old female who developed abdominal pain and hematuria. Pelvic magnetic resonance imaging (MRI) reported an urachal mass with invasion to the bladder that was resected by partial cystectomy. On light microscopy the tumor resembled liver architecture, with polygonal atypical cells in nest formation and trabecular structures. Immunochemistry was positive for alfa-fetoprotein (AFP) and serum AFP was elevated. Hepatoid adenocarcinomas have been reported in multiple organs, being most commonly found in the stomach and the ovaries. Bladder compromise has been rarely described in the literature, and it has been associated with poor prognosis, low remission rates, and early metastasis.
ABSTRACT
Introducción. La nefritis lúpica es histológicamente cambiante, pero no está clara la utilidad de biopsias renales repetidas. Con el objetivo de conocer más sobre la utilidad de una segunda biopsia renal estudiamos retrospectivamente nuestros casos de pacientes con 2 biopsias renales. Métodos. Catorce pacientes (28 biopsias) fueron incluidos en este trabajo. Revisamos las biopsias y registramos la clase de nefritis e índices de actividad y cronicidad. Determinamos la necesidad de cambios terapéuticos basados en hallazgos histológicos y analizamos la evolución de lesiones agudas y crónicas. Resultados. Las razones para re-biopsiar fueron: proteinuria (recurrente, incrementada o de novo) en 10 casos (71,4%) o algún grado de insuficiencia renal en 4 casos (28,6%). En 6 pacientes (42,9%) no hubo cambio en la clase de nefritis. En 6 casos de lesiones proliferativas en la primera biopsia, la segunda mostró también lesiones proliferativas (100%), mientras que en 6 de 8 pacientes con lesiones no proliferativas hubo cambio a lesiones proliferativas (75%); por lo tanto, los cambios clínicamente importantes fueron más frecuentes en pacientes con lesiones no proliferativas (p=0,010). El índice de cronicidad fue significativamente mayor en la segunda biopsia (p=0,003). El índice de actividad no fue estadísticamente diferente (p=0,306). Conclusión. En recaídas o exacerbaciones de la enfermedad es infrecuente el viraje de lesiones proliferativas a no proliferativas, y una segunda biopsia podría no ser necesaria en muchos casos. En pacientes con lesiones no proliferativas en la biopsia inicial es frecuente el cambio a lesiones proliferativas, por lo que sería recomendable una segunda biopsia(AU)
Background. Although lupus nephritis is a disease with frequent class switches, the usefulness of repeat renal biopsies is questionable in some cases. In order to assess the clinical utility of repeat biopsies, a retrospective study was made of our lupus nephritis patients who had undergone a second renal biopsy. Methods. Fourteen patients (28 biopsies) were included in the study. All biopsies were revised and classified according to ISN/RPS classification and activity and chronicity indexes were assessed. Class switches and necessity of treatment changes, based on histopathology, were determined. Acute and chronic changes between biopsies were also analyzed. Results. Main reasons for the second biopsy were proteinuria (recurrent, increased or de novo) in 10 cases (71.4%) and some degree of renal insufficiency in 4 (28.6%). In 6 patients (42.9%), there was no shift in nephritis class on repeat biopsies. All the cases with proliferative lesions in the first biopsy (6 cases) also showed proliferative lesions (100%) on the second biopsy, whereas 6 of 8 cases with non-proliferative lesions on the reference biopsy switched to proliferative lesions on the repeat biopsy (75%). Therefore, clinically significant class switches were more frequent in patients with non-proliferative lesions (P=.010). Chronicity index was significantly higher in the second biopsy (P=.003), while activity index was not statistically different (P=.306). Conclusion. These results show that therapeutically relevant switches from proliferative to non-proliferative lesions are a rare event and a second biopsy during a lupus nephritis flare could prove unnecessary in many cases. In the cases of a non-proliferative lesion in the reference biopsy, class switches are frequently found and repeat biopsies are advisable(AU)
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Biopsy/trends , Biopsy , Lupus Nephritis/diagnosis , Proteinuria/diagnosis , Proteinuria/pathology , Kidney Glomerulus/pathology , Lupus Nephritis/pathology , Retrospective Studies , Kidney Glomerulus/cytology , 28599ABSTRACT
Este trabajo analiza las políticas de salud implementadas por la Municipalidad de Rosario en la década del '90, cuando gran parte de la población perdió su cobertura de obra social y se produjo un aumento significativo de la demanda sobre el sector público de servicios de salud. Se describe cómo el gobierno socialista de Rosario redefinió las políticas sanitarias y orientó su gestión de manera divergente al área nacional y provincial mediante la incorporación de una serie de innovaciones en políticas de salud que impactaron directamente en los planos de la atención, gestión y financiamiento. Para ello, el gobierno local promovió la conformación de equipos técnico-políticos que lograron el apoyo y constituyeron una coalición con actores externos, como la Asociación Médica de Rosario y la Universidad Nacional de Rosario. A partir de casos concretos, se muestra cómo, desde la gestión local, se piensan y se materializan las propuestas de cambios orientadas a mejorar la accesibilidad de la población al sistema de salud pública, fundamentalmente en un contexto de reformas y reconfiguración de las responsabilidades del Estado para garantizar el derecho a la salud.
This work analyzes the health policies implemented by the Municipality of Rosario during the 1990's, when a great number of the population lost their health insurance and significantly increasing the demand on public health services. It is described how the socialist government of Rosario redesigned the sanitary policies and oriented its management differently from the national and provincial areas through the incorporation of a series of innovations in health policies which had a direct impact on assistance, management and financing areas. In order to do that, the local government promoted the formation political-technical equipments which gained support and constituted a coalition with external actors such as the Medical Association of Rosario and the National University of Rosario. From concrete cases, it is showed how proposals of change may be thought and materialized by local management, to improve the access of the population to public health services, particularly in a context of reforms and reconfiguration of the State responsibilities to guarantee health rights.
