ABSTRACT
Multiple myeloma is a clonal proliferation of the plasma cell line that accounts for approximately 10% of all hematological malignancies. It is characterized by abnormal growth of plasma cells producing monoclonal immunoglobulin or light chain (paraprotein), with subsequent development of osteolytic bone lesions, anemia, hypercalcemia, and renal failure. In 3-6% of myeloma patients, more than one monoclonal protein (usually two) is discovered, with different heavy or light chain or both. These additional monoclonal proteins may be identified at the time of diagnosis or appear later during an observation or therapy. The authors describe two patients with biclonal myeloma, one diagnosed during evaluation for newly discovered renal failure, and one identified in the course of treatment of monoclonal gammopathy. The discussion of the diagnosis, natural history, and prognosis in patients with biclonal myeloma are also reported.
ABSTRACT
AIM: The aim of the study is to make a retrospective analysis of the incidence of AV fistulas after renal biopsy (RB) of native and transplanted kidney. MATERIALS AND METHODS: Five hundred and sixteen (516) RB were analyzed. One hundred twenty nine (129) were native kidneys RB performed in Clinic of Nephrology (CN), 190 were performed in Clinic of Nephrology and transplantation (CNT) and 197 were transplanted kidney biopsies from the same clinic. Biopsy technique type Gun with needle 14G, 16 and 18 G was used in CN, CNT used the same technique with needles 16G. Doppler ultrasound was made for A-V fistulas diagnosis. RESULTS: The A-V fistulas incidence was 0.8%. The frequency of A-V fistulas registered in CN was significantly higher than that registered in CNT (2.3% vs. 0.5%, p < 0.01). Biopsies performed by 14 G needles provide a higher percentage of A-V fistulas compared to those done by 16 G. (3.3% vs. 2.4%, p < 0.5). The frequency of the A-V fistulas in native and transplanted kidneys in CNT was similar (0.5% vs. 0.5%, p > 0.05). CONCLUSION: The A-V fistulas incidence is very low. The needle thickness is an important factor relevant to the risk of occurrence of A-V fistulas.
ABSTRACT
BACKGROUND: Different autoantibodies and immunologic abnormalities have been described in heroin abusers positive for human immunodeficiency virus, hepatitis B surface antigen, or hepatitis C virus, as well as in addicts with negative viral markers. OBJECTIVES: To investigate the prevalence of different autoantibodies in heroin addicts. METHODS: We studied 10 heroin addicts (8 males and 2 females aged 18-30 years) with a mean duration of heroin abuse of 46.5 months (range 6-96) for the presence of the following autoantibodies: antinuclear antibodies and anti-neutrophil cytoplasmic antibodies--using indirect immunofluorescent technique; ds-DNA, ss-DNA, Sm, RNP, Ro and La antibodies--using counter immunoelectrophoresis; and immunoglobulins G and M anticardiolipin and beta 2-glycoprotein-I antibodies--using enzyme-linked immunosorbent assay. All patients were tested for VDRL, HIV, HBsAG and anti-HCV antibodies. RESULTS: Four patients were positive for ANA, of whom two were positive for anti-HCV and two for ANCA. Three patients were positive for IgM aCL, one of whom was positive for IgG beta 2 GPI with clinical data of acute renal failure in the course of heroin coma and antiphospholipid syndrome (deep vein thrombosis) and positive Sm and ds-DNA antibodies, and another had subacute endocarditis and biopsy-proven chronic tubulo-interstitial nephritis (in both these patients aCL gradually fell to normal levels after the cessation of heroin abuse). One patient was HBsAG positive with negative autoantibodies. All patients were HIV and VDRL negative. CONCLUSION: Our data support the importance of ANA and aCL determination as a predictor of some systemic complications in heroin addicts.
