Clinicopathological correlations and prognostic factors in lupus nephritis.

OBJECTIVE: To define prognostic factors at the moment of the diagnosis in lupus nephritis, and to assess the contribution of renal histologic data. PATIENTS AND METHODS: Sixty-two patients with systemic lupus erythematosus (SLE) and histologic evidence of nephritis were studied for renal outcome. Correlations between clinical or biological and histological data were carried out as an indicator of the utility of the renal biopsy. RESULTS: There were no significant differences in creatinine between the different histologic classes at the moment of the diagnosis, although the WHO classification correlated well with proteinuria and immunologic activity. There was a strong correlation between clinical and histological activity as measured by the activity index in proliferative glomerulonephritis, mainly with creatinine and proteinuria, but not with haematuria or immunological activity. Young age at the time of renal biopsy, proliferative classes III and IV, and the chronicity index were associated with a poorer renal prognosis. CONCLUSIONS: High immunologic activity, mainly elevated anti-DNA titers and decreased levels of CH100, is highly suggestive of proliferative glomerulonephritis. Proliferative classes III and IV and high chronicity indexes are associated with a worse prognosis in lupus nephritis.

Multiple liver abscesses due to Yersinia enterocolitica discloses primary hemochromatosis: three cases reports and review.

We report three cases of multiple liver abscesses due to Yersinia enterocolitica that led to previously unknown diagnoses of primary hemochromatosis. Y. enterocolitica is an iron-dependent bacterium that relies entirely on exogenous iron for growth. A review of the literature with use of MEDLINE (National Library of Medicine, Bethesda, MD) disclosed 35 cases of Y. enterocolitica liver abscesses; 21 (60%) of these cases were associated with hemochromatosis. In 11 of the remaining 14 cases, two common manifestations of hemochromatosis, diabetes mellitus and cirrhosis of the liver, also were present; these findings were significant. Finally, we emphasize that when iron overload cannot be documented at the time of diagnosis of the liver abscess, long-term follow-up for determination of increasing iron stores is mandatory. With this approach, most manifestations of hemochromatosis in asymptomatic patients can be prevented.

[Renal vasculitis without hematuria in senile patients]. / Vasculitis renal no hematúrica en pacientes seniles.

Systemic vasculitis is a disease whose prognosis has improved considerably with steroid and immunosuppressive treatment, which points up the importance of early diagnosis. In elderly, diagnosis is made more difficult because the frequent onset in the form of a febrile syndrome with non-specific disturbances in general condition. In these patients it is not uncommon that a kidney involvement is what leads to diagnosis of the disease. Hematuria is almost a constant in vasculitis nephropathy. In their absence, acute renal failure in elderly is usually attributed to hemodynamic causes and the frequent presence of iatrogenic tubular factors. This is a report on the case of three elderly patients who presented a febrile syndrome with asthenia, anorexia and weight loss. The three cases progressed to acute renal failure with no disorders in urinary sediment. In two cases was a history of administration of gentamycin, indomethacin and iodated contrast. The clinical diagnosis was toxic and ischemic tubulopathy and, when dialysis became necessary, a renal biopsy was done which showed granulomatous vasculitis, intersticial nephritis and in two cases, necrotizing glomerulitis and crescent formation. Treatment with steroids and cyclophosphamide was started which improved general condition and renal function in one case. Early renal biopsy is advisable in senile patients with non specific systemic symptoms and progressive acute renal failure of unclear origin, even when hematuria is lacking. In this setting, the appearance of underdiagnosed renal vasculitis is possible, and consequent immunosuppressive treatment is a factor for consideration.