ABSTRACT
No disponible
Subject(s)
Humans , Hemofiltration/methods , Multiple Myeloma/therapy , Immunoglobulin Light Chains, Surrogate/metabolism , Kidney Diseases/complications , Kidney Diseases/therapy , Multiple Myeloma/complicationsSubject(s)
Image-Guided Biopsy/adverse effects , Kidney Diseases/pathology , Kidney/pathology , Ultrasonography, Interventional/adverse effects , Humans , Image-Guided Biopsy/instrumentation , Image-Guided Biopsy/methods , Needles , Patient Safety , Predictive Value of Tests , Risk Assessment , Risk FactorsABSTRACT
Encapsulating peritoneal sclerosis (EPS) is a rare and life-threatening complication of long-term peritoneal dialysis and until now, there is no established medical treatment for it. Many factors have been incriminated in its pathogenesis but they do not explain all risk conditions. EPS is significantly associated with PD duration, particularly more than 5 years, however the relationship between long-term PD and EPS increased risk is currently unknown. The "two-hit hypothesis" analyzes the relationship between the histological changes Peritoneal Dialysis-induced and intercurrent acute inflammatory episodes, but it does not explain the transition from Sclerosis Simple to EPS. We report our experience and we investigate the predisposing factors. The abdominal cocooning is a pathognomonic finding but it requires further investigations. Probably unidentified factors make some patients more susceptible to developing encapsulating peritoneal sclerosis.
Subject(s)
Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Peritoneal Dialysis/adverse effects , Peritoneal Fibrosis/diagnosis , Peritoneal Fibrosis/etiology , Aged , Fatal Outcome , Female , Humans , Ileocecal Valve/surgery , Intestinal Obstruction/surgery , Kidney Failure, Chronic/therapy , Peritoneal Fibrosis/surgery , Shock, Septic/etiologySubject(s)
Glomerulonephritis/etiology , Legionellosis/complications , Adult , Female , Humans , Kidney Glomerulus/physiopathologySubject(s)
Humans , Female , Adult , Legionellosis/complications , Glomerulonephritis/etiology , Kidney Glomerulus/physiopathologySubject(s)
Acute Kidney Injury/diagnosis , Kidney/pathology , Nephritis, Interstitial/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/pathology , Acute Kidney Injury/therapy , Adrenal Cortex Hormones/therapeutic use , Aged , Biopsy , Humans , Male , Nephritis, Interstitial/etiology , Nephritis, Interstitial/pathology , Nephritis, Interstitial/therapy , Predictive Value of Tests , Renal Dialysis , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Fibrinolytic Agents/therapeutic use , Renal Dialysis/instrumentation , Thrombosis/prevention & control , Urokinase-Type Plasminogen Activator/therapeutic use , Catheterization, Central Venous , Central Venous Catheters/adverse effects , Humans , Thrombolytic Therapy/methods , Thrombosis/etiologySubject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy , Glomerulonephritis/therapy , Granulomatosis with Polyangiitis/therapy , Hemolytic-Uremic Syndrome/therapy , Plasmapheresis , Female , Glomerulonephritis/etiology , Humans , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/therapy , Male , Plasmapheresis/adverse effects , Plasmapheresis/methods , Steroids/therapeutic useABSTRACT
Encapsulating peritoneal sclerosis is a rare and life-threatening complication of long-term peritoneal dialysis and until now there is no established medical treatment. Many factors have been incriminated in its pathogenesis but they do not explain all risk conditions. We report our experience and we investigate the predisposing factors. Probably unidentified factors make some patients more susceptible to developing encapsulating peritoneal sclerosis.
ABSTRACT
Acute crescentic transformation is a rare but well described event in patients with membranous glomerulonephritis. We report our experience with a 66-year-old Caucasian man presented for rapid decline in renal function. For nearly 10 years, he was suffering from hypertension and mixed sensori-motor polyneuropathy. He performed therapy with prednisone and azathioprine, suspended 1 year before presentation. Moreover, six months before presentation, laboratory tests showed a serum creatinine concentration 220 mol/L and a 24-h protein excretion 0,75 g/d. The physical examination showed oedema and severe hypertension; the 24-h protein excretion was 1,1 gr/d and creatinine concentration was 550.8 mol/L; ANCA and other immunological tests were negative. There was no evidence of SLE, infection or malignancy. The kidney biopsy highlighted a membranous GN with crescentic overlap. The patient was treated with steroid and cyclophosphamide. Because there was no sign of improvement after 2 months, we stopped the cyclophosphamide therapy and the patient started chronic haemodialysis treatment. Unlike membranous nephropathy, patients with superimposed crescentic glomerulonephritis appear to have a more aggressive clinical course. The importance of recognizing this group of patients with membranous nephropathy and crescentic glomerulonephritis is that immunosuppressive therapy may ameliorate the progression of renal damage and in some cases early treatment was associated with useful recovery of renal function.
Subject(s)
Glomerulonephritis, Membranoproliferative/complications , Glomerulonephritis, Membranous/complications , Aged , Glomerulonephritis, Membranoproliferative/pathology , Glomerulonephritis, Membranous/pathology , Humans , MaleABSTRACT
No disponible
