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1.
Invest Clin ; 47(4): 405-11, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17176908

ABSTRACT

Behcet's disease (BD) is associated with renal involvement in about one-third of the cases and a variety of renal lesions have been reported. A 27-year-old man presented a history of recurrent oral and genital ulcers, associated with pseudofoliculitis and arthritis in his left knee. The first laboratory tests revealed: urea = 53mg/dL, creatinine = 1.8 mg/dL. The urinalysis showed leukocyturia. Initial treatment with ceftriaxone, thalidomide and prednisone was instituted. He became clinically stable, with normal renal function, but presenting hematuria and proteinuria. One year later the patient presented dark urine. The new laboratory tests showed urea=58 mg/dL, creatinine = 1.4 mg/dL, and mild proteinuria (500-1000 mg/24h). Two years later the proteinuria was 2230 mg/day. The renal biopsy showed one glomerulus with severe glomerular sclerosis, mild tubular atrophy, mild interstitial fibrosis and thickening of arterial walls. Treatment with captopril was started to decrease proteinuria. Two years later, the patient presented creatinine = 1.7 mg/dL and proteinuria = 2509 mg/day. A new renal biopsy evidenced proliferative crescentic glomerulonephritis, with diffuse granullary deposits of IgA, IgM and C3. It was instituted pulsotherapy with metilprednisolone, monthly endovenous cyclophosphamide and maintenance prednisone. The patient became clinically stable, with creatinine of 1.3 mg/dL and proteinuria of 500 mg/day. BD could be one of the various causes of secondary IgA nephritis. It is important to periodically perform renal function evaluation in patients with BD, through urinalysis and measurement of serum creatinine and its clearance, in order to detect any abnormality and provide an early adequate treatment.


Subject(s)
Behcet Syndrome/complications , Glomerulonephritis, IGA/etiology , Adult , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Biopsy , Brazil , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Drug Therapy, Combination , Follow-Up Studies , Glomerulonephritis, IGA/diagnosis , Glomerulonephritis, IGA/drug therapy , Glomerulonephritis, IGA/pathology , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Injections, Intravenous , Kidney/pathology , Kidney Function Tests , Male , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Prednisone/administration & dosage , Prednisone/therapeutic use , Pulse Therapy, Drug , Time Factors , Treatment Outcome
2.
Invest. clín ; 47(4): 405-411, dic. 2006. ilus
Article in English | LILACS | ID: lil-462854

ABSTRACT

La enfermedad de Behcet (EB) está asociada a daño renal en cerca de un tercio de los casos y una variedad de lesiones renales han sido descritas. Un hombre de 27 años presentaba historia de ulceraciones orales y genitales, en asociación con pseudofoliculitis y artritis en su rodilla izquierda. Los primeros exámenes evidenciaban urea = 53mg/dL, creatinina = 1,8mg/dL. El análisis de orina presentaba leucocituria. El tratamiento inicial fue ceftriaxone, talidomida y prednisona. El enfermo se quedó clínicamente estable, con función renal normal, pero presentando hematuria y proteinuria. Pasado un año, su orina resultó oscura. Nuevos exámenes mostraban urea = 58mg/dL, creatinina = 1,4mg/dL y proteinuria (500-1000mg/día). Dos años después la proteinuria aumentó para 2230mg/día. La biopsia renal mostraba uno glomérulo con esclerosis severa, atrofia tubular blanda, fibrosis intersticial blanda y espesamiento de las paredes arteriales. Tratamiento con captopril fue iniciado para reducir la proteinuria. Dos años después el paciente presentaba creatinina = 1,7mg/dL y proteinuria = 2509mg/día. Una nueva biopsia renal fue realizada e identificó glomerulonefritis creciente proliferativa, con depósitos granulares de IgA, IgM y C3. Fue ministrada pulsoterapia con metilprednisolone, ciclofosfamida endovenosa mensal y prednisone de manutención. El paciente se quedó estable, con creatinina de 1,3mg/dL y proteinuria de 500mg/día. La EB puede ser una de las muchas causas de nefritis secundaria por IgA. Es importante realizar periódicamente exámenes de función renal en los pacientes con EB, a través del análisis de orina y medidas de creatinina sérica y su clearance, para se detectar cualquier anormalidad y providenciar un tratamiento precoz


Subject(s)
Humans , Male , Female , Acute Kidney Injury , Behcet Syndrome , Glomerulonephritis , Glomerulonephritis, IGA , Nephrology , Venezuela
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