RESUMO
A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.
Assuntos
Glomerulosclerose Segmentar e Focal/complicações , Hipertensão Renovascular/complicações , Síndrome Nefrótica/etiologia , Glomerulosclerose Segmentar e Focal/diagnóstico , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/cirurgia , Rim/patologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Nefroesclerose/patologia , Obstrução da Artéria Renal/patologiaRESUMO
A 70-year-old man with polycystic kidney disease developed nephrotic syndrome, deteriorating to renal insufficiency. Histological examination revealed IgA nephropathy. With treatment of prednisolone, an angiotensin-converting enzyme inhibitor, and an angiotensin II receptor-blocker, his proteinuria markedly decreased and renal function was stabilized. This case supports the idea that renal biopsy is needed in patients with polycystic kidney disease with nephrotic-range proteinuria, for appropriate treatment and prevention of renal failure.
Assuntos
Glomerulonefrite por IGA/etiologia , Síndrome Nefrótica/etiologia , Rim Policístico Autossômico Dominante/complicações , Idoso , Biópsia , Dipiridamol/uso terapêutico , Glomerulonefrite por IGA/tratamento farmacológico , Humanos , Rim/patologia , Losartan/uso terapêutico , Masculino , Síndrome Nefrótica/tratamento farmacológico , Rim Policístico Autossômico Dominante/tratamento farmacológico , Rim Policístico Autossômico Dominante/patologia , Prednisolona/uso terapêutico , Tiazepinas/uso terapêuticoRESUMO
A 40-year-old woman was referred to our hospital with severe hypovolemic shock and anasarca. The laboratory findings showed marked hemoconcentration and a decrease in total serum protein with the presence of monoclonal IgG-lambda. She had had a similar episode of generalized edema 2 years previously. We diagnosed the patient as having typical systemic capillary leak syndrome (SCLS) and she improved gradually after infusion of albumin-containing fluid. SCLS is a very rare condition caused by unexplained episodic capillary hyperpermeability. Its treatment has remained largely supportive and the prognosis is generally poor. Awareness of SCLS is necessary for improvement of the outcome.
