IgA nephropathy in Brazil: apropos of 600 cases.

IgA nephropathy (IgAN) is th e commonest primary glomerular disease worldwide. Studies on its prevalence in Brazil are however scarce. Databases and clinical records from 10 reference centres were retrospectively reviewed. Clinical and laboratory features at the moment of the biopsy were retrieved (age, gender, presence of hematuria, serum creatinine [mg/dL], proteinuria [g/24 h]). Renal biopsy findings were classified according to Haas single grade classification scheme and the Oxford Classification of IgAN. 600 cases of IgAN were identified, of which 568 (94.7 %) were on native kidneys. Male to female ratio was 1.24:1. Patients averaged 32.76 ± 15.12 years old (range 4-89, median 32). Proteinuria and hematuria were observed, respectively in 56.63 and 72.29 % of patients. The association of both these findings occurred in 37.95 % of the cases. Serum creatinine averaged 1.65 ± 0.67 mg/dL (median 1.5 mg/dL) at diagnosis. Segmental sclerosis and mesangial hypercellularity were the main glomerular findings (47.6 and 46.2 %) The commonest combination by Oxford Classification of IgAN, was M0 E0 S0 T0 (22.4 %). Chronic tubulo-interstitial lesions with an extension wider than 25 % of the renal cortex could be identified in 32.2 % of the cases. Tubular atrophy and interstitial fibrosis were more strongly associated with higher 24-h proteinuria and serum creatinine levels. Segmental sclerosis (S1) showed a stronger tendency of association with the presence of tubulo-interstitial lesions (T1 and T2) than other glomerular variables. To the best of our knowledge this is the largest series of IgAN in Brazil. It depicts the main biopsy findings and their possible clinical correlates. Our set of data is comparable to previous reports.

Renal acute cellular rejection: correlation between the immunophenotype and cytokine expression of the inflammatory cells in acute glomerulitis, arterial intimitis, and tubulointerstitial nephritis.

BACKGROUND: Acute renal transplant glomerulopathy (ARTG) refers to a glomerular inflammation mainly within the three 1st months posttransplantation, characterized by the influx of lymphomononuclear cells and swelling of endothelial and mesangial cells. The reported occurrence of ARTG is between 4.3% and 14% of all renal allografts. Investigations on the pathogenesis and on the impact on graft survival have been critically reviewed. The simultaneous occurrence of ARTG and acute vascular rejection (AVR) is common. However, cases of ARTG with no vascular inflammation suggest distinct pathogenic mechanisms for the entities. The objective of the present work was to compare the immunophenotype of the infiltrating cells and the cytokine immunoexpression (ICE) in ARTG with those of arterial intimal inflammation in AVR. We also compared the glomerular ICE with that in acute tubulointerstitial rejection and in arterial intimal inflammation. METHODS: Forty kidney transplant biopsy specimens were allocated to 4 groups: 10 cases of acute tubular necrosis without ARTG or AVR (group I, Control); 10 cases of ARTG without AVR (group II); 10 cases of ARTG with AVR (group III); and 10 cases of AVR without ARTG (group IV). RESULTS: The immunoexpressions of CD68 (macrophages), CD8 (cytotoxic T lymphocyte), CD4 (helper T lymphocyte), CD20 (B lymphocyte), S100 protein (antigen-presenting cells), interleukin (IL)-4, IL-10, and interferon (INF)-gamma-positive cells were evaluated in the glomeruli, arterial intima, and tubulointerstitium. In the comparative study between ARTG and arterial intimal inflammation, CD68+ cells predominated in the ARTG and T CD8+ cells in inflammation; the cytokine patterns were similar in both cases (IL-4 predominance). CONCLUSIONS: Altogether, the data suggested similar pathogenic mechanisms, with mild sequential differences, for the glomerulitis, intimitis, and tubulointerstitial inflammation in cellular acute rejection. These findings seem to confirm the immunological nature of ARTG, indicating that ARTG might be included in the Banff classification as an additional parameter for acute rejection.

The skin of the medial area of the arm: morphometric study of interest to liposuction.

The study of the skin of medial area of the arm in cadavers made it possible to evaluate its regional characteristics. Sex or race were not reported, but the age group most appropriate to liposuction was considered. In this way, authors believed that, as per standards established at the time, results as to skin retraction in liposuction, will be able to be analyzed in a comparative way in the future.

Alteraçöes histopatológicas do intestino delgado após preservaçäo hipotérmica com as soluçöes da Universidade de Wisconsin e Euro-Collins. Estudo experimental / Histopathological changes of the small bowel after hypothermic preservation with University of Wisconsin and Euro-Collins solutions. Experimental study

Existe interesse em prolongar o tempo de isquemia hipotérmica do intestino delgado (ID) com o uso de soluçöes de preservaçäo. OBJETIVO. Oobjetivo deste trabalho foi comparar as alteraçöes do ID isolado sob preservaçäohipotérmica com as soluçöes da Universidade de Wisconsin (UW) e Euro-Collins (EC) utilizando método de análise histopatológica. MÉTODO. Utilizaram-se 40 ratos Wistar (250-300g) cujo ID foi retirado por meio de técnica microcirúrgica e tratado com soluçäo UW ou soluçäo EC. Realizaram-se biópsias do jejuno proximal e íleo distal periodicamente, de 8 em 8 horas, a partir da retirada do ID (tempo 0) até 48 horas. Classificaram-se as alteraçöes histopatológicas encontradas no ID, quantitativamente, em 4 graus de gravidade de lesäo. De acordo com a progressäo de degeneraçäo hidrópica na vilosidade, os resultados obtidos foram analisados por estatística näo-paramétrica (p<0,05). RESULTADOS. Observou-se aumento significante da freqüência do acometimento do ID por lesöes isquêmicas ao longo dos períodos de tempo analisados para ambos os grupos. A freqüência e a gravidade das lesöes foram significantemente maiores no grupo EC do que no grupo UW, para os segmentos jejunais no tempo 8 horas, no jejuno e íleo no tempo 24 horas, e no jejuno e íleo no tempo 48 horas. CONCLUSÄO. concluiu-se que a soluçäo UW näo impediuo aparecimento de lesöes isquêmicas do ID, porém apresentou melhor açäo protetora, ao longo do tempo, nos segmentos jejunal e ileal, reduzindo a gravidade e a freqüência das lesöes histopatológicas, quando comparada com a soluçäo EC

[Histopathological changes in the small intestine after hypothermic preservation with University of Wisconsin and Euro-Collins solutions. Experimental study]. / Alterações histopatológicas do intestino delgado após preservação hipotérmica com as soluções da Universidade de Wisconsin e Euro-Collins. Estudo experimental.

PURPOSE: The objective of this study is to compare small bowel histopathologic alterations under hypothermic preservation with University of Wisconsin (UW) and Euro-Collins (EC) solutions. METHODS: In 40 Wistar rats (250-300g) the small bowel was microsurgically withdrawn and randomly treated with UW solution or EC solution. Periodic intestinal biopsies were taken from the proximal jejunum and distal ileum each 8 hours after small bowel withdrawing (time 0) until 48 hours. The histopathologic alterations were semiquantitatively classified in 4 degrees of severity and the obtained results were analysed statistically by appropriated tests (p < 0.05). RESULTS: There was a significant increase of the small bowel ischaemic lesions over the time for both experimental groups. The lesions frequency and severity were significantly more increased in the EC group than in the UW group, for jejunal segments at 8 hours, in jejunal and ileal segments at 24 and in jejunal and ileal segments at 48 hours. CONCLUSION: The UW solution did not avoid the development of small bowel ischaemic lesions but, with time, it protected better jejunal and ileal segments, decreasing frequency and severity of histopathological alterations, when compared to EC solution.