RESUMO
IgA nephropathy (IgAN) and Henoch-Schönlein purpura (HSP) are both characterized by IgA-mediated tissue injury, including mesangial proliferative glomerulonephritis. Abnormalities of IgA1 glycosylation are described in IgA nephropathy and HSP nephritis. IgA-antineutrophil cytoplasmic antibodies (ANCA) have been inconsistently described in the serum of patients with HSP. In IgA myeloma, the paraprotein-mediated renal lesion is typically cast nephropathy; IgAN or HSP have only rarely been reported in myeloma even when an IgA paraprotein is circulating in large concentrations. We report the case of a 50-year-old man with IgA myeloma who presented with HSP including nephritis and rapidly progressive renal failure. His IgA1 had altered O-glycosylation in the pattern seen in IgAN and also contained an IgA-ANCA. This case adds further weight to the evidence that IgA1 O-glycosylation abnormalities predispose to mesangial IgA deposition and also that IgA-ANCA may have a pathogenic role in the development of HSP.
Assuntos
Vasculite por IgA/etiologia , Imunoglobulina A/sangue , Imunoglobulinas/sangue , Mieloma Múltiplo/complicações , Nefrite/etiologia , Anticorpos Anticitoplasma de Neutrófilos/sangue , Glicosilação , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Proteínas do MielomaAssuntos
Transplante de Rim/fisiologia , Doadores de Tecidos , Cadáver , Estudos de Coortes , Ciclosporina/uso terapêutico , Sobrevivência de Enxerto , Parada Cardíaca , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Estudos Prospectivos , Estudos Retrospectivos , Tacrolimo/uso terapêuticoRESUMO
BACKGROUND: The aim of this study was to identify clinical and operative risk factors that might influence the rate of independent ambulation following major limb amputation. METHODS: Between 1989 and 1993, 172 patients had 193 lower limb amputations for peripheral vascular disease: 98 below-knee, 86 above-knee and nine through-knee. RESULTS: The overall revision rate was 13.5 per cent. Revision was significantly more frequent in those patients who had a previous vascular reconstruction. Only 26 per cent of patients were able to ambulate independently after rehabilitation and limb-fitting. Univariate risk factor analysis suggested that independent ambulation was not affected by age, mode of presentation, the presence of ischaemic heart disease, diabetes, smoking status, previous vascular reconstruction or the level of amputation. However, fewer patients whose amputation was performed by a junior trainee could walk with a prosthetic limb (P = 0.03). CONCLUSION: Patients considered suitable for walking training should have amputation performed by a senior trainee or consultant to optimize independent ambulation with a prosthetic limb.
