RESUMO
INTRODUCTION: Several studies have shown that Hispanic patients generally experience a worse renal prognosis than non-Hispanic white patients with lupus. To date, there is no report on American College of Rheumatology (ACR) renal response criteria (ACR-RRC) in patients from Latin America. OBJECTIVE: To evaluate treatment response in patients with proliferative and membranous lupus nephritis (LN) according to ACR-RRC. METHODS: A retrospective study (2001-2011) was performed in our hospital and the data collected included clinical information, renal assessment and immunological parameters. Details related to treatment received during induction and maintenance therapy were also recorded. RESULTS: The study included forty-three Latin American patients (37 women) from Argentina. Mean follow-up was 54 months. The regimen used for induction therapy included intravenous cyclophosphamide (IV-CYC) for six months in 36 patients and only seven received mycophenolate mofetil (MMF) given twice daily for a total dose of 2.5 ± 0.5 grams a day. For the maintenance period, six patients continued with quarterly IV-CYC, 20 patients received MMF (1.5 ± 0.5 grams a day) and 17 patients received azathioprine (AZA) 1.5 - 2 mg/kg/day. ACR-RRC observed after induction therapy was complete response in 19%, partial response in 9%, improvement in 42%, unchanged in 14%, and 16% had deterioration despite treatment. ACR-RRC observed after maintenance therapy was complete response in 30%, partial response in 23%, improvement in 19%, unchanged in 16%, and 12% had deterioration. Relapse was observed in 11 patients (25%). Ten out of 11 cases (91%) who relapsed did not achieve a complete response at the end of the induction therapy. CONCLUSION: In Latin American patients from Argentina, only 19% could achieve a complete response after induction therapy and 30% achieved a complete response after maintenance therapy. Failing to obtain a complete response after induction therapy was related to an increased risk of relapse during long-term follow-up in our study.
Assuntos
Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/patologia , Administração Intravenosa , Adolescente , Adulto , Idoso , Argentina , Azatioprina/administração & dosagem , Ciclofosfamida/administração & dosagem , Feminino , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/análogos & derivados , Prognóstico , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
El objetivo de este trabajo fue evaluar las diferentes alteraciones renales morfológicas y funcionales secundarias a la pérdida de la masa renal por nefrectomía subtotal (Nx5/6) e investigar los mecanismos patogénicos involucrados en el daño TI en este modelo.Se utilizaron machos Sprague-Dawley (280-290 g) divididos en dos grupos. GI, (Nx5/6) N=15 y G2, (Sham) n= 15, los que fueron sometidos a una operación simulada "sham operation". La duración del experimento fue 24 semanas obteniéndose en el período basal y cada 4 semanas hasta la finalización del estudio, registros de presión arterial (PA) y muestras de sangre y orina. Los resultados indicaron que este modelo de nefrectomía subtotal, produce en 24 semanas un DRC con ascenso de la PA correlacionándose significativamente con el ascenso de la creatininemia
Assuntos
Animais , Ratos , Nefrectomia , Rim/fisiopatologiaRESUMO
El objetivo de este trabajo fue evaluar las diferentes alteraciones renales morfológicas y funcionales secundarias a la pérdida de la masa renal por nefrectomía subtotal (Nx5/6) e investigar los mecanismos patogénicos involucrados en el daño TI en este modelo.Se utilizaron machos Sprague-Dawley (280-290 g) divididos en dos grupos. GI, (Nx5/6) N=15 y G2, (Sham) n= 15, los que fueron sometidos a una operación simulada "sham operation". La duración del experimento fue 24 semanas obteniéndose en el período basal y cada 4 semanas hasta la finalización del estudio, registros de presión arterial (PA) y muestras de sangre y orina. Los resultados indicaron que este modelo de nefrectomía subtotal, produce en 24 semanas un DRC con ascenso de la PA correlacionándose significativamente con el ascenso de la creatininemia
Assuntos
Animais , Ratos , Rim/fisiopatologia , NefrectomiaRESUMO
We report the case of a young white man with Charcot-Marie-Tooth disease type 1 that began at 4 years. At 15 years, he developed proteinuria, arterial hypertension, and renal insufficiency. Renal biopsy specimens studied by electron microscopy showed deposition of nonamyloidotic microfibrils. This is the first report of fibrillary glomerulopathy associated with this neurological disorder.
Assuntos
Doença de Charcot-Marie-Tooth/complicações , Glomerulonefrite/complicações , Glomerulonefrite/diagnóstico , Citoesqueleto de Actina/ultraestrutura , Adolescente , Mesângio Glomerular/patologia , Humanos , MasculinoRESUMO
A 22 year-old woman with a seven year history of (SLE) was readmitted because of oliguria, edema, dyspnea and arterial hypertension. She had a previous biopsy diagnosis of focal glomerulonephritis, (WHO III b), and had been treated with immunosuppressors and steroids. Laboratory data showed lupus activity, AHM with thrombocytopenia, nephrotic-range proteinuria and renal failure. A second renal biopsy was performed showing diffuse proliferative nephritis, (WHO IV), in association with noninflammatory necrotizing vasculopathy with luminal obliteration. She started with hemodialysis and was subsequently treated with methylprednisolone pulses, plasmapheresis, cyclophosphamide and oral steroids. During the inpatient period, she had generalized seizures, acute lung injury and pulmonary hemorrhage. These complications, the AHM and the thrombocytopenia receded totally. Renal function was never resumed. We emphasize that this association of diffuse proliferative nephritis with noninflammatory necrotizing vasculopathy is not infrequent and has a poor renal prognosis. The AHM with thrombocytopenia was interpreted as secondary to endothelial cell damage due to vasculopathy.
Assuntos
Anemia Hemolítica/etiologia , Rim/irrigação sanguínea , Rim/patologia , Lúpus Eritematoso Sistêmico/complicações , Obstrução da Artéria Renal/etiologia , Trombose/etiologia , Adulto , Feminino , Glomerulosclerose Segmentar e Focal/etiologia , Humanos , Hipertensão Renovascular/etiologia , Nefrite Lúpica/etiologia , Insuficiência Respiratória/etiologia , Trombocitopenia/etiologiaRESUMO
We report the reversion of fetal paroxysmal atrial tachycardia with 2:1 atrioventricular block obtained by vagal maneuvers during week 35 of gestation in a 31-year-old woman. All events were documented by fetal echocardiography.