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INTRODUCTION: In hospitalized patients with acute renal injury (AKI), acute tubulointerstitial nephritis (AIN) constitutes one of the leading etiologies. The objective of this study was to identify clinical and biochemical variables in patients with AKI associated with kidney biopsy-confirmed AIN. METHODS: For our prospective study, we recruited hospitalized patients aged 18 years and older who were diagnosed with AKI based on biochemical criteria. Prior to enrollment, each patient was assessed with a complete metabolic panel and a kidney biopsy. RESULTS: The study consisted of 42 patients (with a mean age of 45 years) and equal numbers of male and female patients. Diabetes and hypertension were the main comorbidities. Nineteen patients had histological findings consistent with AIN. There was a correlation between histology and the BUN/creatinine ratio (BCR) (r = -0.57, p = 0.001). The optimal Youden point for classifying AIN via a receiver operating characteristic (ROC) curve analysis was a BCR ≤ 12 (AUC = 0.73, p = 0.024). Additionally, in diagnosing AIN, BCR had a sensitivity of 76%, a specificity of 81%, a positive predictive value of 81%, a negative predictive value of 76%, and OR of 14 (95% CI = 2.6 to 75.7, p = 0.021). In the multivariable analysis, BCR was the sole variable associated with AIN. CONCLUSION: A BCR ≤ 12 identifies AIN in patients with AKI. This study is the first to prospectively assess the relationship between renal biopsy results and BCR.
Assuntos
Injúria Renal Aguda , Nefrite Intersticial , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Creatinina/análise , Nitrogênio da Ureia Sanguínea , Estudos Prospectivos , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/patologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/patologiaRESUMO
BACKGROUND: Kidney disease is a rare manifestation of ankylosing spondylitis (AS) and its pathological alterations remain poorly described. The aim of this study was to investigate the clinical presentation and pathological alterations on kidney biopsy of AS patients and review and discuss the current literature on the issue. METHODS: We retrospectively studied the clinical presentation and kidney pathological alterations of 15 Caucasian AS patients submitted to kidney biopsy between October 1985 and March 2021. RESULTS: Patients were predominantly male (66.7%) with median age at the time of kideney biopsy of 47 years [IQR 34 - 62]. Median serum creatinine at presentation was 1.3 mg/dL [IQR 0.9 - 3] and most patients also had either proteinuria (85.7%) and/or hematuria (42.8%). The most common indication for kidney biopsy was nephrotic syndrome (33.3%), followed by acute or rapidly progressive kidney injury (20%) and chronic kidney disease of unknown etiology (20%). Chronic interstitial nephritis (CIN) (n=3) and AA amyloidosis (n=3) were the most common diagnosis. Others included IgA nephropathy (IgAN) (n=2), focal segmental glomerulosclerosis (n=2), membranous nephropathy (n=1), and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN)(n=1). CONCLUSIONS: We present one of the largest series of biopsy-proven kidney disease in Caucasian AS patients. We found a lower prevalence of IgAN than previously reported in Asian cohorts. We found a higher prevalence of CIN and a lower prevalence of AA amyloidosis than that described in previous series of Caucasian patients. We also present the first case of AS-associated IC-MPGN.
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Amiloidose , Glomerulonefrite por IGA , Nefrite Intersticial , Espondilite Anquilosante , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Espondilite Anquilosante/complicações , Espondilite Anquilosante/patologia , Amiloidose/patologia , Glomerulonefrite por IGA/epidemiologia , Biópsia , Rim/patologiaRESUMO
Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality. Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.
Assuntos
Injúria Renal Aguda , Febre de Chikungunya , Vírus Chikungunya , Nefrite Intersticial , Humanos , Febre de Chikungunya/complicações , Febre de Chikungunya/epidemiologia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , RimRESUMO
Bovine polyomavirus-1 (BoPyV-1, Epsilonpolyomavirus bovis) is widespread in cattle and has been detected in commercialized beef at supermarkets in the USA and Germany. BoPyV-1 has been questioned as a probable zoonotic agent with documented increase in seropositivity in people exposed to cattle. However, to date, BoPyV-1 has not been causally associated with pathology or disease in any animal species, including humans. Here we describe and illustrate pathological findings in an aborted bovine fetus naturally infected with BoPyV-1, providing evidence of its pathogenicity and probable abortigenic potential. Our results indicate that: (i) BoPyV-1 can cause severe kidney lesions in cattle, including tubulointerstitial nephritis with cytopathic changes and necrosis in tubular epithelial cells, tubular and interstitial inflammation, and interstitial fibroplasia; (ii) lesions are at least partly attributable to active viral replication in renal tubular epithelial cells, which have abundant intranuclear viral inclusions; (iii) BoPyV-1 large T (LT) antigen, resulting from early viral gene expression, can be detected in infected renal tubular epithelial cells using a monoclonal antibody raised against Simian Virus-40 polyomavirus LT antigen; and (iv) there is productive BoPyV-1 replication and virion assembly in the nuclei of renal tubular epithelial cells, as demonstrated by the ultrastructural observation of abundant arrays of viral particles with typical polyomavirus morphology. Altogether, these lesions resemble the "cytopathic-inflammatory pathology pattern" proposed in the pathogenesis of Human polyomavirus-1-associated nephropathy in immunocompromised people and kidney allograft recipients. Additionally, we sequenced the complete genome of the BoPyV-1 infecting the fetus, which represents the first whole genome of a BoPyV-1 from the Southern Hemisphere. Lastly, the BoPyV-1 strain infecting this fetus was isolated, causing a cytopathic effect in Madin-Darby bovine kidney cells. We conclude that BoPyV-1 is pathogenic to the bovine fetus under natural circumstances. Further insights into the epidemiology, biology, clinical relevance, and zoonotic potential of BoPyV-1 are needed.
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Transplante de Rim , Nefrite Intersticial , Infecções por Polyomavirus , Polyomavirus , Infecções Tumorais por Vírus , Animais , Anticorpos Monoclonais , Antígenos Virais de Tumores , Bovinos , Feto/patologia , Humanos , Rim , Transplante de Rim/efeitos adversos , Nefrite Intersticial/complicações , Nefrite Intersticial/patologia , Infecções por Polyomavirus/complicações , Vírus 40 dos Símios , Infecções Tumorais por Vírus/complicaçõesRESUMO
INTRODUCTION: Studies based on kidney biopsies are important for the epidemiological understanding of nephropathies. OBJECTIVE: To describe the main nephropathies diagnosed through renal biopsies, and compare them with regards to gender, time, healthcare insurance and age. METHODS: A population-based retrospective study that reviewed all kidney disease diagnoses obtained by biopsy of a native kidney from pathology services between 2008 and 2019 in Joinville, Brazil. RESULTS: Of 778 biopsies performed, 44.5% were primary nephropathies and 28.5% were secondary. The highest prevalence was focal segmental glomerulosclerosis (FSGS) [18.1%], followed by tubulointerstitial nephropathy (TIN) [15.9%] and IgA nephropathy (IgAN) [9.1%]. There was a growing increase in the prevalence of TIN among elderly and uninsured patients over the period. In the multivariate analysis, among the primary glomerulopathies, males had a higher risk for the occurrence of IgAN [OR=2.02; 95% CI 1.13-3.61; p=0.018], as well as being a protective factor for the occurrence of lupus glomerulonephritis (LGN) [OR=0.20, 95% CI 0.08-0.49; p<0.001]. Advancing age and dependence on a public healthcare decreased the likelihood of having a diagnosis of LGN [OR=0.91, 95% CI 0.88-0.94, p < 0.001 and OR=0.45, CI 95 % 0.21-0.96; p = 0.036, respectively]. Patients without private healthcare insurance were more likely to have TIN [OR=1.77, 95%CI 1.16-2.70; p = 0.008]. CONCLUSION: Sex, age and type of medical healthcare insurance may be related to the occurrence of some nephropathies. The increased risk of TIN in individuals without a private healthcare plan may be an indication of inequalities in health care.
Assuntos
Glomerulonefrite por IGA , Nefropatias , Nefrite Lúpica , Nefrite Intersticial , Idoso , Humanos , Masculino , Biópsia , Brasil/epidemiologia , Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/patologia , Rim/patologia , Nefropatias/epidemiologia , Nefropatias/patologia , Nefrite Lúpica/patologia , Estudos RetrospectivosRESUMO
Resumen El síndrome de DRESS (Reacción a drogas con eosinofilia y síntomas sistémicos) es una patología poco frecuente en Pediatría, descrita por primera vez en 1996, por Bocquet. Puede presentarse en un tiempo variable luego de exposición a algunos medicamentos, se caracteriza por fiebre, compromiso cutáneo y de órganos internos. En este caso, se presenta a un paciente de 13 años, con antecedente de uso de Trimetroprim sulfa desde hace 2 meses, con cuadro de 3 días consistente en fiebre y rash cutáneo, sin compromiso de mucosas, con respuesta no favorable al manejo con esteroide, requiriendo Inmunoglobulina IV. Semanas después del inicio de los síntomas y evolución estable presenta insuficiencia renal aguda que requirió terapia de reemplazo renal. Se descartaron otras patologías subyacentes de índole autoinmune. Hubo recuperación de azoados y normalización de los demás paraclínicos el día 40 de la enfermedad. El paciente continúa asintomático, 4 meses después, con tratamiento con esteroide oral, en descenso lento y gradual. Se debe considerar la evaluación permanente de las pruebas de función renal en los pacientes que presenten Síndrome de DRESS, por su asociación con Nefritis intersticial aguda y complicaciones relacionadas.
Abstract DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a rare pathology in Pediatrics, first described in 1996 by Bocquet. It can appear in a variable period of time after exposure to some medications, it is characterized by fever, skin involvement and internal organs. A 13-year-old patient is presented, with a history of use of Trimethoprim sulfa for two months, with a disease of three days of evolution, consisting of fever and skin rash, without mucosal involvement, with an unfavorable response to steroid management, requiring Intravenous inmunoglobulin. Weeks after the onset of symptoms and stable evolution, he presented acute renal failure that required renal replacement therapy. Other underlying autoimmune pathologies were ruled out. There was recovery of renal function test and normalization of the other paraclinical on day 40 of the disease. Patient remains asymptomatic four months later, with oral steroid treatment, in slow and gradual decline. Permanent evaluation of renal function tests should be considered in patients with DRESS syndrome, due to its association with acute tubulointerstitial nephritis and related complications.
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Humanos , Masculino , Adolescente , Eosinofilia , Insuficiência Renal , Síndrome de Hipersensibilidade a Medicamentos , Testes de Função Renal , Nefrite Intersticial , Esteroides , Trimetoprima , Imunoglobulinas , Preparações Farmacêuticas , Terapia de Substituição Renal , Exantema , FebreRESUMO
Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.
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Injúria Renal Aguda/patologia , COVID-19/patologia , Glomerulonefrite/patologia , Rim/patologia , Microangiopatias Trombóticas/patologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/imunologia , Imunidade Adaptativa/imunologia , Arteriosclerose/imunologia , Arteriosclerose/patologia , COVID-19/sangue , COVID-19/imunologia , Citocinas/imunologia , Glomerulonefrite/imunologia , Glomerulonefrite por IGA/imunologia , Glomerulonefrite por IGA/patologia , Glomerulosclerose Segmentar e Focal/imunologia , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Imunidade Inata/imunologia , Infarto/imunologia , Infarto/patologia , Rim/irrigação sanguínea , Rim/imunologia , Necrose do Córtex Renal/imunologia , Necrose do Córtex Renal/patologia , Nefrite Intersticial/imunologia , Nefrite Intersticial/patologia , Nefrose Lipoide/imunologia , Nefrose Lipoide/patologia , Rabdomiólise , SARS-CoV-2 , Trombofilia/sangue , Microangiopatias Trombóticas/imunologiaRESUMO
Background: A detailed ultrasound examination of the fetal urinary tract as part of prenatal care is important to detect possibleabnormalities. Early diagnosis can prevent more serious damage such as loss of kidney function. Interstitial nephritis cancompromise renal functionality. Also, acute interstitial nephritis is a frequent cause of acute kidney injury and can becomechronic if not treated. Besides, a renal biopsy can help in the diagnosis and at the staging of the disease. Therefore, thisreport aims to describe the ultrasonographic findings of the renal tissues in a canine fetus affected by interstitial nephritis.Case: Gestational ultrasound evaluations were performed in a female Pug, at the 25th, 45th, and 58th gestational days.Ultrasound examination was performed with a 9.0 MHz linear transducer and a high-resolution digital transducer with afrequency standardized at 17.0 MHz. During the first evaluation, embryonic vesicles were detected and were compatible withthe gestational period. At 45 days of gestation, some abnormalities were observed in the kidneys of one of the fetuses, suchas increased cortical echogenicity, cortical thickening, loss of corticomedullary ratio (1:1), renal pelvis and ureter dilatationby echogenic content. Biparietal and abdominal diameters were also lower than that from the other fetuses, which did notshow abnormalities, being compatible with the estimated gestational age. However, the heart rate was similar among allfetuses. On the 58th day, we observed in the underdeveloped fetus that both kidneys still presented the abnormalities seenpreviously, in addition to the presence of a cystic structure in the right kidney, in the cranial...(AU)
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Animais , Feminino , Gravidez , Cães , Cães/anormalidades , Nefrite Intersticial/veterinária , Desenvolvimento Fetal , Rim/anormalidades , Ultrassonografia Pré-Natal/veterinária , Cuidado Pré-NatalRESUMO
BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.
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Vírus BK , Transplante de Coração , Nefrite Intersticial , Infecções por Polyomavirus , Infecções Tumorais por Vírus , Humanos , Imunossupressores , Infecções por Polyomavirus/complicações , Infecções por Polyomavirus/diagnóstico , Infecções Tumorais por Vírus/diagnósticoRESUMO
Background: A detailed ultrasound examination of the fetal urinary tract as part of prenatal care is important to detect possibleabnormalities. Early diagnosis can prevent more serious damage such as loss of kidney function. Interstitial nephritis cancompromise renal functionality. Also, acute interstitial nephritis is a frequent cause of acute kidney injury and can becomechronic if not treated. Besides, a renal biopsy can help in the diagnosis and at the staging of the disease. Therefore, thisreport aims to describe the ultrasonographic findings of the renal tissues in a canine fetus affected by interstitial nephritis.Case: Gestational ultrasound evaluations were performed in a female Pug, at the 25th, 45th, and 58th gestational days.Ultrasound examination was performed with a 9.0 MHz linear transducer and a high-resolution digital transducer with afrequency standardized at 17.0 MHz. During the first evaluation, embryonic vesicles were detected and were compatible withthe gestational period. At 45 days of gestation, some abnormalities were observed in the kidneys of one of the fetuses, suchas increased cortical echogenicity, cortical thickening, loss of corticomedullary ratio (1:1), renal pelvis and ureter dilatationby echogenic content. Biparietal and abdominal diameters were also lower than that from the other fetuses, which did notshow abnormalities, being compatible with the estimated gestational age. However, the heart rate was similar among allfetuses. On the 58th day, we observed in the underdeveloped fetus that both kidneys still presented the abnormalities seenpreviously, in addition to the presence of a cystic structure in the right kidney, in the cranial...