RESUMEN
PURPOSE: Cytomegalovirus (CMV) infection is an important complication in organ and bone marrow recipients as well as patients infected with HIV. Although screening and prophylaxis have been defined in these patients, there are few data about the frequency of CMV disease in glomerular diseases treated by immunosuppression. METHODS: We recruited 133 patients with glomerular diseases treated by immunosuppression between 2006 and 2013. Patients who had any symptoms suggestive of CMV disease were screened for viral DNA. Immunosuppressive treatments were as follows: Group 1, steroid only; Group 2, steroid with cyclophosphamide (CP); Group 3, steroid with cyclosporine A; and Group 4, steroid with mycophenolate mofetil or azathioprine. RESULTS: Patients developing CMV and non-CMV disease were compared for age, sex, renal pathology, hypertension, diabetes, baseline creatinine, and estimated glomerular filtration rate, and immunosuppressive regimen. At follow-up, 55 patients were tested for CMV disease during immunosuppressive treatment. Twenty-six patients had CMV DNA positivity of 1,112-205,500 copies/mL. Patients with CMV disease were all seen within the first 5 months of immunosuppressive treatment, and the disease was observed most commonly (14 patients, 53 %) in the first 2 months of treatment. Multiple regression analysis revealed that high baseline creatinine levels, older age, and use of steroids with CP were independent risk factors for development of CMV disease. CONCLUSIONS: CMV disease is not an uncommon complication in patients with glomerular diseases treated by immunosuppression. Further prospective studies and prophylaxis should be addressed in future studies, including particular groups of patients.
Asunto(s)
Infecciones por Citomegalovirus/epidemiología , Inmunosupresores/uso terapéutico , Enfermedades Renales/tratamiento farmacológico , Adulto , Azatioprina/uso terapéutico , Biopsia , Ciclofosfamida/uso terapéutico , Ciclosporina/uso terapéutico , Infecciones por Citomegalovirus/mortalidad , Femenino , Glucocorticoides/uso terapéutico , Humanos , Enfermedades Renales/mortalidad , Masculino , Persona de Mediana Edad , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Factores de Riesgo , Turquía/epidemiologíaRESUMEN
BACKGROUND: Although several lines of evidence suggest that renin angiotensin system (RAS) proteins are synthesized by cyst epithelium and dilated tubules, role of intrarenal RAS in the progression of otozomal dominant polycystic kidney disease (ADPKD) is not well known. We aimed to study the levels and clinical correlations of urinary angiotensinogen (UAGT) in normotensive ADPKD patients compared with age- and sex-matched healthy subjects. METHODS: The study included 20 normotensive ADPKD patients (F/M: 11/9) and 20 age and sex matched healthy controls (F/M: 9/11). Diagnosis of ADPKD was made based on Ravine criteria. Twenty-four hours ambulatory blood pressure monitoring (ABPM) was performed. Serum concentrations of creatinine, Na, K, uric acid, and urinary concentrations of Na, K, uric acid, creatinine, protein and albumin were measured. UAGT were measured via commercially available ELISA kit. RESULTS: ADPKD patients had higher urinary albumin:creatinine ratio (UAIb/UCrea) than healthy controls (p < 0.01). UAGT/UCrea levels significantly positively correlated with urinary protein: creatinine ratio (UPro/UCrea) (r = 0.785, p = 0.01), and UAIb/UCrea (r = 0.681, p = 0.01) in normotensive ADPKD patients. CONCLUSION: This pilot study demonstrates that UAGT levels tend to be elevated and are correlated with proteinuria and albuminuria in normotensive ADPKD patients during relatively early stages of the disease.
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Angiotensinógeno/orina , Riñón Poliquístico Autosómico Dominante/orina , Adulto , Presión Sanguínea , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Proyectos Piloto , Adulto JovenRESUMEN
Mixed cryoglobulinemia is commonly related to chronic HCV infection, and renal complications occur frequently. Typical renal involvement presents with diffuse proliferative glomerular pathology, similar to membranoproliferative glomerulonephritis, with necrotizing arteritis of medium-sized vessels, referred to as cryoglobulinemic glomerulonephritis. However, the histological appearance may vary according to the clinical presentation and treatment applied. Not only membranoproliferative glomerulonephritis but also certain types of systemic vasculitis (Systemic Lupus Erythematosus, Polyarteritis Nodosa), thrombotic microangiopathy, and Waldenstrom's Macroglobulinemia may exhibit similar histopathological findings in the biopsy with cryoglobulinemic glomerulonephritis. For an optimal differential diagnosis, clinicopathological correlation and serological findings should accompany the pathological findings. We present a case of cryoglobulinemic glomerulonephritis, and discuss the differential diagnosis in detail.
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Crioglobulinemia/diagnóstico , Glomerulonefritis Membranoproliferativa/diagnóstico , Adulto , Antivirales/uso terapéutico , Crioglobulinemia/sangre , Crioglobulinemia/tratamiento farmacológico , Crioglobulinemia/virología , Crioglobulinas/análisis , Diagnóstico Diferencial , Femenino , Glomerulonefritis Membranoproliferativa/sangre , Glomerulonefritis Membranoproliferativa/tratamiento farmacológico , Glomerulonefritis Membranoproliferativa/virología , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/patología , Humanos , Interferón-alfa/uso terapéutico , Glomérulos Renales/metabolismo , Glomérulos Renales/patología , Metilprednisolona/uso terapéutico , Polietilenglicoles/uso terapéutico , Proteínas Recombinantes/uso terapéutico , Resultado del TratamientoRESUMEN
Increased numbers of circulating endothelial cells (CECs) have previously been reported after various diseases associated with endothelial injury. The aim of this study was to evaluate the CECs in patients with Behçet's disease and to demonstrate a possible association between CECs and disease activity. Sixty individuals (45 Behçet's disease patients and 15 healthy controls) with normal renal function are included in the study. Peripheral blood samples are first incubated with antiCD146 antibody and subsequently conjugated to immunomagnetic beads to isolate CECs. Cells are stained with UEA-1 before counting. Behçet's patients [7-135 cells/mL, mean 50 cells/mL, median 43 cells/mL (SD 35), P<0.001] have elevated numbers of CECs compared to controls [3-14 cells/mL, mean 9 cells/mL, median 8 cells/mL (SD 4)]. The number of CECs is higher in the active period of the disease compared to the inactive period. Further studies are needed to demonstrate the potential prognostic importance of CECs in Behçet's vasculitis.
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Síndrome de Behçet/patología , Endotelio Vascular/patología , Adolescente , Adulto , Anciano , Síndrome de Behçet/sangre , Síndrome de Behçet/fisiopatología , Biomarcadores/sangre , Recuento de Células , Separación Celular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Arterial stiffness and left ventricular hypertrophy (LVH) are major independent risk factors for cardiovascular disease in healthy and renal population. In this study, we aimed to investigate comparative long-term effects of renal transplantation (RTx) and of hemodialysis (HD) on both arterial stiffness and LVH. METHODS: Twenty-eight RTx patients, 23 HD patients, and 20 healthy subjects were included in this prospective study. In addition to demographical and laboratory parameters, arterial stiffness [pulse wave velocity (PWV)] and left ventricular mass index (LVMi) were assessed before and one-yr after RTx, and at the baseline and one-yr later in HD patients. RESULTS: There were no differences in the parameters between HD and RTx patients at baseline. PWV was significantly higher than that of healthy controls. After one yr, PWV had significantly decreased in RTx patients, but was unchanged in HD patients. Changes in PWV were significant when both groups were compared (p < 0.0001). Although LVMi significantly decreased after RTx (p = 0.02), changes were not significant between the groups. CONCLUSIONS: Renal transplantation markedly improved arterial stiffness, while it remained elevated in HD patients at the one-yr follow-up. There was no difference between maintenance HD and RTx groups with respect to impact on LVMi in the one-yr follow-up.