RESUMEN
Diagnosis of Epstein-Barr virus (EBV) infection is based on clinical symptoms and serological markers, including the following: immunoglobulin G (IgG) and IgM antibodies to the viral capsid antigen (VCA), heterophile antibodies, and IgG antibodies to the EBV early antigen-diffuse (EA-D) and nuclear antigen (EBNA-1). The use of all five markers results in 32 possible serological patterns. As a result, interpretation of EBV serologies remains a challenge. The purpose of this study was to use a large population of patients to develop evidence-based tools for interpreting EBV results. This study utilized 1,846 serum specimens sent to the laboratory for physician-ordered EBV testing. Chart review was performed for more than 800 patients, and diagnoses were assigned based on physician-ordered testing, clinical presentation, and patient history. Testing for all five EBV antibodies was performed separately on all serum samples using the Bio-Rad BioPlex 2200 system. Presumed EBV diagnosis (based on previous publications) was compared to EBV diagnosis based on a medical record review for each serological pattern. Interestingly, of the 32 possible serological patterns, only 12 occurred in > or = 10 patients. The remaining 20 patterns were uninterpretable because they occurred with such infrequency. Two easy-to-use tables were created to interpret EBV serological patterns based on whether three (EBV VCA IgG, IgM, and heterophile) or five markers are utilized. The use of these two tables allows for interpretation of >95% of BioPlex serological results. This is the first evidence-based study of its kind for EBV serology.
Asunto(s)
Anticuerpos Antivirales/sangre , Infecciones por Virus de Epstein-Barr/diagnóstico , Infecciones por Virus de Epstein-Barr/inmunología , Herpesvirus Humano 4/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Proteínas Virales/inmunología , Adulto JovenAsunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Colchicina/efectos adversos , Ciclosporina/uso terapéutico , Supresores de la Gota/uso terapéutico , Inmunosupresores/uso terapéutico , Enfermedad Aguda , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Glomerulonefritis/diagnóstico , Hemorragia/diagnóstico , Alveolos Pulmonares , Lesión Renal Aguda/etiología , Anciano , Diagnóstico Diferencial , Glomerulonefritis/etiología , Hemorragia/etiología , Humanos , Trasplante de Riñón/efectos adversos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/etiología , Masculino , Insuficiencia Respiratoria/etiologíaRESUMEN
Diabetic nephropathy is one of the most serious complications of diabetes mellitus because of the associated mortality and morbility. The proteinuria, together with hypertension and renal function, are the clinical features. It is linked with a major prevalence of the other late complications of the disease. In recent years progress has been made in the knowledge of the natural history of the disease, as well as, its predictive factors. We review the etiopathogenia, the actual therapeutic management with special emphasis on hypertension treatment and the controversial metabolic control.