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BACKGROUND: The present study was designed to know the clinical course of lupus nephritis and the risk factors associated with the development of end stage renal disease. METHODS: This a retrospective study performed in a cohort of 154 patients with biopsy proven lupus nephritis that were seen in our hospital between 1984 and 1990. The clinical records of all patients were reviewed in order to collect the following information at the time of the biopsy: age, sex, number and type of lupus criteria according with the American College of Reumathology, mean arterial pressure, serum creatinine, BUN, and albumin, as well as urinary protein excretion. The follow up was registered from the day the biopsy was performed to one of the following end points: end stage renal disease (defined as requirement of chronic dialysis), death or the end of study. All biopsies were analyzed by light microscopy to obtain the hystological subtype of lupus nephritis (WHO classification) and when type IV was diagnosed, the activity and chronicity indexes were also assessed. Kaplan-Meier survival tables were constructed. The association of clinical and laboratory variables with the development of end stage renal disease was obtained by log rank analysis. Variables obtained as significant were used to evaluate their individual impact using either the Cox multivariate proportional hazard method. RESULTS: Follow up was complete in 144 patients with a follow up time of 68 +/- 38 months. Ninety three patients were female with mean age of 28 +/- 9 years. At the time of the biopsy, renal manifestations had been present for 35 +/- 38 months and the number of lupus criteria per patient were 4 +/- 1. The clinical picture at the time of the biopsy was: nephrotic syndrome in 60%, non nephrotic proteinuria in 40%, and nephritic syndrome in only 2%. The hystological type of lupus nephritis was: I in 2%, II in 8%, III in 6%, IV in 71% and V in 11%. At the end of the study 28 patients developed end stage renal disease. For the whole group the survival of renal function was 85% at 70 months and 70% at 140 months. All, but one patient that developed end stage renal disease exhibited type IV nephropathy. In this subpopulation the mean activity and chronicity indexes were 8.5 +/- 3.5 and 3.1 +/- 2.4, respectively. By multivariate analysis the strongest predictors of end stage renal disease were the serum creatinine at the time of the biopsy, chronicity index, and age. The higher the serum creatinine and chronicity index at the time of biopsy, the higher the probability of developing end stage renal disease. CONCLUSIONS: We conclude that the clinical course of lupus nephritis in our population is similar to that seen in other series. The variables indicating advanced renal disease, such as high serum creatinine and chronicity index, were the strongest predictors of end stage renal disease.

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UNLABELLED: Percutaneous renal biopsy is an invasive procedure that can result in major and minor complications. The objective of this study was to know the frequency and type of complications in relation with this procedure, as well as the efficacy to obtain enough material for diagnosis. METHODS: Retrospective study. We review the charts of patients to whom a percutaneous renal biopsy of native kidneys was done between January 1970 and March 1996. The following data were obtained: age, gender, clinical and histopathological diagnosis, complications associated with the procedure (minor: hematuria, local infections, hematoma; major: transfusions, severe infections, surgery, nephrectomy, arteriography, embolism and death). RESULTS: We analyzed 1,005 renal biopsies in 840 patients, mean age 37.7 +/- 13.1 years, 67% female. There were no complications in 88.8% (893 biopsies), minor complications in 8.65% (87 biopsies) and only in 2.4% of the procedures major complications. We divided the cases in two groups: percutaneous renal biopsy without complications (n = 893, 89%) and with complications (n = 112, 11%). The most frequent complications were hematuria (91 cases, 9.1%) and perirenal hematoma (29 cases, 2.7%). In these cases transfusion was required in 2.4% (26). Infectious complications were: urosepsis in 7 cases (0.7%), bacteremia, sepsis and perirenal abscesses (1 case each, 0.1%). One patient died because of multiple complications (0.1%). We observed greater risk of major complications on patients in those who biopsy was done because of acute renal failure (OR 4.03, p < 0.003). DISCUSSION: In our experience percutaneous renal biopsy is a low risk procedure. Most complications are minor and without clinical repercussion. There must be a strict selection criteria of the patients to whom percutaneous renal biopsy is going to be done because of the risk of severe complications.

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Assuntos

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Parathyroid carcinoma is a rare cause of primary hyperparathyroidism with a prevalence ranging between 0.5 and 4%. Because of their aggressiveness, prompt diagnosis and treatment are mandatory. A parathyroid carcinoma was found in four patients (4.5%) of 88 patients who underwent surgical cervical exploration for primary hyperparathyroidism at the Institute Nacional de la Nutrición in a period of seven years. Our paper gives the clinical characteristics, diagnosis, treatment and outcome of the four patients.

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Clear cell eccrine carcinomas of the skin are rare and have been reported with several names. Of the 47 cases found in the literature, only one had the lesion in the sole. The present case is a 38 year old woman with an 18 year history of a 3.2 cm lesion in the lateral portion of the sole in the right foot. The patient developed inguinal metastases four and five months after the plantar resection, and suffered a local recurrence on two occasions. The histopathologic analysis of the sole lesion showed a neoplasm with more than 80% of clear cells, and less clear cells in the metastatic and recurrent lesions. Clear cells showed diffuse positivity to PAS with diastase lability. PAS reactivity was related to the presence of clear cells. Focal reactivity of mucin and colloidal iron in sebaceous-like cells and tubular structures was seen. Also, we found diffuse cytoplasmic and membrane surface positivity of epithelial membrane antigen in the clear cells, and focal in poroid and sebaceous cells and in tubular structures. The carcinoembryonic antigen showed a focal positivity in poroid and sebaceous cells and in tubular structures. We also identified focal positivity of S-100 protein in the sebaceous-like cells. Cytophotometric measurement of the nuclear DNA showed euploid cells in the primary and metastatic lesions. We conclude that clear cell eccrine carcinomas comprise a heterogeneous group of lesions with variable biological behavior, but with morphological, histochemical and immunohistochemical markers useful in their diagnosis.

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