1,720,975 research outputs found
Fever of unknown origin in a young HIV-negative patient with end-stage renal disease: a challenging diagnosis of visceral leishmaniasis.
No full textANCA-Negative Paucimmune Glomerulonephritis and Glomerular Recovery: Possible Role of Mesenchymal Stem Cells in a 69 Year-Old Patient
No full textBACKGROUND: Pauci-immune crescentic glomerulonephritis is one of the most common causes of rapidly progressive glomerulonephritis, usually associated with anti-neutrophil cytoplasmic antibody (ANCA) but a minority of patients lack ANCAs. To date no effective treatments have been addressed for ANCA-negative glomerulonephritis despite several studies describe the possibility to adopt pharmacologic therapies. Cellular, molecular and preclinical studies demonstrate that mesenchymal stem cells (MSCs) contribute to glomerular cell turnover and repair and might represent a new therapeutic approach for ANCA-negative glomerulonephritis.
AIM: In our study we presented a case report of a patient with ANCA-negative pauci-immune glomerulonephritis in order to underlie the growing need of an alternative therapy for glomerular diseases.
MATERIALS AND METHODS: We report the case of a 69 year-old woman who presented to our department with diarrhea, vomiting and increased serum creatinine levels. At the First Aid Department, renal ultrasonography excluded dilatations of urinary tract and since the occurrence of progressive dyspnea, anuria and severe hypertension renal replacement therapy was started.
RESULTS: A second kidney Doppler ultrasonography showed hyperechoic parenchyma, reduced thickness and increased resistive index. Urinalysis revealed persistent active sediment and proteinuria. Autoimmunity profile showed C3, IgE and IgM increased levels. Renal biopsy was performed showing diffuse extracapillary proliferative glomerulonephritis with negative Immunofluorescence (IF). ANCA test was negative for a second time by both IF analysis and antigen-specific ELISA. The diagnosis was ANCA-negative glomerulonephritis and steroid bolus was administered, improving urinary sediment and proteinuria but not glomerular filtration rate.
DISCUSSION: Our data demonstrated that pharmacological treatment of ANCA-negative glomerulonephritis correlated with poor response and is not effective, pointing out the importance of new therapeutic options for this disease. In this regard MCSs may represent a valid alternative in the treatment of ANCA-negative glomerulonephritis.
CONCLUSIONS: MSCs may provide an effective therapeutic option in glomerular diseases and future studies should be performed in order to pave the way for this cell-based therapy
Rapidly Progressive Renal and Hepatic Failure in AL-Amyloidosis: Bortezomib and Steroid Support in a Young Woman Two Months After Delivery
No full textINTRODUCTION: The epidemiology of amyloidosis is not well known and its diagnosis is difficult, due to unspecific early clinical manifestations. Amyloidosis is considered when organ failure occurs. Renal, cardiac and hepatic involvement usually occurred despite therapy. Presenting this case report, we aimed to underline the need of new treatments for amyloidosis.
MATERIALS AND METHODS: We describe a 41 years old woman admitted to the hospital with proteinuria (1280 mg/24h) and rapid deterioration of renal function (serum creatinine from 0.8 to 1.6 mg/dL). Autoantibodies, immunoglobulin and C3/C4 were negative. A renal biopsy showed the presence of AL-Amyloidosis with k-light chains deposition at immunofluorence. Subsequently, the patient showed nephrotic syndrome onset (proteinuria 4000 mg/24h with albuminuria 3400 mg/24h) and increased rates of cholestasis with hepatomegaly and hepatic failure.
RESULTS: Treatment with bortezomib and dexamethasone gave a complete hematological response but renal function was not improved.
DISCUSSION: This case is very interesting because renal involvement was the initial presentation of amyloidosis and rapid progressive renal and hepatic failure was subsequentely observed; its management was challenging from the clinical approach to the final diagnosis and treatment.
CONCLUSIONS: In terms of organ response, it is necessary to develop new strategies to counteract the progressive organ failure due to amyloid deposition
Insufficienza renale acuta in pazienti cirrotici di sesso femminile: criteri AKIN vs criteri convenzionali.
No full textGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Hypokalemic rhabdomyolysis: a rare manifestation of primary aldosteronism
Full text linkRhabdomyolysis is a rare presentation of hypokalemia, although muscle weakness is a well-known manifestation of hypokalemia. Primary aldosteronism is characterized by hypertension, suppressed plasma renin activity, increased aldosterone excretion and hypokalemia with metabolic alkalosis. Rhabdomyolysis is not common in primary aldosteronism. We present here a 40-year-old woman presenting with rhabdomyolysis accompanied by severe hypokalemia as heralding symptom of primary aldosteronism
Female gender and overestimation of glomerular filtration rate: independent predictors of acute kidney injury after liver transplantation
No full textAcute kidney injury (AKI) in liver transplant (LT) setting is a recognized complication and is related to increased morbidity and mortality. Pre-LT renal function is difficult to estimate, in particular for the female gender. The aim of the study was to evaluate the incidence of post-LT AKI, its relationship with survival, and related risk factors. In a single-center retrospective study of consecutive LT patients (2008 - 2015), we assessed patient characteristics and intra-LT events, and post-operative data were collected. The occurrence of AKI post-LT was also evaluated (KDIGO guidelines). Data of 145 LT patients were analyzed. 45 (31.0%) patients showed an overestimation of glomerular filtration rate (over-GFR), defined as GFR > 120 mL/min/1.73m2; 83 patients (57.2%) developed post-LT AKI. The patients (n = 145) were divided into two groups: 123 (84.8%) patients with no-AKI & AKI stage 1 and 22 (15.2%) patients with AKI stages 2 and 3. Patients with AKI stages 2 and 3 were characterized by a significantly decreased 5-year survival (p < 0.001). On the multivariable analysis, female gender and over-GFR were significantly predictive for development of AKI stages 2 and 3. Female gender has already been reported as a discriminant factor for LT candidates. Altered estimation of renal function also needs to be considered in this setting, as this could mask the presence of an unknown compromised renal function.
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