scholarly journals Case of immunotactoid glomerulopathy showing high responsiveness to steroids therapy despite severe pathological features

2019 ◽  
Vol 12 (7) ◽  
pp. e229751 ◽  
Author(s):  
Atsuki Ohashi ◽  
Jiro Kumagai ◽  
Kiyotaka Nagahama ◽  
Hajime Fujisawa
Keyword(s):  
Renal Function ◽  
Immunosuppressive Therapy ◽  
Oral Prednisolone ◽  
Lymphoproliferative Disease ◽  
Proliferative Glomerulonephritis ◽  
Renal Pathology ◽  
High Responsiveness ◽  
Immunotactoid Glomerulopathy ◽  
Appropriate Therapy ◽  
Endocapillary Proliferative Glomerulonephritis

A 72-year-old woman presented with nephrotic proteinuria and moderate haematuria. Renal pathology was compatible with immunotactoid glomerulopathy (ITG), for which there is no consensus for appropriate therapy. We, therefore, postponed immunosuppressive therapy. After 4 years, the patient’s renal function started to decline and renal pathology was re-evaluated, revealing a pathological change from mesangial proliferative glomerulonephritis to endocapillary proliferative glomerulonephritis. Treatment with oral prednisolone (30 mg/day) was initiated. Within 5 weeks, complete remission of proteinuria was obtained (proteinuria 6.02 g/gCr to 0.12 g/gCr), and the patient’s renal function stabilised. Generally, responsiveness to immunosuppressive therapy is poor in patients with ITG, and the present case represented a very rare clinical course. Some previous cases have indicated susceptibility to the therapy, regardless of the severity of renal damage. As a possible distinct entity that determines susceptibility to immunosuppressive therapy, we suggest the presence of a latent lymphoproliferative disease with no significant haematological symptoms.

scholarly journals MO638ANEMIA IN DIABETIC PATIENTS REFLECTS SEVERE TUBULOINTERSTITIAL INJURY AND ASSISTS CLINICALLY IN PREDICTING DIAGNOSIS OF DIABETIC NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Soichiro Yokota ◽  
Kenji Ito ◽  
Maho Watanabe ◽  
Koji Takahashi ◽  
Naoko Himuro ◽  
...  
Keyword(s):  
Renal Function ◽  
Regression Analysis ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Kidney Biopsy ◽  
Renal Pathology ◽  
Diabetic Patients ◽  
Pathological Findings

Abstract Background and Aims Diabetic nephropathy (DN) is currently a leading cause of end-stage kidney disease worldwide. Kidney biopsy is generally performed in diabetic patients to discriminate between DN and non-diabetic kidney disease (NDKD), and to provide more specific treatments. In addition to conventional predicting factors of DN, recent studies suggested the predictive value of anemia in the diagnosis of DN, however detailed pathophysiology and the significance of anemia in renal pathology are not fully understood. This study aimed to investigate the impact of anemia on renal pathology and clinical course in patients who underwent kidney biopsy. Method We reviewed 81 patients (60.4 ± 13.7 years, 54 men and 27 women) with type 2 diabetes who underwent percutaneous kidney biopsy in Fukuoka University Hospital from January 2001 through March 2020. DN was diagnosed by mesangial expansion or nodular glomerulosclerosis observed under a light microscope, and immunofluorescence assisted in differentiating NDKD from DN. Anemia was defined as hemoglobin level <13 g/dL in males and <12 g/dL in females in accordance with the World Health Organization standards. Laboratory and pathological findings, and clinical courses were investigated. Results According to their pathological findings, patients were classified into two groups: isolated DN (DN group, n=30) and NDKD alone or concurrent DN (NDKD group, n=51). There were 11 types of NDKD. Of these, membranous nephropathy was the most common (23.5%), followed by IgA nephropathy (17.6%), and crescentic glomerulonephritis (13.7%). In multiple logistic regression analysis, absence of severe hematuria (odds ratio (OR) 11.66, 95% confidence interval (CI) 1.68 - 89.9) and presence of anemia (OR 11.38, 95% CI 2.51 - 51.52) were significantly related with the diagnosis of DN. Akaike’s information criterion (AIC) and net reclassification improvement (NRI) analyses revealed improved predictive performance by adding anemia to the conventional factors (AIC 100.152 to 91.844; NRI 27.0%). The tissues of patients in the DN group demonstrated more severe interstitial fibrosis and tubular atrophy (IF/TA) than the NDKD group (p<0.05) regardless of the rate of global glomerulosclerosis (figure), and IF/TA was related to the prevalence of anemia (odds ratio: 7.31, 95% confidence interval: 2.33 - 23.00) in multivariate regression analysis. These results suggest DM-associated severe IF/TA (compared with NDKD) impaired erythropoietin production, resulting in earlier anemia, independent of glomerular injuries and renal function. Furthermore, the renal prognosis was significantly better in the NDKD group than in the DN group using Log-rank test (p<0.05). Conclusion DN is associated with anemia because of severe IF/TA regardless of renal function, and anemia helps clinician discriminate clinically between isolated DN and NDKD.

Proliferative glomerulonephritis

2010 ◽  
pp. 3988-3990
Author(s):  
Peter W. Mathieson
Keyword(s):  
Renal Function ◽  
Proliferative Glomerulonephritis

Proliferative glomerulonephritis—which occurs in many conditions—describes the finding of increased cellularity of the glomerulus, which may be due to proliferation of intrinsic glomerular cells, infiltration of leucocytes, or both. Patients will typically have haematuria, and this may be associated with proteinuria and/or impairment of excretory renal function and/or hypertension. Different subtypes of proliferative glomerulonephritis are recognized:...

Variabilty of arterial pressure and renal function

2016 ◽  
Vol 94 (4) ◽  
pp. 245-249
Author(s):  
A. Ya. Kravchenko ◽  
Anna A. Chernykh ◽  
A. V. Budnevsky
Keyword(s):  
Renal Function ◽  
Risk Factor ◽  
Cardiovascular Diseases ◽  
Arterial Pressure ◽  
Arterial Hypertension ◽  
Renal Pathology ◽  
Cardiac Outcomes ◽  
Target Organs ◽  
The Relationship ◽  
Adverse Factor

This review deals with variability of arterial pressure (VAP) as an adverse factor contributing to the development and progression of cardiovascular diseases and renal pathology. VAP has recently attracted much attention in connection with results of ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) showing that VAP is a risk factor of stroke and other complications of arterial hypertension (AH).The relationship between VAP and renal function remains unexplored and is considered to be a vicious circle in which kidneys are both a cause of AH and its target organs. Evidently, elucidation of the relationship between enhanced VAP and renal function is of primary importance.

IMMUNOSUPPRESSIVE THERAPY IN ADULTS WITH PROLIFERATIVE GLOMERULONEPHRITIS

The Lancet ◽  
1971 ◽  
Vol 297 (7691) ◽  
pp. 191
Author(s):  
RussellE. Randall ◽  
L.J. Booth ◽  
G.M. Aber
Keyword(s):  
Immunosuppressive Therapy ◽  
Proliferative Glomerulonephritis

scholarly journals Alternative Diagnostic Strategy for the Assessment and Treatment of Pulmonary Embolus: A Case Series

2020 ◽  
Vol 4 (3) ◽  
pp. 308-311
Author(s):  
Ayaz Aghayev ◽  
Aliza Memon ◽  
Paul Greenough ◽  
Lakshmi Nayak ◽  
Sijie Zheng ◽  
...  
Keyword(s):  
Renal Function ◽  
Pulmonary Artery ◽  
Pulmonary Embolus ◽  
Clinical Symptoms ◽  
Main Pulmonary Artery ◽  
Anticoagulation Therapy ◽  
Case Series ◽  
Lymphoproliferative Disease ◽  
Diagnostic Strategy ◽  
Iodinated Contrast

Introduction: Ferumoxytol-enhanced magnetic resonance angiography (FeMRA) can be used as an alternate and safe method to diagnose patients with compromised renal function who present with acute pulmonary embolus in the emergency department (ED) setting. Case Report: A 62-year old man with a history of renal transplant and lymphoproliferative disease described new onset of breathlessness. His clinical symptoms were suggestive of pulmonary embolus. He underwent FeMRA in the ED to avoid exposure to intravenous iodinated contrast. FeMRA demonstrated a left main pulmonary artery embolus, which extended to the left interlobar pulmonary artery. Afterward, the patient initiated anticoagulation therapy. With preserved renal function he was able to continue his outpatient chemotherapy regimen. Conclusion: This case highlights a safe imaging technique for emergency physicians to diagnose pulmonary embolus and subsequently guide anticoagulation therapy for patients in whom use of conventional contrast is contraindicated.

scholarly journals Comparison of Allogenic and Autogenic Implantations of Dedifferentiated Fat Cells On Monoclonal Antibody 1-22-3-Induced Glomerulonephritis in Rats

2021 ◽  
Author(s):  
Takashi Maruyama ◽  
Noboru Fukuda ◽  
Taro Matsumoto ◽  
Morito Endo ◽  
Kei Utsunomiya ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Renal Function ◽  
Immunosuppressive Therapy ◽  
Serum Levels ◽  
Urinary Protein ◽  
Brdu Incorporation ◽  
Dedifferentiated Fat Cells ◽  
Dfat Cells ◽  
Progenitor Cell Line ◽  
Necrosis Factor

Abstract Background We established an adipogenic progenitor cell line derived from mature adipocytes and named these cells dedifferentiated fat (DFAT) cells, which have been shown to have characteristics very similar to those of mesenchymal stem cells (MSCs). The potential application of DFAT cells to support cell-based therapies for regenerative and immunosuppressive therapies has been suggested. The present study was designed to address beneficial ways that DFAT implantation can be used clinically as immunosuppressive therapy to treat immunological glomerulonephritis. Methods We evaluated distribution of DFAT cells after intravenous injection through the tail vein in Wistar rats. We examined effects of allogenic implantation of DFAT cells on BrdU incorporation into kidney from rats with monoclonal antibody (mAb) 1-22-3-induced glomerulonephritis. We compared effects of allogenic and autogenic implantations of DFAT cells on excretion of urinary protein, renal function, and glomerular and nephrotubular injuries in these rats, and serum levels of tumor necrosis factor-stimulated gene-6 (TSG-6), and expression of TSG-6 mRNA in kidney. Results The allogenic implantations of DFAT cells trapped in lung improved excretion of urinary protein and renal function, and significantly suppressed glomerular and nephrotubular injuries in the rats with mAb1-22-3-induced glomerulonephritis compared with the autogenic implantations. The allogenic implantation of DFAT cells increased serum levels of TSG-6 especially in mAb 1-22-3-induced glomerulonephritis and significantly increased the expression of TSG-6 mRNA in kidney compared to the autogenic implantation. Conclusion These findings suggest that allogenic implantation of DFAT cells could be clinically useful immunosuppressive therapy for immunological glomerulonephritis.

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