Nefrite tubulointersticial associada à mesalazina

Inflammatory bowel disease and its various treatments may affect the kidney in several ways tubulointersticial nephritis is a rare but serious complication of longer-term mesalazine use. There are few cases reported in the literature. We report the first two cases of mesalazine-induced tubulointersticial nephritis, recently diagnosed in our department. The first one refers to a patient with ulcerous colitis and the second one to a patient with Crohn’s disease. Then the authors present a review of literature about the renal involvement in the inflammatory bowel disease. New cases of mesalazine nephrotoxicity should be reported to allow more accurate incidence estimation of this serious adverse effect. Routine monitoring of renal function is simple, inexpensive and allows an early diagnosis of this complicationA doença inflamatória intestinal e as terapêuticas que lhe estão associadas podem afetar o rim de várias formas. A nefrite tubulointersticial é uma complicação rara, mas potencialmente grave inerente à terapêutica com mesalazina. Há alguns casos descritos na literatura. Os autores descrevem os dois primeiros casos de nefrite tubulointersticial associados ao uso de mesalazina, recentemente diagnosticados no nosso Serviço; um deles num doente com colite ulcerosa, outro num doente com doença de Crohn. Apresentam uma revisão da literatura sobre o atingimento renal na doença inflamatória intestinal. Os casos de nefrotoxicidade associada à mesalazina devem continuar a ser descritos para permitir estabelecer uma incidência mais precisa desde efeito adverso. A monitorização da função renal durante o tratamento é simples, barata e pode ajudar a diagnosticar precocemente esta complicaçã

Urinary Biomarkers for Kidney Disease in ATTR Amyloidosis

Aim: The detection and prognosis of nephropathy in transthyretin amyloidosis depends on albuminuria and renal function. Knowing that urinary levels of alpha-1 microglobulin and beta-2 microglobulin reflect tubular dysfunction while urinary alpha-2 macroglobulin implies glomerular damage, we decide investigate the diagnostic value of these markers in the patients with transthyretin amyloidosis. Methods: Serum and urinary samples collected from 30 patients and 11 asymptomatic carriers were tested for alpha-1 microglobulin, beta-2 microglobulin, alpha-2 macroglobulin, albumin, creatinine and cystatin C. Results: Pathological urinary alpha-1 microglobulin was detected in 17 patients, beta-2 microglobulin in 6 and alpha-2 macroglobulin in 5; 5 patients had albuminuria (mg/g creatinine) 30-300 and in 20 patients values >300 were present. Asymptomatic carriers did not present pathological excretion of these biomarkers and albuminuria was >30 in 1 individual. The excretion rates of alpha-1 microglobulin and beta-2 microglobulin were positively correlated with albuminuria (P<0.001), serum creatinine (P<0.05) and cystatin C (P<0.001). Urinary alpha-2 macroglobulin was almost exclusively found in the presence of albuminuria, although their levels do not correlate. Conclusion: Urinary biomarkers emerge as a potential approach to detect renal disease but unexpectedly, urinary alpha-2 macroglobulin was not a marker of the severity of albuminuria

McArdle disease presenting with rhabdomyolisis and acute kidney injury

A doença de McArdle apresenta-se tipicamente por mialgias, intolerância aos esforços, cãibras e mioglobinúria na infância ou jovens adultos. A deficiência hereditária da enzima miofosforílase incapacita a degradação de glicogénio, com consequente acumulação no tecido muscular e défice energético. A rabdomiólise pode ocorrer e complicar-se de lesão renal aguda mas raramente, em cerca de 11% dos casos, é manifestação inicial da doença. Apresentamos um caso de Doença de McArdle num paciente de 38 anos de idade. Tinha antecedentes de mialgias, intolerância aos esforços e episódio isolado de mioglobinúria. A doença foi diagnosticada num episódio de rabdomiólise grave complicada de lesão renal aguda oligúrica, com necessidade de hemodiálise. A biópsia renal demonstrou necrose tubular aguda. Apesar da recuperação renal, os marcadores de lise muscular permaneceram elevados. Na suspeita de miopatia metabólica realizou biópsia muscular que revelou deposição subsarcolémica de glicogénio e ausência de atividade da miofosforilase. As miopatias metabólicas devem ser consideradas na abordagem de LRA associada a rabdomiólise severa

Small animal disease surveillance: respiratory disease 2017

This report focuses on surveillance for respiratory disease in companion animals. It begins with an analysis of data from 392 veterinary practices contributing to the Small Animal Veterinary Surveillance Network (SAVSNET) between January and December 2017. The following section describes canine respiratory coronavirus infections in dogs, presenting results from laboratory-confirmed cases across the country between January 2010 and December 2017. This is followed by an update on the temporal trends of three important syndromes in companion animals, namely gastroenteritis, pruritus and respiratory disease, from 2014 to 2017. A fourth section presents a brief update on Streptococcus equi subspecies zooepidemicus in companion animals. The final section summarises some recent developments pertinent to companion animal health, namely eyeworm (Thelazzia callipaeda) infestations in dogs imported to the UK and canine influenza virus in the USA and Canada

Membranoproliferative glomerulonephritis associated with type II cryoglobulinaemia in a renal transplant patient with hepatitis C

The most common HCV-related nephropathy is membranoproliferative glomerulonephritis (MPGN), usually in the context of cryoglobulinaemia. The treatment of this entity is not consensual and represents a challenge to clinicians. We report a case of membranoproliferative glomerulonephritis associated with cryoglobulinaemia type II in a 46-year-old Caucasian male recipient of a deceased kidney transplant in 2010. His baseline serum creatinine (SCr) was 1.1 mg/dl. After three years post-transplantation, he presented with nephritic syndrome in association with renal function impairment (SCr – 2.1 mg/dl). The laboratory tests revealed positive rheumatoid factor, hypocomplementaemia and a positive cryocrit with type II cryoglobulinaemia. Antinuclear autoantibodies and anti-double stranded DNA antibodies were negative. Despite the presence of anti-HCV antibodies, the viral load remained undetectable. The allograft biopsy showed lesions compatible with membranoproliferative glomerulonephritis, with staining in the immunofluorescence for granular IgM and C3 and no C4d. He was treated with methylprednisolone pulses followed by oral prednisolone in association with rituximab. Two months after the last dose of rituximab, the SCr improved to 1.27 mg/dl, the proteinuria decreased and serum C3 levels normalized. Cryogloglobulins and rheumatoid factor became negative and HCV RNA remained undetectable. The patient was lost for follow-up. In our case, the treatment with rituximab resulted in a favourable outcome, although a longer follow-up period may be needed to evaluate the clinical response, since other studies reported high relapse rates

Advanced Glycation End Products Evolution after Pancreas-Kidney Transplantation: Plasmatic and Cutaneous Assessments

Diabetes mellitus leads to increased Advanced Glycation End Products (AGE) production, which has been associated with secondary diabetic complications. Type 1 diabetic patients undergoing pancreas-kidney transplantation (SPKT) can restore normoglycemia and renal function, eventually decreasing AGE accumulation. We aimed to prospectively study AGE evolution after SPKT. Circulating AGE were assessed in 20 patients, at time 0 (T0), 3 months (T3), 6 months (T6), and 12 months (T12) after successful SPKT. Global AGE and carboxymethyllysine (CML) were analyzed, as well as advanced oxidation protein products (AOPP). Skin biopsies were obtained at T0 and T12. Immunohistochemistry with anti-AGE antibody evaluated skin AGE deposition. AGE mean values were 16.8 ± 6.4 μg/mL at T0; 17.1 ± 3.8 μg/mL at T3; 17.5 ± 5.6 μg/mL at T6; and 16.0 ± 5.2 μg/mL at T12. CML mean values were 0.94 ± 0.36 ng/mL at T0; 1.11 ± 0.48 ng/mL at T3; 0.99 ± 0.42 ng/mL at T6; and 0.78 ± 0.38 ng/mL at T12. AOPP mean values were 130.1 ± 76.8 μMol/L at T0; 137.3 ± 110.6 μMol/L at T3; 116.4 ± 51.2 μMol/L at T6; and 106.4 ± 57.9 μMol/L at T12. CML variation was significant (P = 0.022); AOPP variation was nearly significant (P = 0.076). Skin biopsies evolved mostly from a cytoplasmic diffuse to a peripheral interkeratinocytic immunoreaction pattern; in 7 cases, a reduction in AGE immunoreaction intensity was evident at T12. In conclusion, glycoxidation markers decrease, plasmatic and on tissues, may start early after SPKT. Studies with prolonged follow-up may confirm these data.info:eu-repo/semantics/publishedVersio

Genetic polymorphisms in key hypoxia-regulated downstream molecules and phenotypic correlation in prostate cancer

Background In this study we sought if, in their quest to handle hypoxia, prostate tumors express target hypoxia-associated molecules and their correlation with putative functional genetic polymorphisms. Methods Representative areas of prostate carcinoma (n = 51) and of nodular prostate hyperplasia (n = 20) were analysed for hypoxia-inducible factor 1 alpha (HIF-1α), carbonic anhydrase IX (CAIX), lysyl oxidase (LOX) and vascular endothelial growth factor (VEGFR2) immunohistochemistry expression using a tissue microarray. DNA was isolated from peripheral blood and used to genotype functional polymorphisms at the corresponding genes (HIF1A +1772 C > T, rs11549465; CA9 + 201 A > G; rs2071676; LOX +473 G > A, rs1800449; KDR – 604 T > C, rs2071559). Results Immunohistochemistry analyses disclosed predominance of positive CAIX and VEGFR2 expression in epithelial cells of prostate carcinomas compared to nodular prostate hyperplasia (P = 0.043 and P = 0.035, respectively). In addition, the VEGFR2 expression score in prostate epithelial cells was higher in organ-confined and extra prostatic carcinoma compared to nodular prostate hyperplasia (P = 0.031 and P = 0.004, respectively). Notably, for LOX protein the immunoreactivity score was significantly higher in organ-confined carcinomas compared to nodular prostate hyperplasia (P = 0.015). The genotype-phenotype analyses showed higher LOX staining intensity for carriers of the homozygous LOX +473 G-allele (P = 0.011). Still, carriers of the KDR−604 T-allele were more prone to have higher VEGFR2 expression in prostate epithelial cells (P < 0.006). Conclusions Protein expression of hypoxia markers (VEGFR2, CAIX and LOX) on prostate epithelial cells was different between malignant and benign prostate disease. Two genetic polymorphisms (LOX +473 G > A and KDR−604 T > C) were correlated with protein level, accounting for a potential gene-environment effect in the activation of hypoxia-driven pathways in prostate carcinoma. Further research in larger series is warranted to validate present findings.info:eu-repo/semantics/publishedVersio

Relación entre los serotipos de lengua azul y su vector, en Europa y cuenca mediterránea

La Lengua Azul es una enfermedad de distribución mundial que afecta a rumiantes y se transmite a través de la picadura de las hembras del mosquito del Género Culicoides. Tradicionalmente, la enfermedad ha estado ligada a la presencia del mosquito Culicoides imicola, pero estudios recientes apuntan a una posible implicación de otras especies de mosquitos que puedan sobrevivir en regiones más frías. Utilizando un sistema de visualización geográfica ARCGIS 9.2 (ESRI®) se ha podido representar la distribución de las principales especies de Culicoides implicadas en la transmisión de Lengua Azul en Europa y norte de África y compararlo con el mapa de distribución de los serotipos del virus de la Lengua Azul. El análisis de los mapas realizados prueba que Culicoides imicola está relacionado con la transmisión de los serotipos 1, 2, 4, 9 y 16 y que el complejo Obsoletus transmite el serotipo 8 y podría ser capaz de transmitir otros serotipos del virus con los que hasta ahora no ha tenido contacto.Bluetongue (BT) is a worldwide spread disease affecting ruminants, which is transmitted by the biting of female midges from the Genus Culicoides. Traditionally, this disease has been linked with the presence of the midge Culicoides imicola, but, recent studies have suggested the possibility of other midge species being involved in the transmission of Bluetongue in cooler regions. By applying the geographic information system ARCGIS 9.2 (ESRI®), the distribution of the main Culicoides species involved in Blue Tongue transmission in Europe and the North of Africa and the distribution of BT serotypes in the same region has been represented. The analysis of the maps obtained shows that Culicoides imicola is involved in the transmission of Bluetongue serotypes 1, 2, 4, 9 and 16 and the Obsoletus complex could be able to transmit, besides BTV-8, other BT serotypes with which it has never been in contact so far