Minimal change nephrotic syndrome after stem cell transplantation: a case report and literature review

Graft-versus-host disease is one of the most frequent complications occurring after haematopoietic stem cell transplantation. Recently, renal involvement has been described as a manifestation of chronic graft-versus-host disease. Immunosuppression seems to play a major role: clinical disease is triggered by its tapering and resolution is achieved with the resumption of the immunosuppressive therapy. Prognosis is apparently favourable, but long term follow up data are lacking

Manuel Botelho: obra e projecto 1980-2008

Este livro, publicado pela editora Circo de Ideias, com edição de António Neves, Bruno Baldaia e Carlos Maia, é o culminar de um processo longo e que implicou acções e momentos diversos. O impulso inicial foi o reconhecimento de que à qualidade da obra de Manuel Botelho não correspondia uma visibilidade que lhe fosse proporcional. Manuel Botelho é autor de obras premiadas e destacadas, está presente em exposições importantes no panorama da arquitectura portuguesa dos últimos cinquenta anos, é um professor marcante para a Escola Superior de Belas Artes do Porto e Faculdade de Arquitectura da Universidade do Porto e para esse lugar da arquitectura portuguesa a que chamamos Escola do Porto. Uma monografia inédita do arquitecto Manuel Botelho que reúne ao longo de 360 páginas uma selecção de 27 obras e projectos, bem como um conjunto de ensaios originais de Carlos Machado, José Manuel Soares, Jorge Reis, Victor Mestre e Bruno Baldaia.O projecto editorial contou com o apoio da Fundação Marques da SilvaUniversidade do Porto. Faculdade de Arquitectura. Centro de Estudos de Arquitectura e UrbanismoUniversidade do Minho. Escola de Arquitectura, Arte e DesignUniversidade do Minho. Laboratório de Paisagens, Património e TerritórioOrdem dos Arquitecto

Minimal change nephrotic syndrome after stem cell transplantation: a case report and literature review

Abstract Graft-versus-host disease is one of the most frequent complications occurring after haematopoietic stem cell transplantation. Recently, renal involvement has been described as a manifestation of chronic graft-versus-host disease. Immunosuppression seems to play a major role: clinical disease is triggered by its tapering and resolution is achieved with the resumption of the immunosuppressive therapy. Prognosis is apparently favourable, but long term follow up data are lacking. We report a case of a 53-year-old man who developed nephrotic syndrome 142 days after allogeneic stem cell transplantation for acute myeloid leukaemia. Onset of nephrotic syndrome occurred after reduction of immunosuppressants and was accompanied by manifestations of chronic graft-versus-host disease. Histological examination of the kidney was consistent with Minimal Change Disease. After treatment with prednisolone and mycophenolate mofetil he had complete remission of proteinuria and improvement of graft-versus-host disease. Eighteen months after transplantation the patient keeps haematological remission and normal renal function, without proteinuria. Since patients with chronic graft-versus-host disease might be considered at risk for development of nephrotic syndrome, careful monitoring of renal parameters, namely proteinuria, is advisable.</p

Effects of Sevelamer Hydrochloride and Calcium Carbonate on Renal Osteodystrophy in Hemodialysis Patients

Disturbances in mineral metabolism play a central role in the development of renal bone disease. In a 54-wk, randomized, open-label study, 119 hemodialysis patients were enrolled to compare the effects of sevelamer hydrochloride and calcium carbonate on bone. Biopsy-proven adynamic bone disease was the most frequent bone abnormality at baseline (59%). Serum phosphorus, calcium, and intact parathyroid hormone were well controlled in both groups, although calcium was consistently lower and intact parathyroid hormone higher among patients who were randomly assigned to sevelamer. Compared with baseline values, there were no changes in mineralization lag time or measures of bone turnover (e.g., activation frequency) after 1 yr in either group. Osteoid thickness significantly increased in both groups, but there was no significant difference between them. Bone formation rate per bone surface, however, significantly increased from baseline only in the sevelamer group (P = 0.019). In addition, of those with abnormal microarchitecture at baseline (i.e., trabecular separation), seven of 10 in the sevelamer group normalized after 1 yr compared with zero of three in the calcium group. In summary, sevelamer resulted in no statistically significant changes in bone turnover or mineralization compared with calcium carbonate, but bone formation increased and trabecular architecture improved with sevelamer. Further studies are required to assess whether these changes affect clinical outcomes, such as rates of fracture