Clinical features of kidney involvement in microscopic microscopic polyangiitis

Aim. To evaluate clinical features and outcomes of renal involvement in patients with microscopic polyangiitis (MPA). Materials and methods: We enrolled 99 patients with MPA, diagnosed in accordance with the algorithm of the European Medicines Evaluation Agency (EMEA) and the Chapel Hill consensus conference definition (2012). Serum creatinine (sCr), estimated glomerular filtration rate (eGFR), hematuria and proteinuria were estimated. Frequency of rapidly progressive renal failure (a twofold increase in the sCr level in ≤3 months) was regarded as the clinical equivalent of rapidly progressive glomerulonephritis (RPGN). Results and discussion. Renal involvement was present in 92 (92.9%) patients. RPGN developed in 51 (55,4%) patients. The most common features of kidney involvement were hematuria and subnephrotic proteinuria. Arterial hypertension was revealed in 32 (34.7%) patients and was associated with RPGN (

Relationship between serologic profile (ANCA type) and clinical features of renal involvement in ANCA-associated vasculitides

Objective. To compare the frequency, clinical features and outcomes of renal involvement in ANCA-associated vasculitides (AAV) in patients with antibodies against proteinase-3 (pr3-ANCA) and myeloperoxidase (MPO-ANCA). Materials and methods. In our retrospective study we enrolled 264 patients, 94 males and 170 females, median age 53 [36; 62] years. Among them 157 were pr3-ANCA positive and 107 were MPO-ANCA positive. AAV was diagnosed according to ACR criteria and Chapel Hill consensus conference definition (2012). Median follow up was 44 [18; 93] months. We assessed baseline BVAS and VDI by the end of the follow up. Serum creatinine (sCr), estimated glomerular filtration rate (eGFR), hematuria and daily proteinuria were estimated. Diagnosis and stage of chronic kidney disease (CKD) and acute kidney injury (AKI) were established according to KDIGO guidelines (2012) and Scientific Society of Russian Nephrologists (2016). Results. Renal involvement was present in 181 (68.6%) patients, and its frequency was similar in pr3-ANCA and MPO-ANCA subgroups. Patients with MPO-ANCA developed rapidly progressive glomerulonephritis and hypertension significantly more often than patients with pr3-ANCA: 50.7% vs 35.6% (p=0.049) and 46.1% vs 29.8% (p=0.029) respectively. At disease onset, median sCr was significantly higher and eGFR was significantly lower in patients with MPO-ANCA (

Морфофункциональная характеристика слизистой оболочки желудка у больных с бронхиальной астмой разной степени тяжести

Summary. Morphological characteristics of gastric mucosa in patients with asthma of different severity with regard to corticosteroid therapy were described in this article. The aim of this study was to substantiate optimized standards of asthma treatment. Clinical and morphological investigations were conducted at the city clinical hospital № 31. We investigated all structural components of the gastric mucosa in biopsy specimens with light binocular microscopy and performed morphometric study of inflammatory infiltrates. As a result, several signs of protective effect of inhaled corticosteroids on gastric mucosa were found. We did not obtain any results that could confirm the key role of glucocorticosteroids in occurrence of gastrointestinal erosions in asthma patients. Therefore, prevention of erosive gastritis and other inflammatory gastrointestinal diseases in asthma patients should consider other risk factors besides glucocorticosteroid therapy and cover all stages of asthma.Резюме. Статья посвящена оценке и анализу морфологических характеристик слизистой оболочки желудка у больных с бронхиальной астмой разной степени тяжести в зависимости от вида проводимой глюкокортикостероидной терапии с целью выявления научных обоснований для оптимизации стандартов ведения этой категории пациентов. Клинико-морфологическое исследование было проведено на базе Городской клинической больницы № 31 Департамента здравоохранения г. Москвы. Морфологически и морфометрически изучена слизистая оболочка желудка. В результате выявлены признаки гастропротективного эффекта от применения ингаляционных глюкокортикостероидов. Мнение о ключевой роли глюкокортикостероидов в развитии эрозивных процессов желудочно-кишечного тракта при бронхиальной астме не было подтверждено. Профилактика эрозивного гастрита и других воспалительных заболеваний желудка при бронхиальной астме должна ассоциироваться не только с приемом глюкокортикостероидов, ее следует учитывать на всех стадиях бронхиальной астмы