Membranous Nephropathy Associated with Eosinophilic Gastroenteritis: First Report

Membranous nephropathy represents the most common cause of nephrotic syndrome in adult patients. In 85% of cases the disease is classified as idiopathic membranous nephropathy, and in the remainder 15 % as secondary membranous nephropathy (systemic lupus erythematosus, infections, drugs, tumors, inorganics salts). Treatment of secondary membranous nephropathy is guided by therapy of the original disease, or by elimination of the responsible cause. Eosinophilic gastroenteritis is a rare uncommon disease of unknown origin affecting the gastrointestinal apparatus and is characterized by diffuse eosinophilic infiltration of the gastro-enteric wall. Any segment of gastrointestinal tract can be interested, but the stomach results to be the most commonly affected organ, followed by the small intestine and the colon. The diagnosis is based on the presence of gastrointestinal symptoms, documented eosinophilic gut infiltration and the exclusion of intestinal parasites or extraintestinal disease. To date there are no randomized prospective therapeutic trials. The mainstay of treatment is represented by use of corticosteroids (with 90% of remission rate in some reports). We describe for the first time the case of a 43-year-old man affected by eosinophilic gastroenteritis who developed a nephrotic syndrome due to membranous nephropathy after he voluntarily stopped the steroidal oral therapy. Reintroduction of corticosteroid treatment led to the complete remission of the nephrotic syndrome within 6 months treatment

Interleukin-6 is a stronger predictor of total and cardiovascular mortality than C-reactive protein in haemodialysis patients

Background. Despite the well known association between interleukin-6 (IL-6) and cardiovascular mortality, no study has so far verified whether IL-6 adds prognostic information to that provided by C-reactive protein (CRP). Methods. A cohort of 218 haemodialysis patients from four different dialytic centres was followed-up retrospectively. Plasma IL-6 and CRP concentrations were determined. Full information on co-morbidities was available in 162 patients. Results. With respect to the lowest quartile (13.9 pg/ml for IL-6, and >12.8 mg/l for CRP) was 5.20 (95% confidence interval 2.06-13.011) for IL-6 and 3.16 (1.41-7.12) for CRP. When both variables were included, the estimates were 4.10 (1.30-12.96) for IL-6 and 1.29 (0.47-3.57) for CRP. As to continuous variables, the relationship between both variables and mortality tended to level off for the highest values, but became fairly linear after log transformation of the variables. For one unit SD of the log (variable), the RR was 2.09 (1.52-2.88) for IL-6 and 1.66 (1.23-2.24 for CRP. When they were included in the same model, the estimates were 1.90 (1.18-2.82) for IL-6 and 1.16 (0.81-1.66) for CRP. Conclusions. IL-6 has a stronger predictive value than CRP for cardiovascular mortality and provides independent prognostic information, while conveying most of that provided by CRP. © ERA-EDTA 2004; all rights reserved