Autoimmune polyglandular syndrome in a woman of 51 years

INTRODUCTION: Autoimmune polyglandular syndromes (APS) are constellations of symptoms and signs of multiple glandular insufficiencies. We report a rare case of type III APS in a female patient.CASE REPORT: A 51-year-old woman was treated with radiotherapy because of thymus hyperplasia when she was two years old; she was diagnosed with celiac disease and autoimmune hypothyroidism at 41 years old and with sicca syndrome and myasthenia gravis seronegative a few years later.CONCLUSIONS: Our patient demonstrates a previous constellation of diseases of APS, which may be a random association but may also indicate a common immunological and genetic disturbance. The APS is an expression of a system impairment of immune tolerance to autoreactive clones, and this is necessary because the phenomena can become aggressive and expressed clinically. We suppose that the development of thymic hyperplasia or its radiotherapy in childhood may have compromise the patient's immune system

P1190 Oxidative stress and inflammation in peritoneal dialysis: dangerous and to be solved.

Background and Aims: Cardiovascular disease is the leading cause of excess mortality in chronic kidney disease (CKD) and dialysis patients with oxidative stress (OxSt) and inflammation playing a pivotal role, as non-traditional risk factors and OxSt and inflammation have been shown to increase in peritoneal dialysis. Rho kinase (ROCK) activation is deeply involved in the induction of OxSt and inflammation and is closely linked to cardiovascular-renal remodeling. We aimed to evaluate in peritoneal dialysis patients with a molecular biology approach OxSt, in terms of phosphorylation state of MYPT-1 (marker of ROCK activity), the protein expression of p22phox (subunit of NADPH oxidase, essential for the generation of ROS), and inflammation state, in terms of acute-phase proteins level (Interleukin 6 (IL-6), ultra-sensitive C-reactive protein (US-CRP), Ferritin, Albumin and Transferrin). Method: 9 male ESRD patients (39-81 years old) were enrolled and analyzed before (baseline) and after three and six months of peritoneal dialysis treatment (CAPD 7 patients, APD 2 patients). Mononuclear cells (PBMCs) MYPT-1 phosphorylation state and p22phox protein expression were determined by Western Blot. Specific acute-phase proteins as IL-6, US-CRP, Ferritin, Albumin and Transferrin were assessed through blood chemistry tests. Results: MYPT-1 phosphorylation was increased after six months of treatment with peritoneal dialysis compared with three months and predialysis (1.0360.07 vs 1.0260.04 vs 1.5760.16 d.u., p<0.0001). p22phox protein expression (0.7260.05 vs 0.7360.10 vs 1.2860.12 d.u., p<0.0001) and ferritin level (101.4615.3 vs 173.6611.5 vs 189.0620.3 mg/l, p=0.002) increased as well. Albumin was decreased after six months of peritoneal dialysis treatment compared with three months and predialysis (43.3860.10 vs 40.0061.59 vs 36.4661.43 g/l, p=0.007). IL-6 and US-CRP remained unchanged at a high level. Conclusion: The increase of OxSt and inflammation during peritoneal dialysis is confirmed also at molecular biology level and may lead in the medium-long term to dangerous consequences. The necessary improvement of OxSt status in peritoneal dialysis needs a multitarget approach. It might include the use of neutral pH, low glucose degradation products, low lactate and iso-osmolar peritoneal dialysis solutions, strict glycemic control, optimal volume management and, likely, a supplementation with antioxidants as N-acetylcysteine

Nephropathies in HIV-infected patients: an overview

Introduction The incidence and spectrum of kidney disease in Human Immunodeficiency Virus-infected patients have been altered by the diffused use of highly active antiretroviral therapy; indeed, acute and chronic kidney disease has emerged as a significant cause of morbidity and mortality among Human Immunodeficiency Virus-infected population. Risk factors associated with kidney disease in such Human Immunodeficiency Virus-infected population include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, low CD4 cell count, and high Human Immunodeficiency Virus viral load. The aim of this review was to discuss nephropathies in Human Immunodeficiency Virus-infected patients. Materials and Methods We conduct a review on the actual knowledge of acute and chronic Human Immunodeficiency Virus-associated renal disease, metabolic alterations and related nephropathies, and the side effects of highly active antiretroviral therapy. Results We examined all the randomised controlled trial sand quasi-randomised controlled trials that evaluate the current knowledge on acute and chronic Human Immunodeficiency Virus and highly active antiretroviral therapy associated renal disease. After quality appraisal, 170 met the inclusion criteria for the review. The studies included in the review were grouped into two areas: nephropathy Human Immunodeficiency Virus associated and nephropathy highly active antiretroviral therapy associated. Conclusion Early identification and treatment of kidney disease is imperative for preventing further renal damage in Human Immunodeficiency Virus-infected populations and for instituting appropriate management efficiently. The Infectious Diseases Society of America guidelines recommend urinalysis and estimation of kidney function for all Human Immunodeficiency Virus-infected persons at the time of Human Immunodeficiency Virus diagnosis. Periodic monitoring of albuminuria, tubular parameters such as low-molecular-weight proteinuria, and the estimated glomerular filtration rate may be useful for early diagnosis of patients at risk for acute or chronic renal disease

Vitamin D deficiency, insulin resistance, and ventricular hypertrophy in the early stages of chronic kidney disease

Background: Chronic kidney disease (CKD) is associated with markedly increased cardiovascular (CV) risk. This increase is not fully explained by traditional CV risk factors but may in part be mediated by nontraditional risk factors, such as inadequate vitamin D (vit D) levels and insulin resistance (IR). Although IR is shown in nondiabetic CKD, its association with vit D deficiency and vascular disease in this population is unknown and what this study aims to investigate. Materials and methods: The study comprised 67 patients with CKD (eGFR30mL/min) and 15 healthy controls matched for age and sex. The phlogosis indexes, vit D levels, IR, carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured. Results: In our study, the mean value of LVMI and cIMT was significantly higher in patients with eGFR30mL/min compared with controls (p=0.037 and p<0.001). The IR and intact parathyroid hormone (iPTH) levels were increased in CKD patients, whereas the serum levels of vit D were significantly reduced (p=0.044, p=0.012, p=0.038). A positive correlation was found between LVMI and IR (r=0.704, p=0.041) and a negative correlation was found between IR and vit D levels (r=-0.238, p=0.031). Conclusions: In our study, IR and vit D deficiency were found to be independent predictors of left ventricular hypertrophy and atherosclerotic disease. Vitamin D deficiency and IR are thus associated with increased CV risk. More novel approaches to improving IR and vit D supplementation in the CKD population might lead to potential strategies for preventing excess CV mortality. \ua9 2014 Informa Healthcare USA, Inc

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis.

Introduction: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. Materials and Methods: 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated. Results: LVMI was higher in PD than HD patients (139 \ub1 19 vs. 104 \ub1 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. Conclusions: Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored