Иммуноглобулин G4-ассоциированные заболевания c поражением легких

Lung involvement in IgG-related diseases is poorly investigated. The current approach to IgG-related diseases including IgG-related lung disease was discussed in the article. The authors described recent classification and diagnostic criteria of IgG4-related lung disease, including radiological, serological and morphological parameters, and therapeutic approaches. Two clinical cases of IgG4-related disease with involvement of the lungs (organizing pneumonia), lacrimal glands (dacryoadenitis), kidneys (tubulointerstitial nephritis), eyes (iridocyclitis), and salivary glands (sialadenitis) were described in the article. Immunosuppressive therapy was successful in both cases. Среди всех IgG4-ассоциированных заболеваний (IgG4-АЗ) легочные поражения являются наименее изученными практическими врачами. В обзоре изложен современный взгляд на проблему IgG4-АЗ, в т. ч. с поражением легких. Подробно изложена современная классификация вариантов легочной патологии, а также диагностические критерии, включающие рентгенологические, серологические и морфологические параметры; рассмотрены подходы к лечению IgG4-АЗ легких. Приводятся 2 собственных клинических наблюдения IgG4-АЗ с поражением легких (организующаяся пневмония), слезных желез (дакриоаденит), почек (тубулоинтерстициальный нефрит), органа зрения (иридоциклит) и слюнных желез (сиалоаденит). Продемонстрированы хорошие результаты иммуносупрессивной терапии, проведенной в обоих случаях

CLINICAL MANIFESTATIONS OF CUSHING'S DISEASE (RESULTS OF ANALYSIS OF THE CLINICAL DATABASE OF THE MOSCOW REGION)

Background: Cushing's disease (CD) is a  severe multimorbid disorder that affects primarily young people in their productive age. In most cases, the diagnosis is delayed and patients with complications of hypercorticism are seen by doctors of various specialties.Aim: To identify the most frequent clinical signs and symptoms of CD at the time of diagnosis, to assess an association between clinical manifestations of hypercorticism and main clinical and laboratory parameters.Materials and methods: We examined 44 CD patients registered in the database of CD patients of the Moscow Regional Research and Clinical Institute (MONIKI).Results: The mean age of patients was 37.9±10.5 years, with most of them (68.2%) being in the age range of 30 to 50 years. The median of disease duration was 35.5 [22; 75] months. Facial plethora, which is the most characteristic sign of hypercorticism, was seen in 97.7% of patients. Striae, thought to be most often associated with hypercorticism, were found only in 38.6% of patients. The most frequent complaints (> 80%) were weight gain, fatigue, headache, and menstrual dysfunction. Some of the symptoms showed a positive correlation with cortisol levels.Conclusion: Clinical manifestations of CD are mostly non-specific. Only facial plethora was highly prevalent of all typical symptoms of hypercorticism. At least one of the "specific" symptoms was found in all patients

In hospital risk factors for acute kidney injury and its burden in patients with Sars-Cov-2 infection: a longitudinal multinational study

Acute kidney injury (AKI) is associated with increased mortality in most critical settings. However, it is unclear whether its mild form (i.e. AKI stage 1) is associated with increased mortality also in non-critical settings. Here we conducted an international study in patients hospitalized with SARS-CoV-2 infection aiming 1. to estimate the incidence of AKI at each stage and its impact on mortality 2. to identify AKI risk factors at admission (susceptibility) and during hospitalization (exposures) and factors contributing to AKI-associated mortality. We included 939 patients from medical departments in Moscow (Russia) and Padua (Italy). In-hospital AKI onset was identified in 140 (14.9%) patients, mainly with stage 1 (65%). Mortality was remarkably higher in patients with AKI compared to those without AKI (55 [39.3%] vs. 34 [4.3%], respectively). Such association remained significant after adjustment for other clinical conditions at admission (relative risk [RR] 5.6; CI 3.5- 8.8) or restricting to AKI stage 1 (RR 3.2; CI 1.8–5.5) or to subjects with AKI onset preceding deterioration of clinical conditions. After hospital admission, worsening of hypoxic damage, inflammation, hyperglycemia, and coagulopathy were identified as hospital-acquired risk factors predicting AKI onset. Following AKI onset, the AKI-associated worsening of respiratory function was identified as the main contributor to AKI-induced increase in mortality risk. In conclusion, AKI is a common complication of Sars-CoV2 infection in non-intensive care settings where it markedly increases mortality risk also at stage 1. The identification of hospital-acquired risk factors and exposures might help prevention of AKI onset and of its complications