O impacto da microscopia eletrónica na biópsia renal. Em colaboração com o Serviço de Hefrologia

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Severe Acute Kidney Injury and Double Tubulopathy Due to Dual Toxicity Caused by Combination Antiretroviral Therapy.

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Cellular Variant of Focal Segmental Glomerulosclerosis Treated with Plasma Exchange

Focal segmental glomerulosclerosis (FSGS) is the most common primary glomerular disease in nephrotic patients in the United States, frequently leading to end stage renal disease (ESRD). The cellular variant is a rare form of FSGS commonly associated with poor outcome. We report a case of cellular variant FSGS with progressive kidney dysfunction successfully treated with plasma exchange (PE). A 49-year-old Caucasian female presented with two days of ankle edema and hypertension. Laboratory findings showed serum creatinine (SCr) 1.6 mg/dL, urine albumin/creatinine ratio (uACR) 2.8 g/g, haematuria 3+ and no immunological abnormalities. Kidney biopsy revealed a cellular FSGS variant with segmental endocapillary proliferation on light microscopic, negative immunofluorescence and widespread foot process effacement by electronic microscopic. Prednisolone 1 mg/Kg was started. Four days later the SCr worsened (3.6 mg/dL) and the patient became severely nephrotic with uACR of6.8g/g, quickly attaining a maximum of 24.6 g/g in a short time and albumin of 2.15g/dL. Pulsed methyl prednisolone was started. Despite a 10 course of steroids, no clinical improvement was observed. Considering the rapidly worsening renal function and severe nephrotic syndrome, PE was begun in association with mycophenolate mofetil and tacrolimus. Kidney function recovered after one week. Complete remission was achieved at 3rd week and remains in complete remission at 27 months follow-up. Prolonged remission is a challenge in primary FSGS. PE associated with combined immunosuppression was effective in the present case. The short and long-term effects of plasma exchange in primary FSGS should be evaluated in prospective studies.info:eu-repo/semantics/publishedVersio

Kidney biopsy in Lupus Nephritis: still essential in clinical practice

Renal involvement in Systemic Lupus Erythematous is common and its management remains a daily challenge for clinical providers. Percutaneous kidney biopsy remains the gold standard for diagnosis of lupus nephritis. More recently, we have seen the role of the biopsy being challenged, considering the widespread use of corticosteroids and mycophenolate mofetil for all forms of lupus nephritis. We present a review of published evidence regarding first and repeat kidney biopsies for patients with lupus nephritis. Based on the available literature, we recommend a kidney biopsy to guide treatment and determine prognosis and we also suggest an algorithm for kidney rebiopsy in lupus nephritis.info:eu-repo/semantics/publishedVersio

Gastrointestinal Tuberculosis Mimicking Crohn’s Disease

We present the case of a 24-year-old woman with complaints of abdominal pain, bloody diarrhea, and weight loss for 3 months. An outpatient colonoscopy revealed scattered ulcers, suggestive of Crohn's disease (CD). Histopathology also favored the diagnosis of CD. However, after admission to our hospital for further investigation, a chest radiograph revealed pulmonary cavitations. A computed tomography scan suggested the diagnosis of active pulmonary tuberculosis (TB). Therefore, a bronchofibroscopy, a total colonoscopy with ileoscopy, and an upper endoscopy were performed. Not only were acid-fast bacilli present in both bronchoalveolar lavage fluid and gastric juice, but also in colonic biopsies. A complete resolution of gastrointestinal symptoms was achieved 2 weeks after starting anti-TB drugs.info:eu-repo/semantics/publishedVersio

Testis-sparing surgery attempt: case report

Introduc¸ão: Até ao fim dos anos 80 defendia-se que qualquer nódulo testicular suspeito devia ser excisado com orquidectomia radical. No entanto, com o aumento do diagnóstico incidental de massas testiculares, a maior acuidade dos exames extemporâneos e a evidência das vantagens potenciais da orquidectomia parcial, questionou-se se seria necessário sacrificar, sempre, todo o testículo, mesmo na presenc¸a de um testículo contralateral normal. Caso clínico: Apresentamos o caso de um doente de 23 anos, com o diagnóstico de um nódulo testicular com 7,5 mm, não palpável, assintomático e marcadores tumorais negativos. Foi submetido a orquidectomia parcial guiada por ecografia e exame extemporâneo, no entanto, por suspeita anatomopatológica de provável tumor de células germinativas, optou-se pela totalizac¸ão da orquidectomia. O resultado histológico final foi de tumor de células de Leydig. Tendo em conta a elevada probabilidade de lesões testiculares não palpáveis e de pequenas dimensões serem benignas (até 80%), os efeitos da orquidectomia radical na espermatogénese, func¸ão endócrina e estética e que não devem ser ignorados, a orquidectomia parcial é um procedimento que, embora não seja um procedimento padrão, pode ser equacionado como primeira abordagem em casos selecionados e em centros de referência especializados.Introduction: Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy; however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis-sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present. Clinical Case: We present a 23-year-old patient who was asymptomatic at diagnosis of a non- -palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis-sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non-palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis- -sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers

A case report of imported paracoccidioidomycosis

A Paracoccidioidomicose (PCM) é uma importante micose endémica na América do Sul. Na Europa a doença é muito rara e encontrada apenas em viajantes oriundos da América Latina. Os autores descrevem um caso de um jovem brasileiro de 24 anos, a viver em Portugal há 7 anos (durante o qual não regressou ao seu país natal), previamente saudável, admitido no nosso hospital com febre, perda do peso (cerca de 5Kg), dor epigástrica inespecífica, anorexia não selectiva, fadiga, linfoadenopatias periféricas e lesões cutâneas papulo- nodulares, com ulceração central, e que envolvia a cabeça, face e o tronco. Analiticamente, hypereosinofilia. Realizaram-se biopsias cirúrgicas dos gânglios linfáticos e das lesões cutâneas. O resultado anátomo-patológico foi consistente com PCM. Iniciou terapêutica antifúngica com melhoria clínica evidente