183 research outputs found
Púrpura de Henoch-Schönlein Associada a Adenocarcinoma do Pulmão
Introduction: The Henoch-Schönlein purpura (HSP) is an immunoglobulin A (IgA)-mediated smallvessel
systemic vasculitis, rare in adults. The association with solid tumours has been described,
especially with lung cancer. Case Report: We present the case of a 60-year-old Caucasian male, diagnosed
with lung adenocarcinoma that underwent surgical resection without (neo)adjuvant theraphy.
Two months latter he was admitted for abdominal pain, purpuric rash on his lower extremities and
acute kidney injury, with serum creatinine (Scr) of 2 mg/dl. Urinalysis revealed haematuria and 24h
proteinuria (P24h) of 1.5 g. The serum protein electrophoresis, complement components C3 and C4,
circulating immune complexes, cryoglobulins, ANCA, ANA, anti-dsDNA and the remaining immunologic
study as screening for viral infections (HCV, HBV and HIV) were negative. Renal ultrasound was normal
and kidney biopsy revealed mild mesangial proliferation; 2 cellular glomerular crescents and 1 fibrinoid
necrosis lesion; large amounts of red blood cell casts; lymphocytic infiltration in the intertubular interstitial
capillaries; moderate arteriolar hyalinosis. Immunofluorescence demonstrated mesangial and
parietal deposits of IgA. The diagnosis of HSP was assumed, and the patient started prednisolone 1
mg/kg/day. Ten months after diagnosis the patient’s baseline Scr is 1.4 mg/dl with P24h of 0.18g,
without haematuria. Conclusion: Although this is a rare association and the exact mechanism behind
the disease is yet unknown, physicians should be aware of it. The early recognition and treatment may
prevent renal disease progression
Cultivo do meloeiro sob fertirrigação por gotejamento no Meio-Norte do Brasil.
O objetivo desta publicacao foi apresentar os resultados de pesquisas desenvolvidas com a cultura do melao pela Embrapa Meio-Norte, envolvendo a avaliacao de cultivares, manejo de irrigacao e fertirrigacao por gotejamento em solos arenosos de Tabuleiros Costeiros, respaldados por outras informacoes disponiveis na literatura sobre a cultura e coloca-las ao alcance do usuario.bitstream/item/36285/1/Cir21.pd
Anaemia, Acute Renal Failure and Proteinuria – A Case to Solve
info:eu-repo/semantics/publishedVersio
An Unexpected Cause of Chronic Renal Dysfunction and Haemato-Proteinuria
info:eu-repo/semantics/publishedVersio
A 54-Year-Old Man with New-Onset Nephrotic Syndrome
info:eu-repo/semantics/publishedVersio
Transplantation in Highly Sensitised Patients Treated with Intravenous Immunoglobulin and Rituximab
Renal transplant in highly sensitised patients is associated with increased morbidity. The aim of this retrospective study was to evaluate the clinical evolution
of 30 highly sensitised deceased donor kidney
transplants and the influence of different timing of B cell directed treatment and its importance in the outcome of these patients. All recipients had negative complement dependent lymphocytotoxicity cytotoxic
T cell crossmatch and no identified anti human leucocyte antigen class I donor specific antibodies. T cell flow crossmatch was performed within 24h of transplantation with serum obtained pretransplant (historic, recent or baseline). Posttransplant flow
crossmatch were performed prospectively starting on the 3rd posttransplantation day. The immunosuppressive regime included thymoglobulin, tacrolimus, mycofenolate mofetil and steroids.
Positive flow crossmatch occurred in 20/29
patients by the 3rd posttransplantation day, and in 17/27 patients after the 3rd posttransplantation day. All patients were started on intravenous immunoglobulin
before transplantation: in nine patients
(group A) at 400mg/kg/day for five days; in the remaining 21 patients (group B), as a continued infusion of 2g/kg during 48h. In group A, Rituximab was added only in the presence of antibody mediated rejection; in group B, introduced on the 3rd posttransplantation day whenever a positive
flow crossmatch (with serum obtained pre or posttransplant) was reported. Antibody mediated rejection was observed in 44.4% of patients in group A, and 19% of those in group B. Mean follow-up was 12.2±5.5 months. Overall allograft survival was 76.6%, 81% in group B, and 66.6% in group A. At last follow up, mean serum creatinine was 1.3±0.6 mg/dl.
Renal transplantation with pretransplant positive flow crossmatch is highly associated with antibody mediated rejection, despite introduction of intravenous
immunoglobulin pretransplantation. However
high dose intravenous immunoglobulin for 48h plus Rituximab by the 3rd posttransplantation day reduce the incidence of antibody mediated rejection by more than 50% and allowed for allograft survival of
81% at one year, with an excellent renal function
Oxalate Nephropathy Following Roux‑en‑Y Gastric Bypass Surgery – Mini‑Review
Oxalate Nephropathy is characterised by the presence of tubular crystalline deposits of calcium oxalate, which
can lead to both acute and chronic tubular injury and progressive renal failure. Enteric hyperoxaluria is the most
common cause of moderate hyperoxaluria; it occurs in conditions associated with fat or bile acid malabsorption,
which include jejunoileal bypass and other bariatric procedures such as Roux‑en‑Y gastric bypass surgery.
We present the clinical case of a 69‑year‑old man who was hospitalised for non‑oliguric renal dysfunction,
with a serum creatinine of 10 mg/dl and normocytic normochromic anaemia. There was no prior history of renal
disease. Twenty months before admission the patient was diagnosed with a gastro‑oesophageal junction adenocarcinoma and was treated with pre‑operative chemotherapy, followed by total gastrectomy, with a Roux‑en‑Y gastric bypass reconstruction. On discharge from gastric surgery, renal function was normal.
On the first day of hospital stay haemodialysis was initiated. Over the following days, the rapid unexplained
renal impairment was investigated, and this workup [2] included a kidney biopsy. Histological examination of the biopsy specimen revealed a predominantly interstitial nephropathy with tubular atrophy and interstitial fibrosis, with bright intra‑tubular calcium oxalate crystals in over 50% of the tubules and so the histological diagnosis was of oxalate nephropathy. Subsequently, no recovery of renal function was observed, so the patient is currently undergoing regular haemodialysis. Oxalate nephropathy is a rare but severe complication of Roux‑en‑Y gastric bypass surgery that can lead to a rapid progression to kidney failure. Although the treatment of obesity is the main indication for this surgery, this is also the preferred approach for gastrointestinal reconstruction after total gastrectomy for treatment of gastric carcinoma. Considering the rapid progression of oxalate nephropathy to kidney failure, patients who undergo Roux‑en‑Y gastric bypass surgery should have regular follow‑up of renal function.info:eu-repo/semantics/publishedVersio
Biosurfactant Production by Pseudomonas aeruginosa and Burkholderia gladioli Isolated from Mangrove Sediments Using Alternative Substrates
Biosurfactants are surface-active agents produced by a variety of microorganisms. To make biosurfactant production economically feasible, several alternative carbon sources have been proposed. This study describes biosurfactant production by strains of Pseudomonas aeruginosa and Burkholderia gladioli isolated from mangrove sediments in Northeastern Brazil and cultured in mineral media enriched with waste cooking oil. The biosurfactants were tested for drop collapse, emulsion formation and stability and surface tension. P. aeruginosa performed better both at lowering the surface tension (from 69 to 28 mN/m) and at forming stable emulsions (approximately 80%) at 48 hours of culture. The strains tested in this study were found to be efficient biosurfactant producers when cultured on substrates enriched with vegetable oil.
DOI: http://dx.doi.org/10.17807/orbital.v8i5.77
A New Anatomo-Clinical Approach to an Old Disease
info:eu-repo/semantics/publishedVersio
Triple Regimen with Rituximab, Plasmapheresis and Intravenous Immunoglobulin in the Treatment of Dialysis Dependent Acute Humoral-Mediated Rejection in Kidney Grafts
Introduction: The clinical importance of humoral-mediated acute rejection has been progressively recognised. Early recognition and treatment with plasmapheresis and intravenous immunoglobulin have recently improved short term prognosis.
Case report: In this report we describe the
clinical features of three 2nd transplant patients developing severe acute humoral rejection during the first week post-transplant while on anti-thymocyte globulin therapy. Treatment with plasmapheresis/
intravenous immunoglobulin/rituximab resulted in rapid reversal of oliguria,and recovery of renal function within the 1st week of treatment in 2/3 patients. Diagnosis was confirmed by graft biopsies revealing peritubular neutrophiles and C4d deposits.
Sequential graft biopsies in all three patients revealed complete histological recovery within two weeks. One patient never recovered renal function, and one patient lost his graft at three months following hemorrhagic shock. After 2 years follow up, the remaining patient maintains a serum creatinine of 1.1mg/dl.
Conclusion: The regimen using plasmapheresis
plus intravenous immunoglobulin and rituximab was effective in rapidly reversing severe
acute humoral rejection
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