Membranous nephropathy

ABSTRACT Membranous nephropathy is a glomerulopathy, which main affected target is the podocyte, and has consequences on the glomerular basement membrane. It is more common in adults, especially over 50 years of age. The clinical presentation is nephrotic syndrome, but many cases can evolve with asymptomatic non-nephrotic proteinuria. The mechanism consists of the deposition of immune complexes in the subepithelial space of the glomerular capillary loop with subsequent activation of the complement system. Great advances in the identification of potential target antigens have occurred in the last twenty years, and the main one is the protein “M-type phospholipase-A2 receptor” (PLA2R) with the circulating anti-PLA2R antibody, which makes it possible to evaluate the activity and prognosis of this nephropathy. This route of injury corresponds to approximately 70% to 80% of cases of membranous nephropathy characterized as primary. In the last 10 years, several other potential target antigens have been identified. This review proposes to present clinical, etiopathogenic and therapeutic aspects of membranous nephropathy in a didactic manner, including cases that occur during kidney transplantation

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Lipiduria correlates with proteinuria and serum albumin, but not with markers of kidney damage in patients with proteinuric glomerulopathies

O termo lipidúria significa a presença de ésteres de colesterol na urina e é encontrada em pacientes com síndrome nefrótica, apesar de não ser essencial para este diagnóstico. Lipidúria é identificada pela presença de partículas lipídicas na urina e são identificadas pelo seu aspecto de cruz de Malta sob microscopia com luz polarizada. Entretanto, a lipidúria raramente é avaliada e tampouco tem sua importância estabelecida. Este estudo tem como objetivo investigar a relevância da lipidúria em pacientes com síndrome nefrótica e sua possível participação na formação da fibrose intersticial. Métodos: A lipidúria foi avaliada em amostras de urina de pacientes adultos com proteína nefrótica e não nefrótica submetidos à biópsia renal. A medida da gordura urinária foi feita através da contagem de partículas lipídicas em câmara de Neubauer em microscópio sob luz polarizada, e também pela dosagem de gordura total urinária (GTU) calculada pelo índice concentração de GTU/concentração urinária de creatinina. Estas dosagens foram comparadas com proteinúria de 24 h, albumina sérica, filtração glomerular, fibrose intersticial (FI) e com a expressão de sinaptopodina glomerular e de cubulina tubular (imuno-histoquímica). Dados estão expressos como média e desvio padrão ou mediana e variação. A comparação numérica entre os grupos com proteinúria nefrótica e não nefrótica foi feita com o Mann-Whitney U-test. O teste de correlação de Spearman foi utilizado para a correlação entre a contagem de partículas lipídicas ou da GTU com as demais variáveis quantitativas. Foi considerado p< 0,05 como nível de significância estatística Resultados: A contagem de partículas lipídicas foi de 3500/mL (1763; 21550/mL) nos pacientes com síndrome nefrótica (n=13) e de 400/mL (250; 850/mL) naqueles com proteinúria não nefrótica (n=11; p<0.005). Não houve diferença estatisticamente significante entre estes grupos para a GTU e tampouco houve correlação estatisticamente significante entre estas duas variáveis. A contagem de partículas lipídicas mostrou correlação estatisticamente significante com a proteinúria (r: 0,5202; p<0,01) e com a albumina sérica (r: - 0,4554; p<0,05), mas não com a filtração glomerular, FI e com a expressão de sinaptopodina e de cubulina. A dosagem de GTU não mostrou correlação significante com qualquer variável estudada. Conclusão: A lipidúria pode ser medida pela contagem das partículas lipídicas urinárias pela sua associação com a proteinúria e a albuminemia, mas não pela dosagem da gordura total urinária. Além disso, a ausência de correlação da contagem das partículas lipídicas urinárias com a filtração glomerular, a fibrose intersticial e expressa o tubular de cubulina não confirma a hipótese da sua participação na patogênese da doença renal progressiva nas glomerulopatias proteinúricas. Todavia, este resultado pode ser consequência da amostra insuficiente de pacientes, da heterogeneidade das glomerulopatias e também pela não avaliação dos diversos componentes dos ésteres de colesterol que compõem as partículas lipídicas.Lipiduria is present in the urine of patients with nephrotic syndrome. It can be recognized by its Maltese cross appearance of the lipid particles when viewed by a polarizing microscope. However, lipiduria is not searched on the clinical routine. This study aims to study the relevance of lipiduria in patients with nephrotic syndrome and its possible role in the pathogenesis of interstitial fibrosis. Methods: Lipiduria was evaluated in urine samples of adult patients with nephrotic and non-nephrotic proteinuria who underwent renal biopsy. The quantification of urinary fat was carried out by counting lipid particles in the Neubauer chamber with a polarizing microscope. The total urinary fat (TUF) measured the urinary fat concentration/urinary creatinine concentration index. These measurements were compared with 24 h proteinuria, serum albumin, glomerular filtration, interstitial fibrosis (IF), and the glomerular and tubular expression of synaptopodin and cubilin respectively. Data are presented as media and standard deviation or median and range. The comparison between the nephrotic and non-nephrotic proteinuria groups was made with the Mann-WhitneyU-test. A Spearman\'s rank correlation was used to estimate the correlation between the counting of urinary lipid particles and the other quantitative variables.pvalues < 0.05 were considered statistically significant. Results: the counting of urinary lipid particles was 3,500/mL (1,763; 21,550/mL) in the nephrotic proteinuria group (n = 13), and 400/mL (250; 850/mL) in the patients with non-nephrotic proteinuria group (n=11; p<0.005). There was no statistically significant difference between the two groups for TUF. There was no correlation between urinary lipid particles and TUF. The counting of urinary lipid particles showed a significant statistical difference correlation with proteinuria (r: 0.5202;p<0.01) and with serum albumin (r: - 0.4554;p<0.05), but not with glomerular filtration, IF, and with the expression of glomerular synaptopodin and tubular cubilin. The TUF showed no significant correlation with any variable. Conclusion: Lipiduria can be evaluated by the counting of urinary lipid particles because of its association with proteinuria and serum albumin; however, the total urinary fat did not show this association. Furthermore, the no correlation of the urinary lipid particles with the glomerular filtration and markers of interstitial fibrosis did not confirm the hypothesis of the role the urinary lipid particles in the pathogenesis of the progressive renal disease in the proteinuric glomerulopathies. It must be emphasized that these results may be a consequence of the small sample of patients, the heterogeneous glomerulopathies

Peritonitis caused by paracoccidioides spp. in a patient on continuous ambulatory peritoneal dialysis – A case report

Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Forty-eight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM

Testicular histology after intestinal pedicle flap (cecum) apposition in rats Histologia testicular depois da aposição de um retalho intestinal (ceco) em ratos

PURPOSE: Histological study of vascularization between a cecal pedicle flap and the testicle of Wistar rats. METHODS: Fifty-three rats were studied. G1: submitted to celiotomy (a), mobilization of the right testicle (RT) to the abdomen (b), cecal flap suture to the RT (d) and cavity closure. G1: procedures a, b and d and fixation of RT into abdomen. G3: procedures a, b and d, exposition of RT to air and reposition into scrotum. G4: not operated. Euthanasia and histology was done after 20 days. Histometry and lesions score classification was done. Testicular vascularization was studied with comparison between G1 and G3. A p < .05 was considered significant. RESULTS: The G1 RT diameters were not different to G2 RT and all have decreased size in comparison with RT of G3 and G4. The lesions score in the RT was 5.83 in G1 and 3.3 in G2 without statistical difference. The vascularization's average in G1 was 16.9 vessels in 400X field in the RT. In the G3 this average was 0.96 to the RT and 0.92 to left testicles. The weight's average in G1 was similar with G2 but different of G3 and G4. CONCLUSION: A significant increase of vascularization was observed between the intestinal flap and the rat testicle.<br>OBJETIVOS: Estudar histologicamente a vascularização entre um retalho cecal e o testículo de ratos Wistar. MÉTODOS: Cinquenta e três ratos foram estudados. G1, submetidos a (a) celiotomia, (b) mobilização do testículo direito (TD) para o abdome, (c) sutura do retalho cecal ao TD, (d) fechamento da cavidade. G2, procedimentos (a, b e d), com o TD fixado no abdome. G3, procedimentos (a, b e d), com exposição do TD ao ar e retorno ao escroto. G4 não operados. Após 20 dias, eutanásia e histologia. Realizou-se histometria e classificação segundo escore de lesão. Avaliou-se a vascularização testicular, comparando-se os grupos 1 e 3. Considerou-se significativo um p < 0,05. RESULTADOS: Diâmetros dos TD no G1, iguais ao G2 e diferentes de G3 e G4. O escore de lesão nos TD foi de 5,83 pontos para o G1, de 3,3 pontos para o G2, não havendo diferença significativa, porém diferentes de G3 e G4 (sem lesão). A vascularização no G1 teve média de 16,9 vasos por campo de grande aumento no TD. No G3 a média foi de 0,96 no TD e 0,92 no TE, com diferença significativa. O peso médio do G1 foi igual ao G2 e diferente de G3 e G4. CONCLUSÃO: Houve aumento significativo da vascularização entre o retalho e o testículo do rato

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data