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Schistosomal glomerulopathy and changes in the distribution of histological patterns of glomerular diseases in Bahia, Brazil
dos-Santos, Washington Luis Conrado;Sweet, Glória Maria Maranh?o;Bahiense-Oliveira, Marília;Rocha, Paulo Novis;
Memórias do Instituto Oswaldo Cruz , 2011, DOI: 10.1590/S0074-02762011000700017
Abstract: distinct patterns of glomerular lesions, including membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis, are associated with infection by schistosoma mansoni or schistosoma japonicum. evidence suggests that immune complex deposition is the main mechanism underlying the different forms of schistosomal glomerulonephritis and that immune complex deposition may be intensified by portal hypertension. the relationship between focal segmental glomerulosclerosis and schistosomiasis remains poorly understood. a clinicopathologic classification of schistosomal glomerulopathies was proposed in 1992 by the african association of nephrology. in brazil, mass treatment with oral medications has led to a decrease in the occurrence of schistosomal glomerulopathy. in a survey of renal biopsies performed in salvador, brazil, from 2003-2009, only 24 (4%) patients were identified as positive for s. mansoni infection. among these patients, only one had the hepatosplenic form of the disease. focal segmental glomerulosclerosis was found in seven patients and membranoproliferative glomerulonephritis was found in four patients. although retrospective studies on the prevalence of renal diseases based on kidney biopsies may be influenced by many patient selection biases, a change in the distribution of glomerulopathies associated with nephrotic syndrome was observed along with a decline in the occurrence of severe forms of schistosomiasis.
Anti-glomerular basement membrane disease superimposed on membranous nephropathy: a case report and review of the literature
Dhruval Patel, Noel Nivera, Allan R Tunkel
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-237
Abstract: A 59-year-old Hispanic man presented with acute onset of nausea and vomiting and was found to have renal insufficiency. Work-up included a kidney biopsy, which revealed anti-glomerular basement membrane disease with underlying membranous nephropathy. He was treated with emergent hemodialysis, intravenous corticosteroids, plasmapheresis, and cyclophosphamide without improvement in his renal function.Simultaneous anti-glomerular basement membrane disease and membranous nephropathy is very rare. There have been 16 previous case reports in the English language literature that have been associated with a high mortality and morbidity, and a very high rate of renal failure resulting in hemodialysis. Co-existence of membranous nephropathy and anti-glomerular basement membrane disease may be immune-mediated, although the exact mechanism is not clear.Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune disorder with significant morbidity and mortality and is characterized by pulmonary hemorrhage, crescentic glomerulonephritis, and the presence of circulating anti-GBM antibodies which bind to the alpha-3 chain of type 4 collagen found in the glomerular and alveolar basement membranes [1]. The etiology of anti-GBM disease is unclear, but may result from hydrocarbon exposure; specific HLA molecules have also been found to be associated with disease. Anti-GBM disease accounts for approximately 10 to 20 percent of patients with rapidly progressive crescentic glomerulonephritis in the United States. The diagnosis is established by demonstration of high titers of anti-GBM antibodies in the circulation and/or renal biopsy. Early treatment with high-dose corticosteroids, plasmapheresis and cyclophosphamide is recommended because early and appropriate treatment may reverse the extent of renal damage and potentially prevent the need for life-long dialysis. In untreated patients, anti-GBM disease progresses to renal failure and death. There have been very few case re
Angiotensinogen Expression Is Enhanced in the Progression of Glomerular Disease  [PDF]
Maki Urushihara, Hiroyuki Kobori
International Journal of Clinical Medicine (IJCM) , 2011, DOI: 10.4236/ijcm.2011.24064
Abstract: Intrarenal renin-angiotensin system (RAS) activation plays a critical role in the development and progression of renal injury. In the kidney, all of the RAS components are present and intrarenal angiotensin II (Ang II) is formed by multiple independent mechanisms. Angiotensinogen (AGT) is the only known substrate for renin that is a rate-limiting enzyme of the RAS. Recently, enhanced intrarenal AGT levels have been shown to reflect the intrarenal RAS status in hypertension, chronic glomerular disease and diabetic nephropathy. In this review, we focus on AGT expression of the diseased glomeruli in the progression of glomerular disease. An anti-glomerular basement membrane nephritis rat model developed progressive proteinuria and glomerular crescent formation, accompanied by increased macrophage infiltration and glomerular expression of AGT and Ang II. The addition of Ang II type 1 receptor blocker to CC-chemokine recaptor 2 antagonist markedly attenuated the induction of macrophage infiltration, AGT and Ang II, and reduced glomerular crescent formation. Next, the levels of glomerular AGT expression and marker of reactive oxygen species in Zucker diabetic fatty (ZDF) obese rats were higher than those in ZDF lean rats. Hydrogen peroxide (H2O2) induced an increase in the AGT expression in primary rat mesangial cells. Furthermore, the H2O2-induced upregulation of AGT was inhibited by a mitogen-activated protein kinase kinase and a c-Jun N-terminal kinase inhibitor. These data suggest the potential contribution of enhanced AGT expression in glomeruli to the intrarenal RAS activation for the development of glomerular disease.
Bilateral paravertebral block in advanced schistosomal liver disease: A prospective study  [cached]
Abou Zeid Haitham,Al-Ghamdi Abdul Mohsen,Abdel-Hadi Maha,Zakaria Hazem
Saudi Journal of Gastroenterology , 2004,
Abstract: Background: Surgery in patients with schistosomal liver disease is usually associated with high risks of morbidity and mortality. Bilateral paravertebral block (BPVB) has been advocated as a useful technique for ventral abdominal hernias′ repairs. Aim of the study: To compare the efficacy of BPVB with general anesthesia (GA) for anterior abdominal wall hernias in advanced schistosomal liver disease patients. Patients and Methods: Sixty patients were randomly allocated into two groups to receive either GA or BPVB. Variables were hospital stay, hemodynamic stability, postoperative nausea and vomiting (PONY), postoperative pain measured on a visual analogue scale (VAS) with assessment of the hepatic cell integrity using glutathione S transferase alpha (GSTA) and other liver enzymes. Results: The main significant finding was an apparently significant shorter length of hospital stay following BPVB as compared with GA in patients (P < 0.005). Conclusions: BPVB was superior to GA following abdominal ventral hernia repair in schistosomal liver fibrosis patients
Renal involvement in prolonged salmonella bacteremia: the role of schistosomal glomerulopathy
Martinelli, Reinaldo;Pereira, Luis Jose Cardoso;Brito, Edilson;Rocha, Heonir;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1992, DOI: 10.1590/S0036-46651992000300002
Abstract: renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged salmonella bacteremia (psb). whether there is a specific renal lesion related to psb or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. to analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and psb (group i) were compared with 8 patients with schistosomal glomerulopathy (group ii) matched by sex and glomerular disease. the mean age in group i was 17.7 years. all patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. in group ii the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. all patients in group i experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group ii the patients had persistent, steroid-resistant, nephrotic syndrome. on histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group i. these observations strongly suggest that psb exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia
Monitoring renal function: measured and estimated glomerular filtration rates - a review
Salgado, J.V.;Neves, F.A.;Bastos, M.G.;Fran?a, A.K.;Brito, D.J.;Santos, E.M.;Salgado Filho, N.;
Brazilian Journal of Medical and Biological Research , 2010, DOI: 10.1590/S0100-879X2010007500040
Abstract: chronic kidney disease (ckd) is a world-wide public health problem, with adverse outcomes of kidney failure, cardiovascular disease, and premature death. this finding has led to the hypothesis that earlier recognition of kidney disease and successful intervention may improve outcome. the national kidney foundation, through its kidney disease outcomes quality initiative (k/doqi), and other national institutions recommend glomerular filtration rate (gfr) for the definition, classification, screening, and monitoring of ckd. blood creatinine clearance, the most widely used clinical marker of kidney function, is now recognized as an unreliable measure of gfr because serum creatinine is affected by age, weight, muscle mass, race, various medications, and extra-glomerular elimination. cystatin c concentration is a new and promising marker for kidney dysfunction in both native and transplanted kidneys. because of its low molecular weight, cystatin c is freely filtered at the glomerulus and is almost completely reabsorbed and catabolized, but not secreted, by tubular cells. given these characteristics, cystatin c concentration may be superior to creatinine concentration in detecting chronic kidney disease. this review aims to evaluate from recent literature the clinical efficiency and relevance of these gfr markers in terms of screening ckd.
Frequency of primary glomerular disease in northeastern China
Wu, Yi-Qi;Wang, Zheng;Xu, Hua-Feng;Jin, Xiao-Ming;Zhou, Hai-Zhou;
Brazilian Journal of Medical and Biological Research , 2011, DOI: 10.1590/S0100-879X2011007500089
Abstract: most frequently reported chinese renal biopsy data have originated from southeastern china. the present study analyzed the renal biopsy data from northeastern china. the records of 1550 consecutive native patients who were diagnosed with primary glomerular diseases (pgd) after renal biopsy at our hospital during 2005-2009 were used. these patients were divided into four age groups for stratified analysis: <15, 15-44, 45-59, and ≥60 years old. among pgd, minimal change disease (mcd) was the most common histologically diagnosed disease (30.7%), followed by iga nephropathy (igan), mesangial proliferative glomerulonephritis (mspgn), membranous nephropathy (mn), membranoproliferative glomerulonephritis (mpgn), focal segmental glomerulosclerosis (fsgs), and endocapillary proliferative glomerulonephritis (enpgn). mcd was the disease most frequently observed (43.7%) in the <15-year-old group. mspgn was the most common disease in the elderly group (38.1%). mspgn was more prevalent in females (27.8%), whereas mcd was more prevalent in males (35.3%). primary glomerular diseases constituted the most commonly encountered group of diseases with a high prevalence of mcd, which predominantly affected males and young adults. the prevalence of mcd was high in northeastern china. further study is necessary to expand the epidemiologic data available for renal disease in china.
Schistosomal hepatopathy
Andrade, Zilton A;
Memórias do Instituto Oswaldo Cruz , 2004, DOI: 10.1590/S0074-02762004000900009
Abstract: gross anatomical features and a complex set of vascular changes characterize schistosomal hepatopathy as a peculiar form of chronic liver disease, clinically known as "hepatosplenic schistosomiasis". it differs from hepatic cirrhosis, although clinical and pathological aspects may sometimes induce confusion between these two conditions. intrahepatic portal vein obstruction and compensatory arterial hypertrophy render the hepatic parenchyma vulnerable to ischemic insult. this may lead to focal necrosis, which may give place to focal post-necrotic scars. these events are of paramount importance for the clinico-pathological evolution of schistosomal hepatopathy. although portal fibrosis due to schistosomiasis sometimes reveals numerous myofibroblasts, it does not mean that such fibrosis belongs to a peculiar type. damage to the muscular walls of the portal vein may be followed by dissociation of smooth muscle cells and their transition toward myofibroblasts, which appear only as transient cells in schistosomal portal fibrosis. studies made with plastic vascular casts, especially those with the murine model of "pipestem" fibrosis have helped to reveal the mechanisms involved in systematized portal fibrosis formation. however, the factors involved in the pathogenesis of hepatosplenic disease remain poorly understood. a process of chronic hepatitis is a common accompaniment of portal fibrosis in schistosomiasis. most of the times it is caused by concomitant viral infection. however, no especial interaction seems to exist between schistosomal hepatopathy and viral hepatitis.
Primary glomerular diseases: variations in disease types seen in Africa and Europe
Okpechi,Ikechi; Duffield,Maureen; Swanepoel,Charles;
Portuguese Journal of Nephrology & Hypertension , 2012,
Abstract: glomerular diseases account for a significant number of patients with chronic kidney disease worldwide. iga nephropathy (igan) is the predominant primary glomerular disease (pgd) seen across europe, whereas in africa, the prevalence of igan is not common. the most frequently described glomerular disease in africa is mesangiocapillary glomerulonephritis (mcgn). the difference in the prevalence of pgds seen in africa and europe may depend on several factors including genetic, socio-economic and demographic influences. variations in exposure to infections (hygiene hypothesis) and patterns of th1 and th2 responses may also contribute significantly to observed differences.
Glomerular malondialdehyde levels in patients with focal and segmental glomerulosclerosis and minimal change disease  [cached]
Nezhad Simin,Momeni Babak,Basiratnia Mitra
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: Minimal Change Disease (MCD) and Focal and Segmental Glomerulosclerosis (FSGS) are often studied together, because both present with heavy proteinuria and the nephrotic syndrome. The precise distinction between MCD and FSGS is sometimes difficult because of inadequate number of glomeruli for definite diagnosis. Some evidence suggests that markers of lipid peroxidation, such as Malondialdehyde (MDA) is an index of free radical mediated injury and may be involved in the pathogenesis of FSGS. In this study, we assessed the immuno-reactivity of MDA, the end product of lipid peroxidation in glomeruli of patients with idiopathic FSGS, MCD as well as normal controls (NC). Our results showed that the immunostaining level of MDA was significantly higher in patients with FSGS (mean = 1.5) than in either patients with MCD (mean = 0.16) or normal controls (mean = 0.11) with P value < 0.001. Glomerular MDA level correlated well with the degree of glomerulosclerosis in patients with idiopathic FSGS. Our data demonstrates that the glomerular level of MDA is higher in idiopathic FSGS than MCD. We suggest that MDA immunostaining can be helpful in differentiating between FSGS and MCD in problematic cases and when we do not have enough glomeruli for definite and correct diagnosis.
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