Case reports
Association of parvovirus B19 infection with acute glomerulonephritis in healthy adults: case report and review of the literature
Y. Mori, H. Yamashita, Y. Umeda,Y.U. Uchiyama-Tanaka, A. Nose,N. Kishimoto, Y. Kijima, T. Nagata,M. Mori, H. Matsubara, H. Yoshida and T. Iwasaka
Price
42.00 $
Volume 57 (2002) p. 69 - 73
Abstract
Y. Mori, H. Yamashita, Y. Umeda,Y.U. Uchiyama-Tanaka, A. Nose,N. Kishimoto, Y. Kijima, T. Nagata,M. Mori, H. Matsubara, H. Yoshida and T. Iwasaka
1Department of Medicine II, Kansai Medical University, Osaka, and
2Department of Clinical Laboratory Medicine, Fukui Medical University,
Fukui, Japan
An otherwise healthy 20-year-old woman presented with an erythematous rash on her face as well as arthralgia and anemia. She also had systemic edema, proteinuria and hypertension. Laboratory data on admission showed hypocomplementemia, human parvovirus B19 (HPV) DNA and both immunoglobulin (Ig) M and IgG antibodies to HPV in her serum. Renal biopsy specimens showed features of endocapillary glomerulonephritis under light microscopy. Electron microscopy showed massive subendothelial electron-dense deposits. No cause was probable other than immune complex-mediated glomerulonephritis associated with HPV infection. In a review of this and similar cases reported in the literature, several characteristic features come to light: female dominance, onset in the second or third decade of life, hypocomplementemia, histologic renal endocapillary and/or mesangioproliferative glomerulonephritis with subendothelial deposits and spontaneous recovery.
Originals
Glomerulonephritis in children with mixed connective tissue disease
S. Ito, T. Nakamura, R. Kurosawa, T. Miyamae, T. Imagawa, M. Mori, Y. Aihara and S. Yokota
Price
42.00 $
Volume 66 (2006) p. 160 - 165
Abstract
S. Ito, T. Nakamura, R. Kurosawa, T. Miyamae, T. Imagawa, M. Mori, Y. Aihara and S. Yokota
1Department of Pediatrics, Yokohama City University Medical Center, 2Department of Pediatrics, Yokohama City University, School of Medicine, Yokohama, Japan
Aims: Mixed connective tissue disease (MCTD) has overlapping clinical features with systemic lupus erythematosus (SLE). Renal biopsy is necessary for all children with SLE to evaluate the prognosis, because they are at a quite high risk of developing renal complications. Furthermore, lupus nephritis and hypocomplementemia usually precede the appearance of clinical manifestations. Immune complex-mediated nephritis is one of the major complications of MCTD. Juvenile MCTD is known to be associated with a higher risk of nephritis than adult MCTD. However, it is uncertain whether all children with MCTD should be subjected to a renal biopsy, and whether most of those with hypocomplementemia present nephropathy, as in patients with SLE. We examined the histopathological characteristics of juvenile MCTD nephritis, the importance of renal biopsy and the implications of hypocomplementemia in our patients and reported cases of MCTD. Material and methods: We performed renal biopsy in 11 children with MCTD and found 6 patients with glomerulonephritis. In addition, we studied the frequency and the characteristics of glomerulonephritis in 71 cases of juvenile MCTD (our 11 patients and 60 reported cases). We also analyzed the relationship between hypocomplementemia and pathological features in 41 cases of MCTD nephritis (23 adults, 18 children). Results: 6 of our 11 patients had glomerulonephritis, but of them four had no abnormality in urinalysis at the time of biopsy. In 5 patients renal biopsy showed normal findings. Review of 71 cases of juvenile MCTD showed that of them 28% presented latent asymptomatic nephritis at the time of biopsy. Membranous nephropathy (MN) and mesangial proliferative glomerulonephritis (MPG) were common in MCTD. Interestingly, hypocomplementemia was more frequently observed in patients with MN or mixed form of MN and MPG (MPG/MN) than simple MPG based on our review of 41 cases (p < 0.01). Conclusion: A more aggressive indication of renal biopsy should be considered in children with MCTD because of the high incidence of non-clinical nephritis. The hypocomplementemia observed in patients with MCTD suggests the high frequency of glomerulonephritis, including membranous lesions.Correspondence to:
S. Ito, MD, PhD
Department of Pediatrics
Yokohama City University Medical Center
Yokohama, Urafunecho 4-57, Minamiku
Yokohama, Kanagawa, 232-0024 Japan
Email: [email protected]
Original
An amplification of IL-10 and TGF-beta in patients with IgG4-related tubulointerstitial nephritis
H. Nakashima, K. Miyake, M. Moriyama, A. Tanaka, M. Watanabe, Y. Abe, H. Sato, S. Nakamura and T. Saito
Price
42.00 $
Volume 73 (2010) p. 385 - 391
Abstract
Clinical Nephrology, Vol. 73 – No. 5/2010 (385-391)
An amplification of IL-10 and TGF-beta in patients with IgG4-related tubulointerstitial nephritis
H. Nakashima1, K. Miyake1, M. Moriyama2, A. Tanaka2, M. Watanabe1, Y. Abe1, H. Sato3, S. Nakamura2 and T. Saito1
1Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, 2Department of Oral and Maxillofacial Surgery, Graduate School of Dental Science, Kyushu University, Fukuoka, and 3Division of Nephrology, Endocrinology and Vascular medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Background: IgG4-related tubulointerstitial nephritis (TIN) shows characteristic serum IgG4 elevation and increased IgG4-positive plasma cells in the renal interstitium, and inclusion of TIN as an IgG4-related systemic disease has been suggested. IgG4 is the rarest IgG subclass and is a Th2-dependent isotype with low affinity for target antigen. Although the pathogenesis of this disease has not been elucidated, positive serum immune complex and hypocomplementemia in some patients with this disease suggest that immune complex mechanisms are involved in the causation of this disease. Method: We selected 20 cases of histological diagnosed TIN. These cases were etiologically different and included 4 cases of IgG4-related TIN. We extracted RNA from paraffin embedded biopsied kidney and evaluated expression levels of various cytokines for each case by real time PCR. Results: Comparison of cytokine production patterns among different disease-associated TINs revealed that IgG4-related TIN exhibited a quite distinct pattern. On the one hand, there was no expression of IL-2, IFN-γ, IL-17 and IL-6, whereas production of IL-4, IL-10 and TGF-β was, on the other hand, remarkably increased in IgG4-related TIN. Conclusion: Based on these cytokine production results, Th2 and Treg appear to play a central role in IgG4-related TIN.Correspondence to:
H. Nakashima, MD, PhD
Division of Nephrology and Rheumatology
Department of Internal Medicine
Faculty of Medicine
Fukuoka University
7-45-1 Nanakuma, Jonann-ku
Fukuoka 814-0180, Japan
Email: [email protected]
Original
Factors associated with silent cerebral microbleeds in hemodialysis patients
T. Naganuma, Y. Takemoto, T. Yamasaki, H. Shima, T. Shoji, E. Ishimura, Y. Nishizawa, M. Morino, M. Okamura and T. Nakatani
Price
42.00 $
Volume 75 (2011) p. 346 - 355
Abstract
Clinical Nephrology, Vol. 75 – No. 4/2011 (346-355)
Factors associated with silent cerebral microbleeds in hemodialysis patients
T. Naganuma1, Y. Takemoto1, T. Yamasaki1, H. Shima2, T. Shoji2, E. Ishimura2, Y. Nishizawa2, M. Morino3, M. Okamura4 and T. Nakatani1
1Department of Urology, 2Department of Nephrology, 3Department of Neurosurgery, Osaka City University Graduate School of Medicine, and 4Department of Nephrology, Ohno Memorial Hospital, Osaka, Japan
Background: The recent development of gradient-echo T2*-weighted magnetic resonance imaging (MRI) has enabled the highly accurate detection of prior cerebral microbleeds (CMBs), which might indicate a higher risk of future intracerebral hemorrhage (ICH) and be a marker of cerebral small-vessel disease in the general population. The present study investigated the clinical factors associated with the presence of CMBs in hemodialysis (HD) patients. Methods: Cranial MRI, including T2*-weighted MRI, was performed on 179 HD patients without symptomatic cerebrovascular disease and 58 healthy control subjects, and we investigated the prevalence of CMBs and clinical factors associated with the presence of CMBs. We also investigated the relationship between CMBs and other cerebral small-vessel diseases. Results: The prevalence of CMBs was significantly higher in the HD patients than in the healthy subjects (45 patients (25.1%) vs. none in the healthy controls (0%), p < 0.0001). Multiple logistic regression analysis showed that independent and significant factors associated with the presence of CMBs were age, systolic blood pressure, diastolic blood pressure and pulse pressure. Moreover, the presence of CMBs correlated significantly with the presence of lacunar infarcts, periventricular hyperintensity and deep and subcortical white matter hyperintensity. Conclusions: These findings indicated a high prevalence of CMBs among HD patients, and that older age and high blood pressure were strong factors associated with the presence of CMBs. Moreover, CMBs were closely associated with other cerebral small-vessel diseases.Correspondence to:
T. Naganuma, MD
Department of Urology
Osaka City University Medical School
1-4-3 Asahi-machi, Abeno-ku
Osaka, 545-8585, Japan
Email: [email protected]
Übersicht
Übelkeit und Erbrechen bei Analgesie und Analgosedierung in der Notfallmedizin
L.H.J. Eberhart und A.M. Morin
Price
42.00 $
Jahrgang 41 p. 162 - 169
Abstract
Intensiv und Notfallbehandlung, Jahrgang 41, Nr. 4/2016, S. 162-169
Übelkeit und Erbrechen bei Analgesie und Analgosedierung in der Notfallmedizin
L.H.J. Eberhart und A.M. Morin
Klinik für Anästhesie und Intensivtherapie, Philipps-Universität Marburg
Opioide sind ein unverzichtbarer Bestandteil einer suffizienten Analgesie in vielen Notfallsituationen. Übelkeit und Erbrechen sind häufige Nebenwirkungen aller Medikamente aus dieser Substanzgruppe, die im Rettungsdienst durch Bewegungsreize aggraviert werden können. Sie stellen eine starke Belastung für Patient aber eben auch für das Rettungsdienstpersonal dar. Daher soll die Indikation für die prophylaktische oder therapeutische Gabe von Antiemetika (auch als Kombinationstherapie) großzügig gestellt werden, zumal die Substanzen durchweg ein gutes Nebenwirkungsprofil aufweisen. Dopaminantagonisten (z.B. niedrig dosiertes Haloperidol; ≤ 1mg), 5-HT3- Antagonisten und Dimenhydrinat sind einzeln oder in Kombination effektiv. Dagegen stellen Antiemetika bei Einleitung einer Kurznarkose oder einer tiefen Analgosedierung keinen zuverlässigen Schutz gegen passive Regurgitation und konsekutiver Aspiration dar.Correspondence to:
Prof. Dr. Leopold Eberhart
Klinik für Anästhesie und Intensivtherapie
Philipps-Universität Marburg
Baldingerstraße
35043 Marburg
Email: [email protected]
