Chronic interstitial cystitis and ureteral stenosis has occasionally been reported in systemic lupus erythematosus, mostly associated with gastrointestinal symptoms. We report a case of obstructive uropathy associated to chronic interstitial cystitis as the only manifestation of lupus flare in a patient with SLE and anti-phospholipid syndrome (APS) who had been in remission for many years. The development of chronic interstitial cystitis in patients with SLE and APS has not been previously reported. Histopathological study of her urinary bladder and ureteral meatus showed chronic inflammatory infiltrate in the subepithelium. Lack of significant lower urinary tract symptoms and gastrointestinal involvement were some of the factors that could have prevented an earlier diagnosis. Obstructive uropathy and renal insufficiency initially improved with immunosuppressive treatment and endoureteral protheses, but poor compliance to the therapy led to ominous ending.
We describe a 36-year-old woman with Primary Sjögren's Syndrome (PSS). Purpura, corneal perforation, metabolic acidosis, decreased glomerular filtration, hypokalemia, hyposthenuria, and polyuria were present. Chronic renal insufficiency and renal tubular acidosis type I were diagnosed. Kidney biopsy revealed mesangial glomerulonephritis, interstitial nephritis, and tubular atrophy. Replacement treatment with saliva, tears, and potassium citrate was started. She was given prednisone and cyclophosphamide. This would be the first description of PSS, mesangial glomerulonephritis, and chronic renal insufficiency.
<p>El mieloma múltiple (MM) es la segunda neoplasia hematológica más común. Reportamos un caso de tubulopatía por cristales en un contexto de proteinuria de rango nefrótico. Este es el segundo caso reportado de tubulopatía en el mieloma múltiple sin síndrome de Fanconi<span style="font-size: 8.33333px;">.</span></p>
<p>El síndrome crioglobulinémico es producido por inmunoglobulinas que precipitan reversiblemente a bajas temperaturas, llamadas crioglobulinas. Su producción se asocia a varias causas, como desórdenes linfoproliferativos, infecciones crónicas y trastornos autoinmunitarios. No obstante, en muchos casos la etiología no logra determinarse. Existen tres tipos, siendo las de tipo II y III las que forman parte de las denominadas crioglobulinemias mixtas. Estas últimas producen un cuadro de vasculitis sistémica con manifestaciones clínicas diversas. La púrpura palpable es la más frecuente, acompañada en forma variable por artralgias, neuropatía y afección renal en forma de glomerulonefritis membranoproliferativa de tipo I. Presentamos el caso clínico de un paciente de sexo masculino de 71 años de edad con insuficiencia renal, síndrome nefrítico, hipertensión arterial y lesiones cutáneas purpúricas palpables ambos miembros, tórax y abdomen. Durante la internación se diagnostica crioglobulinemia mixta esencial asociada a vasculitis leucocitoclástica cutánea y glomerulonefritis membranoproliferativa tipo I. Describimos los métodos complementarios utilizados para llegar al diagnóstico, el tratamiento instituido y la evolución clínica del paciente. </p>
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