Summary:GVHD is one of the most frequent complications of BMT and recently nephrotic syndrome (NS) has been described as a manifestation of chronic GVHD. Here, we present an AA patient who developed NS 1 year after BMT when cyclosporine was stopped. Renal biopsy showed focal sclerosis associated with membranous deposits. He also had other clinical manifestations of chronic GVHD: sicca-like syndrome and colestasis. After 15 days of CsA therapy, he experienced a remarkable improvement in the NS and GVHD as a whole. We comment on immunological mechanisms that could be involved in the pathogenesis of this manifestation.
We report on a case of a patient with HIV infection, diagnosed 18 months prior to the development of an anti-glomerular basement membrane (anti-GBM) rapidly progressive glomerulonephritis; this is probably the first report of such an association. A 30-year-old white man presented with elevation of serum creatinine (1.3 -13.5 mg/dL within one month). At admission, the urinalysis showed proteinuria of 7.2 g/L and 8,000,000 erythrocytes/mL. Renal biopsy corresponded to a crescentic diffuse proliferative glomerulonephritis mediated by anti-GBM, and serum testing for anti-GBM antibodies was positive; antinuclear antibodies (ANA) and anti-neutrophilic cytoplasmic antibodies (ANCA) were also positive. The patient underwent hemodyalisis and was treated with plasmapheresis, cyclophosphamide and prednisone. The association described here is not casual, as crescentic glomerulonephritis is not common in HIV-positive patients, anti-GBM glomerulonephritis is rare and anti-GBM antibodies are frequently observed in HIV-positive subjects when compared to the overall population. Based on the current case and on the elevated frequency of the positivity for such antibodies in this group of patients, it is advisable to be aware of the eventual association between these two conditions and to promote an active search for anti-GBM antibodies and early diagnosis of eventual urinary abnormalities in HIV-positive subjects, considering the severity of anti-GBM glomerulonephritis.
Background: There are few reports of glomerulonephritis (GN) with crescents and a rapidly progressive course that lead to a diagnosis of a previously unsuspected B-cell dyscrasia. Case Presentation: We report a case of rapidly progressive GN: the patient showed no evidence of etiology at the time of biopsy and was diagnosed as IgA multiple myeloma (MM) during investigation based on a renal biopsy. He presented diffuse proliferative and exudative GN and marked plasma cell infiltration of the kidney. Conclusion: The present case raises the possibility that proliferative GN with crescents may be a rare mode of presentation of MM.
Em 1998, foi publicada uma revisão das diretrizes a respeito de diversos aspectos relacionados à anticoagulação¹. Recentemente, uma atualização destas diretrizes veio a ser publicada². Recomendações principais: A) Indivíduos submetidos a cirurgia geral com:Baixo risco de tromboembolismo -neste grupo não há evidência para se realizar profilaxia (recomendação nível 1C; neste nível tal recomendação pode mudar a partir de estudos com evidências mais fortes).Risco moderado -neste grupo recomenda-se heparina não fracionada em baixa dose, heparinas de baixo peso, compressão intermitente de membros inferiores ou meias elásticas (evidência 1A; recomendação feita a partir de estudos randomizados, com forte evidência).Alto risco -neste grupo recomenda-se heparina não fracionada ou heparina de baixo peso (evidência 1A). Nas orientações publicadas em 2001, profilaxia com compressão intermitente também é considerada evidência 1A. Nos indivíduos com tendência a sangramento, o método mecânico de profilaxia é preferido.Risco altíssimo -neste grupo combina-se método farmacológico e compressão intermitente de membros inferiores (evidência 1C). B) Indivíduos submetidos a cirurgias eletivas de quadril -a profilaxia recomendada é heparina de baixo peso iniciada 12 horas antes do procedimento, ou anticoagulante por via oral (INR 2,0 a 3,0) imediatamente após a cirurgia (recomendação 1A). C) Indivíduo submetido a cirurgias de joelho -é recomendado heparina de baixo peso, anticoagulante por via oral ou compressão intermitente (1A de recomendação). Nos casos de fratura de bacia o uso pré-operatório de heparina de baixo peso ou anticoagulante oral (INR 2,0 a 3,0) é recomendação 1B em 2001. D) Nas condições clínicas de IAM e AVC isquêmico -o uso de heparina em baixa dose ou anticoagulação plena tem recomendação 1A (1998/2001
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