BackgroundKidney injury in mixed connective tissue disease (MCTD) is an uncommon manifestation. Prevalence has been reported to be <4% in some cohorts. The frequency of renal involvement in Hispanic patients with MCTD is not known.ObjectivesWe aimed to describe the prevalence, clinical characteristics and outcomes of renal involvement in Mexican patients with MCTD.MethodsWe conducted a retrospective single-centre study. We included patients with a diagnosis of MCTD according to the Alarcón-Segovia criteria who regularly attended to a referral centre in Mexico City (2003–2017) and we identified those with renal involvement defined as proteinuria >500 mg/d with or without active sediment, creatinine elevation 50% above baseline or development of glomerular filtration rate (GFR) <60 ml/min, with no other known cause. We collected demographics, clinical manifestations, follow-up time, treatment, outcomes and damage (SLICC/ACR-DI), renal function, serological and histological variables.ResultsOne hundred and thirty one patients with MCTD were followed at our centre. We identified 14 patients with renal involvement with a prevalence of 10.7%. Among those patients, 13 were women (92.8%); mean age at onset of renal involvement was 44±8 years. Most frequent manifestations were Raynaud’s phenomenon in 13 (92.8%) patients, arthritis in 12 (85.7%), puffy hands in 12 (85.7%), sclerodactily in 8 (77.1%), sicca syndrome in 8 (77.1%) and myositis in 7 (50%). Median time elapsed from MCTD diagnosis to renal involvement was 83 (2–365) months. In 3 patients, renal involvement was present at MCTD onset. Seven (50%) patients had other signs of MCTD activity at the time of renal involvement onset. Four (28.5%) patients presented with sub- nephrotic proteinuria, 3 (21.4%) with nephrotic range proteinuria and kidney injury, 2 (14.3%) with sub-nephrotic proteinuria and kidney injury, 2 (14.3%) with nephrotic range proteinuria, 1 only with nephrotic range proteinuria and 1 (7.1%) with end-stage renal disease. Microscopic hematuria was present in 9 (64.3%) patients and leukocyturia in 6 (42.8%). Renal biopsy was performed in 8 (57%) patients; pathological diagnoses were: crescentic and necrotizing glomerulonephritis (GN) (2 patients; one of these patients developed positive ANCA antibodies), GN ISN/RPS 2003 class III+V,1 GN ISN/RPS 2003 class III+V with thrombotic microangiopathy,1 GN ISN/RPS 2003 class IV+V and vasculopathy,1 membranous GN,1 minimal mesangial GN1 and chronic tubulointerstitial nephritis with vasculopathy.1 Ten (71.4%) patients achieved either total or partial remission at a median follow up of 82 (1–367) months. Only one patients required dialysis. At last follow up the median SLICC/ACR-DI was 1.5 (0–4) points. Two patients died.ConclusionsIn our cohort of MCTD patients, prevalence of renal involvement was low, although higher than the one reported in other populations. Clinical presentation and pathological diagnoses were diverse. Renal biopsy was helpful, since glomerulonephritis, vasculopathy and overlap with ANCA assoc...
BackgroundAutoimmune diseases (AD) in patients with HIV have been observed since the beginning of the HIV/AIDS pandemic. Epidemiologic studies have reported a prevalence of rheumatic and autoimmune manifestations ranging from 1–72%, including only systemic (SAD) and articular AD (AAD), and not organ-specific AD (OSAD)[1]. Prevalence of AD in patients with HIV infection in Mexico has not been fully addressed.ObjectivesThe aim of this study was to assess the prevalence of AD in HIV-infected patients.MethodsWe performed a retrospective study in two tertiary referral centers in Mexico. All subjects seen from june 15th 2003 to june 15th 2014 with a confirmed diagnosis of HIV infection and a diagnosis of an AD were included. We extracted demographic data, HIV infection history, and AD history from the clinical recordResultsA total of 5876 HIV-infected patients were seen during the study period. Eighty one AD were found in 77 patients (prevalence: 1.31%). Eight (9.9%) were SAD, 12 (14.8%) AAD and 61 (75.3%) OSAD (Table 1). Four patients (5.2%) had 2 AD. Fifty eight were male (75.3%). Mean age at diagnosis of AD was 34.8 years. In twenty two (27.2%) AD preceded HIV infection, in 23 (28.4%) HIV infection was diagnosed simultaneously with the AD, in 36 (44.4%) AD developed after HIV infection. Mean CD4 T lymphocyte count in patients with a simultaneous diagnosis of HIV infection and AD was 287 cel/μl, only one with undetectable viral load; mean CD4 T lymphocyte count in patients who developed AD after HIV infection was 353 cel/μl, half with undetectable viral load. Sixteen patients were classified with AIDS at AD diagnosis. Five (6.2%) AD were a consequence of immune reconstitution inflammatory syndrome (IRIS); prevalence of autoimmune IRIS was 0.08%. Prevalence of HBV and HCV coinfection was 5.2% and 2.6% respectively. Immunosuppressive treatment was used in 87% of patients.Table 1Autoimmune diseasesNo.PrevalenceSystemic: SLE (5), AFS (1), Sjögren syndrome (1), DILS (1)80.13%Articular: rheumatoid arthritis (5), spondyloarthritis (7)120.20%Neurological: Guillain-Barré syndrome (3), CIDP (2), ADEM (1)60.10%Dermatologic: psoriasis (10), vitiligo (1), alopecia areata (1), cutaneous vasculitis (3)150.25%Endocrinological: DM1 (5), autoimmune adrenal insufficiency (2), Graves' disease (3), Hashimoto's thyroiditis (1)110.18%Gastroenterological/hepatic: ulcerative colitis (6), Crohn's disease (2), autoimmune hepatitis (2)100.17%Hematologic: immune thrombocytopenia (18), autoimmune hemolytic anemia (1)190.32%ConclusionsThis is the first study to address solely AD without combining non-autoimmune musculoskeletal entities and the largest cohort to date. Prevalence of AD in HIV-infected patients in Mexico was low (1.31%) and OSAD was the most frequent. AD were diagnosed in all stages of HIV infection. Prevalence of HBV and HCV coinfection and autoimmune IRIS was very low. Prospective studies are needed to identify risk factors for the development of autoimmune IRIS.ReferencesPatel N, Patel N, Espinoza LR. HIV infection and rheumatic di...
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