Acute interstitial nephritis (AIN) is a relevant cause of acute renal failure. Drugs are the predominant cause, followed by infections and idiopathic lesions. AIN, as a form of hypersensitivity reaction, is an uncommon manifestation in the setting of human parasitic infections. We report a case of a polyparasitic infection ( Giardia lamblia, Entamoeba coli, and Endolimax nana) resulting in a severe biopsy-proven AIN in a 61-year-old male patient. Despite the antiparasitic treatment followed by corticosteroid therapy, and during the 6-month follow-up period, the patient remained dialysis-dependent, and he developed autoimmune hemolytic anemia. Extensive search for another infection or neoplasia was negative. Immunological tests were also negative. The resulting hypersensitivity reaction to the triple parasite infection would have led to fatal evolution for the kidneys affected by this unusual type of AIN.
Acute post streptococcal glomerulonephritis (APSGN) results from a recent infection caused by nephritogenic strains of group a beta-hemolytic streptococci. On the other hand, there is a strong link between streptococcal tonsillitis and IgA nephropathy. Methods: We report the case of a female patient who developed IgA nephropathy 2 years after an episode of acute post-streptococcal glomerulonephritis. We wonder if IgA nephropathy is the chronic form of post streptococcal glomerulonephritis. Results: A 39 year-old female with no medical past history was hospitalized in nephrology department in 2013 for acute nephritic syndrome 15 days after tonsillitis. Laboratory data revealed kidney injury (creatinine level at 171mmol/l), hypocomplementemia (C3= 0.14g/l), biologic inflammatory syndrome, nephrotic proteinuria (8g/d), countless red blood cells on the cytobacteriological urine examination, and elevated ASLO level (400UI/). Renal biopsy showed malignant postinfectious glomerulonephritis. The stomatological examination before corticosteroid therapy revealed the presence of 2 dental abscesses.The patient received 3 boli Solumédrol 1g/day X 3 days switched by oral relay (1mg/Kg/day) after dental treatment (Antibiotherapy (Augmentin 1gx2/day x 10 days) +dental extractions + scaling).We obtained an improvement in renal function: creatinine =101mmol/l at the 9th day of corticotherapy. Unfortunately, the patient has been lost to sight. Two years later, she consulted us for macroscopic hematuria evolving for 2 weeks and concomitant with a tonsillitis. Laboratory data showed correct renal function, normal level of C3 (1g/l), proteinuria at 0.6g/d, correct protidemia and albuminemia, with countless red blood cells on the cytobacteriological urine examination. The stomatological examination was redone and once again showed dental abscesses which were treated. Kidney biopsy was performed and showed IgA nephropathy. She was put under nephroprotective treatment (ACE inhibitor). In front of this presentation, we discussed first of all a diagnostic error that was eliminated by re-reading the first biopsy. We then evoked an AGN added to IgA nephropathy. In this case, the absence of IgA could be explained by the intense inflammatory reaction in the glomeruli which can be responsible for the mesangial clearance of IgA. These IgA could also be phagocytized by macrophages and neutrophils. On the other hand, complement activation during AGN could dissociate immune complexes. Therefore, the finding of presumed streptococcal dental abscesses (elevation of ASLO) accompanying the 2 nephropathies presented by the patient, led us to believe that acute glomerulonephritis was an acute consequence of a streptococcal infection and that IgA nephropathy was the consequence of the chronic carriage of this germ. Conclusions: Both AGN and IgA nephropathy are 2 post-streptococcal glomerulonephritis.The first is an acute complication whereas the IgA nephropathy is secondary to the chronic carriage of nephritogenic strains of group A Streptococci.
Objectives For a long time, axillary lymph node dissection (ALND) was routinely performed in patients with an involved sentinel lymph node (SLN). However, in 30 to 50% of cases, the non-sentinel lymph nodes (NSLN) were not involved, and these patients would have suffered the morbidity of ALND excessively. The aim of our study was to identify the risk factors for NSLN involvement in patients with a positive SLN. Methods We included patients with early breast cancer and positive sentinel node who underwent ALND in Salah Azaiez Institute of Oncology between 2005 and 2018. We analyzed retrospectively the clinicopathological data to predict NSLN involvement. Results Among the 77 selected patients, 36% did not have any NSLN involvement during the pathological examination of the ALND product. Univariate analysis using a=0.05 as the significance level, showed that radical surgery(p=0.05), tumor size>30 mm(p=0.01), number of extracted SLN£2 (p=0.02), number of positive SLN>1(p=0.01), ratio positi-veSLN/Extracted SLN>0.5(p=0.05), macrometastasis(p<10 -3 ), SBRIII grade(p=0.007), and Ki67>20%(p=0.04) were predictive of NSLN involvement. In multivariate analysis, the type of surgery, the tumor size, the Ki67 level and the ratio Positive SLN/Extracted SLN were excluded. Only the number of extracted SLN£2 (OR=18.518, CI=1.402-250, p=0.027), the number of positive SLN>1(OR=9.624, CI=1.266-73.172, p=0.029), SBRIII grade (OR=58.82, CI=2.86-1000, p=0.008), and macrometastasis (OR=759.19, CI=10.166-56698.2, p=0.003) were found to be independent risk factors of NSLN involvement. Conclusions Our results prove that there is a correlation between tumors' clinicopathological features and NSLN involvement. Therefore, a careful study of these criteria could avoid unnecessary ALND in patients with positive SLN who do not need it.
Objectives For a long time, axillary lymph node dissection (ALND) was routinely performed in patients with an involved sentinel lymph node (SLN). However, in 30 to 50% of cases, the non-sentinel lymph nodes (NSLN) were not involved, and these patients would have suffered the morbidity of ALND excessively. The aim of our study was to identify the risk factors for NSLN involvement in patients with a positive SLN. Methods We included patients with early breast cancer and positive sentinel node who underwent ALND in Salah Azaiez Institute of Oncology between 2005 and 2018. We analyzed retrospectively the clinicopathological data to predict NSLN involvement. Results Among the 77 selected patients, 36% did not have any NSLN involvement during the pathological examination of the ALND product. Univariate analysis using a=0.05 as the significance level, showed that radical surgery(p=0.05), tumor size>30 mm(p=0.01), number of extracted SLN£2 (p=0.02), number of positive SLN>1(p=0.01), ratio positi-veSLN/Extracted SLN>0.5(p=0.05), macrometastasis(p<10 -3 ), SBRIII grade(p=0.007), and Ki67>20%(p=0.04) were predictive of NSLN involvement. In multivariate analysis, the type of surgery, the tumor size, the Ki67 level and the ratio Positive SLN/Extracted SLN were excluded. Only the number of extracted SLN£2 (OR=18.518, CI=1.402-250, p=0.027), the number of positive SLN>1(OR=9.624, CI=1.266-73.172, p=0.029), SBRIII grade (OR=58.82, CI=2.86-1000, p=0.008), and macrometastasis (OR=759.19, CI=10.166-56698.2, p=0.003) were found to be independent risk factors of NSLN involvement. Conclusions Our results prove that there is a correlation between tumors' clinicopathological features and NSLN involvement. Therefore, a careful study of these criteria could avoid unnecessary ALND in patients with positive SLN who do not need it.
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