A 42-year-old man with chronic renal failure and homograft transplantation developed adult T cell lymphoma in one native kidney. The role of transfusion in the acquisition of human T-lymphotropic virus type I and its role in the early development of adult T cell lymphoma, particularly on the background of chronic immunosuppression, are discussed. To our knowledge, this is the first such case.
The majority of patients seen at the renal clinic of the University Hospital of the West Indies (UHWI) are of African descent. The case notes of patients with systemic lupus erythematosus (SLE) with class 4 nephritis and who were given standard pulse intravenous cyclophosphamide therapy during the period 1990-2000 were retrospectively reviewed. Primary outcomes were doubling of serum creatinine and development of end stage renal disease (ESRD). Secondary outcomes were return of proteinuria to normal and renal remission. A total of 117 patients had a renal biopsy for SLE nephritis at the UHWI between 1990 and 2000. Of the patients, 34 (29%) had diffuse proliferative glomerulonephritis (WHO class 4), of which 29 were reviewed. Twenty-two patients of 24 in whom it was measured (92%) had significant proteinuria at presentation. The 24-hour proteinuria was measured at final review in 16 patients and in 10 patients it went into complete remission. At the beginning of therapy, 24 patients (83%) had renal impairment. Of the 18 who had final creatinine values, the renal function returned to normal in eight patients (44%) and an additional six patients showed a significant improvement in renal function at final review. Six patients developed end stage renal disease (ESRD). The risk (95% confidence interval) of developing ESRD at one year was 16.2% (CI, 6.4-37.6) and at two years was 23.2% (CI, 10.0-48.5). There were three deaths, two from sepsis and one from heart failure. The one-year mortality (95% CI) was 8% (CI, 2.0-28.5), the two-year mortality was 15.6% (CI, 4.9-43.5) and the five-year mortality was also 15.6% (CI, 4.9-43.5). Intravenous pulse cyclophosphamide for Jamaican patients with SLE and diffuse proliferative glomerulonephritis is an ineffective form of treatment.
The case records of 75 patients who had systemic lupus erythematosus (SLE) and renal involvement on renal histology were reviewed. There were 70 females and 5 males, with a ratio of 14:1. The majority of the patients were in their second and third decades of life. SLE nephritis was distinctly uncommon in patients below 10 years of age and above 50 years of age. In nearly 80% of the patients, SLE nephritis was diagnosed within the year prior to presentation. The most common presenting clinical features were arthritis in 78% and a rash in 48%. The two most common renal features were proteinuria in 60% and renal failure in 55%. Of these patients, 20%, 12%, 48%, and 17% fell into Class II (mesangial GN), Class III (focal GN), Class IV (diffuse GN), and Class V (membranous GN), respectively, when the renal histological abnormalities were categorized according to the World Health Organization classification. The remaining 3% of patients had sclerosis and as a result were unclassifiable. The two major clinical manifestations in the Class IV patients were an acute nephritis syndrome in 83% and renal failure in 61%. The nephrotic syndrome was seen in 62% of Class V (membranous GN) cases. There was 100% survival in Classes II (mesangial GN) and V (membranous GN), and 62% percent in Classes III (focal GN) and IV (diffuse GN) combined.
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