Clinical Evidence Of Renal Disease Research Articles

Use of radiographs and computed tomography for measurement of kidney size in healthy chinchillas (Chinchilla lanigera)

BackgroundChinchillas, being small mammals, are subject to many of the urinary disorders that affect other companion animals. In cats and dogs, relationships between renal length and the presence of renal pathology have been well documented through the use of diagnostic imaging. Radiography and computed tomography (CT) are two commonly utilized diagnostic imaging modalities for assessing renal pathology. Presently, there are no published data on chinchilla kidney size and appearance using radiography or CT. This study aimed to determine healthy adult chinchilla renal size and correlate renal size to L2 body length and aortic diameter by use of radiography and CT. MethodsTwenty-eight healthy adult chinchillas with no clinical evidence of renal disease were placed under sedation for acquisition of radiographs and CT imaging. Both kidneys were measured on the radiographic views (right lateral, left lateral and ventrodorsal), when identifiable. Renal length, L2 body length and abdominal aortic diameter were measured on CT multiplanar reformatted images in specified planes and windows. ResultsIn 25% (7/28) of chinchillas, the renal length of either kidney could not be obtained on any of the three radiographic views due to superimposition of fluid and ingesta within the alimentary tract. Both the right and left kidney were identified on CT images in 100% of chinchillas (28/28). The left renal and right renal 95% confidence intervals from the dorsal plane CT images were 2.26 – 2.33 cm and 2.31 – 2.39 cm, respectively. No correlation was found between kidney length, L2 body length and diameter of the abdominal aorta on CT images. ConclusionsBased on dorsal plane CT imaging, normal chinchilla renal length is proposed to be between 2.25–2.4 cm. Clinical RelevanceRadiographic evaluation of chinchilla renal length is greatly limited due to their large fluid- and ingesta-filled colon and cecum, as is typical of animals that are hindgut fermenters. Through establishment of a normal CT reference interval for renal length and the ever-increasing clinical utility of CT, clinicians can better evaluate chinchilla renal length and identify alterations that may indicate pathologic processes.

Effect of an increased dose of colchicine on microalbuminuria in children with Familial Mediterranean Fever

Aim of workFamilial Mediterranean Fever (FMF) is an autosomal recessive condition causing recurrent attacks of fever and polyserositis and may result in amyloidosis of the kidney. The aim of the present work was to investigate the response to an increased dose of colchicine in a group of Egyptian children suffering from FMF and albuminuria. Patients and methods40 FMF patients with microalbuminuria were prospectively followed up in the Pediatric Rheumatology Outpatient Clinic of Children’s Hospital, Cairo University, for a period of one year. All children were in an attack-free period and had no clinical evidence of renal disease. Colchicine doses were increased by 50%. ResultsPatients' mean age was 9.8 ± 3.08 years (5–17 years), disease duration was 3.96 ± 2.21 years (1–10 years) and were 15 males and 25 females. The mean dose of colchicine was 0.96 ± 0.46 mg/day and increased to 1.36 ± 0.46 mg/day during the study period. The new dose of colchicine was well tolerated by most patients with a few minor complaints of diarrhea and no affection of liver functions. The number of annual attacks decreased significantly with the increased doses of colchicines from 39.9 ± 22.43 attacks/year to 7.92 ± 4.92 attacks/year (p = 0.0001). Resolution of the microalbuminuria occurred in 50% within 3 months; another 30% responded within 6 months, and the remaining 20% responded after the 6th month of treatment. There was no significant association between the types of mutations and microalbuminuria. ConclusionIncreased doses of colchicine are effective in treating microalbuminuria of FMF and should be given to children with frequently recurring attacks. All patients with FMF should be regularly screened for microalbuminuria.

Differential “diagnosis” for burnout and depression – Does hair show the difference?

Chinchillas, being small mammals, are subject to many of the urinary disorders that affect other companion animals. In cats and dogs, relationships between renal length and the presence of renal pathology have been well documented through the use of diagnostic imaging. Radiography and computed tomography (CT) are two commonly utilized diagnostic imaging modalities for assessing renal pathology. Presently, there are no published data on chinchilla kidney size and appearance using radiography or CT. This study aimed to determine healthy adult chinchilla renal size and correlate renal size to L2 body length and aortic diameter by use of radiography and CT.Twenty-eight healthy adult chinchillas with no clinical evidence of renal disease were placed under sedation for acquisition of radiographs and CT imaging. Both kidneys were measured on the radiographic views (right lateral, left lateral and ventrodorsal), when identifiable. Renal length, L2 body length and abdominal aortic diameter were measured on CT multiplanar reformatted images in specified planes and windows.In 25% (7/28) of chinchillas, the renal length of either kidney could not be obtained on any of the three radiographic views due to superimposition of fluid and ingesta within the alimentary tract. Both the right and left kidney were identified on CT images in 100% of chinchillas (28/28). The left renal and right renal 95% confidence intervals from the dorsal plane CT images were 2.26 – 2.33 cm and 2.31 – 2.39 cm, respectively. No correlation was found between kidney length, L2 body length and diameter of the abdominal aorta on CT images.Based on dorsal plane CT imaging, normal chinchilla renal length is proposed to be between 2.25–2.4 cm.Radiographic evaluation of chinchilla renal length is greatly limited due to their large fluid- and ingesta-filled colon and cecum, as is typical of animals that are hindgut fermenters. Through establishment of a normal CT reference interval for renal length and the ever-increasing clinical utility of CT, clinicians can better evaluate chinchilla renal length and identify alterations that may indicate pathologic processes.

Clinical Significance of Hilar Hyalinosis in Glomeruli of Children with Idiopathic Nephrotic Syndrome

Introduction: Hilar hyalinosis (HH) of glomeruli has been thought for a long time to be a precursor or a variant of focal glomerulosclerosis (FGS). In view of its implications on treatment and prognosis of nephrotic syndrome, a retrospective study of hilar hyalinosis in children with the idiopathic nephrotic syndrome (INS), but without any other histologic evidence of FGS, was performed to determine the clinic-pathologic significance of this lesion. Methods: A total of 92 Children with INS who had kidney biopsies for frequent relapses, steroid dependency or resistance were included. Eight of them had a biopsy-proven diagnosis of either minimal change disease or mild IgM nephropathy with HH in 6-25% of glomeruli were compared to control group consisting of 84 children with either minimal change disease (n=57) or IgM nephropathy (n=27) but without HH. Results: Clinically HH patients presented with NS and followed a steroid-dependent relapsing course prior to biopsy. Around 75% of the HH patients received at least one course of cytotoxic therapy after biopsy. At last visit, 6 patients were in remission, 2 were protein-free but on medication. None had hypertension or renal insufficiency. Apart from having a shorter interval between presentation and biopsy (P<0.001) and a lower remission rate (P<0.05), control patients followed a similar course. Pathologically HH patients showed less mesangial change (P<0.001) than the controls but similar mean glomerular size and tubuloinerstitial damage. Conclusion: The results do not support the concept of HH being a precursor lesion of FGS. Kibara [10] have reported HH in the kidneys of children without clinical evidence of renal disease. In view of the possibility that Hilar and perihilar hyalinosis is a precursor or a variant of FGS with its implications for treatment and prognosis, a retrospective study of HH in children with the nephrotic syndrome (NS) but without any other histologic evidence of FGS was performed to determine the clinic-pathologic significance of this lesion.

Interleukin-17 - association to silent lupus nephritis and disease activity

Background: Systemic lupus erythematosus is a multiorganic, chronic immune disease and lupus nephritis, a severe manifestation, represents the strongest predictor of a poor outcome of this pathology. Cytokines play an important role in lupus nephritis and consequently, their use as biomarkers of active systemic lupus erythematosus disease is of particular interest. The purpose of this work was to study the pro-inflammatory role of interleukin-17 in renal involvement in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective study of 87 patients diagnosed with SLE according to the Systemic Lupus International Collaborating Clinics 2012 diagnosis criteria. In this study, we determined the serum levels of interleukin-17 by ELISA. Results: It was observed that 49 patients in the study group presented with positive values of interleukin-17, range (1.12 - 23.66) pg/ml. There was a positive correlation of interleukin-17 with active SLE as assessed by the Systemic Lupus Erythematous Disease Activity Index. No association was found between serum interleukin-17 level and renal pathology at the inclusion or in the clinical history of the patients. Patients with leukocyturia and hematuria presented higher values of serum interleukin-17 than those without these manifestations. In the linear regression model, after adjusting for age, gender and treatment we found an independent association between serum IL-17 levels and leukocyturia presence with OR=2.06, 95% CI range (1.22-2.89). Conclusions: A positive correlation has been observed between serum IL-17 and the SLE disease activity as assessed by the SLEDAI score computed without anti-DNA antibodies. Also, the IL-17 levels was strongly associated with the presence of leukocyturia and hematuria, even in patients with no clinical evidence of renal disease that might have silent lupus nephritis usually associated with a benign renal outcome.

Morphological aspects and distribution of interstitial cells of Cajal in the human upper urinary tract.

The mechanism by which the ureter propels urine towards the bladder has a myogenic origin, through peristaltic contractions. This pyeloureteral autorhythmicity is generated by specialized, electrically active cells, the interstitial cells of Cajal, located in the proximal regions of the upper urinary tract. The aim of this study was to describe the exact location and the distribution of interstitial Cajal cells in the human upper urinary tract and to analyze their normal number and morphology. This is a preliminary study, which will allow the study of these cells in different urinary tract pathologies. Urinary tract fragments were sampled at different levels, from 13 autopsy cases. Cases with clinical evidence of renal disease, and with histological changes in the kidney or in the urinary tract tissue samples, visible in hematoxylin-eosin staining, were excluded. The interstitial Cajal cells were highlighted with anti-CD117 antibody, immunohistochemically. Cajal cells were indirectly highlighted by the presence of a finely granulated cytoplasm indicating immunoreactivity. These cells were spindle-shaped or stellate, with cytoplasmic extensions at one or both poles of the cell and large oval nucleus. We found that interstitial Cajal cells were located at all upper urinary tract levels, with a higher predominance in the calyces and pyelon. Interstitial Cajal cells were observed mostly between the two layers of the muscularis, but also between the muscle bundles. Most often, these cells were parallel to the muscle fibers. Our study describes the method of detection of interstitial Cajal cells in normal human urinary tract. These results can be used to analyze the number, morphology and the location of these cells in different congenital pathologies, such as vesicoureteral reflux, pyeloureteral junction obstruction or primary obstructive megaureter.

Renal histopathological study of Human Immunodeficiency Virus - Positive patients with clinical evidence of renal disease in Benin City, Nigeria

Renal histopathological study of Human Immunodeficiency Virus - Positive patients with clinical evidence of renal disease in Benin City, Nigeria

Lupus nephritis in a Nigerian child: A first documented case report in South-East Nigeria

Systemic lupus erythematosus (SLE) is reportedly becoming a common condition among Black Africans in the sub-Saharan countries like Nigeria. Generally, clinical evidence of renal disease occurs in approximately half of the cases of SLE at presentation. The severity of the renal involvement determines the morbidity and mortality of the disease. We report the first documented case of lupus nephritis in an 11-year-old boy in South-East Nigeria. The diagnosis was based on the clinical presentation of a malar rash, photosensitivity rash, discoid skin lesion, oral ulcer, hematuria and massive proteinuria with anasarca; renal biopsy histology revealed lupus nephritis class IIB and constitutional symptoms. He is responding slowly and steadily to corticosteroids and oral cyclophosphamide. SLE with renal involvement is not an unusual disease and accessibility to diagnostic facilities may bring a major change in the approach of the disease in the sub-region.

ULTRASONOGRAPHIC MEASUREMENT OF KIDNEY‐TO‐AORTA RATIO AS A METHOD OF ESTIMATING RENAL SIZE IN DOGS

Renal size is an important parameter in the assessment of renal disease in dogs. However, because of the great variability in body conformation, absolute renal measurements cannot solely be used when evaluating kidneys with ultrasonography. The use of a ratio comparing renal length and aortic luminal diameter (K/Ao) was investigated. After confirming the reproducibility of these measurements, K/Ao ratios were obtained in 92 dogs without clinical evidence of renal disease. Left and right K/Ao ratios were statistically similar. Based on 95% confidence intervals, renal size should be considered reduced if the K/Ao ratio is < 5.5 and increased when > 9.1.

End-stage renal disease as the presenting manifestation of renal systemic lupus erythematosus

About one-half of all children with systemic lupus erythematosus have clinical evidence of renal disease at initial presentation, such as proteinuria and acute renal failure. Herein, we report a case of a teenager who presented with end-stage renal disease (ESRD) of uncertain etiology, and who was subsequently determined to have lupus. The purpose of this report is to make health-care professionals aware of this unusual presentation of renal lupus, which has never been reported before. Children presenting in ESRD should be worked-up for autoimmune diseases since the discovery of such a disease process may impact future decision-making, especially with respect to subsequent renal transplantation.

Padronização do método para cálculo da captação renal absoluta do99mTc-DMSA em cria

OBJETIVO: O trabalho teve por objetivo padronizar o método e estabelecer valores normais da captação renal absoluta do99mTc-DMSA em crianças. MATERIAIS E MÉTODOS: Vinte e duas crianças (idade de 7 meses a 10 anos; média de 4,5 anos) sem doença renal prévia foram submetidas a cintilografia renal estática com 99mTc-DMSA. Dezoito apresentavam ultra-sonografia, uretrocistografia miccional, "clearance" de creatinina e padrão visual da cintilografia renal estática normais. Quatro crianças foram excluídas por não terem completado ou por apresentarem redução do "clearance" de creatinina. A captação absoluta de DMSA (DMSA-Abs) foi calculada como a porcentagem da atividade administrada retida em cada rim após seis horas da administração do radiofármaco. RESULTADOS: Os valores de DMSA-Abs foram de 21,8% ± 3,2% para o rim direito e de 23,1% ± 3,3% para o rim esquerdo. Os valores da captação absoluta não mostraram correlação com a idade dos pacientes estudados, apesar da tendência de aumento do "clearance" de creatinina com a idade. CONCLUSÃO: A definição de valores normais da DMSA-Abs permite o emprego deste parâmetro na avaliação inicial e acompanhamento de doenças renais, principalmente em pacientes com acometimento bilateral ou com rim único (nos quais a função diferencial direita X esquerda tem valor limitado).

Renal disease in the Australian Aboriginal population: A pathological study

Summary: End‐stage renal failure and clinical evidence of renal disease are more frequent in Australian Aboriginals than in the non‐Aboriginal Australian population. to investigate the lesions responsible for this excess a systematic study of renal biopsy findings in a series of Aboriginal patients in South Australia and the Northern Territory was performed and the data on these patients were compared with a consecutive series of renal biopsy findings in non‐Aboriginal patients. Histological and morphometric comparison was made between biopsies from 206 Aboriginal and 690 non‐Aboriginal patients. the distribution of glomerular lesions was found to differ significantly between the Aboriginal and non‐Aboriginal groups: diabetic glomerulosclerosis, idiopathic glomerular enlargement (glomerulomegaly), mesangiocapillary glomeru‐lonephritis (MCGN), and non‐IgA mesangiopathic glomerulonephritis (GN) were found more frequently in the Aboriginal population, whereas there were fewer than expected examples of thin membrane nephropathy, minimal change disease and membranous GN. Diabetic glomerulosclerosis was significantly more frequent, and the lesions more severe, in Central Australia (where diabetes is more prevalent) and glomerulomegaly was especially common in Bathurst Island. These two conditions accounted for one third of the series and evidence is presented to suggest that a substantial proportion of renal disease in Aboriginals may be the consequence of conversion to a Western life style. of the 206 Aboriginal patients, 23 presented with chronic renal failure, suggesting either late presentation or unusually aggressive renal lesions, and 10 had end‐stage renal disease on biopsy.

Immunoassays for serum and urine myoglobin: myoglobin clearance assessed as a risk factor for acute renal failure

We compared four immunoassays for serum and urine myoglobin. Within-run CVs were 5-13%, with biases seen between assays. Myoglobin was stable for 1 month in serum and 12 days in urine when the pH was adjusted to between 8.0 and 9.5. Hemoglobin caused no interference. We assayed 91 pairs of serum and timed urine specimens from 41 patients admitted for acute trauma or rhabdomyolysis. Most were treated with mannitol and alkalinization. Upon initial presentations, 21 patients with either low serum myoglobin concentrations (< 400 micrograms/L) or high myoglobin clearances (> or = 4 mL/min) had normal creatinine clearances and no clinical evidence of renal disease. The remaining 20 had low myoglobin clearances. Seven were in rhabdomyolysis-induced acute renal failure, or subsequently developed this complication. We suggest that low myoglobin clearance may indicate a high risk for developing renal failure or may be an early marker for kidney dysfunction. Low myoglobin clearance may prove useful in indicating failure of prophylactic treatment to clear myoglobin.

Antibasement Membrane Antibody Disease without Clinical Evidence of Renal Disease

A 20-yr-old man is described with the rare presentation of antibasement membrane antibody (ABMA) disease confirmed on renal biopsy, but with normal renal function and urinary sediment. This distinct subgroup of ABMA appears to have an excellent prognosis. The relevant literature is reviewed and summarized.

Accuracy of creatinine clearance in measuring glomerular filtration rate in patients with systemic lupus erythematosus without clinical evidence of renal disease

We sought to determine whether creatinine clearance (Ccr) gives an accurate measurement of the glomerular filtration rate in patients with systemic lupus erythematosus (SLE) with no clinical evidence of renal disease. Eighteen such SLE patients underwent measurement of Ccr and 99mtechnetium-DTPA clearance (CDTPA). The mean +/- SD Ccr:CDTPA ratio was 1.12 +/- 0.15 (95% confidence interval 1.04-1.20). These results indicate that Ccr gives an accurate measurement of the glomerular filtration rate in the majority of SLE patients who do not have clinical evidence of renal disease.

Kidney Biopsy in SLE. I. A Clinical-Morphologic Evaluation

The relationship between renal morphology and clinical disease was analysed in 148 patients with SLE attending a lupus clinic. Patients were not selected for renal disease. Renal tissue was assessed according to the World Health Organization classification of lupus nephritis, the presence of active and chronic lesions was recorded and disease activity was measured according to a standard protocol. All sections of the classification were represented in this group of patients. Active and chronic lesions were more likely to occur among patients with Class III/IV (proliferative glomerulonephritis), than in any other category. Patients with Class III/IV biopsy were more likely to have evidence of clinical renal disease than patients in Class II (mesangial). However, almost half of the Class II patients had some evidence of renal disease, including elevated serum creatinine, as well as important non-glomerular lesions. Without biopsy they might have been thought to have proliferative lesions and been treated more aggressively. Two patients with proliferative glomerulonephritis had no clinical evidence of renal disease. Thus, at the time of biopsy results renal histological examination did not uniformly correlate with clinical renal disease.

Overview of pediatric nephropathology

I have given a brief overview of the morphologic basis of renal disease in children. Obviously I have been unable to include all the important and well-done studies of various conditions, which together cover the entire spectrum of pediatric renal disease. It is evident from the many studies that the renal biopsy has been, is, and will be quite helpful in elucidating the histologic pattern and severity of injury in the child with clinical evidence of renal disease. As therapy becomes more effective for renal diseases known to cause progressive renal insufficiency, the impact of the renal biopsy will become even greater. Because of the frequent discordance between clinical laboratory findings and renal histologic severity, an initial or baseline biopsy is often the only way to stage the alterations in renal structure. Present tests of renal function are imperfect and are insensitive parameters of insidious and progressive renal disease. The capacity of the kidney to compensate for nephron loss by hypertrophy and modification of the remaining nephrons can mask progressive renal disease and thus impair our ability to detect meaningful differences in therapeutic results. A repeated biopsy or "second look" allows detailed comparison and study of the effects of various therapeutic regimens on the renal disease process. Continued, detailed clinical-morphologic correlations and studies using improved techniques hopefully will provide us with better profiles or predictors of the type, severity, and pathogenesis of the renal disease in the individual patient. Determination of the histologic pattern by renal biopsy at present remains one of the, if not the, most important and reliable prognostic indicators in the individual patient and allows us a unique look at the host response to the varying types of injuries leading to pediatric renal disease.

Goodpasture's syndrome: Recurrence after a five-year remission: Case report and review of the literature

Herein is reported the case of a man who has had a recurrence of Goodpasture's syndrome following a five-year remission. The patient presented initially in 1977 at the age of 28 with Goodpasture's syndrome manifested by pulmonary hemorrhage without clinical evidence of renal disease, and positive antiglomerular basement membrane antibody. Following treatment with corticosteroids, remission occurred and the serum antiglomerular basement membrane antibody became negative. In 1983, he experienced a relapse with the reappearance of serum antiglomerular basement membrane antibody, the development of severe life-threatening intrapulmonary hemorrhage, and hematuria. This case illustrates that life-threatening relapse may occur in Goodpasture's syndrome despite a prolonged remission and the disappearance of detectable antiglomerular basement membrane antibody in the circulation.

Glomerulonephritis Associated With Takayasu's Arteritis: Report of Three Cases and Review of Literature

Clinical features and pathologic findings of the kidney in three patients with Takayasu's arteritis and associated nephritis are described. Clinical evidence of renal disease included proteinuria, hematuria, and a reduction of glomerular filtration rate. Renal histology revealed mesangial proliferative glomerulonephritis in one patient and minor glomerular abnormalities in the other two. The clinical course of the glomerulopathy is slow, yet progressive, and the corticosteroid and immunosuppressive therapy appear to delay the progression of the glomerular damage. In one patient in whom repeated examination of the kidney after corticosteroid and immunosuppressive treatment was possible, the glomerular pathology remained unchanged. This report of three patients with Takayasu's arteritis and concomitant nephritis supports the previous speculation of the association between these two conditions. The glomerular, vasculitic, and arteriopathic involvements in these patients may suggest a common immunologic mechanism.

The urinary myeloma cast. Frequency of detection and clinical correlations in 30 patients with multiple myeloma.

The authors examined urine specimens from 30 patients with multiple myeloma (MM) to determine the usefulness of cytodiagnostic urinalysis in evaluating such patients. Nine patients had clinical evidence of renal failure. In six of these nine patients (67%), or 20% of all patients, the urine sediment contained unique "MM-casts." These were characterized by a waxy to granular matrix surrounded by reactive, syncytial, giant cells with occasional renal cells embedded in the cast matrix. These casts were not observed in urine specimens from patients with normal renal function. Renal biopsy in two patients with MM-casts confirmed that cytologic diagnosis of "MM-kidney." The patient groups with or without MM-casts were comparable with respect to age, sex, and clinical stage of disease. In contrast, those with MM-casts were more likely to have clinical evidence of renal disease (100% vs. 13%), Bence Jones proteinuria (100% vs. 35%), hypercalcemia (50% vs. 8%), and hyperuricemia (50% vs. 4%). The two groups could not be distinguished reliably by urine physicochemical determinations. However, there were marked differences in the frequency of microscopic abnormalities. All patients with MM-cast formation excreted other pathologic casts as well and had evidence of tubular injury, while five of six had evidence of ischemic necrosis. This compared with 17%, 13%, and 21%, respectively, of those without MM-casts. Thus, cytodiagnostic urinalysis is of value in distinguishing MM-kidney from the numerous other causes of renal failure in patients with MM.