Renal Lesions In Patients Research Articles

Does the standard proteinuria cut-off for renal biopsy in lupus nephritis as per the current guidelines hold good for Asian population? A single-centre study from South India.

Current rheumatology and nephrology society guidelines in lupus nephritis do not recommend renal biopsy for proteinuria of less than 500mg/24h. This might lead to a significant delay in the early diagnosis of lupus nephritis. The main aim of this study is to determine the nature of renal lesions in patients with low-grade proteinuria and to analyze the predictors for clinically significant lupus nephritis. This was a single-center, retrospective study. All consecutive patients of lupus nephritis, with low-grade proteinuria (200mg to 500mg/24h) undergoing renal biopsy were enrolled in this study. The renal biopsies were classified into significant lesions (Class III/IV/V) and non-significant lesions (Class I and II). Treatment naïve groups and treatment-modified groups were analyzed separately. Predictive factors for significant renal lesions were determined by univariate and multivariate analysis. We identified 183 patients of lupus with proteinuria between 200 and 500mg / 24h. Mean (SD) age was 30.2 (11.39) years with 167 (91.2%) of them being females. The mean (SD) baseline proteinuria was 351.03 (98.1) mg/24h 85 patients (46.5%) had proliferative lupus nephritis where whereas 17 patients (9.3%) had membranous nephropathy. Crescents and fibrinoid necrosis were seen in 10 (5.46%) and 24 (13.11 %) patients respectively. Isolated proteinuria without any other sediments was seen in 95 patients (51.9%) of which 29 patients had proliferative lupus nephritis. Elevated Anti-double stranded DNA (anti-dsDNA), low C3, low C4 and the presence of urinary sediments were significantly associated with significant renal lesions in biopsy. Significant renal lesions were seen in around half of the patients with low-grade proteinuria underscoring the importance of performing a renal biopsy in this set of patients. Low C3 and C4, urinary sediments, and elevated anti-dsDNA were predictors for significant renal lesions.

Clinicopathological Spectrum of Diabetic and Non-diabetic Renal Lesions in Patients with Diabetes Mellitus: An Experience from A Tertiary Care Center

Clinicopathological Spectrum of Diabetic and Non-diabetic Renal Lesions in Patients with Diabetes Mellitus: An Experience from A Tertiary Care Center

The Potentials of Contrast-Free Renal ASL MRI Perfusion in the Diagnosis and Dynamic Follow-Up of Renal Lesions in Patients with Diffuse Liver Diseases

Objective: to evaluate the potentials of contrast-free renal arterial spin labeling (ASL) perfusion during magnetic resonance imaging (MRI) for the diagnosis and dynamic follow-up of renal lesions in patients with diffuse liver diseases (DLD). Material and methods. The prospective study enrolled 82 patients with various DLD: alcoholic, viral, druginduced, autoimmune and mixed etiology. Ultrasound examination with Doppler abdominal and renal ultrasonography was conducted using Apogee 5300 (SIUI, China); abdominal MRI with contrast-free renal ASL-perfusion was performed using Vantage Titan 1.5 T (Toshiba, Japan). The parameters of renal perfusion (renal blood flow, RBF) were measured when the patients were admitted to the hospital, then during dynamic follow-up for 18 months. Results. Mathematical processing of results revealed normal RBF values (≥ 450 ml/100 g/min) and values associated with hepatorenal syndrome (HRS) (≤ 449 ml/100 g/min). High correlation between renal ASL-perfusion indicators and results of Doppler renal vessels ultrasonography was detected (r = 0,856). The diagnostic effectiveness parameters of contrast-free renal ASL-perfusion were: sensitivity 0.83, specificity 0.92, diagnostic accuracy 0.87. We created the algorithm of DLD patients examination for early HRS diagnosis and follow-up. Conclusion. Contrast-free renal ASL-perfusion is an informative method for predicting, diagnosis and dynamic follow-up of renal lesions in patients with various DLD.

Correlation Study between C-Reactive Protein and Renal Lesions in Patients with Type 2 Diabetes Mellitus

Correlation Study between C-Reactive Protein and Renal Lesions in Patients with Type 2 Diabetes Mellitus

Characterization of Microscopic Multicellular Foci in Grossly Normal Renal Parenchyma of Von Hippel-Lindau Kidney.

Background and Objectives: This study aims to describe the earliest renal lesions in patients with von Hippel-Lindau (VHL) disease, especially the multicellular microscopic pathologic events, to get information into the genesis of renal neoplasms in this condition. Materials and Methods: Multicellular events were identified, and 3dimensional reconstruction was performed in grossly normal kidney parenchyma from VHL disease patients by using H&E-stained slides previously prepared. Results: The lesions were measured and the volume of clusters was calculated. Immunohistochemistry was performed for downstream HIF-target protein carbonic anhydrase 9 (CAIX) as well as CD34 for assessment of angiogenesis. We divided lesions into four types according to lesion height/size. The number of lesions was markedly decreased from lesion 1 (smallest) to lesion 2, then from lesions 2 to 3, and again from lesion 3 to 4. Distribution was highly consistent in the four cases, and the same decrement pattern was seen in all blocks studied. The volumes of clusters were measured and divided into three categories according to their volume. The most frequent pathologic event in VHL kidneys was category 1 (smallest volume), then category 2, and then category 3. Conclusion: We demonstrate that tracking histologic and morphologic changes in 3 dimensions of multicellular microscopic pathologic events enabled us to confirm a protracted sequence of events from smaller to larger cellular amplification events in VHL kidney.

Role of ultra-high b-value DWI in the imaging of hereditary leiomyomatosis and renal cell carcinoma (HLRCC).

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is associated with an aggressive form of renal cell carcinoma with high risk of metastasis, even in small primary tumors with unequivocal imaging findings. In this study, we compare the performance of ultra-high b-value diffusion-weighted imaging (DWI) sequence (b = 2000s/mm2) to standard DWI (b = 800s/mm2) sequence in identifying malignant lesions in patients with HLRCC. Twenty-eight patients (n = 18 HLRCC patients with 22 lesions, n = 10 controls) were independently evaluated by three abdominal radiologists with different levels of experience using four combinations of MRI sequences in two separate sessions (session 1: DWI with b-800, session 2: DWI with b-2000). T1 precontrast, T2-weighted (T2WI), and apparent diffusion coefficient (ADC) sequences were similar in both sessions. Each identified lesion was subjectively assessed using a six-point cancer likelihood score based on individual sequences and overall impression. The ability to distinguish benign versus malignant renal lesions improved with the use of b-2000 for more experienced radiologists (Reader 1 AUC: Session 1-0.649 and Session 2-0.938, p = 0.017; Reader 2 AUC: Session 1-0.781 and Session 2-0.921, p = 0.157); whereas no improvement was observed for the less experienced reader (AUC: Session 1-0.541 and Session 2-0.607, p = 0.699). The inclusion of ultra-high b-value DWI sequence improved the ability of classification of renal lesions in patients with HLRCC for experienced radiologists. Consideration should be given toward incorporation of DWI with b-2000s/mm2 into existing renal MRI protocols.

MO1025: Periostin as a Potential Biomarker of Renal and Arterial Damage in Children with Tuberous Sclerosis Complex

Abstract BACKGROUND AND AIMS Experimental data suggest that periostin is involved in the formation of renal cysts. Tuberous sclerosis complex (TSC) is a multisystem genetic disease characterized by the formation of lesions in virtually all organs, including the kidney—most commonly angiomyolipomas (AML) and cysts. There are no reliable markers of progression of renal lesions in patients with TSC. The study aimed to evaluate serum periostin levels in children with TSC and to assess the usefulness of periostin as a marker of renal lesion severity and arterial damage in this group of patients. METHOD In a group of 35 children with TSC (mean age 8.46 ± 5.64 years, 17 boys, 18 girls), serum periostin levels (ng/mL), anthropometric parameters, renal changes (by ultrasound and magnetic resonance imaging), blood pressure and biochemical parameters were evaluated. The control group consisted of 25 healthy children (mean age 8.72 ± 4.73 years, 14 boys, 11 girls). In addition, central pressure and parameters of arterial structure and function (cIMT, PWV, AIx75HR) were assessed in 20 children with TSC and 17 healthy children (age ≥ 4 years). RESULTS Arterial hypertension was found in two (5.7%) patients; AML was present in 20 (57.1%) children, including 9 (27.3%) atypical AML and 22 (62.8%) had cysts in the kidneys. Children with TSC did not differ in periostin levels compared with healthy children [67.46 ± 35.61 versus 68.14 ± 24.07 (ng/mL), P = .499]. In children with TSC, periostin concentration was negatively correlated with age (r = −0.614, P < .001), height (r = −0.634, P < .001), body weight (r = −0.658, P < .001), maximum cyst size (r = −0.481, P = .004) and office and ABPM systolic and diastolic blood pressure (r = −0.396 to −0.621, P < .050). There was no relationship between periostin levels and AML size or arterial damage parameters. In multivariate analysis, the only determinant of serum periostin levels in children with TSC was age [beta = −0.547, 95% confidence interval (95% CI) (−0.831 to −0.262)]. CONCLUSION The usefulness of serum periostin determination as a marker of renal cystic lesions in children with tuberous sclerosis requires further study.

Renal Involvement at Cryoglobulinemic Vasculitis

The aim of the work was to evaluate the frequency and nature of renal lesion in patients with cryoglobulinemic vasculitis. According to clinical, laboratory and sonographic data renal damage is observed in 2/3 of the number of patients that is associated with the presence of the pathology of myocardium, joints, lungs and peripheral nervous system, with the severity of integrated extrarenal signs of the disease, and kidney failure is diagnosed in every second observation, nephrotic syndrome — in every sixth one. Morphological lesion of glomeruli, tubules and stroma of the kidneys resembles primary mesangioproliferative or mesangiocapillary glomerulonephritis with severe tubulointerstitial component. Renal function and the rate of progression of nephropathy influence the levels of high molecular weight proteins in the urine (fibronectin, b2-microglobulin) and nitrogen products (uric acid, nitrites), as well as physical and chemical surface features of urine.

Monoclonal Immunoglobulin-Associated Renal Lesions in Patients with Newly Diagnosed Multiple Myeloma: A Report from a Single Center.

BackgroundMonoclonal immunoglobulin-associated renal lesions in patients with newly diagnosed myeloma vary. We aimed to determine the pathological spectrum and analyze associated prognostic factors.MethodsFifty-six patients with newly diagnosed multiple myeloma and biopsy-proven renal lesions were enrolled. Kidney biopsies were reanalyzed, and the baseline clinical characteristics, treatments and outcomes were recorded.ResultsFifty-one patients had monoclonal immunoglobulin-associated renal lesions, with myeloma cast nephropathy (MCN) being the most common pattern. We divided our cohort into pure MCN, MCN+ other pathologies and non-MCN. Patients with MCN had more severe renal injury than those with non-MCN. In our cohort, none of the patients with pure MCN or MCN + other pathologies presented with nephrotic syndrome. Patients with non-MCN had better renal and overall survival than those with pure MCN but similar survivals to those with MCN + other pathologies. Number of myeloma casts (HR 1.08, p = 0.012) was the only independent prognostic factor for renal survival. Male sex (HR: 3.64; p = 0.015) and number of casts (HR: 1.17; p = 0.001) were independent prognostic factors for overall survival.ConclusionPatients with MCN had more severe renal injury than those with non-MCN. Patients with non-MCN had better renal and overall outcomes than those with pure MCN, but their outcomes were similar to those with MCN + other pathologies. The independent predictors of overall survival were male sex and number of myeloma casts.

POS-121 RENAL FEATURES AND LESIONS OF SICKLE CELL DISEASE (SCD)

Sickle cell disease (SCD) is a common cause of hemolytic anemia and it is an increasing cause of chronic kidney disease. We aim to determine risk factors of renal involvement and different types of renal lesions in patients with SCD.

Clinical and morphologic spectrum of renal involvement in idiopathic hypereosinophilic syndrome.

To explore the clinical and pathological features of renal lesions in patients with kidney involvement in idiopathic hypereosinophilic syndrome (IHES). The demographic, clinical, and pathological characteristics and the treatment and follow-up data were analyzed. We identified 18 patients with IHES and renal involvement. Eleven patients presented with nephrotic syndrome, and 6 patients had impaired renal function. 15 patients underwent renal biopsy, and the pathological findings included the following: membranoproliferative glomerulonephritis in 3 patients; minimal-change disease in 3; mesangial proliferative nephritis in two; IgA nephropathy in 2; membranous nephropathy in two; chronic interstitial nephritis in two; focal segmental sclerosis in one; and eosinophil infiltration into the renal interstitium in 11 and into the glomerulus in 3. After treatment with glucocorticoids, the eosinophil count decreased. 15 patients werefollowed up, and 14 showed a decrease in urinary protein or renal function recovery. When glucocorticoids were discontinued, eosinophil increased (8 cases), urine protein increased (1 case), and 1 patient progressed to end-stage renal disease. Nephrotic syndrome with or without renal insufficiency is the main clinical manifestation. A wide spectrum of renal lesions can be observed in patients with IHES. Eosinophil infiltration into the renal interstitium was common in these patients. Most patients have a good prognosis after glucocorticoid therapy.

Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy

Contrast-enhanced ultrasound (CEUS) is an imaging modality that utilizes a non-nephrotoxic, intravascular microbubble agent to capture real-time perfusion of the target organ. CEUS has demonstrated utility for the evaluation and surveillance of indeterminate renal lesions in patients who are unable to receive conventional contrast agents, yet its potential utility in renal surgery remains poorly defined in the current literature. We present a series of 4 patients who underwent successful intraoperative CEUS during partial nephrectomy (PN) to help define renal mass contour and proximity to vascular structures in an attempt to optimize renal function after PN. All cases were endophytic with moderate-high complexity (R.E.N.A.L. scores>9). CEUS was safely performed in all cases providing excellent tumor contour definition. In one case, CEUS provided better visualization of tumor proximity within the hilum than conventional US, facilitating surgical resection and reconstruction. In another case, CEUS provided better definition of tumor contour, allowing wedge resection rather than heminephrectomy. Margins were negative in all cases. The average global renal function preserved following PN was 90%. While grey-scale US with color Doppler is usually sufficient for intraoperative tumor visualization, CEUS can be considered during PN for complex endophytic, infiltrative or hilar tumors where accurate delineation of tumor contour is critical.

MP36-03 EXAMINING THE ROLE OF CONTRAST-ENHANCED RENAL ULTRASOUND IN CHARACTERIZING INDETERMINATE RENAL LESIONS IN THE SETTING OF CHRONIC KIDNEY DISEASE

You have accessJournal of UrologyImaging/Radiology: Uroradiology I (MP36)1 Apr 2020MP36-03 EXAMINING THE ROLE OF CONTRAST-ENHANCED RENAL ULTRASOUND IN CHARACTERIZING INDETERMINATE RENAL LESIONS IN THE SETTING OF CHRONIC KIDNEY DISEASE Ava Saidian*, Taylor Tucker, Stephen Leahy, Kristin Porter, and Soroush Rais-Bahrami Ava Saidian*Ava Saidian* More articles by this author , Taylor TuckerTaylor Tucker More articles by this author , Stephen LeahyStephen Leahy More articles by this author , Kristin PorterKristin Porter More articles by this author , and Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000880.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prevalence of chronic kidney disease (CKD) in the United States is estimated to be over 14%. A particular difficulty that arises when caring for CKD patients is accurate diagnosis of renal lesions without the use of intravenous contrast. Contrast Enhanced Renal Ultrasound (CEUS) is a diagnostic tool with the potential for more precise imaging without the nephrotoxic effects of standard contrast in patients with indeterminate renal lesions and CKD. The primary objective of this study was to compare the results of CEUS with other imaging modalities in both renal sufficient and insufficient patients when evaluating indeterminate renal lesions. METHODS: Retrospective chart review of patients who underwent CEUS from 2014 to 2015 was performed at a single institution with data collection focused on renal function, prior imaging of renal lesions, and final clinical and pathological diagnoses. Patients were separated into two cohorts based on renal function with an eGFR<60 defining the CKD cohort. Using SPSS Statistics, comparative analysis between results of prior imaging and follow-up CEUS was performed for each cohort. RESULTS: A total of 169 patients had a CEUS completed from 2014 to 2015 at our institution. There were 104 patients who were classified as having CKD. Imaging modalities patients underwent prior to CEUS included Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and non-contrast enhanced ultrasound. A comparative analysis of categorical variables was done using chi-squared and Fisher’s exact test. CEUS provided specific diagnosis, new diagnosis and/or confirmed diagnosis of previously labeled “indeterminate renal lesions” by other imaging modalities in 41 (39.4%) CKD patients compared to 13 patients (20.0%) with normal renal function (p=0.0084). CEUS resulted in a change in Bosniak cyst classification in 2 (4.3%) CKD patients compared to 8 (22.8%) patients with normal renal function (p=0.017). CEUS also resulted in a change in the number of lesions in 2 (1.9%) CKD patients compared to 5 (7.7%) patients with normal renal function (p=0.11). CONCLUSIONS: CEUS can be used to diagnose and follow renal lesions in patients with CKD who otherwise are not able to undergo imaging with nephrotoxic contrast. CEUS can help differentiate and further classify indeterminate renal lesions that may be concerning for malignancy. Further studies are necessary to validate these findings and further elucidate the diagnostic role of CEUS in patients with and without CKD. Source of Funding: UAB UCSD O’Brien Center for Kidney Injury © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e522-e523 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ava Saidian* More articles by this author Taylor Tucker More articles by this author Stephen Leahy More articles by this author Kristin Porter More articles by this author Soroush Rais-Bahrami More articles by this author Expand All Advertisement PDF downloadLoading ...

Significance of Hematological Parameters and Biochemical Markers in Severe Forms of Covid-19

"SARS-CoV-2 is a new virus that affects the human population, about which not all the details are known, and for which the research is ongoing. Several common in vitro diagnostic tests have been implicated in the unfavorable progression of COVID-19, providing potentially important prognostic information. According to some synthesis studies, the progressively low values of the lymphocyte / leukocyte ratio, and progressively increased of the neutrophil / lymphocyte and neutrophil / platelets ratios, correlate with the more severe evolution of COVID-19. The existence of a number of lymphocytes &lt;20% on day 10-12 indicates a pre-severe condition, and a number of &lt;5% on days 17-19 indicates a critical one. D-dimers are the most important prognostic element in monitoring patients with severe forms of COVID-19. Elevated levels of D-dimers compared to the reference biological interval observed at hospitalization of patients with COVID-19 and their marked increase, up to 3-4 times the initial value, were associated with increased mortality, which probably reflects the activation of coagulation in infection / sepsis, cytokine storm and imminent organ failure. Increasing ALT values by more than 5 times the reference biological interval increased the risk of mortality of patients with COVID-19 by seven times. High levels of AST compared to the biological reference range were observed in both patients with non-severe COVID-19 disease as well as in a double the number of patients with severe disease. The value of serum creatinine at hospitalization is a predictor of the death of hospitalized patients for COVID-19. More frequent measurements of serum creatinine are recommended in the management of COVID-19 to improve the early detection of renal lesions in patients with COVID-19. At patients confirmed with COVID19, elevated levels of highly sensitive troponin I (hs-cTnI) were observed during hospitalization, and more than 50% of those who died had a significantly higher concentration of hs-cTnI compared to the biological interval of reference. Hyperferritinemia has been associated with an increased severity of COVID-19 disease, because of elevated ferritin levels compared to the reference biological range, the so-called ""cytokine storm"" is developed which can be fatal for half of COVID-19 patients, especially for the elderly. Lactate dehydrogenase (LDH) has been associated with altered outcomes in patients with viral infections. In an American study (n = 1532 COVID-19 patients), the association between elevated LDH levels (that were measured as soon as possible after hospitalization ) and the severity of the disease in patients with COVID-19 was assessed. Elevated LDH levels were associated with a 6 fold increase in the chance of developing severe symptoms and a 16 fold increase in mortality in patients with COVID-19. C-reactive protein (CRP) is part of the acute phase plasma proteins. COVID-19 increases CRP. This seems to correlate the severity and prognosis of the disease. Studies have found low levels of PCR in patients who do not require oxygen therapy (mean 11 mg / L,) compared to patients who have become hypoxemic (mean 66 mg / L)."

Germline VHL gene variant in patients with von Hippel-Lindau disease does not predict renal tumor growth.

To determine whether the type of VHL gene pathogenic variant influences the growth rate or CT enhancement values of renal lesions in VHL patients. Thirty-two VHL patients (19 male) were selected from a prospectively maintained imaging database for patients that underwent surgical tumor resection between 2014 and 2016. One hundred and eleven VHL lesions were marked for resection and pathology analysis. Whole lesion volumetric segmentation was performed on nephrographic phase of the two most recent contrast-enhanced CT scans before surgery. Intensity distribution curves were obtained from segmentations. A linear mixed model, accounting for within-patient correlations, was used to compare the growth and enhancement differences between different germline pathogenic variant types. There was no significant difference for the lesions' total growth between different germline pathogenic variants (P value=0.78). The median growth rate for all lesions was 1.7cc/year (IQR 0.5, 3.9) with a baseline median size of 4.1cm3 (IQR 1.7, 11.7). In complex lesions, the solid portion of the tumor demonstrated a higher growth rate (1.6cc/year) than cystic portions (0.02cc/year) which stayed relatively unchanged. Only one pathogenic variant (Splice donor) showed some levels of difference in its relative enhancement from other subtypes. The type of germline pathogenic variant on the VHL gene does not affect the growth rate or CT enhancement values of renal lesions in patients with VHL. The absolute growth rate of these tumors may be used in the scheduling of follow-up studies.

Focal segmental glomerulosclerosis associated with cutaneous and systemic plasmacytosis.

Cutaneous and systemic plasmacytosis (CSP) is a rare lymphoproliferative disorder that mainly affects middle-aged Asian individuals. Although Castleman disease is often complicated with various renal involvements, glomerulonephritis associated with CSP, which is considered as a variant of Castleman disease, is rare. This report presents the case of a 41-year-old Japanese man with nephrotic syndrome associated with CSP. Renal biopsy findings showed focal segmental glomerulosclerosis (FSGS) and diffusely mild segmental mesangial proliferation. Plasma cell infiltration in the interstitium was not observed. Electron microscopic findings showed diffuse foot process effacement, localized involvement of subendothelial space widening with amorphous materials, and endothelial cell swelling. Lymph node biopsy findings denied Castleman disease. His skin regions and proteinuria were successfully treated with prednisolone and cyclosporine. The causal relationship between CSP and FSGS is unknown. However, increased serum levels of IL-6 and VEGF and decreased VEGF expression in the podocyte may contribute to renal lesions in patients with CSP. To our best knowledge, this is the first case of a patient with FSGS associated with CSP.

Clinical and morphologic spectrum of renal involvement in patients with HBV-associated cryoglobulinaemia.

Cryoglobulinaemic glomerulonephritis related to hepatitis B virus (HBV) infection has been rarely reported. The aim of this study was to investigate the clinical features, renal biopsy findings in patients with HBV-associated cryoglobulinaemia. Twelve patients with HBV-associated cryoglobulinaemia were identified in this study. The demographic, clinical, pathological characteristics, treatment and follow-up data were analyzed. Renal involvement was characterized by nephrotic range proteinuria with microscopic haematuria in all patients, and impaired renal function in nine patients (75%). Purpuric rash was the main extrarenal manifestation (58.3%). Type II cryoglobulinaemia was presented in three patients and type III in nine patients. Hypocomplementaemia and positive of rheumatoid factors were present in all patients. Membranoproliferative glomerulonephritis (MPGN) was observed in all kidney specimens. Seven patients also had evidence of prominent cryoglobulins thrombi on renal biopsy, but only three patients had HBV antigen deposits in renal tissues. Antiviral and steroids or immunosuppressive agents have been used in most of patients. During follow-up, two patients died, and four reaching end-stage renal disease; three patients had complete remission, and three patients had renal function improved after therapy. Nephrotic syndrome with haematuria and renal insufficiency are the main clinical manifestation; cryoglobulinaemic glomerulonephritis are the main renal lesion in patients with HBV-Associated cryoglobulinaemia; half of patients have poor outcome even with antiviral and immunosuppressive therapy. The results of this study indicate that cryoglobulins should be detected in hepatitis B virus-Associated nephropathy in endemic area.

Urinary Albumin Levels are Independently Associated with Renal Lesion Severity in Patients with Lupus Nephritis and Little or No Proteinuria.

BackgroundSystemic lupus erythematosus (SLE) leads to renal lesions, which may be clinically silent in patients with little or no proteinuria. Early detection of these lesions may improve prognosis, but early markers are controversial. This study aimed to determine renal marker proteins associated with renal lesion severity in patients with lupus nephropathy (LN) and little or no proteinuria.Material/MethodsPatients with LN and little or no proteinuria (<0.5 g/24 hours) (n=187) that underwent kidney biopsy were grouped according to: low severity (Class I or II; n=116) versus high severity (Class III, IV, or V; n=71). Disease status was determined according to the SLE disease activity index (SLEDAI). Renal marker proteins (serum β2-macroglobulin, urinary β2-macroglobulin, albumin, IgG, and α1-macroglobulin) were measured using radioimmunoassay.ResultsCompared with the low severity group, patients in the high severity group had higher urinary albumin (11.60±8.94 versus 7.08±10.07 μg/mL, p=0.008) and urinary IgG (13.21±9.35 versus 8.74±8.90 μg/mL, p=0.007) levels. Multivariate conditional logistic regression analysis showed that urinary albumin (odds ratio (OR)=1.417, 95% confidence interval (95% CI): 1.145–1.895, p=0.001) and SLEDAI (OR=2.004, 95% CI: 1.264–3.178, p=0.003) were independently associated with severe renal lesions in these patients. Using an optimal cutoff point of urinary albumin of 7.53 μg/mL resulted in 67% sensitivity and 82% specificity for the detection of high severity renal lesions.ConclusionsUrinary albumin levels and SLEDAI were independently associated with histological severity of renal lesions in patients with LN and little or no proteinuria. These parameters could be used to help select patients for renal biopsy.

Renal involvement at Takayasu's aortoarteritis

The aim and objectives of the work was to evaluate the frequency and nature of renal lesion in patients with Takayasu's aortoarteritis, connection with extrarenal signs of the disease and issues of pathogenesis of such nephropathy. The study included 29 patients (7 men and 22 women aged 20-75 years). Changes in the kidneys are observed in 62 % of cases of aortoarteritis, and pathology of lung and liver affect them, and, stenosis of renal arteries is diagnosed in 44 % of nephropathy cases, renal sonographic changes – in 39 %, kidney failure – in 56 %, and morphological changes in the kidney are characterized by proliferation of mesangiocytes, increase of mesangial matrix, cleavage of capillary loops and thickening of the basement membrane of Shumlyansky-Bowman's capsule, glomerular sclerosis/hyalinosis, lymphohistiocytic infiltration of interstitium, periglomerular and perivascular sclerosis, plasmatic impregnation, vascular elastosis and fibrosis, deposits of immunoglobulins (A, G, M), C3- and C1q- components of complement in the glomeruli and the stroma, that is associated with blood levels of fibrinogen and antibodies to cardiolipin, with the size of the aorta, heart cavities, the degree of vasodilation and pressure in the pulmonary artery.

Renal lesions in patients with type 2 diabetes: a puzzle waiting to be solved.

Renal lesions in patients with type 2 diabetes: a puzzle waiting to be solved.