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Renal diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Renal cortical necrosis can be considered a severe form of ATN, often associated with disseminated coagulopathy and usually occurring in a setting of septic shock, septic abortion, or severe abruptio placentae. Bilateral renal cortical necrosis (BRCN) is estimated to occur in about 2% of the adult patients with ARF, but the incidence is the highest in obstetric patients, especially in the last part of pregnancy and postpartum (74). The risk of BRCN seems to be higher with prolonged anuria, usually longer than 2 weeks. Patients require dialysis and some will become dialysis dependent. Kidney biopsy provides the definitive diagnosis and prognostic information. Imaging techniques could be employed to show decreased cortical blood flow. CT angiogram or renal angiography shows decreased cortical nephrogram.
Peripheral Neuropathies
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Gareth Llewelyn, Robert Powell
In isolated peripheral nerve vasculitis, the ESR and CRP may be slightly raised, but other serological markers are usually normal (Box 16.7). In systemic vasculitis, serological tests may help identify the underlying syndrome. CSF analysis is rarely helpful, other than in excluding other causes, such as infections and malignant infiltration. Because of the need for long-term treatment with potentially toxic medication, the diagnosis of vasculitis usually needs histological confirmation. The patchy nature of the neuropathy means that it can easily be missed on a sural nerve biopsy. Recent studies have suggested a modest increase in diagnostic yield from a combined nerve and muscle biopsy, compared to nerve alone. A kidney biopsy is likely to yield the diagnosis in cases where there is renal involvement.
Mechanisms of Fibril Formation and Cellular Response
Published in Martha Skinner, John L. Berk, Lawreen H. Connors, David C. Seldin, XIth International Symposium on Amyloidosis, 2007
Martha Skinner, John L. Berk, Lawreen H. Connors, David C. Seldin
Patient #1: A 52 yo Caucasian male with a 15 year history of ankylosing spondylitis with rheumatological symptoms, well controlled on prednisone, indomethacin and etanercept (anti-tumor necrosis factor), developed progressive renal failure. Despite discontinuation of indomethacin, renal failure continued to progress. His estimated proteinuria never exceeded 400 mg/day and renal biopsy was performed. The clinical suspicion was chronic interstitial process, possibly drug related. Initial evaluation of the kidney biopsy
Identification of a circRNA-miRNA-mRNA network to explore the effects of circRNAs on renal injury in systemic lupus erythematosus
Published in Autoimmunity, 2023
Ya Li, Juan Chen, Min Xie, Yihui Cao, Yan Zhou, Ruixian Zhang
Lupus nephritis (LN) is the most serious complication of systemic lupus erythematosus. Current diagnostic and therapeutic criteria for LN cannot accurately predict early renal damage and severity in SLE patients [14]. Currently, routine clinical parameters such as proteinuria, GFR, urinary sediment, anti-dsDNA and complement levels have poor sensitivity and specificity in patients with lupus nephritis [15]. Kidney biopsy is an invasive procedure with a high risk of infection. Therefore, it is necessary to develop new non-invasive diagnostic methods and detection markers for the clinical diagnosis of LN. Research suggests that urine and blood samples may be a source of biomarkers for lupus nephritis. For example, complement, autoantibodies, chemokines, cytokines, and leukocytes have been reported as potential non-invasive biomarkers for LN [16,17]. However, the detection effect of these markers for LN is still not ideal. In addition to some classical clinical indicators (C3, C4, CH50, etc.), there are no ideal and effective indicators for clinical diagnosis of LN [18].
Clinicopathological features and outcome in elderly patients with idiopathic membranous nephropathy
Published in Renal Failure, 2023
Jinxiu Liang, Wenke Hao, Fangxiao Xia, Zhi Zhao, Yanhua Wu, Feng Yu, Wenxue Hu, Xiaowu Fang, Wei Liu
The treatment outcomes were classified as remission (including complete remission and partial remission) and non-remission during at least 1-year follow-up from kidney biopsy. The observation period for non-remission group was at least 12 months, and the longest one was for 24 months. Referring to the 2012 KDIGO guideline [21], complete remission, partial remission and no remission were defined as follows: (1) Complete remission (CR): urinary protein excretion <0.3 g/d (uPCR <300 mg/g or <30 mg/mmol), confirmed by two values at least 1 week apart, accompanied by a normal serum albumin concentration, and normal serum creatinine. (2) Partial remission (PR): urinary protein excretion <3.5 g/d (uPCR <3500 mg/g or <350 mg/mmol) and a 50% or greater reduction from peak values, confirmed by two values at least 1 week apart, accompanied by an improvement or normalization of the serum albumin concentration and stable serum creatinine. (3) No remission (NR): patients did not achieve clinical remission after treatment.
Shear wave elastography parameters adds prognostic value to adverse outcome in kidney transplantation recipients
Published in Renal Failure, 2023
Tian-yi Zhang, Jiayi Yan, Jiajia Wu, Wenqi Yang, Shijun Zhang, Jia Xia, Xiajing Che, Hongli Li, Dawei Li, Liang Ying, Xiaodong Yuan, Yin Zhou, Ming Zhang, Shan Mou
Allogenic kidney transplantation is one of the effective treatments for kidney failure, and previous studies have shown that patients receiving a kidney transplant have lower mortality and better quality of life than those on other kidney replacement therapies [1,2]. Despite the improvement in surgical techniques and immunosuppressive drugs, kidney transplantation recipients still face a variety of adverse outcomes including rejection, infections, malignancies and failure of the transplanted kidney [3]. Prognostic determinants of patients after kidney transplantation are complex, including adjustment of immunosuppressive regimen, donor type and characteristics, intraoperative cold ischemia time, primary kidney diseases and comorbidities of the recipients [4–8]. Histologic changes such as interstitial fibrosis/atrophy and infiltration of inflammatory cells, have been shown to correlate with allograft dysfunction [9,10]. Kidney biopsy is the gold standard to evaluate histological changes, but as an invasive procedure it has complications such as hemorrhage, arteriovenous fistula and infections [11]. Therefore, an early accurate non invasive identification of kidney allograft fibrosis might be beneficial in improving the prognosis of recipients [12]. And we aim to validate the prognostic ability of such non invasive assessment methods.