B/C基因型的乙型肝炎病毒在不同ALT状态下对乙型肝炎相关性肾炎的差异性影响

【目的】探讨不同ALT状态下B/C基因型的乙型肝炎病毒对乙型肝炎相关性肾小球肾炎的差异性影响。【方法】回顾性分析兰州大学第一医院确诊为乙型肝炎相关性肾小球肾炎的患者558例,所选病人均病历完整,均接受过肾组织病理学检查,化验指标包括：丙氨酸氨基转移酶、肌酐、尿β2微球蛋白、尿N-乙酰-β-D-葡萄糖苷酶、血尿素氮、肾小球滤过率、乙型肝炎病毒载量及基因型。【结果】B型C型基因型的乙肝相关性肾小球肾炎均以弥漫性膜增生性肾病为主（57.9%vs.54.4%）,其次为毛细血管内增生性肾小球肾炎（25.3%vs.28.0%）,局灶节段肾小球硬化（9.7%vs.9.0%）和系膜增生性病变（7.1%vs.8.6%）较为少见。在ALT正常组B/C基因型的乙型肝炎病毒对肾脏功能影响差异无统计学意义（P>0.05）。而在ALT≥2倍上限组中,C型基因型较B型基因型的乙型肝炎相关性肾小球肾炎患者中,血肌酐、血尿素氮、24h尿蛋白定量、尿NAG、尿β2M明显增高（P<0.05）,而肾小球滤过率GFR明显下降（P<0.05）,差异有统计学意义。在ALT正常组中B/C型的乙型肝炎病毒对慢性肾脏病分期差异无统计学意义（P>0.05）。而在ALT≥2倍上限组中,C型基因型较B型基因型的乙型肝炎相关性肾小球患者中,慢性肾脏病分期有趋于加重的倾向（χ2=11.144,P=0.025）。【结论】对比分析不同基因型的乙型肝炎病毒对乙型肝炎相关性肾炎的差异性影响,将有助于帮助临床诊治乙型肝炎相关性肾炎。     

Relationship between cryoglobulinemia-associated nephritis and HCV infection

The pathogenetic mechanisms in hepatitis C virus (HCV)-related cryoglobulinemia are sustained by the chronic lymphocyte stimulation of HCV infection, and include the synthesis of IgM rheumatoid factor and tissue deposition of immunocomplexes, characterized by abnormal kinetics and an underlying lymphoproliferative disorder. Based on postulated pathogenetic mechanisms, therapeutic strategies include antiviral, immunosuppressive and immunomodulatory treatments. Combined interferon and ribavirin has shown a better response rate than interferon alone. Pegylated interferons are currently recommended in association with ribavirin. Advances in tolerance might be achieved by tailoring doses and treatment duration according to genotype and individual factors. Conventional immunosuppressive therapy has been widely used in patients with progressive renal involvement or relapsing disease. Rituximab is a promising alternative treatment option for severe cryoglobulinemic vasculitis and nephritis. Although the optimal treatment strategy in HCV-related cryoglobulinemia has not been determined yet, an algorithm based on the clinical severity of disease could be proposed, in which rituximab might be a first-line option in severe cases.     

Rituximab or Cyclophosphamide in the Treatment of Membranous Nephropathy: The RI-CYCLO Randomized Trial

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Oliguric and non-oliguric acute renal failure in malaria in west zone of rajasthan,India-A comparative study

ObjectiveTo report a comparative clinical and histopathological study on oliguric and non-oliguric acute renal failure (ARF) in malaria.Method311 consecutive cases of malaria out of which 74 (23.79%) had ARF as per WHO criteria were conducted. Mean age was 32.58 (range 15–60 years) and male: female was 2:1.ResultMost of the cases developed ARF within 10 d of onset. 18 cases (11 falciparum, 2 mixed, 5 vivax) presented with oliguric and 56 (41 falciparum, 6 mixed, 9 vivax) with non-oliguric renal failure. Associated major manifestations were jaundice (75.68%), cerebral malaria (41.89%), bleeding manifestations (32.43%), severe anemia (27.03%), hypotension (25.68%), multi-organ failure (18.92%), severe thrombocytopenia (12.16%), and ARDS (8.11%). Kidney biopsy (n=20) showed acute tubular necrosis (n=7), Mesangioproliferative glomerulonephritis (n=4) or both (n=9). Hemodialysis was done in 8 cases of oliguric renal failure out of which 4 survived (average no. of session 2.9).ConclusionMost of the cases recovered within 3 weeks. Total mortality was 28.38% (n=21) and mortality was more in oliguric renal failure (72.22%) as compare to non-oliguric renal failure (14.29%).     

肾炎方联合缬沙坦分散片对慢性肾小球肾炎患者的疗效与肾功能的影响

目的:探究肾炎方联合缬沙坦分散片治疗慢性肾小球肾炎患者的疗效及对肾功能的影响。方法:选取2016年2月至2019年2月重庆医科大学附属一医院合川医院肾脏内科收治的慢性肾小球肾炎患者122例作为研究对象,随机分为对照组和观察组,每组61例。对照组患者采用下缬沙坦分散片治疗,观察组在对照组基础上采用自拟肾炎方与缬沙坦分散片联合治疗,分析比较2组患者的肾功能指标的动态变化、炎性因子的表达水平、临床疗效及治疗后不良反应。结果:治疗后观察组TC、TG、BUN、Scr及24 hUPE5项指标的动态变化均低于对照组,差异有统计学意义(P<0.05),且观察组ALB动态变化高于对照组,差异有统计学意义(P<0.05);治疗后观察组IL-6、IL-10、CRP及TNF-α水平明显低于对照组,差异有统计学意义(P<0.05),观察组治疗有效率(98.4%)优于对照组(86.9%),差异有统计学意义(P<0.05);观察组不良反应发生率(6.6%)低于对照组(31.1%),差异有统计学意义(P<0.05)。结论:采用自拟肾炎方与缬沙坦分散片联合的治疗方案可增强疗效,提升肾功能,降低促炎性因子的表达水平及不良反应,值得在临床中推广普及。     

Criterios específicos de respuesta tumoral

Recent advances in biology and genetics have accelerated our knowledge about the development, growth, and dissemination of cancer, generating great expectations that these new discoveries will be translated into effective treatments for patients. Imaging techniques play a central role in the care of oncologic patients, since they have become tools capable of evaluating important characteristics of tumors and the response of tumors to different treatments. The objective of this article is to evaluate the different imaging-based criteria for assessing tumor response, discussing their advantages and limitations and illustrating the possible contribution of new imaging techniques as biomarkers of tumor response.     

Complement inhibition in C3 glomerulopathy

C3 glomerulopathy (C3G) describes a spectrum of glomerular diseases defined by shared renal biopsy pathology: a predominance of C3 deposition on immunofluorescence with electron microscopy permitting disease sub-classification. Complement dysregulation underlies the observed pathology, a causal relationship that is supported by well described studies of genetic and acquired drivers of disease. In this article, we provide an overview of the features of C3G, including a discussion of disease definition and a review of the causal role of complement. We discuss molecular markers of disease and how biomarkers are informing our evolving understanding of underlying pathology. Research advances are laying the foundation for complement inhibition as a targeted approach to treatment of C3G.     

Fortuitous Vasculitis

A 43-year-old man with a cardiac device for dilated cardiomyopathy presented with fever, night sweats, and weight loss. Investigations revealed pancytopenia, acute renal failure, abnormal lung function, and raised inflammatory markers. A renal biopsy demonstrated pauci-immune necrotizing crescentic glomerulonephritis. He was diagnosed with pulmonary–renal antineutrophil cytoplasmic antibody-negative systemic small vessel vasculitis. He commenced immunosuppression with prednisolone and cyclophosphamide with recovery from pancytopenia and improvement in renal function 3 months later. Subsequently, a bone marrow culture grew Mycobacterium fortuitum. Isolation on repeat peripheral mycobacterial blood cultures prompted treatment with ciprofloxacin and clarithromycin. Four months later, he presented with neutropenic sepsis, influenza A/H1N1, and Aspergillus flavus pneumonia. Despite treatment he deteriorated. A transthoracic echocardiogram revealed a vegetation on the right ventricular pacing wire. The device was removed. The vegetation revealed acid and alcohol fast bacilli on Ziehl–Neelsen staining and grew M. fortuitum on culture, sensitive to ciprofloxacin and clarithromycin. Despite device removal and antimicrobial therapy, the patient succumbed to treatment-related complications. The association between glomerulonephritis and endocarditis is well known; however, this is the first case to our knowledge describing pauci-immune necrotizing crescentic glomerulonephritis in the context of M. fortuitum endocarditis. Clinicians should maintain a high index of suspicion for endocarditis in patients with a cardiac device who present with fever and pauci-immune necrotizing crescentic glomerulonephritis. Patients should be investigated with mycobacterial blood cultures, at least three sets of standard blood cultures and transthoracic and transesophageal echocardiography. Clinicians should beware the perils of immunosuppression in the face of an occult sepsis.