Pathophysiology of inflammatory bowel disease: an overview

Inflammatory bowel disease, Crohn's disease, and ulcerative colitis are considered idiopathic diseases affecting the gastrointestinal tract. These two diseases are often considered together because of multiple similarities, including gastrointestinal inflammation, waxing and waning severity and symptoms, and unknown etiology. However, they have separate symptoms and microscopic characteristics as well as patterns within the gastrointestinal tract.     

Heavy chain deposition disease: an overview

Heavy chain deposition disease (HCDD) is one of three entities of monoclonal immunoglobulin deposition disease, characterized histopathologically by the presence of nodular glomerulosclerosis and glomerular and tubular deposition of monoclonal heavy chains without associated light chains. Although HCDD is an extremely rare disease, >30 cases have been reported to date in the literature. Of these cases, only three cases have been reported in Japan. The majority of the patients presents with nephrotic syndrome, hematuria, and hypertension, and develop progressive renal failure with or without the complication of multiple myeloma. Some cases have been treated successfully using chemotherapy. Because of its rarity, a thorough understanding of HCDD is essential for both accurate diagnosis and adequate subsequent treatment.     

Corneal and scleral involvement in inflammatory rheumatic disease: Rheumatologists and ophthalmologists exchanging views

Corneal and scleral disorders related to inflammatory rheumatic diseases vary both in frequency and in severity. Sicca syndrome and its complications are the most common ocular manifestations and, together with episcleritis, can usually be managed by topical treatments. In contrast, the various forms of scleritis and peripheral ulcerative keratitis generally require systemic glucocorticoid therapy and the initiation or intensification of immunosuppressive treatment. Corneal and scleral manifestations are inaugural in a few patients with chronic inflammatory rheumatic disease. No direct information is available on the frequency of severe corneal and scleral involvement, which can only be estimated by extrapolating data from case-series or cohorts, many of which are historical. Similarly, given the absence of randomized controlled trials, treatment decisions must rely on clinical experience acquired in referral centers and on reports of small case-series studies. The rheumatologist and ophthalmologist must work closely together to ensure the prompt and optimal management of these potentially serious conditions.     

Kidney in inflammatory rheumatic diseases

Renal lesions in inflammatory rheumatic diseases are presented.     

Hip in inflammatory rheumatic diseases

The hip changes in inflammatory rheumatic diseases are presented.     

Hepatitis C virus-related kidney disease: an overview

Hepatitis C virus (HCV)-infection leads to chronic liver disease, but also to extra-hepatic manifestations, including kidney disease. We provide an overview of HCV-related kidney diseases in non-transplanted and in kidney transplant patients, and their therapies. Membranoproliferative glomerulonephritis, associated with Type 2 cryoglobulinemia, is the predominant Type of HCV-related glomerulonephritis. Membranous glomerulonephritis and focal segmental glomerular sclerosis are less commonly described. HCV infection seems to be linked to Type 2 diabetes mellitus, and might alter the progression of diabetic-related nephropathy. Patients infected by HCV should be annually screened for markers of kidney disease and, similarly, patients with membranoproliferative or membranous glomerulonephritis should be screened for HCV infection. After transplantation, cryoglobulinemia is frequent and is associated with HCV markers. HCV-related kidney disease requires specific treatment. In non-kidney-transplant patients, treatment relies on either only anti-HCV therapy in cases of moderate renal disease, or combined anti-viral and immunosuppressive therapies in cases of severe renal disease, i.e., nephrotic syndrome and/or progressive renal failure, and in diseases that are refractory to anti-HCV therapy. In kidney transplant patients, ribavirin monotherapy could be used cautiously, whereas rituximab might be a treatment of choice in the presence of cryoglobulinemia. In liver-transplant patients, in addition to anti-HCV therapy, rituximab might be also used.     

Adynamic bone disease: an update and overview

Adynamic bone disease (ABD) is a variety of renal osteodystrophy characterized by reduced osteblasts and osteoclasts, no accumulation of osteoid and markedly low bone turnover. It has been found in a relatively high percentage of patients on dialysis, either peritoneal or hemodialysis, but also in CKD patients on conservative treatment. The histologic pattern of ABD is generally associated to low levels of PTH. However, PTH serum levels in CKD are generally higher than normal even when associated to ABD. Therefore, it is felt that, basically in uremia, bone tissue is resistant to PTH, so that a relative reduction of its levels is able to induce the emergence of a low turnover state. Several factors theoretically responsible for skeletal resistance to PTH, and able to slow bone turnover have been considered. Among these are downregulation of PTH receptors in bone cells, increased levels of osteoprotegerin, decreased production and circulating levels of bone morphogenetic proteins, the peripheral effect of leptin and also a possible effect of increased N-terminal truncated PTH molecular species, which have been found to counteract the whole molecule, PTH 1-84 on the bone. In conclusion, ABD should probably be considered a skeletal condition induced by overtreatment of secondary hyperparathyroidism and not a disease. However, its development reveals a deranged ability of uremic bone to maintain a normal bone turnover, when PTH serum levels decrease beyond relatively low levels, which would be considered normal in the general population.     

Renal disease and drug metabolism: an overview

Renal disease will perturb the disposition of drugs that primarily depend upon renal excretory function for elimination. While changes in drug half-life (T1/2) are often cited as evidence of altered drug disposition, it must be remembered that T1/2 is a dependent variable whose magnitude varies directly with volume of distribution (Vd) and indirectly with total body clearance (ClT). ClT is the one term that succinctly describes drug elimination. ClT is defined as the sum of the renal (ClR) and nonrenal (ClNR), or metabolic, clearances of a drug. Renal failure has been shown to alter the hepatic microsomal mixed-function oxidase system of drug metabolizing enzymes. Therefore, in end-stage renal failure, the potential exists for the modification of the disposition of drugs whose elimination is primarily hepatic. The kidneys themselves contain many of the enzymes important in hepatic drug metabolism. Drugs such as morphine, paracetamol, and p-aminobenzoic acid are metabolized in the kidney and experimental renal disease has been shown to reduce drug metabolism in the diseased kidney compared with the contralateral normal kidney. Renal disease, then, has the potential to alter not only the renal clearance of unchanged drug but also may substantially modify the metabolic transformation of drugs in both the liver and the kidneys. It can no longer be assumed that the pharmacokinetics of drugs that are disposed mainly by metabolism will be unaltered in renal failure.     

Steroids in rheumatic disease: a podiatric perspective

Glucocorticoids are a class of steroids involved in the metabolism of glucose. Although decades of extensive use of these agents have clearly established their place as one of the most beneficial classes of medications ever known, their proper use is extremely complex and is associated with a multitude of devastating and even potentially fatal complications. The use of steroids in the treatment of the rheumatic diseases is sufficiently widespread that it is essential for any physician caring for rheumatoid patients to be aware of the drugs' potential risks as well as benefits. This paper provides an overview of the use of steroids in the management of rheumatic disease from a podiatric perspective.     

Non-surgical options for the management of gallstone disease: an overview

Summary The modalities for the non-surgical treatment of gallstones include oral dissolution by bile salts, local dissolution by methyl-tert-butyl-ether (MTBE), extracorporeal shockwave lithotripsy (ESWL) and percutaneous gallstone clearance. The results of oral bile salt therapy for cholesterol stones have been disappointing, and the only indication for this treatment is after ESWL. The high efficacy initially reported for MTBE has not been confirmed by subsequent experience in other centres: this therapy is toxic and best confined to specialized centres. ESWL, though effective in noncalcified stones, has limited overall applicability (approx. 15%) and is frequently followed by recurrence despite maintenance therapy with oral bile salts. Percutaneous gallstone clearance (radiologic or laparoscopic) has been superseded by laparoscopic cholecystectomy. This offers definitive treatment in a single session and has significant advantages over open cholecystectomy in terms of short hospital stay and accelerated recovery with early return to work or full activity. Destruction of the gallbladder by sclerosant agents (chemical cholecystectomy) requires further experimental evaluation before its introduction to clinical practice.     

Tamsulosin: an overview

This article reviews the contemporary literature related to tamsulosin, which is now the most widely used alpha antagonist in treating benign prostatic hyperplasia. The primary emphasis of this article is on the clinical data that exist related to this agent. Currently, there are no adequate studies that effectively compare existing agents for the treatment of benign prostatic hyperplasia using a randomised, placebo-controlled design with adequate numbers and this needs to be addressed in future studies.