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      Insuficiencia renal aguda por inmunoglobulina A


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          Se presenta el caso de una paciente de 20 años y raza blanca en la que pudo apreciarse la asociación de un episodio de hematuria macroscópica asociada a una insuficiencia renal aguda. La biopsia renal percutánea realizada posteriormente demostró nefropatía por inmunoglobulina A. La frecuencia de esta complicación es poco conocida. Se ha sugerido que la obstrucción mecánica ocasionada por los cilindros hemáticos y/o su toxicidad sobre las células tubulares podrían desempeñar un importante papel patogénico. En el caso reportado llamó la atención la intensidad de la hematuria y su prolongada duración, el grado de insuficiencia renal alcanzada y la posterior recuperación de la función renal.

          Translated abstract

          A case of a 20-year old, white patient in whom an association of macroscopic hematuria with acute renal failure was observed is reported. The percutaneous renal biopsy performed later evidenced the occurrence of a IgA nephropathy. The frequency of this complication is rare. It has been suggested that the mechanical obstruction caused by the hematic cylinders and/or their toxicity on tubular cells could play a very important pathogenic role. The most significant events that drew our attention in this case was the intensity of hematuria and its prolonged duration, the degree of renal failure, and the subsequent recovery of the renal function.

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          The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering.

          In the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT), a 19% lower incidence of coronary heart disease (CHD) in cholestyramine-treated men was accompanied by mean falls of 8% and 12% in plasma total (TOTAL-C) and low-density lipoprotein (LDL-C) cholesterol levels relative to levels in placebo-treated men. When the cholestyramine treatment group was analyzed separately, a 19% reduction in CHD risk was also associated with each decrement of 8% in TOTAL-C or 11% in LDL-C levels (P less than .001). Moreover, CHD incidence in men sustaining a fall of 25% in TOTAL-C or 35% in LDL-C levels, typical responses to the prescribed dosage (24 g/day) of cholestyramine resin, was half that of men who remained at pretreatment levels. Adherence to medication was associated with reduced incidence of CHD only when accompanied by falls in TOTAL-C and LDL-C levels. Small increases in high-density lipoprotein cholesterol levels, which accompanied cholestyramine treatment, independently accounted for a 2% reduction in CHD risk. Thus, the reduction of CHD incidence in the cholestyramine group seems to have been mediated chiefly by reduction of TOTAL-C and LDL-C levels.
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            Acute worsening of renal function during episodes of macroscopic hematuria in IgA nephropathy.

            The appearance of renal failure during episodes of macroscopic hematuria (EMH) in IgA nephropathy (IgAN) has been described as very unusual. The results of a prospective investigation on the effect of EMH on renal function in IgAN are presented. During a 3-year period, 29 episodes of EMH occurring in 21 patients with IgAN have been studied. A derangement of renal function (increase of serum creatinine by more than 0.5 mg/dl) was observed in 11 episodes (37.9%) with peak creatinine values ranging from 1.2 to 6.7 mg/dl. The worsening of renal function was accompanied by a longer duration of EMH (4.8 +/- 1.3 vs. 3.5 +/- 1.5 days; P less than 0.05) but not by arterial hypertension or edema. A complete recovery of renal function was observed in every patient 1 to 2 months after the start of EMH. The histological survey disclosed that the decrease of renal function correlated closely with the presence of red blood cell casts in as much as 50% of the tubular lumen and with findings of tubular necrosis. We conclude that a worsening of renal function can be observed frequently during the EMH. Tubular damage and obstruction by red blood cell casts may play a significant role in the pathogenesis of this complication.
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              Macroscopic hematuria in mesangial IgA nephropathy: correlation with glomerular crescents and renal dysfunction.

              One hundred and eighty-six renal biopsy specimens from 79 adult patients with mesangial IgA nephropathy were examined and correlated with clinical data at the time of biopsy. Forty patients (group 1) with a history of macroscopic hematuria were compared with 39 patients (group 2) without such a history. Group 1 patients had a higher serum creatinine, 240 +/- 20 mumoles/liter vs. 140 +/- 10 mumoles/liter (P less than 0.01), lower creatinine clearance 69 +/- 36 ml/min vs. 87 +/- 30 ml/min (P less than 0.05), and a higher percentage of patients presenting with serum creatinine greater than 300 mumoles/liter, 22.5% vs. 5.1% (P less than 0.05). Fourteen biopsies were performed in 11 patients during an episode of macroscopic hematuria (group 1A). One hundred percent of these biopsy specimens showed crescents. Ninety-one percent of 11 biopsy specimens from ten patients (group 1B), taken 3 to 27 days following an episode but at a time when urinary red cells were less than 1,000,000/ml, also showed crescent formation. Of 14 biopsy specimens from 13 patients without macroscopic hematuria, but with greater than 1,000,000 red cells/ml in the urine just prior to biopsy (group 2A), 79% had crescents. In conclusion, macroscopic hematuria in adult patients with mesangial IgA nephropathy is associated with a high likelihood of crescents on renal biopsy specimens and worse renal function. Careful quantitative assessment of the urine for renal bleeding may help to better define the activity of disease in these patients.

                Author and article information

                Revista Cubana de Medicina
                Rev. Cuban de Med
                Centro Nacional de Información de Ciencias Médicas; Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                August 1996
                : 35
                : 2
                : 136-139
                [01] Ciudad de La Habana orgnameInstituto Superior Medicina Militar Luis Díaz Soto Cuba
                S0034-75231996000200008 S0034-7523(96)03500208

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                : 22 November 1995
                : 24 January 1996
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 4

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