Justine Huart

IgG4-related membranous glomerulonephritis and generalized lymphadenopathy without pancreatitis: a case report

BackgroundIgG4-related disease is a recently described pathologic entity. This is the case of a patient with nephrotic syndrome and lymphadenopathy due to IgG4-related disease. Such a kidney involvement is quite peculiar and has only been described a few times recently. Renal biopsy showed a glomerular involvement with membranous glomerulonephritis in association with a tubulo-interstitial nephropathy. Moreover, the patient was not suffering from pancreatitis.Case presentationThe patient is a middle-aged man of Moroccan origin. He has developed recurrent episodes of diffuse lymphadenopathies, renal failure and nephrotic syndrome. Renal biopsies showed membranous glomerulonephritis.Discussion and conclusionThe diagnostic approach of this atypical presentation is discussed in this case report as well as diagnostic criteria, therapeutic strategies, biomarkers and pathophysiology of IgG4-related disease. IgG4-related membranous glomerulonephritis is a well-established cause of membranous glomerulonephritis. It must be sought after in every patient with a previous diagnosis of IgG4-related disease and in every patient with this histological finding on renal biopsy. Corticoids are still the first-line treatment of IgG4-related disease. New therapeutic strategies are needed to avoid glucocorticoids long term side-effects. Interestingly, the patient was prescribed cyclophosphamide in addition to glucocorticoids for an immune thrombocytopenia. This treatment had a very good impact on his IgG4-related disease.

Genetic susceptibility to delayed graft function following kidney transplantation: a systematic review of the literature

Abstract Delayed graft function (DGF) is defined as the need for dialysis within 7 days following kidney transplantation (KTx). DGF is associated with increased costs, higher risk for acute rejection and decreased long-term graft function. Renal ischaemia/reperfusion (I/R) injury plays a major role in DGF occurrence. Single nucleotide polymorphisms (SNPs) in certain genes may aggravate kidney susceptibility to I/R injury, thereby worsening post-transplant outcomes. The present article proposes an extensive review of the literature about the putative impact of donor or recipient SNPs on DGF occurrence in kidney transplant recipients (KTRs). Among 30 relevant PubMed reports, 16 articles identified an association between 18 SNPs and DGF. These polymorphisms concern 14 different well-known genes and one not-yet-identified gene located on chromosome 18. They have been categorized into five groups according to the role of the corresponding proteins in I/R cascade: (i) oxidative stress, (ii) telomere shortening, (iii) chemokines, (iv) T-cell homeostasis and (v) metabolism of anti-inflammatory molecules. The remaining 14 studies failed to demonstrate any association between the studied SNPs and the occurrence of DGF. A better understanding of the genetic susceptibility to renal I/R injury may help prevent DGF and improve clinical outcomes in KTRs.

Erratum: Elevated basal levels of circulating activated platelets predict ICU-acquired sepsis and mortality: a prospective study.

Platelets are now considered to be immune and inflammatory agents as well as key cells in coagulation, and as such have been implicated in the pathophysiology of sepsis [1]. Thrombocytopenia is associated with sepsis severity and poor prognosis, and hyperactivated platelets probably contribute to microvascular thrombosis and organ failure. In the present study, we evaluated platelet activation markers as potential predictive markers of sepsis and of mortality among four commonly encountered populations of patients admitted to ICUs.

Erratum: Prospective immune profiling in critically ill adults: before, during and after severe sepsis and septic shock.

Author details Department of General Intensive Care, University Hospital Centre of Liege, Domaine Sart-Tilman B35, Liege 4000, Belgium. GIGA-Cardiovascular Sciences, Laboratory of Thrombosis and Hemostasis, University of Liege, Domaine Sart-Tilman B35, 4000 Liege, Belgium. CHU de Liege, Domaine Sart-Tilman B35, 4000 Liege, Belgium. Laboratory Hematology, University Hospital Centre of Liege, Liege, Belgium. Systems and Modeling, Department of Electrical Engineering and Computer Science and GIGA-R, University of Liege, Domaine Sart-Tilman B35, 4000 Liege, Belgium. Reference 1. Layios N. Prospective immune profiling in critically ill adults: before, during and after severe sepsis and septic shock. Crit Care. 2015;19(Suppl 1):P43.