Lectícia B. Jorge

Urothelial carcinoma transmission via kidney transplantation

Transmission of urothelial carcinoma via solid organ transplant has never been reported in the literature to our knowledge. We report a case of transmission of this tumour to a kidney recipient. The donor was a 37-year-old woman, victim of a subarachnoid haemorrhage. The recipient was a 21-year-old girl, with a history of chronic kidney disease secondary to neurogenic bladder. This fatality has been rarely described in literature, but never with this histological type of cancer. Nowadays, with the expanded criteria for donation, older people are accepted as donor because of the shortage of organs. However, this may increase the likelihood of the number of cancer transmission.

Schistosoma mansoni and membranous nephropathy

Figure 2 | Ultrastructural findings showing glomerular capillaries with subepithelial and intramembranous electron-dense deposits besides intervening projections (spikes) regularly distributed on the glomerular basement membrane. Original magnification 8000. A 53-year-old Brazilian man presented with lower limb edema that progressed to anasarca. He had no personal or family history of renal disease. Laboratory tests revealed urea level, 35 mg/dl; hemoglobin value, 9.8 g/dl; leukocyte count, 7500/mm; platelet count, 204,000/mm; serum albumin level, 1.2 g/dl; total cholesterol level, 239 mg/dl; and low-density lipoprotein cholesterol level, 92 mg/dl. Urinalysis showed no leukocyturia or hematuria; the 24-hour urinary protein level was 19.7 g. Serum complement levels were normal. Autoantibody testing and serologic test results were negative for hepatitis B, hepatitis C, and HIV. Light microscopy in a renal biopsy sample revealed mesangial hypercellularity, diffuse chain-like thickening with some spikes of the basement membrane, and interstitial lymphocytes (Supplementary Figure S1 online). A foreign body giant cell reaction was seen around an elliptical structure with a lateral spicule, consistent with a Schistosoma mansoni egg (Figure 1). Immunofluorescence showed granular deposits of IgG, IgA, IgM, C1q, C3, kappa, and lambda in the glomerular capillary loop. The pathologic diagnosis was of stage III membranous nephropathy (Figure 2) with tubulointerstitial

Worse renal outcome of subclass IV-G lupus nephritis patients over IV-S

Background International Society of Nephrology/ Renal Pathology Society (ISN/RPS) consensus on the classification of lupus nephritis (LN) subdivided class IV into diffuse segmental (IV-S) and diffuse global (IV-G). Nephrologists and nephropathologists believe that this subclassification would be clinically relevant based on hypothetical distinct immunopathogenesis of those subclasses guiding therapy as well as judging prognosis. Methods All adult patients with a renal biopsy-confirmed diagnosis of LN class IV undergoing regular follow-up in the Nephrology Division between January 2004 and December 2014 were enrolled excluding those with diabetes, hepatitis B, hepatitis C, HIV as well as those with insufficient clinical and hystopathological data. Biopsies were reviewed and reclassified according to ISN/RPS 2003 classification by two experienced pathologists and were examined by light microscopy and direct immunofluorescence. Results On baseline subclass IV-G compared to IV-S showed higher frequency of males and histologically higher activity (7.5 ± 2.8 vs 5.1 ± 2.3, p = 0.004) and chronicity index (3.4 ± 1.6 vs 2.4 ± 1.8, p = 0.016) as well as a higher percentage of epithelial crescents (12.9 vs 5.1, p = 0.0001) and vessel abnormalities (72% vs 42%, p = 0.017). Although renal function on baseline was not different between subclasses, IV-G showed lower levels, although not significant, of estimated glomerular filtration based on CKD-EPI formula (91.0 ± 34.8 vs 64.4 ± 44.5, p = 0.059) at the end of follow-up. In addition, we observed a higher rate of patients reaching CKD-EPI under 60 mL/min/1.73 m2 in subclass IV-G over IV-S on last follow-up. Conclusion Subclasses IV-S and IV-G patients show some clinical and pathological differences that might represent distinct stages of the same disease and they should thus be treated the same.

Chronic Nicotine Exposure Reduces Klotho Expression And Triggers Different Renal And Hemodynamic Responses In Klotho-Haploinsufficient Mice

The klotho gene, which encodes a single-pass transmembrane protein and a secreted protein, is expressed predominantly by the distal renal tubules and is related to calcium phosphorus metabolism, ion channel regulation, intracellular signaling pathways, and longevity. Klotho deficiency aggravates acute kidney injury and renal fibrosis. Exposure to nicotine also worsens kidney injury. Here, we investigated renal Klotho protein expression in a mouse model of chronic (28-day) nicotine exposure, in which mice received nicotine or vehicle (saccharine) in drinking water, comparing wild-type (WT) mice, klotho-haploinsufficient ( kl/+) mice, and their respective controls, in terms of the effects of that exposure. Nicotine exposure was associated with a significant decline in renal Klotho expression in WT and kl/+ mice as well as a reduction in the glomerular filtration rate in WT mice. Although plasma electrolytes were similar among the groups, fractional excretion of sodium was reduced in both nicotine-exposed groups. The nicotine-WT mice presented augmented baroreflex sensitivity to nitroprusside and augmented sympathetic cardiac modulation. However, nicotine- kl/+ mice presented higher plasma levels of urea and aldosterone together with a higher α-index (spontaneous baroreflex) and higher peripheral sympathetic modulation, as evaluated by spectral analysis. We can conclude that nicotine downregulates Klotho expression as well as that renal and autonomic responses to nicotine exposure are modified in kl/+ mice.

Female Patient with Alport Syndrome and Concomitant Membranous Nephropathy: Susceptibility or Association of Two Diseases

Alport syndrome (AS) is a disorder of collagen IV, a component of glomerular basement membrane (GBM). The association of AS and immunocomplex nephropathies is uncommon. This is a case of a 37-year-old woman with family history of X-linked AS, including 4 affected sons. This patient developed full-blown nephrotic syndrome along a 3-month period, a presentation not consistent with AS progression. This scenario suggested an alternative diagnosis. A kidney biopsy was therefore performed, showing membranous nephropathy (MN) in addition to GBM structural alterations compatible with AS. Whole exome sequencing also confirmed the diagnosis of X-linked AS, revealing a heterozygous pathogenic mutation in COL4A5. While a negative serum anti-phospholipase A2 receptor did not rule out a primary form of MN, it was also uncertain whether positive serologic tests for syphilis could represent a secondary factor. It is currently unknown whether this unusual association represents AS susceptibility to immunocomplex-mediated diseases or simply an association of 2 disorders.

Clinical and histological features of patients with membranoproliferative glomerulonephritis classified by immunofluorescence findings

BACKGROUND New classification for membranoproliferative glomerulonephritis has been proposed in the literature. The aim of this study was to compare the clinical, biochemical, etiology and renal biopsy findings of these patients grouped by immunofluorescence as proposed by the new classification. METHODS Patients with renal biopsy-proven membranoproliferative glomerulonephritis unrelated to systemic lupus erythematosus, diagnosed between 1999 and 2014. The patients were divided according to immunofluorescence: Immunoglobulin positive group, C3 positive only and negative immunofluorescence group. RESULTS We evaluated 92 patients, the majority of which were in the immunoglobulin positive group. Infectious diseases, hepatitis C virus and schistosomiasis, were the most frequent etiology. A negative immunofluorescence group had more vascular involvement in renal biopsy compare with others groups. CONCLUSIONS The only difference between the groups was higher vascular involvement in renal biopsy in negative immunofluorescence group. These new classification was satisfactory for the finding of etiology in one part of the cases.