Antiphosphlipid Syndrome Presented with Renovascular Hypertension |
Author : Savas Ozturk, Mukremin Uysal, Fulya Cosan, Banu Buyukaydin*, Murat Inanc, Reyhan Diz-Kucukkaya, Isin Kilicarslan, Aydin Turkmen, Rumeyza Kazancioglu |
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Abstract :Renovascular pathologies are one of the treatable causes of hypertension. Antiphospholipid syndrome develops owing to a heterogeneous group of antiphospholipid antibodies which causes various thrombotic problems. This entity may effects very small vessels and sometimes leads to hypertension. We present a 55-year-old female with unilateral renal artery stent implantation because of renovascular hypertension. After application, a re-stenosis developed and in-stent angioplasty was performed, but it was required a nephrectomy because of haemorrhage. Severe ischemic nephropathy was detected in the nephrectomy material. She was diagnosed with antiphospholipid syndrome. Prolonged prothrombin time with hemorrhagic diathesis which coexisting thrombosis responded steroid therapy. But in follow-up, the thrombocytopenia developed, the patient could not recieve anticoagulant therapy and died due to a pulmonary embolism-like syndrome. This case reminds, renovascular hypertension is one of the major reasons of secondary hypertension and antiphospholipid syndrome always should be considered in thrombotic processes.
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Rapidly Progressive Glomerulonephritis Associated with Systemic Lupus Erythematosus |
Author : Jastrzebska K*, Gozdowska J, Perkowska-Ptasinska A and Durlik M |
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Abstract :Lupus nephritis is a frequent manifestation of multisystem autoimmune disease - Systemic Lupus Erythematosus and a significant cause of both acute renal injury and the end stage renal disease. Renal involvement is observed in approximately 60% of patients with SLE. We report a case of crescentic glomerulonephritis in a previously healthy 21-year old man who showed signs of insidious symptoms (lower limbs and facial mild edema) in February 2011 and within a brief period developed such clinical features as fever, nausea, vomiting, headache, loin pain, hematuria, oliguria and hypertension. Rapidly worsening renal function became an important determinant of renal failure therefore hemodialysis therapy was introduced. Conducted immunological tests showed an elevated level of antinuclear antibodies and antibodies to dsDNA as well as low complement (C3, C4) levels. The diagnosis of rapidly progressive glomerulonephritis in the background of diffuse glomerulonephritis with crescent formation was confirmed by the presence of pathological features in a renal biopsy. In addition to hemodialysis, treatment with steroids (methylprednisolone) and immunosuppressive agents (cyclophosphamide) was applied.The therapy resulted in slow but successful clinical improvement. After two months of treatment there was a recovery of renal function and the patient became dialysis independent. Maintenance therapy has been continued for about 4 years. The serum creatinine level is about 1.2 mg/dL, without proteinuria. Crescentic glomerulonephritis in the course of SLE correlated with unfavorable prognosis and therefore must be treated promptly to prevent irreversible kidney injury. This case illustrates the potential of long-term high-dose immunotherapy in the treatment of RPGN in the course of SLE.
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Estimate and Evaluation of Drug Nephrotoxicity Caused with Most Used Medicals in Patients with Rheumathoid Arthritis |
Author : Dejan Spasovski* |
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Abstract :Aim: To estimate the effect of initial therapy with Paracetamol (Acetaminophenum) and nonsteroidal anti-inflamatory drugs (Ketoprofenum) on glomerular and tubular integrity in patients with Rheumatoid arthritis (RA), to quantify toxicity of these drugs through measurements of the enzyme excretion that correlates with the damage degree on the tubular epithelium. Microalbuminuria is used as marker for glomerular damage, and the urinary excretion of N-Acetyl-ß-D-glucozaminidase (NAG) as an indicator of proximal tubular damage. To determine if there is a change in the clinical indicators of renal function (serum urea and creatinine, urine urea and creatinine, glomerular filtration rate - GFR) in the course of disease and if that change correlates with the dynamics of the quantity of excreted enzymes in urine, reactants of the acute pfase and index of disease activity (DAS28).
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ANCA-Associated Vasculitis in Patient with CREST-Syndrome - Case Report |
Author : Zakharova EV*, Makarova TA and Stolyarevich ES |
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Abstract :Background: ANCA-associated vasculitis is a small vessel necrotizing vasculitis with few or no immune deposits, necrotizing glomerulonephritis is very common in the microscopic poliangiitis subset. Systemic scleroderma renal involvement is included neither in the current classification criteria, nor in the definition of CREST-syndrome. The presence of ANCA in patients with SS was first described in 1996, and since that has been reported to be rare and not presenting clinical significance. However during next decade about 50 cases with association of SS and AAV were described, and more recently, additional cases were reported and the clinical features of such association were recognized.
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Some Aspects of the Evaluation of Brush Border Enzymuria Originating from Proximal Renal Tubules as Screening Test in Patients with Psoriatic Arthritis |
Author : Dejan Spasovski* |
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Abstract :Aim: To compare diagnostic values and laboratory variables of alanine - aminopeptidase (microsomale AAP), ?-glutamyl transferase (?-GT),ß2-microglobuline (ß2-M), C Reactive Protein (CRP) and index for disease activity (PASI) in early diagnosis in previously untreated Psoriatic arthritis (Psa). To determine the effect of untreated Psoriatic arthritis on tubular function, sensitivity of the Brush Border region as well as the diagnostic value of the enzymes originating from proximal renal tubules.
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Illness Perception and Hopelessness in Hemodialysis |
Author : Mukadder Mollaoglu*, Ferhan Candan and Muratcan Mollaogl |
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Abstract :Background: Illness perception is useful in understanding the impact of hopelessness on ESRD patients. This perception has been found to be an important determinant of behavior and has been associated with a number of important outcomes such as treatment adherence and functional recovery and quality of life. Aim: The aims of this study were to determine, the level of hopelessness and to evaluate whether illness perception is related to hopelessness among End-stage Renal Disease (ESRD) patients on hemodialysis (HD).
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