Protected: La biopsia renale nell’anziano

Abstract

La biopsia renale e l’esame istologico permettono una corretta diagnosi  e un adeguato trattamento di numerose malattie renali acute e croniche. Sebbene la tecnica della biopsia renale percutanea  sia stata migliorata dall’utilizzo di guida ecografica e di aghi automatici, essa resta ancora sottoutilizzata soprattutto nella popolazione anziana e nelle patologie associate quale il diabete mellito. Le indicazioni più frequenti nei vari studi su pazienti anziani sono rappresentate dal danno renale acuto e dalla sindrome nefrosica; le diagnosi più frequenti sono patologie suscettibili di terapie specifiche e mirate, quali  vasculiti, amiloidosi e nefropatia membranosa. Per quanto concerne il diabete mellito, non sempre la diagnosi istologica è rappresentata dalla tipica nefropatia diabetica, ma spesso possono essere presenti quadri di glomerulonefrite che possono giovarsi di terapie immunosoppressive. La stessa nefropatia diabetica presenta varie classi che hanno un forte impatto sull’outcome clinico della insufficienza renale terminale. Sebbene la biopsia renale non sia totalmente scevra di pericoli, alcune revisioni  sistematiche e studi di registro hanno mostrato che le complicanze emorragiche maggiori, quali macroematuria e necessità di emotrasfusione, sono rare e che l’età anagrafica non costituisce un fattore predittivo del rischio emorragico.

 

PAROLE CHIAVE: Biopsia renale, anziano, complicanze emorragiche.

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Monoclonal gammopathy of renal significance and membranoproliferative glomerulonephritis: a complex relationship with promising therapeutic opportunities

Abstract

In the last few years, the increasing awareness of the complex interaction between monoclonal component and renal damage has determined not only a new classification of the associated disorders, called Monoclonal Gammopathy of Renal Significance (MGRS), but has also contributed to emphasize the importance of an early diagnosis of the renal involvement, which is often hard to detect but can evolve towards terminal uraemia; it has also pointed at the need to treat these disorders  with aggressive regimens, even if they are not strictly neoplastic.

The case described here presented urinary abnormalities and renal failure secondary to a membranoproliferative glomerulonephritis (MPGN), with intensively positive immunofluorescence (IF) for monoclonal k light chain and C3, and in the absence of a neoplastic lympho-proliferative disorder documented on bone marrow biopsy. After the final diagnosis of MGRS, the patient was treated with several cycles of a therapy including dexamethasone, cyclophosphamide and bortezomib, showing a good functional and clinical response.

 

Keywords: monoclonal gammopathy of renal significance, membranoproliferative glomerulonephritis, kidney biopsy

Sorry, this entry is only available in Italian.

An unusual presentation of Amyloidosis AL

Abstract

We describe the case of a 74-year-old man admitted to our Nephrology Unit with nephrotic syndrome and mild kidney disease. A complete panel of laboratoristic and instrumental tests did not provide useful information for diagnosis. No specific signs or symptoms suggested the presence of AL amyloidosis. As a matter of fact, diagnosis was reached thanks to the hystopathologic examination of renal tissue and bone marrow, since the associated B-cell lymphoproliferative disorder had not revealed itself through serum and urine electrophoresis and immunofixation. This recent case provides the opportunity to review about the disease and to revaluate the renal biopsy as a first line exam in a clinical context where laboratoristic and instrumental tests offer us poor information.

Keywords: AL amyloidosis, bortezomib, renal biopsy

Sorry, this entry is only available in Italian.

Long-term outcome of renal function in women with preeclampia and pregestational diabetes

Abstract

Pre-eclampsia (PE) is an important cause of acute renal failure and an important risk marker for subsequent chronic kidney disease.
In normal pregnancy, there are marked changes in the renin-angiotensin system (RAS) including considerably elevated angiotensin II (ang II) levels. However, vascular resistance decreases markedly during normal pregnancy, suggesting that pregnant individuals are less sensitive to ang II than non-pregnant individuals. In contrast, decreased circulating components of the RAS with enhanced sensitivity to ang II infusion have been
reported during PE.
Patients with a history of PE have an increased risk of microalbuminuria with a prevalence similar to that of subjects with type 1 diabetes mellitus.
Women with gestational or chronic hypertension have a higher risk of end-stage renal disease (ESRD) vs. normotensive ones, but the risk is much greater for women who had PE or eclampsia than those who had gestational hypertension only.
A previous episode of PE should suggest long-term follow-up, especially with respect to hypertension and microalbuminuria within 6–8 weeks of delivery, and should require a nephrological consult if these disorders do not resolve. Pregestational diabetes was also associated with long-term increased risk of ESRD and death.
Lastly, women who have PE and give birth to offspring with low birth weight and short gestation have a substantially increased risk for having a later kidney biopsy.
For all these reasons, short and long-term evaluation of kidney function should be suggested in women with previous complicated pregnancy.

KEYWORDS: Preeclampsia, microalbuminuria, end-stage renal disease, renal biopsy, pregestational diabetes.

Sorry, this entry is only available in Italian.

Gross Hematuria after kidney biopsy. A case report

Abstract

We describe the clinical case of a patient experiencing severe gross hematuria causing clotting in the renal pelvis, after undergoing a kidney biopsy.The ecocolordopper and CT angiography performed did not reveal the cause of hematuria.The kidney arteriography allowed the diagnosis, revealing an arteriovenous fistula responsible for bleeding together with a small false aneurysm in the lower pole of the biopsied kidney. Both lesions were successfully treated with superselective embolization with microcoils.
We discuss about the diagnostic and therapeutic approach of these rare post-biopsy complications briefly focusing on the technical aspects and on possible risks that the transcatheter embolotherapy may result.

Key Words: embolization, microcoils, arteriovenous fistula, pseudoaneurysm, renal biopsy

Sorry, this entry is only available in Italian.