scholarly journals Rapidly progressive glomerulonephritis in children

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Khemchand N Moorani ◽  
Madiha Aziz ◽  
Farhana Amanullah
Keyword(s):  
Immune Complex ◽  
Search Strategy ◽  
Rapid Development ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Good Prognosis ◽  
Cochrane Library

Rapidly progressive glomerulonephritis (RPGN), characterized by a rapid development of nephritis with loss of kidney function in days or weeks, is typically associated histologically, with crescents in most glomeruli; and is a challenging problem, particularly in low resource settings. RPGN is a diagnostic and therapeutic emergency requiring prompt evaluation and treatment to prevent poor outcomes. Histopathologically, RPGN consists of four major categories, anti-glomerular basement membrane (GBM) disease, immune complex mediated, pauci-immune disorders and idiopathic /overlap disorders. Clinical manifestations include gross hematuria, proteinuria, oliguria, hypertension and edema. Diagnostic evaluation, including renal function tests, electrolytes, urinalysis/microscopy and serology including (anti GBM antibody, antineutrophil cytoplasmic antibody (ANCA)) starts simultaneously with management. An urgent renal biopsy is required to allow specific pathologic diagnosis as well as to assess disease activity and chronicity to guide specific treatment. The current guidelines for management of pediatric RPGN are adopted from adult experience and consist of induction and maintenance therapy. Aggressive combination immunosuppression has markedly improved outcomes, however, nephrotic syndrome, severe acute kidney injury requiring dialysis, presence of fibrous crescents and chronicity are predictors of poor renal survival. RPGN associated post infectious glomerulonephritis (PIGN) usually has good prognosis in children without immunosuppression whereas immune-complex-mediated GN and lupus nephritis (LN) are associated with poor prognosis with  development of end stage kidney disease (ESKD) in more than 50% and 30% respectively. Given the need for prompt diagnosis and urgent treatment to avoid devastating outcomes, we conducted a review of the latest evidence in RPGN management to help formulate clinical practice guidance for children in our setting.Information sources and search strategy: The search strategy was performed in the digital databases of PubMed, Cochrane Library, google scholar, from their inception dates to December 2020. Three investigators independently performed a systematic search using the following search terms “Rapidly progressive glomerulonephritis” “children” “crescentic glomerulonephritis” “management” at the same time, backtracking search for references of related literature. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5774 How to cite this:Moorani KN, Aziz M, Amanullah F. Rapidly progressive glomerulonephritis in children. Pak J Med Sci. 2022;38(2):417-425.   doi: https://doi.org/10.12669/pjms.38.ICON-2022.5774 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals ANCA-Associated Glomerulonephritis and Anti-Phospholipid Syndrome in a Patient with SARS-CoV-2 Infection: Just a Coincidence?

2021 ◽  
pp. 214-220
Author(s):  
Federica Maritati ◽  
Maria Ilaria Moretti ◽  
Valentina Nastasi ◽  
Roberta Mazzucchelli ◽  
Manrico Morroni ◽  
...  
Keyword(s):  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Hemodynamic Instability ◽  
Tubular Necrosis ◽  
Complex Processes ◽  
Anca Associated Vasculitis ◽  
High Incidence ◽  
New Diagnosis ◽  
The Relationship

Many reports have described a high incidence of acute kidney injury (AKI) among patients with COVID-19. Acute tubular necrosis has been reported to be the most common damage in these patients, probably due to hemodynamic instability. However, other complex processes may be involved, related to the cytokine storm and the activation of innate and adaptive immunity. Here, we describe a patient who developed an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with rapidly progressive glomerulonephritis and lung involvement and an antiphospholipid syndrome soon after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After viral pneumonia was excluded by bronchoalveolar lavage, the patient has been treated with rituximab for amelioration of kidney function and resolution of thrombosis without any adverse event. We conclude that COVID-19 may trigger autoimmune diseases including ANCA-associated vasculitis. Thus, this diagnosis should be taken in consideration in COVID-19 patients, especially when they develop AKI with active urinary sediment. In addition, considering the relationship between these 2 diseases, SARS-CoV-2 infection should be excluded in all patients with a new diagnosis ANCA-associated vasculitis before starting immunosuppressive therapy.

scholarly journals The Health Implication of Enterohaemorrhagic Escherichia coli (EHEC) 0157:H7: A Review on Haemolytic Uraemic Syndrome

2019 ◽  
pp. 1-10
Author(s):  
Onengiyeofori Ibama ◽  
Edna O. Ibegbulem ◽  
Donatus Onwuli ◽  
Adline Ben-Chioma
Keyword(s):  
Escherichia Coli ◽  
Haemolytic Anaemia ◽  
Bacterial Strain ◽  
Haemolytic Uraemic Syndrome ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Electrolyte Imbalance ◽  
Health Concern ◽  
Enterohaemorrhagic Escherichia Coli

Consumption of foods, water, vegetables, fruits, undercooked/ground/raw meat, unpasteurized milk or milk products contaminated with the bacterium strain Escherichia coli 0157:H7 has become a serious public health concern. This strain naturally inhabits the digestive tract of healthy cattle, and is released into the environment through the faeces of the animal. This strain cause haemorrhagic enterocolitis or gastroenteritis, and then haemolytic uraemic syndrome (HUS). HUS is a disorder characterised by haemolytic anaemia, low platelet count and acute kidney failure, and this disorder is a consequence of the production and action of Shiga-like toxin produced mainly by this bacterial strain (accounting for 90 percent of all cases), and occurs mainly in children less than five (5) years of age, but also occurs in the elderly. After infection with this bacterial strain, the disorder begins with intestinal perforation and ulceration leading to bloody diarrhoea, and consequently acute kidney injury, thrombocytopenia and microangiopathic haemolytic anaemia. In conjunction with clinical manifestations, several laboratory investigations (haematological, biochemical and microbiological assays) are implicated in the diagnosis of HUS. There is currently no specific treatment for HUS; however, supportive care (such as treatment of hypertension, fluid and electrolyte imbalance, haemodialysis, blood transfusion, etc) happens to be the only ameliorative measure for this disorder.

scholarly journals Acute tubulointerstitial nephritis associated with antineutrophil cytoplasmic antibody following cimetidine treatment: a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keita Morimoto ◽  
Go Kanzaki ◽  
Takahito Niikura ◽  
Kentaro Koike ◽  
Nanae Matsuo ◽  
...  
Keyword(s):  
Tubulointerstitial Nephritis ◽  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Oral Steroid ◽  
Lymphocyte Stimulation Test ◽  
Drug Induced ◽  
Acute Tubulointerstitial Nephritis ◽  
Cimetidine Treatment ◽  
Glomerular Lesions

Abstract Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis usually induces rapidly progressive glomerulonephritis, including pauci-immune necrotizing crescentic glomerulonephritis. Acute tubulointerstitial nephritis (ATIN), which is often drug-induced, is a frequent cause of kidney injury. However, ATIN associated with ANCA without any glomerular lesions has been rarely reported, and drug-induced ATIN associated with ANCA is not well recognized. Here we present a case of an older woman with ATIN associated with myeloperoxidase-ANCA (MPO-ANCA) following cimetidine treatment. Case presentation A 70-year-old woman was admitted to our hospital due to acute kidney injury and mild proteinuria. She had a one-year history of chronic thyroiditis and dyslipidemia, for which she was taking levothyroxine sodium and atorvastatin, respectively. Two weeks before admission she had started cimetidine, methylmethionine sulfonium chloride, and itopride hydrochloride for gastric discomfort persistent since a month. She had experienced fatigue for two weeks and later appetite loss. The patient demonstrated a positive titer for MPO-ANCA (192 IU/mL) and a positive drug-induced lymphocyte stimulation test for cimetidine. She underwent two kidney biopsies that revealed ATIN without any glomerular lesions. Despite discontinuation of cimetidine on admission, renal injury continued with the presence of high MPO-ANCA titer. Oral steroid treatment was closely related with the recovery of her renal function and disappearance of MPO-ANCA. Conclusions In this case, ATIN presented as sustained renal insufficiency and high MPO-ANCA titer despite withdrawal of cimetidine. Therefore, we reason that the development of ANCA-associated ATIN was caused by cimetidine. Serologic follow-up with measurement of MPO-ANCA titers and renal biopsy are recommended when the clinical history is inconsistent with the relatively benign course of drug-induced ATIN.

scholarly journals Use of Antioxidants for the Neuro-Therapeutic Management of COVID-19

Antioxidants ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 971
Author(s):  
Noemí Cárdenas-Rodríguez ◽  
Cindy Bandala ◽  
América Vanoye-Carlo ◽  
Iván Ignacio-Mejía ◽  
Saúl Gómez-Manzo ◽  
...  
Keyword(s):  
Neuromuscular Junctions ◽  
Cardiac Injury ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Systemic Complications ◽  
The Central Nervous System ◽  
Brain Tissue Damage

Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is an emergent infectious disease that has caused millions of deaths throughout the world. COVID-19 infection’s main symptoms are fever, cough, fatigue, and neurological manifestations such as headache, myalgias, anosmia, ageusia, impaired consciousness, seizures, and even neuromuscular junctions’ disorders. In addition, it is known that this disease causes a series of systemic complications such as adverse respiratory distress syndrome, cardiac injury, acute kidney injury, and liver dysfunction. Due to the neurological symptoms associated with COVID-19, damage in the central nervous system has been suggested as well as the neuroinvasive potential of SARS-CoV-2. It is known that CoV infections are associated with an inflammation process related to the imbalance of the antioxidant system; cellular changes caused by oxidative stress contribute to brain tissue damage. Although anti-COVID-19 vaccines are under development, there is no specific treatment for COVID-19 and its clinical manifestations and complications; only supportive treatments with immunomodulators, anti-vascular endothelial growth factors, modulating drugs, statins, or nutritional supplements have been used. In the present work, we analyzed the potential of antioxidants as adjuvants for the treatment of COVID-19 and specifically their possible role in preventing or decreasing the neurological manifestations and neurological complications present in the disease.

scholarly journals Acute renal failure

2002 ◽  
Vol 1 (2) ◽  
pp. 15-23
Author(s):  
Paul A Glynne ◽  
◽  
Liz Lightstone ◽  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Urinary Tract Obstruction ◽  
Specific Treatment ◽  
Rapidly Progressive Glomerulonephritis ◽  
Good Prognosis ◽  
Early Referral ◽  
Risk Patients ◽  
Life Threatening ◽  
Nephrotoxic Drugs

The majority of cases of acute renal failure (ARF)occur in hospital, most commonly due to acute tubule necrosis caused by multiple nephrotoxic insults, particularly hypovolaemia, hypotension and nephrotoxic drugs. In- hospital ARF carries a high mortality rate, and every attempt should be made to identify at-risk patients and prevent its development by suitable hydration and avoidance of nephrotoxins. Out-of-hospital ARF typically presents as single organ disease, and, if the cause is readily identified and treated, often carries a good prognosis. ARF diagnoses that require specific treatment, particularly urinary tract obstruction and rapidly progressive glomerulonephritis,must not be missed. The immediate priority for all patients with ARF is to make them safe from potentially life-threatening metabolic sequelae, with early referral to a nephrologist in case acute dialysis becomes necessary.

Methods for Reducing Contrast Use and Avoiding Acute Kidney Injury During Endovascular Procedures

2020 ◽  
Vol 25 (44) ◽  
pp. 4648-4655 ◽  
Author(s):  
Chrysovalantis Vergadis ◽  
Georgios Festas ◽  
Eleni Spathi ◽  
Paris Pappas ◽  
Stavros Spiliopoulos
Keyword(s):  
Acute Kidney Injury ◽  
Endovascular Procedures ◽  
Rapid Development ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Iodinated Contrast ◽  
Risk Patients ◽  
Prevention Methods

: Iodinated Contrast Media (CM) has a plethora of applications in routine non-invasive or percutaneous invasive imaging examinations and therapeutic interventions. Unfortunately, the use of CM is not without complications, with contrast-induced acute kidney injury (CI-AKI) being among the most severe. : CI-AKI is a syndrome defined as a rapid development of renal impairment after a few days of CM endovascular injection, without the presence of any other underlying related pathologies. Although mostly transient and reversible, for a subgroup of patients with comorbidities related to renal failure, CI-AKI is directly leading to longer hospitalization, elevated rates of morbidity and mortality, as well as the increased cost of funding. : Thus, a need for classification in accordance with clinical and peri-procedural criteria is emerged. This would be very useful for CI-AKI patients in order to predict the ones who would have the greatest advantage from the application of preventive strategies. : This article provides a practical review of the recent evidence concerning CI-AKI incidence, diagnosis, and sheds light on prevention methods for reducing contrast use and avoiding AKI during endovascular procedures. : In conclusion, despite the lack of a specific treatment protocol, cautious screening, assessment, identification of the high-risk patients, and thus the application of simple interventions -concerning modifiable risk factors- can significantly reduce CI-AKI risk.

The Role of Neuroimaging in the Diagnosis and Treatment of Depressive Disorder: A Recent Review

2018 ◽  
Vol 24 (22) ◽  
pp. 2515-2523 ◽  
Author(s):  
Tianbin Song ◽  
Xiaowei Han ◽  
Lei Du ◽  
Jing Che ◽  
Jing Liu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Depressive Disorder ◽  
Diffusion Tensor ◽  
Single Photon ◽  
Rapid Development ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Brain Network ◽  
Emission Computed Tomography ◽  
Resonance Spectroscopy

Depression is a mental disorder with serious negative health outcomes. Its main clinical manifestations are depressed mood, slow thinking, loss of interest, and lack of energy. The rising incidence of depression has a major impact on patients and their families and imposes a substantial burden on society. With the rapid development of imaging technology in recent years, researchers have studied depression from different perspectives, including molecular, functional, and structural imaging. Many studies have revealed changes in structure, function, and metabolism in various brain regions in patients with depressive disorder. In this review, we summarize relevant studies of depression, including investigations using structural magnetic resonance imaging (MRI), functional MRI (task-state fMRI and resting-state fMRI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), brain network and molecular imaging (positron emission tomography [PET] and single photon emission computed tomography [SPECT]), which have contributed to our understanding of the etiology, neuropathology, and pathogenesis of depressive disorder.

Neuroimaging Outcomes in Studies of Cognitive Training in Mild Cognitive Impairment and Early Alzheimer’s Disease: A Systematic Review

2020 ◽  
Vol 17 (5) ◽  
pp. 472-486
Author(s):  
Lucy Beishon ◽  
Kannakorn Intharakham ◽  
David Swienton ◽  
Ronney B. Panerai ◽  
Thompson G. Robinson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cognitive Impairment ◽  
Search Strategy ◽  
Web Of Science ◽  
Cochrane Library ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Early Alzheimer’S Disease ◽  
Magnetic Resonance Imaging Mri ◽  
The Cochrane Library

Background: Cognitive Training (CT) has demonstrated some benefits to cognitive and psychosocial function in Mild Cognitive Impairment (MCI) and early dementia, but the certainty related to those findings remains unclear. Therefore, understanding the mechanisms by which CT improves cognitive functioning may help to understand the relationships between CT and cognitive function. The purpose of this review was to identify the evidence for neuroimaging outcomes in studies of CT in MCI and early Alzheimer’s Disease (AD). Methods: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. Results: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. Conclusions: CT resulted in variable functional and structural changes in dementia, and conclusions are limited by heterogeneity and study quality. Larger, more robust studies are required to correlate these findings with clinical benefits from CT.

Dipeptidyl Peptidase IV Inhibitors for Nonalcoholic Fatty Liver Disease – Systematic Review and Metanalysis

2020 ◽  
Vol 16 ◽  
Author(s):  
Lucas Ribeiro dos Santos ◽  
Marcio Luis Duarte ◽  
Maria Stella Peccin ◽  
Antônio Ricardo de Toledo Gagliardi ◽  
Tamara Melnik
Keyword(s):  
Hepatic Steatosis ◽  
Grey Literature ◽  
Specific Treatment ◽  
Reducing Power ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase Iv ◽  
Cochrane Library ◽  
Vast Number ◽  
Dpp Iv ◽  
Dipeptidyl Peptidase Iv Inhibitors

Introduction:: Hepatic steatosis is a frequent condition, that afflicts, especially, obese and insulin resistant patients; diagnosis is made, usually, through imaging tests. Despite the high prevalence and risk of complications, there is no specific treatment approved, though a vast number of medications have been tested. Objective:: To determine the efficacy of dipeptidyl peptidase IV inhibitors (i DPP-IV) in the treatment of NAFLD. Methods:: We searched the electronic databases of the Cochrane Library, MEDLINE, EMBASE and LILACS, as well as reference lists of the included studies and grey literature; 9 studies were selected for inclusion. Results:: 7 studies were used for metanalysis, for 3 outcomes. i DPP-IV showed an ALT-reducing power of MD -10.83 [95% CI 35.23 to 13.57] at 3 months and MD -9.27 [95% CI 10.92 to -7.62] at 6 months of intervention, as well as reduction of hepatic steatosis via MRI of SMD 0.10 [95% CI 0.31 to 0.50]; the overall incidence of adverse events was very low. The studies were considered of low and very low quality by the GRADE evaluation. Conclusion:: Because of the poor overall quality of the studies and heterogeneity of the population analyzed, i DPP-IV did not show efficacy on inflammatory markers or fibrosis in patients with NAFLD.

The Scoping Review of Smart Healthcare Applications in Medical Health (Preprint)

2020 ◽  
Author(s):  
Cheng Hang Wu ◽  
Ching Ju Chiu ◽  
Yen Ju Liou ◽  
Chun Ying Lee ◽  
Susan C. Hu
Keyword(s):  
Systematic Reviews ◽  
Mobile Health ◽  
Scoping Review ◽  
Search Strategy ◽  
Rapid Development ◽  
Related Research ◽  
Geographic Access ◽  
Smart Healthcare ◽  
Research Findings ◽  
Healthcare Interventions

BACKGROUND There is still no consensus on research terms for smart healthcare worldwide. The study conducted by Lewis 10 years ago showed extending geographic access was the major health purpose of health-related information communication technology (ICT), but today's situation may be different because of the rapid development of smart healthcare. Objective: The main aim of this study is to classify recent smart healthcare interventions. Therefore, this scoping review was conducted as a feasible tool for exploring this domain and summarizing related research findings. OBJECTIVE The main aim of this study is to classify recent smart healthcare interventions. Therefore, this scoping review was conducted as a feasible tool for exploring this domain and summarizing related research findings. METHODS The scoping review relies on the analysis of previous reviews of smart healthcare interventions assessed for their effectiveness in the framework of a systematic review and/or meta-analysis. The search strategy was based on the identification of smart healthcare interventions reported as the proposed keywords. In the analysis, the reviews published from January 2015 to December 2019 were included. RESULTS The number of publications for smart healthcare's systematic reviews has continued to grow in the past five years. The search strategy yielded 210 systematic reviews and/or meta-analyses addressed to target groups of interest. 68.5% of these publications used mobile health as a keyword. According to the classification by Lewis, 37.62% of the literature was applied to extend geographic access. According to the classification by the Joint Commission of Taiwan (JCT), 48.84% of smart healthcare was applied in clinical areas, and 60% of it was applied in outpatient medical services. CONCLUSIONS Smart healthcare interventions are being widely used in clinical settings and for disease management. The research of mobile health has received the most attention among smart healthcare interventions. The main purpose of mobile health was used to extend geographic access to increase medical accessibility in clinical areas. CLINICALTRIAL none

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