scholarly journals Renal Involvement in IgA Vasculitis; Possible Correlation with Positive Antiphospholipid Antibodies

2020 ◽  
Author(s):  
Mehrnoush Hassas Yeganeh ◽  
Aye Yaraghi ◽  
Shima Salehi ◽  
Khosro Rahmani ◽  
Vadood Javadi ◽  
...  
Keyword(s):  
Antiphospholipid Antibodies ◽  
Renal Involvement ◽  
Iga Vasculitis ◽  
Moderate Correlation ◽  
Kappa Index ◽  
Hypersensitivity Vasculitis ◽  
Urine Examination ◽  
Positive Serum ◽  
Rule Out

IgA vasculitis is a hypersensitivity vasculitis, which is usually self-limiting. Renal involvement is the most damaging long-term complication of IgA vasculitis, happening in 20% - 100% of cases. Some factors have been reported to be associated with renal involvement in IgA vasculitis; however, no biomarker has been proved as a risk factor for renal involvement and its severity yet. We followed 48 patients with a confirmed diagnosis of IgA vasculitis for six months. We checked these patients for renal involvement by microscopic urine examination. We checked aPL antibodies in all patients on admission and 12 weeks later. Urinalysis showed renal involvement in 14 of 48 patients with IgA vasculitis (29.16%). Antiphospholipid antibodies were positive in 9 patients with IgA vasculitis and renal involvement (9 out of 14, 64.28%), while they were positive in only six patients with IgA vasculitis without renal involvement (6 out of 34, 17.64%), showing a moderate correlation between positive aLP and renal involvement in patients with IgA vasculitis, with a kappa index of 0.457. Serum aPL antibodies, as a tool to predict renal involvement in IgA vasculitis, show a sensitivity of 64.3%, a specificity of 82.4%, PPV of 60.0%, and NPV of 84.8%, demonstrating that a positive serum aPL antibody can be used to positively predict the renal involvement, while a negative result is not strong enough to rule out future renal involvement.

P0206RITUXIMAB IN ADULT ONSET OF IGA VASCULITIS WITH SEVERE RENAL INVOLVEMENT: A SINGLE CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Roberta Fenoglio ◽  
Martina Cozzi ◽  
Savino Sciascia ◽  
Emanuele De Simone ◽  
Giulio Del Vecchio ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Renal Involvement ◽  
Iga Vasculitis ◽  
Adult Onset ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Clinical Records

Abstract Background and Aims IgA-vasculitis (IgAV) is a systemic small vessels vasculitis characterized by deposition of underglycosylated IgA1 immune complexes. Renal involvement indicates severity of illness and chronic kidney disease represents the most serious long-term complication of IgAV. Presently, no treatment is specifically recommended in IgAV Glucocorticoids (GC) have been traditionally thought to be effective in tempering systemic symptoms, but did not show long-term benefits either in reducing flares or progression of kidney disease. The effectiveness of conventional immunosuppressants is controversial. Recently Rituximab (RTX) has been proved to be effective in a few case series of adults with IgAV. However, long term results are lacking. Aim of the study: to evaluate the effectiveness of RTX as first line therapy in induction and maintenance of remission of adults with IgAV with biopsy-proven crescentic glomerulonephritis. Method We reviewed the clinical records of patients with adult-onset IgAV treated with RTX at our Center. Patients included 8 males and 4 females, mean age 45 years (range 19-75) with mean follow-up duration of 31 months (range 6-144). Diagnosis was based on the combination of clinical assessment, serological tests and histological analysis according to EULAR criteria. All patients (pts) had a biopsy proven IgAV- severe nephritis. RTX was given for the treatment of relapsing or refractory disease or because of definite contraindications to standard dose CS and/or conventional immunosuppressants. Patients received 4 weekly doses of RTX (375 mg/m2) given alone (8 pts) or in combination with CS (4 pts). Disease activity was evaluated by Birmingham Vasculitis Activity Score version 3 at the onset and at 1, 6 and 12 months and at the end of follow up. Complete remission (CR) was defined as BVAS of 0 Results Eleven pts (91.7%) achieved a clinical response at 6 months. Ten pts had a CR while 1 pt had a partial response and was given an additional dose of RTX after 12 months from induction due to persistent proteinuria (1gr/24 hrs), despite systemic remission. He achieved a CR 6 months later. One patient did not respond to RTX and was switched to MMF. Among the 10 pts with CR, 1 patient needed maintenance doses of RTX every 6 months due to relapse of palpable purpura; 1 relapsed after 15 months and received a new induction course showing a CR again. Significant decrease in 24-hour proteinuria (P = 0.043), BVAS (P = 0.031),and CRP level from RTX initiation through the last follow-up visit was detected. RTX was generally well tolerated. One patient, who had a CR with RTX alone died after 6 months of follow-up for cardiovascular cause. Conclusion This extended experience confirms our initial results supporting the use of RTX in the treatment of IgAV with severe renal involvement. Indeed, RTX proved to be effective and safe for induction and maintenance of long-lasting remission. Present data also suggest that RTX is not only effective for severe and refractory IgAV, but can be also proposed as a first line therapy.

scholarly journals AB0423 NEUROPSYCHIATRIC OUTCOME OF CHILDREN BORN TO WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) WOMEN AND EXPOSED IN UTERO TO AZATHIOPRINE: A CASE-CONTROL STUDY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1511.2-1511
Author(s):  
M. G. Lazzaroni ◽  
F. Crisafulli ◽  
I. Debeni ◽  
C. Nalli ◽  
L. Andreoli ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Renal Involvement ◽  
In Utero ◽  
Learning Disorders ◽  
Control Group ◽  
In Utero Exposure ◽  
Term Outcome ◽  
Similar Frequency ◽  
Long Term Outcome

Background:A possible increase in neurodevelopmental (ND) and learning disorders (LD) in the offspring of mothers affected by SLE have been suggested in some studies, along with the identification of different possible risk factors. Azathioprine (AZA) is commonly used during pregnancy, based on its non-teratogenicity and extended experience in women with different diseases. However, a few small studies suggested an association between in utero exposure to AZA and possible increased frequency of ND/LD in children, indirectly derived from increased request of supportive educational services.Objectives:To evaluate the medium-long term outcome in terms of ND/LD in children of school age (≥6 years) born to SLE women treated with AZA during pregnancy, as compared to that of children born to SLE mothers not treated with AZA during pregnancy.Methods:Data from our Pregnancy Clinic registry were collected for prospectively followed pregnancies of SLE women treated with AZA (cases) and compared to pregnancies of SLE women not treated with AZA (controls), that were matched for age at pregnancy, presence of renal involvement and aPL positivity. SLE patients (cases and controls) were interviewed by phone to collect data about their children, focusing on the presence of ND/LD certified by Neuropsychiatrists.Results:Data were collected for 14 SLE mothers in the AZA group and 31 in the control group, with similar age at pregnancy (30.3±5.21 vs 31.4±4.70 years, p:0.45) and frequency of renal involvement (50.0% vs 44.1%, p:0.77), aPL positivity (33.3% vs 29.4%, p:0.76) and anti-Ro/SSA positivity (27.8% vs. 26.5%, p:0.55). A SLE flare during pregnancy was more frequently recorded in the AZA group (27.8% vs. 2.94%, p:0.02). Other medications included HCQ (55.6% vs. 70.6%, p:0.36) and corticosteroids (100% vs 79.4%, p:0.08).We collected data for 18 children in the AZA group and 34 children in the control group, that had a similar mean age at the time of the interview (12.7±4.80 vs. 12.9±5.61 years, p:0.91). The two groups had also similar gestational age (37.4±2.20 weeks vs. 38.0±1.29 weeks, p:0.23), birth weight (3003±433 g vs 3011±453 g, p:0.95) and rate of male sex (61.1% vs 44.1%, p:0.38).We recorded similar frequency of ND/LD in the two groups. In particular, a ND was present in 2/18 (11.1%) of children exposed to AZA vs. 2/34 (5.88%) in the control group (p:0.60). A LD was present in 1/18 cases (5.56%) and 6/34 controls (17.6%) (p:0.40).Conclusion:The medium-long term outcome of children born to SLE mothers in the whole cohort was characterized by the presence of ND in 4/54 (7.69%) and LD in 7/52 (13.5%). ND/LD do not seem to be related to in utero exposure to AZA.Disclosure of Interests:None declared

scholarly journals Myopericytoma in the Antitragus of the Auricle: A Rare Tumor

2020 ◽  
pp. 014556132098457
Author(s):  
Tae Seong Eo ◽  
Jeong Hae Kie ◽  
Hyun Seung Choi ◽  
Junhui Jeong
Keyword(s):  
Large Firm ◽  
Rare Tumor ◽  
Long Term Follow Up ◽  
Slow Growing ◽  
Rule Out

A myopericytoma in the auricle is rare. If an auricle contains a large, firm, red-brown mass, excision should be considered because the mass may be a myopericytoma. After excision, histopathological and immunohistochemical diagnoses are essential to rule out malignancy. Long-term follow-up is required because the tumor is slow-growing.

scholarly journals AB0750 FUNCTIONAL CONDITION OF KIDNEYS IN THE LONG-TERM COURSE OF SLE IN ADOLESCENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1403.2-1403
Author(s):  
L. Bohmat ◽  
N. Shevchenko ◽  
I. Bessonova
Keyword(s):  
Renal Function ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Clinical Analysis ◽  
Average Dose ◽  
One Year

Background:Lupus nephritis is the most severe and adverse systemic lupus erythematosus (SLE) syndrome. According to modern recommendations, the clinical manifestations of active nephritis should be taken under medical control in 6 months after the start of the disease’s treatment1.Objectives:The aim of this study was to examine the functional status of the kidneys in children with SLE in the course of the disease for more than one year.Methods:The analysis included case histories of 43 patients with SLE, mostly females (41), aged 7 to 18 years (mean age 14.4 years) with disease duration of 4.75 ± 0.58 years of whom 22 were less than three years, 21 - more than three years. All children received corticosteroid therapy, at the time of the examination the average dose was 13.85 ± 1.86 mg per day in terms of prednisolone. The second component of therapy was azathioprine (average dose 97.61 ± 2.11 mg). All children received hydroxychloroquine (5 mg/kg per day).To determine the functional state of the kidneys a clinical analysis of urine, a study of the scope of specific gravity of urine during the day (Zymnytsky test), the content of creatinine and urea in serum to determine the glomerular filtration rate (GFR), the level of microalbuminuria per day were evaluated.Results:Renal involvement in the developed SLE occurred in 73.08% of patients. Among them, therapy during the first 6 months was considered quite effective in 58.06% of patients. It was found that in children with disease duration from one to three years proteinuria was registered in 68.18%, a decrease in GFR in 4.45% and hyperfiltration in 9.09%. In the group of children with duration of SLE more than three years revealed deeper changes in renal function; there was proteinuria in 90.47%, the frequency of GFR decreased was in 19.04%, a decrease of renal concentration function was in 14.28% of cases.Indicators of renal function in children with SLE depending on the duration of the disease (M ± m)IndicatorDuration of the diseasefrom 1 year to 3 years n = 22over 3 yearsn = 21Creatinine, mmol/l0,080 ± 0,0140,090 ± 0,018Мочевина, mmol/l5,66 ± 1,425,63 ± 1,61GFR, ml/min117,05 ± 19,68100,20 ± 18,98 *Microalbuminuria, mg/day24,41 ± 13,1334,73 ± 24,76Density min1,007 ± 0,0051,006 ± 0,005Density max1,024 ± 0,0051,019 ± 0,005 ***р<0,03;**р<0,01 the probability of differences when comparing between groupsConclusion:Long-term follow-up of children with SLE over one year reveals a prolongation of renal dysfunction, which worsens after three years, and is the basis for the development of irreversible renal impairment.References:[1]European evidence-based recommendations for the diagnosis and treatment of childhood-onset lupus nephritis: the SHARE initiative /Noortje Groot, Nienke de Graeff, Stephen D Marks et all. //Ann Rheum Dis. 2017 Dec;76(12):1965-1973.Disclosure of Interests:None declared

Justifying Too Much

2020 ◽  
pp. 419-434
Author(s):  
Bob Brecher
Keyword(s):  
Moral Theory ◽  
Long Term Consequences ◽  
Rule Out

In this chapter, I analyze the use and abuse of utilitarianism in the torture debate, arguing that the latter might turn out to be utilitarianism's nemesis. For what the debate lays bare is that, if we are to take utilitarianism seriously, then we must be prepared to torture the alleged terrorist's child, or indeed anyone at all, to prevent the so-called imminent catastrophe. Furthermore, if that conclusion is unpalatable on rule-utilitarian grounds—in terms of the institutional and long-term consequences of such a practice—then those same sorts of consideration rule out torturing the alleged terrorist themselves. That this is systematically obscured by those who would purport to justify interrogational torture by their being highly selective about the consequences they consider, and/or by arbitrarily “modifying” the scope of utilitarianism when it generates inconvenient conclusions, again suggests that utilitarianism may be fundamentally flawed; and that its use to defend interrogational torture shows this. The argument is in four sections: a refutation of the alleged necessity of interrogational torture in “ticking bomb” cases; an analysis of utilitarian proponents' of interrogational torture properly to understand that their utilitarianism cannot accommodate non-utilitarian limits when inconvenient; third, their failure to acknowledge the implications of that for the permissibility of torturing known innocents to force others to divulge information; and, fourth, how these considerations come together to suggest that utilitarianism might not be a moral theory at all.

scholarly journals Intravenous γ Globulin for Intractable Abdominal Pain due to IgA Vasculitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
George Naifa ◽  
George Totikidis ◽  
Sonia Alexiadou ◽  
Christina Kolona ◽  
Elpis Mantadakis
Keyword(s):  
Abdominal Pain ◽  
Iga Vasculitis ◽  
Controlled Clinical Trials ◽  
Corticosteroid Administration ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Term Administration ◽  
Schonlein Purpura ◽  
Safe Treatment Option

IgA vasculitis (formerly known as Henoch–Schönlein purpura or anaphylactoid purpura) is a usually benign vasculitis that affects children of school age. The disease is characterized by the tetrad of palpable purpura, arthralgia/arthritis, abdominal pain, and hematuria. Treatment of IgA vasculitis is mainly supportive, with administration of simple analgesics. Corticosteroids have been shown to reduce and/or ameliorate the occurrence of abdominal pain which may be severe. We present two children with IgA vasculitis and severe abdominal pain despite corticosteroid administration, who responded promptly to intravenous γ globulin (IVIg) with complete resolution of their symptoms and review of the relevant medical literature. Given the toxicity and/or need for long-term administration of other second-line immunosuppressive therapies in corticosteroid-resistant IgA vasculitis, such as rituximab, cyclosporine, cyclophosphamide, azathioprine, or colchicine, we propose that IVIg may be a useful and safe treatment option, although randomized controlled clinical trials are needed in order to clarify its role in the treatment of abdominal pain in IgA vasculitis.

scholarly journals A Study on the Potential Role of Occlusal Fissure Fractures in the Etiopathogenesis of Equine Cheek Teeth Apical Infections

2019 ◽  
Vol 36 (3) ◽  
pp. 171-178 ◽  
Author(s):  
Katherina Y. Wellman ◽  
Padraic M. Dixon
Keyword(s):  
Computed Tomography ◽  
Methylene Blue ◽  
Potential Role ◽  
Histological Study ◽  
Extraction Process ◽  
Dental Tissue ◽  
Rule Out

Thirty-nine equine cheek teeth diagnosed as having anachoretic apical infections and also having occlusal fissure fractures, but without occlusal pulpar exposure, that had been orally extracted without causing occlusal damage and 10 control teeth were used in this study. The teeth were individually imaged by computed tomography, occlusally stained with methylene blue and visually reexamined, then sectioned subocclusally at 5 mm intervals until the fissure fractures could no longer be detected. A limited histological study was then performed on 7 apically infected and 5 control teeth. Standard computed tomography only detected 1 of 39 fissure fractures. Thirteen of the 39 stained teeth had subocclusal fissure fractures visually identified at approximately 6 mm beneath the surface, and in 9 of these 13 teeth the fissure fractures had deeper staining to a level immediately above or into a pulp horn, indicating a potential route for bacterial pulpitis. However, the current study cannot rule out the possibility that the extraction process, long-term formalin storage, or the processing of teeth may have allowed for deeper staining. Additionally, methylene blue may penetrate dental tissue more readily than bacteria can invade. Further studies on the potential role of fissure fractures in the etiopathogenesis of cheek teeth apical infection are warranted.

Historical Explanation in ‘The Critique of Dialectical Reason’

1982 ◽  
Vol 14 ◽  
pp. 97-108
Author(s):  
Mary Warnock
Keyword(s):  
Communist Party ◽  
Algerian War ◽  
Simone De Beauvoir ◽  
Historical Explanation ◽  
Dialectical Reason ◽  
Marxist Tradition ◽  
Rule Out

The Critique of Dialectical Reason was first published in France twenty years ago, in 1960. The book, we know from Simone de Beauvoir, was flung together in a hurry, written virtually without correction during the height of the Algerian war, a period, for Sartre, of stress and anxious stock-taking of his position as a Marxist and a long-term non-joiner of the Communist Party. The whole sense in which, in 1960, Sartre was a Marxist, the question of precisely how eccentric his kind of Marxism was, is centred on his theory of historical explanation. I do not propose to raise many detailed questions about the relation of Sartre's views on history to those of Marx himself, still less to those of other Marxists. Ignorance alone would rule out such a course. I would like if I can, however, to consider Sartre's own view of historical explanation as it appears in the Critique, and leave it to others if they wish to fit it into the Marxist tradition, or exclude it. In order to perform this relatively modest expository task, it will be necessary for me to refer, from time to time, to Sartre's earlier philosophical views. But this will come in incidentally

Sign in / Sign up

Export Citation Format

Share Document