Mesangiolysis due to primary mesangial injury

Hippokratia 2003, 7 (4): 147-151

M Leontsini

Abstract

Mesangiolysis is an injurious glomerular process that affects primarily the mesangium. It can be defined as a dissolution or attenuation of mesangial matrix and degeneration of mesangial cells. This type of injury can be seen in a variety of glomerular diseases arising from a multitude of pathologic conditions (Table 1). Overall, the spectrum of renal injuries in which mesangiolysis may be a contributing element encompasses a significant portion of conventional renal biopsy practice. Morita T et al1, using morphologic criteria, recognizable by light microscopy, classified most of the mesagiolysis - associated conditions into three groups:
a. mesangiolysis due to primary mesangial injury
b. mesangiolysis after endothelial injury and
c. mesangiolysis due to persistent or repeated mesangial and/or endothelial damage.

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Thrombotic Microangiopathy involving the kidney: A Histopathologic Perspective

Hippokratia 2003, 7(4):152-158

H Liapis

Abstract

The aim of the study was to evaluate the relative frequency of Thrombotic microangiopathy (TMA) and to identify histopathologic variables that may facilitate timely and specific therapy. The frequency of TMA among medical and transplant renal biopsies in this institution was < 1%. Eighty percent of TMA occurred in adults, slightly more in women than men. The most frequent cause of TMA in medical kidney biopsies of adults was lupus nephritis followed by cryoglobulenemic glomerulonephritis secondary to hepatitis C and immunosuppressive drugs such as bleomycin and mitomycin. In the traansplant biopsies, the most frequent cause of TMA was cyclosporine A (CsA) toxicity. In children, 50% (4/8) occurred in transplants, and was also due to CsA toxicity; the remaining cases were either classic HUS/TTP or atypical forms of TMA. Notably, clinically evident hemolysis was present in a minority of the cases (8/41). Histopathologically, lupus associated TMA had characteristic immune complex deposits. CsA and other immunosuppressive drugs associated with TMA had fibrinoid necrosis or mesangiolysis. Classic HUS had arteriolar mucoid intimal proliferation, while onion skinning was a characteristic feature of malignant hypertension and connective tissue disorders affecting the kidney. Finally, two cases of atypical childhood HUS with microthrombi on renal biopsy were associated with idiopathic peripheral eosinophilia. Electron microscipy was important in assessing the full spectrum of pathologic changes of TMA that implicate endothelial cell damage. The study demonstrates that the diagnosis of TMA is often made by renal biopsy. Hemolysis is not infrequently absent. Pathologic findings span a spectrum of manifestations, not just thrombosis. Skillful evaluation and standardization of renal biopsy analysis with immunofluorescence and electron microscopy are essential for diagnosis.

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Properties of circulating blood cell membranes regarding sodium content in individuals suffering from essential hypertension

Hippokratia 2003, 7 (4):159-167

K Charalabopoulos

Abstract

The aim of the present review article is to present a global view on perturbations of blood cells membranes which are observed in human essential hypertension.Especially, we are focused on erythrocytes and leukocytes sodium content, since the hypothesis that an increase in cell sodium is regarded to be a leading event in the hypertension process. Of course, essential hypertension is a multifactorial disease and exist several possible confounding factors that could be present in hypertensive patients affecting the erythrocyte and leukocyte sodium content. The major role of sodium pump in controlling the concentration of intracellular sodium,passive sodium permeability, sodium-potassium-chloride cotransport, sodium-hydrogene exchange, as well as some points on sodium intake, are also discussed.

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Tacrolimus in solid organ transplantation

Hippokratia 2003, 7(4):168-172

G Vergoulas

Abstract

Tacrolimus (FK506 or Prograf?) is a macrolidic antibiotic, which acts as a calcineurine inhibitor. Its pivotal mechanism of action is the blocking of calcineurin phosphatase activity and the subsequent production of IL-2 and other cytokine production1. It is ten to one hundred times more potent drug compared to cyclosporine in a weight 1/1 basis2. Tacrolimus may also inhibit nitric oxide synthetase activation3 and enhance apoptosis.

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Pathogenetic mechanisms involved in stomach infection caused by Helicobacter pylori

Hippokratia 2003, 7(4):173-176

K Charalabopoulos, V Papalimneou, NJ Agnantis

Abstract

Helicobacter pylori bacterium colonizes the gastric mucosa in humans causing chronic active gastritis type B and peptic ulcer disease. It is the commonest cause of antral gastric and duodenal ulceration. Furthermore, it is implicated in gastric adenocarcinoma, mucosal atrophy and low grade B-cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma). Re-infection of peptic ulcer is associated with re-infection by the bacterium.In contrast to other pathogens of the gastrointestinal tract, which invade the mucosal barrier, Helicobacter pylori, rarely penetrates the gastric epithelium. Typical histological pattern of inflammation is though observed in the submucosal layer. Antigens constantly found in all strains as well as some other found in certain strains of the bacterium, play an important role in the immune response of the human organism, apoptosis and signal transduction. Pathogenetic mechanisms involved in pathogenesis of various disease processes induced by helicobacter pylori are not yet fully elucidated. Adhesion molecules, interleukins and other inflammation mediators, participate in the hole process. In the present review article all these pathogenetic mechanisms are discussed in detail.

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Persistence of high levels of IL-6 and IL-8 in the cerebrospinal fluid of children with bacterial meningitis and prolonged fever

Hippokratia 2003, 7(4):177-181

H Tsangaropoulou-Stinga, F Kanakoudi-Tsakalidou, E Hatzipantelis, A Taparkou, V Tzimouli, J Kavaliotis, K Avramidou, A Karassavidou, X Dedoukou, N Manos

Abstract

Objective: Changes in the concentration of inflammatory cytokines in the cerebrospinal fluid (CSF) and serum of patients with bacterial meningitis (BM) have been the objective of several studies mainly with respect to their prognostic value. The aim of our study was: 1. To investigate the serial changes of IL-1?, TNFa, IL-6 and IL-8 in the CSF of children with BM during the first three days from the disease onset and 2. To correlate our findings with the disease complications and outcome. Methods: Thirty two children, hospitalised for BM during a 2 year and 4 month period, were studied. In 20 cases a causative agent was isolated (N. meningitides=9, H.influenzae=9, S. pneumoniae=2) while in 12 of them no pathogen was found. All patients were treated with ceftriaxone (100mg/kg/d IV for 7-10d) and dexamethasone (0,6mg/kg/d IV for 2d). The CSF and serum samples were obtained concomitantly on admission (1st), 12-24h later (2nd) and 52-72h after the 1st sample. Levels of IL-1?, ??F-a, IL-6 and IL-8 were assessed using the Quantikine Immunoassay Kit. Results: None of the cases was complicated by shock, none of the patients died and all were cured. 7/32 children presented with secondary fever and 5/32 with prolonged fever. In 4 out of these 5 patients subdural effusion was also present. The levels of all cytokines studied, were increased in the CSF and serum samples but they were significantly higher in the CSF. In the patients with prolonged fever (5) levels of IL-6 and especially of IL-8 in the CSF were persistently higher than those found in patients with secondary fever or early apyrexia, while in serum no difference was found. No correlation of cytokine levels and some other parameters studied (day of disease on admission, treatment prior to admission, causal agent of meningitis etc) was found.Conclusions: Prolonged fever with or without subdural effusion in patients with BM is related with persistence of high CSF levels of IL-6 and IL-8 for more than 3 days. This may be indicative of persistence of the inflammatory process elsewhere in the CNS and may need immunomodulatory therapy.

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Effects of three months fluvastatin treatment on lipid metabolism and proteinuria in patients with nephrotic syndrom

Hippokratia 2003, 7(4):182-185

M Lubomirova, E Andreev, R Krasteva, R Djerassi, B Kiperova

Abstract

We evaluate the effect of HMG-Co A reductase inhibitor fluvasatin on lipid disorders and proteinuria in patients with nephrotic syndrome (NS).Seven female (F) and 12 male (M) pts, average age 39 years, with glomerular filtration rate (GRF) over 90 ml/min and NS with proteinuria over 4.0g/24 h and severe hyperlipidemia were investigated. All pts were treated with corticosteroids alone or in combination with cytotoxic drugs, because of the illness activity. Fluvastatin was administered 40 mg/d for 3 months. Tchol, TG, LDL, HDL and 24 hours proteinuria were examined before the start of the study and after 3 months.Administration of fluvastatine led to a significant reduction of lipid fractions: Tchol mean value (MV) before the treatment 9.3�3.2mmol/l and after 5.9�1.32mmol/l (p<0.001). TG: MV before 5.9� 1.87mmol/l and after 2.74�1.04 mmol/l (p<0,01). LDL: MV before 6.35�1.34 mmol/l and after 3.57�0.81 mmol/l (p<0.001). HDL levels were normal in all pts. MV before 1.61� 0.53 mmol/l and after 1.04 � 0.23mmol/l (p=0.01).The changes of 24 hour proteinuria were not significant: MV before 4.21 � 2.4 g/24h and after-3.03�1.68 g/24h (p= 0.10).Significant reduction of hyperlipidemia was detected in pts. with NS receiving corticosteroid treatment regardless of the fact that the nephrotic proteinuria remains and is not affected by fluvasatin.

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The role of spiral computed tomography in the diagnosis of inflammatory abdominal aortic aneurysms

Hippokratia 2003, 7(4):186-190

G. Grollios, K. Papazoglou, K. Tsarouxas, Ir. Kazantzidou, G. Anastasiou, K. Tsinoglou, T. Karakozoglou, D. Daravigkas, Gr. Terzis, Th. Gerasimidis

Abstract

The aim of the study was to investigate the contribution of spiral computed tomography with simultaneous bolus injection of contrast agents in the prompt, accurate diagnosis and the postoperative course of inflammatory abdominal aortic aneurysms and their proper treatment.Inflammatory abdominal aortic aneurysms are associated with high morbidity and mortality.From January 2000 to May 2003, 11 patients with inflammatory abdominal aortic aneurysm of average age 66,7 years (10male and 1 female) were examined by the means of spiral CT and they were submitted to the hospital with the indication of abdominal aortic aneurysm.They were treated with intralumenar stent placement and reexamined postoperatively. The radiomorphological findings with the use of spiral CT suggested inflammatory aneurysm, with the development of the characteristic periaortic mass outside the calcified aortic wall, due to perianeurysmal fibrosis.In 2 of the patients this mass produced retroperitoneal fibrosis with strangulation of the ureters and hydronephrosis.Spiral CT is the main diagnostic method in the case of inflammatory abdominal aortic aneurysms. It also demonstrates excellently the prosthesis inside the aneurysm and the retroperitoneal structures.

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