2011年2月19日

[醫學] Clinicopathological characteristics of patients wi... [Kidney Int. 2010] - PubMed result

最近見到了一個的 G4-related tubulointerstitial nephritis
正巧前幾個月在KI有篇 review跟大家分享一下


Clinicopathological characteristics of patients wi... [Kidney Int. 2010] - PubMed result

Kidney Int. 2010 Nov;78(10):1016-23. Epub 2010 Aug 18.

Clinicopathological characteristics of patients with IgG4-related tubulointerstitial nephritis.

Saeki T, Nishi S, Imai N, Ito T, Yamazaki H, Kawano M, Yamamoto M, Takahashi H, Matsui S, Nakada S, Origuchi T, Hirabayashi A, Homma N, Tsubata Y, Takata T, Wada Y, Saito A, Fukase S, Ishioka K,Miyazaki K, Masaki Y, Umehara H, Sugai S, Narita I.

Department of Internal Medicine, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan. saekit@nagaoka.jrc.or.jp

Comment in:

Abstract

IgG4-related disease is a recently recognized multi-organ disorder characterized by high levels of serum IgG4 and dense infiltration of IgG4-positive cells into several organs. Although the pancreas was the first organ recognized to be affected by IgG4-related disorder in the syndrome of autoimmune pancreatitis, we present here clinico-pathological features of 23 patients diagnosed as having renal parenchymal lesions. These injuries were associated with a high level of serum IgG4 and abundant IgG4-positive plasma cell infiltration into the renal interstitium with fibrosis. In all patients, tubulointerstitial nephritis was the major finding. Although 14 of the 23 patients did not have any pancreatic lesions, their clinicopathological features were quite uniform and similar to those shown in autoimmune pancreatitis. These included predominance in middle-aged to elderly men, frequent association with IgG4-related conditions in other organs, high levels of serum IgG and IgG4, a high frequency of hypocomplementemia, a high serum IgE level, a patchy and diffuse lesion distribution, a swirling fibrosis in the renal pathology, and a good response to corticosteroids. Thus, we suggest that renal parenchymal lesions actually develop in association with IgG4-related disease, for which we propose the term 'IgG4-related tubulointerstitial nephritis.'

PMID: 20720530 [PubMed - in process]

[醫學] 轉載: Tamoxifen is associated with lower mortality of en... [Nephrol Dial Transplant. 2011] - PubMed result

Tamoxifen is associated with lower mortality of en... [Nephrol Dial Transplant. 2011] - PubMed result

Nephrol Dial Transplant. 2011 Feb;26(2):691-697. Epub 2010 Jun 27.

Tamoxifen is associated with lower mortality of encapsulating peritoneal sclerosis: results of the Dutch Multicentre EPS Study.

Korte MR, Fieren MW, Sampimon DE, Lingsma HF, Weimar W, Betjes MG; on behalf of the investigators of the Dutch Multicentre EPS Study.

Correspondence and reprint requests to: Mario R. Korte; E-mail: m.r.korte@asz.nl.

Abstract

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD) with an increasing incidence. There is no clear consensus on the treatment of EPS, but anecdotal reports indicate improvement in EPS patients treated with tamoxifen. At present, there is no evidence for the effect of tamoxifen treatment in EPS patients. This study investigates the effect of treatment with tamoxifen on survival in EPS patients.

METHODS: This study is a retrospective analysis of survival in EPS patients as part of the Dutch multicentre EPS study in the period January 1996 to July 2007. Sixty-three patients with severe EPS were followed up until August 2008. Demographic, patient and PD-related variables of EPS patients were investigated. Patients treated with tamoxifen were compared to patients not treated with tamoxifen. Survival was analysed with multivariate Cox regression analysis.

RESULTS: Twenty-four patients were treated with tamoxifen, and 39 were not treated with tamoxifen. The clinical and demographic characteristics were similar for the tamoxifen-treated and non-treated groups. The mortality rate was significantly lower in tamoxifen-treated patients compared to EPS patients not treated with tamoxifen (45.8% vs 74.4%, P = 0.03). Survival in tamoxifen-treated patients, adjusted for calendar time, age, use of corticosteroids, presence of functioning transplantation, use of parental nutrition and centre influences was longer in comparison to not-treated patients (HR 0.39, P = 0.056).

CONCLUSIONS: Tamoxifen treatment in EPS patients is associated with lower mortality and shows a trend to an increased multivariate-adjusted survival. This supports additional use of tamoxifen to treat patients with severe EPS.

PMID: 20584735 [PubMed - as supplied by publisher]




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