नेफ्रोलॉजी और थेरेप्यूटिक्स जर्नल

Obstetric cortical renal necrosis is a serious complication that can lead to chronic renal failure and the need for dialysis for life in some cases. In Africa, despite progress, much remains to provide in order to prevent this complication. Difficulties in health care access and lack of monitoring of pregnancies are contributing factors. We propose through 5 cases report the characteristics of obstetric renal cortical necrosis in the tropics.

Membranous Nephropathy (MN) is the leading cause of nephrotic syndrome in adults. Primary or idiopathic Membranous Nephropathy (iMN) has been considered as an organ-specific autoimmune disease with an unknown aetiology. By contrast, secondary membranous nephropathy has been described as the expression of a systemic autoimmune response to malignancy or bacterial/viral infections. In the majority of iMN cases, glomerular lesions are determined by autoantibodies against a podocyte membrane protein, the M-type of phospholipase A2 receptor 1 (PLA2R1). Several studies have suggested that the detection of anti-PLA2R1 in patients sera with nephrotic syndrome may be pathognomonic of iMN, thus obviating the need for a diagnostic renal biopsy and an extensive workup for underlying causes. Many authors inferred that the measurement of anti-PLA2R1 may change the diagnostic algorithm in patients with nephrotic syndrome and guide treatment decisions in patients with iMN. Measurement of anti-PLA2R1 antibodies is now possible through an easy to use, commercially available assay. The aim of this review is to describe the clinical relevance of anti-PLA2R1 assessment in patients with MN, and to extensively discuss the biotechnological methods available to measure them.

Mixed connective tissue disease (MCTD) is a rheumatic disease with a combination of multiple connective tissue disorders, which includes dermatomyositis or polymyositis, systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis and Sjogren’s syndrome. Renal involvement in mixed connective tissue disorder is a rare occurrence. We present a case of MCTD presenting with SRC managed with ACE Inhibitor (Captopril). The patient had advanced renal failure and presently on maintenance haemodialysis.

Objective: In addition to its anticancer function, p53 (regulated by murine double minute 2 oncoprotein, MDM2) has recently been shown to control intracellular metabolic processes. It participates in the regulation of glucose, fatty and amino acid and purine metabolism, influences mitochondrial integrity and oxidative phosphorylation, insulin sensitivity, antioxidant response and autophagy. With respect to the possible impact of genetic variability in p53 and MDM2 on metabolic compensation the aim of the study was to analyse the effect of common germ line Single Nucleotide Polymorphisms (SNPs) - Arg72Pro in the TP53 and SNP309 in the MDM2 - on the progression of Diabetic Nephropathy (DN), cardiovascular morbidity and mortality and all-cause mortality in Type 2 Diabetes Mellitus (T2DM) subjects. Methods: The cross-sectional study comprised a total of 309 (a sum of 155 and 154) unrelated Caucasian diabetic patients with diabetes duration at least 10 years and variable renal function at baseline (309, mean age was 67.2 ± 10.8 years). The stage of diabetic nephropathy was defined according to the urinary albumin excretion and glomerular filtration rate. Patients were followed-up for median 37 (20-59) months. The following end-points were considered: (a) progression of DN, (b) major cardiovascular event (non-fatal or fatal myocardial infarction or stroke, limb amputation, revascularization), (c) all-cause mortality. Genotypes were determined by PCR-based methodology. Time-to-event analysis using Kaplan-Meier curves and log-rank test was used. Results: We found significant difference between CG+GG vs. CC genotypes of the p53 Arg72Pro SNP for DN progression (P=0.046, log-rank test). Carriers of genotypes containing G allele (previously associated with susceptibility to T2DM) had faster progression of DN than CC genotype carriers. We did not find any significant difference between genotypes of MDM2 SNP for any of the end-points studied. Conclusions: Presented findings in general support the role of p53 in the pathogenesis of metabolic diseases, namely progression of hyperglycemia-related morbidity. Nevertheless, further studies are warranted to elucidate the eventual causal involvement of p53 pathway in the development of diabetic complications.