scholarly journals Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review

2021 ◽  
Vol 9 (6) ◽  
pp. 1304
Author(s):  
María Ríos-Barnés ◽  
Clàudia Fortuny ◽  
Ana Alarcón ◽  
Antoni Noguera-Julian
Keyword(s):  
Renal Involvement ◽  
Congenital Nephrotic Syndrome ◽  
Renal Tissue ◽  
Renal Tubules ◽  
Level Of Evidence ◽  
Transmitted Infection ◽  
Congenital Cytomegalovirus ◽  
Functional Studies ◽  
Increased Risk

Background: Congenital cytomegalovirus (cCMV) infection is the most frequent mother-to-child transmitted infection worldwide and a prevalent cause of neonatal disease and long-term morbidity. The kidney is a target organ for CMV, which replicates in renal tubules and is excreted in large quantities in urine for years in children with cCMV infection. Nonetheless, kidney disease has rarely been reported in cCMV-infected patients. Objective: We aimed to describe the available data on renal involvement in patients with cCMV infection at the pathologic, functional, anatomical, and/or clinical levels. Methods: A systematic search was performed in the MEDLINE/PubMed, SCOPUS, and Cochrane databases. Studies describing any renal involvement in fetuses or neonates aged ≤3 weeks at diagnosis of microbiologically confirmed cCMV infection were eligible. Results: Twenty-four articles were included, with a very low level of evidence. Pathologic findings in autopsy studies universally described CMV typical inclusion bodies in tubular cells. No functional studies were identified. cCMV infection was not associated with an increased risk of kidney malformations. Congenital nephrotic syndrome was the most common clinical condition associated with cCMV, but a causal relationship cannot be established. Conclusions: Typical pathological features of cCMV infection are very common in renal tissue, but they do not seem to entail significant consequences at the anatomical or clinical levels.

scholarly journals EFFECTS OF PROTEINURIA ON THE KIDNEY

1949 ◽  
Vol 89 (6) ◽  
pp. 643-668 ◽  
Author(s):  
James H. Baxter ◽  
George C. Cotzias
Keyword(s):  
Casein Hydrolysate ◽  
Blood Stream ◽  
Renal Tissue ◽  
Human Albumin ◽  
Tubular Damage ◽  
Renal Tubules ◽  
Rat Serum ◽  
Tubular Cells ◽  
Functional Studies ◽  
Renal Enlargement

Repeated intraperitoneal injections twice daily of various proteins into young rats were regularly accompanied by an increase in the protein content of the urine, significant renal enlargement, and often some degree of renal pallor. The most marked changes were induced by gelatin, followed in order by human albumin and bovine globulin. Rat serum produced similar but less conclusive changes. Similar changes were not produced by equivalent amounts of urea or casein hydrolysate. In sections from the kidneys of animals receiving gelatin, the cells of the convoluted tubules appeared enlarged, and they contained clear "spaces" throughout the cytoplasm. The tubular cells of the animals receiving the other solutions were not obviously altered in size or shape, and the cytoplasmic changes were slight or absent. There was little evidence of increased multiplication of cells or of tubular dilatation in the kidneys of any of the groups. Changes in concentrations of plasma proteins and hemoglobin, and the results of preliminary studies of the injected proteins in urine and renal tissue following the injections, are described and their possible significance discussed. It appears that the renal enlargement, as well as the increase in proteinuria and the tubular alterations which followed the protein injections, might have been caused in part by effects on the kidney of protein molecules per se, perhaps most likely by the effects on the tubular cells of an increased amount of protein filtered through the glomerular membranes, rather than entirely by effects of products of protein digestion and metabolism reaching the kidney through the blood stream. In the majority of animals there was no evidence from the morphological or functional studies, that the prolonged and continuous proteinuria induced by the protein injections resulted in renal damage, unless the renal enlargement, and the cytoplasmic changes which occurred regularly with gelatin, are considered evidence of damage. Renal enlargement and proteinuria promptly regressed after injections were discontinued. Lesions characterized by severe degrees of tubular damage, possibly as a result of tubular plugging, were observed in some of the animals of one group receiving gelatin solution of the usual concentration, and dilatation of renal tubules and glomerular capsules was present in some other gelatin-treated animals autopsied after relatively brief injection periods. A description is also presented of lesions of remarkable character which developed in the kidneys of all the animals of one small group receiving homologous serum obtained from severely anoxic donors. The possible relationship between the renal changes in the protein-injected animals and certain alterations of the kidneys observed in diseases characterized by large amounts of protein in the urine, is considered.

Nierenbeteiligung bei ANCA-assoziierten Vaskulitiden

2018 ◽  
Vol 143 (02) ◽  
pp. 79-88 ◽  
Author(s):  
Marion Haubitz
Keyword(s):  
Renal Function ◽  
Maintenance Treatment ◽  
Renal Involvement ◽  
Young Patients ◽  
Induction Treatment ◽  
Renal Manifestation ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

AbstractIn patients with ANCA-associated vasculitis renal involvement is frequently seen and the severity of renal manifestation is very important for therapeutic strategies and prognosis. Clinically rapid loss of renal function, nephritic sediment and proteinuria in a non-nephrotic range are characterizing a focal segmental necrotizing pauci-immune glomerulonephritis with extrarenal proliferations. Induction treatment depends on the severity of manifestations. With a normal renal function methotrexate can be used in combination with steroids. In patients with organ threatening involvement but creatinine below 500 µmol/l cyclophosphamide pulses or Rituximab should be used together with steroids, initially with i. v. pulses. Rituximab is more effective in PR3-ANCA vasculitis and should be used in relapsing disease, in young patients to avoid gonadal toxicity and in patients with an increased risk of malignancies. In patients on dialysis or with creatinine > 500 µmol/l plasma exchange should be added. Maintenance treatment (mainly with azathioprine) is necessary as at least 50 % of the patients develop relapses. Rituximab seems more effective, however it is not approved for maintenance treatment and no long-term data are available. Adjuvant treatment, long-term side effects and the increased incidence of cardiovascular events have to be included in the follow-up of vasculitis patients. In end-stage renal disease patients relapses occur but are more difficult to diagnose and treat with higher incidence of infections. Transplantation should be offered as patient and transplant survival is good.

scholarly journals ALCAM and VCAM-1 as urine biomarkers of activity and long-term renal outcome in systemic lupus erythematosus

Rheumatology ◽  
2019 ◽  
Vol 59 (9) ◽  
pp. 2237-2249 ◽  
Author(s):  
Ioannis Parodis ◽  
Sirisha Gokaraju ◽  
Agneta Zickert ◽  
Kamala Vanarsa ◽  
Ting Zhang ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Organ Damage ◽  
Population Based ◽  
Renal Outcome ◽  
Urine Biomarkers ◽  
Increased Risk ◽  
Function Loss

Abstract Objectives We investigated the cell adhesion molecules (CAMs) Vascular CAM 1 (VCAM-1) and Activated Leucocyte CAM (ALCAM) as urinary biomarkers in SLE patients with and without renal involvement. Methods Female SLE patients (n = 111) and non-SLE population-based controls (n = 99) were enrolled. We measured renal activity using the renal domain of the BILAG index and urine (U) and plasma (P) concentrations of soluble (s)VCAM 1 and U-sALCAM using ELISA. U-sCAM levels were next corrected by U-creatinine. Results U-sVCAM-1/creatinine and U-sALCAM/creatinine ratios were higher in SLE patients vs non-SLE controls (P < 0.001 for both), as well as in patients with active/low-active (BILAG A–C; n = 11) vs quiescent (BILAG D; n = 19) LN (P = 0.023 and P = 0.001, respectively). U-sALCAM/creatinine but not U-sVCAM-1/creatinine ratios were higher in patients with nephritis history (BILAG A–D; n = 30) vs non-renal SLE (BILAG E; n = 79) (P = 0.014). Patients with baseline U-sVCAM-1/creatinine ratios ≥75th percentile showed a 23-fold increased risk of a deterioration in estimated glomerular filtration rate by ≥25% during a 10-year follow-up (odds ratio: 22.9; 95% CI: 2.8, 189.2; P = 0.004); this association remained significant after adjustments for age, disease duration and organ damage. Traditional markers including anti-dsDNA antibodies did not predict this outcome. Conclusion While high U-sVCAM-1 levels appear to reflect SLE disease activity, sALCAM might have particular importance in renal SLE. Both U-sVCAM-1 and U-sALCAM showed ability to distinguish SLE patients with active renal involvement from patients with quiescent or no prior nephritis. High U-sVCAM-1 levels may indicate patients at increased risk for long-term renal function loss.

Incidence of Obstetric Lacerations and Episiotomy Following Labiaplasty

2020 ◽  
Author(s):  
Aaron M Kearney ◽  
Sergey Y Turin ◽  
Otto J Placik ◽  
Laura Wattanasupachoke
Keyword(s):  
Vaginal Delivery ◽  
Significant Proportion ◽  
Retrospective Chart Review ◽  
Level Of Evidence ◽  
Obstetric Lacerations ◽  
Phone Survey ◽  
Vaginal Deliveries ◽  
Increased Risk ◽  
Small Cohort

Abstract Background A significant proportion of patients seeking labiaplasty are nulliparous and may experience later changes to their labia following vaginal delivery. Objectives In the present study, the authors reported the long-term outcomes of a single surgeon’s patient cohort who had vaginal delivery after labiaplasty. Methods A retrospective chart review of the senior author’s database was conducted. All patients who underwent in-office labiaplasty from 2007 to 2018 were surveyed. The resulting cohort was stratified into patients who had delivered children prior to labiaplasty and those who delivered after labiaplasty. Results A total of 204 patients responded to a phone survey. Seventy patients had children prior to undergoing labiaplasty, and 33 had children after labiaplasty. The rate of vaginal delivery was lower in the women who had children before labiaplasty (82.6% vs 91.8%, P = 0.015). The tear/episiotomy rate for vaginal deliveries was lower in women who had children prior to labiaplasty compared with after labiaplasty (3.1% vs 17.8%, P < 0.001). Among the women who had children only after labiaplasty, the reported tear/episiotomy rate was 7/39 vaginal deliveries (17.9%). Conclusion Patients in our cohort had over 90% success with vaginal deliveries after labiaplasty. For nulliparous patients contemplating the procedure, the data we present suggest the risk of episiotomy or vaginal tear risk with vaginal birth after labiaplasty is comparable with or lower than the general population, further supporting the safety of this procedure. For patients with previous delivery, the data are more limited but suggest no increased risk in this small cohort. Level of Evidence: 4

scholarly journals The Impact of Selective Fetal Growth Restriction or Birth Weight Discordance on Long-Term Neurodevelopment in Monochorionic Twins: A Systematic Literature Review

2019 ◽  
Vol 8 (7) ◽  
pp. 944 ◽  
Author(s):  
Sophie G. Groene ◽  
Lisanne S.A. Tollenaar ◽  
Dick Oepkes ◽  
Enrico Lopriore ◽  
Jeanine M.M. van Klink
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Management Protocol ◽  
Increased Risk ◽  
The Impact

The aim of this review was to assess the impact of selective fetal growth restriction (sFGR) and/or birth weight discordance (BWD) on long-term neurodevelopment in monochorionic (MC) twins. Five out of 28 articles assessed for eligibility were included. One article concluded that the incidence of long-term neurodevelopmental impairment (NDI) was higher in BWD MC twins (11/26, 42%) than in BWD dichorionic (DC) (5/38, 13%) and concordant MC twins (6/71, 8%). BWD MC twins had a 6-fold higher risk of cerebral palsy compared to DC twins (5/26, 19% vs. 1/40, 3%, p < 0.05). Another article described a linear relationship between birth weight and verbal IQ scores, demonstrating a 13-point difference for a 1000 gram BWD between the twins, with a disadvantage for the smaller twin (p < 0.0001). Three articles analyzing within-pair differences showed that the smaller twin more frequently demonstrated mild NDI (6/80, 8% vs. 1/111, 1%) and lower developmental test scores (up to 5.3 points) as opposed to its larger co-twin. Although these results suggest that MC twins with sFGR/BWD are at increased risk of long-term NDI as compared to BWD DC or concordant MC twins, with a within-pair disadvantage for the smaller twin, the overall level of evidence is of moderate quality. As only five articles with a high degree of heterogeneity were available, our review mainly demonstrates the current lack of knowledge of the long-term outcomes of MC twins with sFGR/BWD. Insight into long-term outcomes will lead to improved prognostics, which are essential in parent counseling and crucial in the process of forming a management protocol specifically for twins with sFGR to optimally monitor and support their development.

scholarly journals Long-term follow-up of conservative treatment of Charcot feet

2021 ◽  
Author(s):  
Viviane Gratwohl ◽  
Thorsten Jentzsch ◽  
Madlaina Schöni ◽  
Dominik Kaiser ◽  
Martin C. Berli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Treatment ◽  
Major Amputation ◽  
Limb Loss ◽  
Ulcer Recurrence ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Charcot Feet

Abstract Background Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. Methods A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. Results Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. Conclusions With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. Level of Evidence III, long-term retrospective cohort study

Long-Term Unemployment in Poland in 2008-2012 - Tendencies, Structure and Selected Determinants

2013 ◽  
Vol 8 (4) ◽  
pp. 347-359
Author(s):  
Leszek Kucharski
Keyword(s):  
Secondary Education ◽  
Young People ◽  
Level Of Education ◽  
Low Level ◽  
Increased Risk

This study presents the structure and tendencies in long-term unemployment in Poland in the years 2008-2012. This study identifies the groups of people with an increased risk of long-term unemployment. The analyses produced the following conclusions. The groups with the highest risk of long-term unemployment include: singles, people aged of 55 and above and people with a low level of education. Young people with university and general secondary education faced the lowest risk of long-term unemployment. 

scholarly journals Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024980 ◽  
Author(s):  
Tiia T M Reho ◽  
Salla A Atkins ◽  
Nina Talola ◽  
Markku P T Sumanen ◽  
Mervi Viljamaa ◽  
...  
Keyword(s):  
Primary Care ◽  
Longitudinal Study ◽  
Occupational Health ◽  
Sick Leave ◽  
Diagnostic Codes ◽  
Frequent Attenders ◽  
Frequent Attendance ◽  
Increased Risk ◽  
Working Age

ObjectivesFrequent attenders (FAs) create a substantial portion of primary care workload but little is known about FAs’ sickness absences. The aim of the study is to investigate how occasional and persistent frequent attendance is associated with sickness absences among the working population in occupational health (OH) primary care.Setting and participantsThis is a longitudinal study using medical record data (2014–2016) from an OH care provider in Finland. In total, 59 676 patients were included and categorised into occasional and persistent FAs or non-FAs. Sick-leave episodes and their lengths were collected along with associated diagnostic codes. Logistic regression was used to analyse associations between FA status and sick leaves of different lengths (1–3, 4–14 and ≥15 days).ResultsBoth occasional and persistent FA had more and longer duration of sick leave than non-FA through the study years. Persistent FAs had consistently high absence rates. Occasional FAs had elevated absence rates even 2 years after their frequent attendance period. Persistent FAs (OR=11 95% CI 7.54 to 16.06 in 2016) and occasional FAs (OR=2.95 95% CI 2.50 to 3.49 in 2016) were associated with long (≥15 days) sickness absence when compared with non-FAs. Both groups of FAs had an increased risk of long-term sick leaves indicating a risk of disability pension.ConclusionBoth occasional and persistent FAs should be identified in primary care units caring for working-age patients. As frequent attendance is associated with long sickness absences and possibly disability pensions, rehabilitation should be directed at this group to prevent work disability.

Epidemiological Evidence that Maternal Influenza Contributes to the Aetiology of Schizophrenia

1993 ◽  
Vol 163 (4) ◽  
pp. 522-534 ◽  
Author(s):  
W. Adams ◽  
R. E. Kendell ◽  
E. H. Hare ◽  
P. Munk-Jørgensen
Keyword(s):  
Data Sets ◽  
Time Lags ◽  
Epidemiological Evidence ◽  
Intrauterine Development ◽  
Increased Risk ◽  
Schizophrenic Patients ◽  
The Relationship ◽  
Monthly Incidence ◽  
Maternal Influenza

The epidemiological evidence that the offspring of women exposed to influenza in pregnancy are at increased risk of schizophrenia is conflicting. In an attempt to clarify the issue we explored the relationship between the monthly incidence of influenza (and measles) in the general population and the distribution of birth dates of three large series of schizophrenic patients - 16 960 Scottish patients born in 1932–60; 22 021 English patients born in 1921–60; and 18 723 Danish patients born in 1911–65. Exposure to the 1957 epidemic of A2 influenza in midpregnancy was associated with an increased incidence of schizophrenia, at least in females, in all three data sets. We also confirmed the previous report of a statistically significant long-term relationship between patients' birth dates and outbreaks of influenza in the English series, with time lags of - 2 and - 3 months (the sixth and seventh months of pregnancy). Despite several other negative studies by ourselves and others we conclude that these relationships are probably both genuine and causal; and that maternal influenza during the middle third of intrauterine development, or something closely associated with it, is implicated in the aetiology of some cases of schizophrenia.

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