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by CKD-EPI of 13<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; Six months previously&#44; he had pCr of 1&#46;36<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and urinalysis with proteinuria and microscopic haematuria&#46; The complementary tests revealed a glomerular proteinuria of 10<span class="elsevierStyleHsp" style=""></span>g per day with microscopic haematuria&#46; The serological tests &#40;hepatitis B and C virus&#44; HIV&#44; CMV&#44; Epstein&#8211;Barr virus&#41; and autoimmunity tests &#40;antinuclear antibodies&#44; antineutrophil cytoplasmic antibodies&#44; anti-glomerular basement membrane antibodies&#44; proteinogram&#44; complement&#44; extractable nuclear antigens&#41; were negative&#47;normal&#46; The A2 antiphospholipid antibodies were not available at the time&#46; He presented occasional fluctuating mild eosinophilia &#40;1&#8211;12&#37;&#44; with eosinophils 100&#8211;900&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A kidney biopsy was performed with a diagnosis of membranous GN in stage 2&#8211;3&#44; with marked interstitial inflammation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Direct immunofluorescence was positive for granular deposits in the basement membrane for IGG&#44; kappa and lambda chains&#44; and in a lower proportion for C3&#44; with these being negative for the rest of the immunoglobulins and C1q &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In view of these findings with significant interstitial inflammation and given the patient&#39;s kidney failure&#44; it was decided to start treatment with prednisone at doses of 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; In addition&#44; the following were added to the treatment&#58; amlodipine&#44; darbepoetin&#44; furosemide&#44; bicarbonate&#44; atorvastatin&#44; iron&#44; omeprazole&#44; trimethoprim&#47;sulfamethoxazole&#44; calcium and vitamin D&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After one month&#44; he came to the clinic reporting anorexia and nonspecific dyspepsia&#46; Kidney function had improved to pCr of 2&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and eGFR 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; as had proteinuria&#44; to 2<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46; Of note from the blood tests were moderate hyponatraemia &#40;127<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#41; with hyperkalaemia &#40;6&#46;7<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#41;&#44; elevation of CA 125 and corticotropin with cortisol in plasma normal&#46; It was decided to admit the patient to hospital to complete testing and on the fourth day he started to have a low-grade fever&#44; tachycardia&#44; bradypsychia and hyporesponsiveness&#46; A few hours later&#44; he developed a generalised epileptic seizure with meningeal signs&#46; A cranial computed tomography scan was performed which ruled out space-occupying lesions and acute haemorrhage&#59; empirical therapy was initiated with ceftazidime and ampicillin&#44; and a lumbar puncture was performed which showed data compatible with bacterial meningitis&#46; The CSF culture identified <span class="elsevierStyleItalic">Escherichia coli</span>&#46; The cephalosporin was therefore replaced with a carbapenem&#46; The clinical course was poor and after 48<span class="elsevierStyleHsp" style=""></span>h he developed dyspnoea&#44; with severe overall respiratory failure and fluctuations in level of consciousness&#46; He therefore required transfer to the ICU with the diagnosis of septic shock secondary to meningitis for assisted mechanical ventilation and support with inotropic amines&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During his stay in the ICU&#44; he developed bicytopenia which required a blood transfusion&#59; adult respiratory distress syndrome secondary to pneumonia due to <span class="elsevierStyleItalic">Cryptococcus neoformans</span>&#59; new culture of CSF with growth of <span class="elsevierStyleItalic">Enterococcus faecium</span>&#59; oligoanuric renal failure which required CVVH&#59; severe malnutrition and polyneuropathy of the critically ill patient&#46; In the anatomopathological study of the bronchoalveolar lavage &#40;BAL&#41; fluid&#44; an inflammatory infiltrate with eosinophils and the presence of parasites indicative of <span class="elsevierStyleItalic">S&#46; stercoralis</span> was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; which were also subsequently identified in the stool culture&#46; He received treatment with meropenem&#44; vancomycin&#44; liposomal amphotericin B and subsequently with fluconazole&#44; trimethoprim&#47;sulfamethoxazole&#44; ivermectin and albendazole&#46; While he was being monitored&#44; CMV in blood developed &#40;1000<span class="elsevierStyleHsp" style=""></span>copies&#47;ml&#41;&#44; so ganciclovir was added&#46; Despite the stool culture&#44; BAL culture and blood cultures becoming negative&#44; the patient did not improve clinically and remained in a state of coma vigil&#46; The electroencephalogram revealed a severe slowing down and diffuse suppression of brain activity&#44; and the brain magnetic resonance imaging identified signs of hyperintensity on a T2 sequence in the right frontal parasagittal region and the occipital horn of the right lateral ventricle&#44; indicative of the persistence of the inflammatory&#47;infectious process&#46; Despite maintaining an appropriate antibiotic therapy for the cultures&#44; the patient died after developing respiratory failure due to nosocomial pneumonia caused by <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This case report reveals the devastating prognosis of <span class="elsevierStyleItalic">S&#46; stercoralis</span> hyperinfection in a patient immunosuppressed due to corticosteroids and who&#44; a priori&#44; did not seem to have other risk factors&#46; <span class="elsevierStyleItalic">S&#46; stercoralis</span> is a soil-transmitted helminth which measures 2&#46;5<span class="elsevierStyleHsp" style=""></span>mm in a female adult state and 0&#46;3&#8211;0&#46;6<span class="elsevierStyleHsp" style=""></span>mm in the larval stage&#44; which lives mainly in Eastern Europe&#44; South-east Asia&#44; South America and sub-Saharan Africa&#44; with prevalence rates close to 30&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Spain was an endemic country&#44; in particular in the Mediterranean area&#44; although in recent decades the number of imported cases have increased as a result of immigration&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> It is transmitted by contact with the soil or by the intake of contaminated food or water&#46; It lives in the upper jejunal mucosa and is reproduced by parthenogenesis&#44; completing its life cycle by transforming from non-infective rhabditiform larvae into infective filariform larvae which self-infect the host crossing the intestinal lumen&#44; reaching the lymph nodes of the wall&#44; and from there the bloodstream&#44; from where it reaches the liver&#44; and subsequently the lungs&#44; kidneys and central nervous system&#44; self-perpetuating its infection&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">When an intestinal or pulmonary invasion of a large number of larvae occurs&#44; it may trigger multiple organ failure which is known as hyperinfection syndrome&#46; It is more common in elderly patients&#44; patients with kidney disease&#44; diabetes&#44; malnutrition&#44; in situations of achlorhydria and patients immunosuppressed due to any cause &#40;leprosy&#44; corticosteroid therapy&#44; HIV&#44; HTLV-I&#44; anti-tumour necrosis factor-alpha therapy&#41;&#44; post solid organ transplant or bone marrow transplant patients<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#8211;12</span></a> and&#44; although rare&#44; it can also occur in immunocompetent patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis of <span class="elsevierStyleItalic">S&#46; stercoralis</span> parasitic infection can be performed by detecting the parasites in faeces or in other biological samples in the case of hyperinfection&#46; Direct viewing of faeces is used routinely in laboratories&#44; but it has a very low sensitivity&#44; with this sensitivity improving somewhat if repeated samples are used&#46; A stool culture in agar and direct or indirect immunoassay methods can also be resorted to&#44; detecting antibodies to <span class="elsevierStyleItalic">Strongyloides</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Ivermectin is considered the treatment of choice when there are symptoms of hyperinfection&#46; Tiabendazole and albendazole achieve comparable remission results in uncomplicated infections&#44; with these being more poorly tolerated than ivermectin&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> In Spain&#44; ivermectin should be requested as a foreign drug and the recommended conventional dose is 0&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;day for two days&#44; with it being necessary to repeat the dose after 15 days&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> In cases of cumulative dose of prednisone above 420<span class="elsevierStyleHsp" style=""></span>mg in four weeks&#44; some authors recommend prophylaxis in patients at risk of infestation&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the ten cases reported in the literature of <span class="elsevierStyleItalic">Strongyloides</span> hyperinfection syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> 88&#46;9&#37; were males&#44; with a mean age of 48 &#40;24&#8211;79&#41;&#44; with onset of abdominal pain as the most common symptom &#40;88&#46;9&#37;&#41; and&#44; in a lower percentage&#44; fever &#40;66&#46;7&#37;&#41;&#44; pulmonary infiltrates &#40;66&#46;7&#37;&#41;&#44; diarrhoea &#40;44&#46;4&#37;&#41;&#44; eosinophilia &#40;66&#46;7&#37;&#41; and mortality of 22&#46;2&#37;&#46; In overall data&#44; eosinophilia does not exceed 20&#8211;35&#37; and tends to be episodic and non-continuous&#46; There are doubts regarding its prognostic value&#44; as it seems to represent an adequate Th2-type immune response&#44; but the data are contradictory&#46; The suspected diagnosis is fundamental in immunosuppressed patients&#44; especially those on treatment with corticosteroids&#44; with eosinopenia or eosinophilia&#44; with protein-losing enteropathy or malabsorption syndrome&#44; nausea&#44; vomiting and ileus&#44; and in patients from endemic countries&#46; Chan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> report the case of a 72-year-old Vietnamese male&#44; resident in Australia&#44; affected by diabetes mellitus and asthma&#44; who developed hyperinfection syndrome after recent laparoscopic surgery and died on the seventh day after starting treatment with ivermectin&#46; Clinically&#44; it has been associated with signs of pseudo-obstruction and may become complicated with tumour processes&#44; such as colon adenocarcinoma&#44; GIT T-cell lymphoma and MALT lymphoma of the stomach and colon&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> in relation to co-infection with Helicobacter pylori&#44; and resolution when treating both infections&#46; The mechanism assumes the interaction of a parasite antigen with the colon mucosa causing a continuous stimulus of T-lymphocytes&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In an extensive review of cases of strongyloidiasis reported in Spain from 2000 to 2015&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> 18 cases were gathered&#59; 66&#46;7&#37; were males with a mean age of 40 &#40;21&#8211;70&#41;&#46; A total of 94&#46;4&#37; were of foreign origin&#44; mainly from South America &#40;82&#46;3&#37;&#41; and secondly from West Africa &#40;17&#46;6&#37;&#41;&#46; Only one indigenous case has been reported since 2006&#46; Some 77&#37; of them were immunosuppressed due to corticosteroid therapy&#44; HIV&#44; HTLV and solid organ transplant&#46; The initial symptoms were gastrointestinal in 55&#46;6&#37; of cases&#44; accompanied by a fever in 27&#46;8&#37;&#46; One case had nephrotic syndrome&#44; with no more data&#44; which is why it was not included in the total count&#46; Mortality was 11&#46;1&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are 18 reported cases which associate <span class="elsevierStyleItalic">Strongyloides</span> infection with glomerular disease&#44; 11 of which have histological diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10&#44;16&#8211;23</span></a> Almost all started between four and eight weeks after starting corticosteroid therapy and most of them are defined as MCGN&#46; In general&#44; the diagnosis of GN preceded that of parasitic infection&#44; which was revealed after the corticosteroid therapy&#44; except in the case reported by Hsieh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> which started with the parasitic infection while the GN developed three months later and was resolved after initiating treatment with ivermectin&#46; Four of the patients died&#46; In the other patients the parasitic infection and the kidney disease was resolved&#44; except in one of the cases reported by Gravellone et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> an Ecuadorian affected by focal segmental GN treated with prednisone&#44; in whom the renal impairment persisted after resolution of the <span class="elsevierStyleItalic">Strongyloides</span> infection&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The case described illustrates the high mortality and severity of <span class="elsevierStyleItalic">Strongyloides</span> hyperinfection syndrome triggered by the immunosuppression which is necessary and used routinely in the treatment of glomerular diseases&#46; This case teaches us two things&#46; First&#44; about a rare association of strongyloidiasis and membranous GN&#44; and second&#44; and most importantly&#44; about the significance of establishing a suspected diagnosis and appropriate treatment in the face of certain infections or diseases with little clinical expression in at-risk patients before starting any immunosuppressive therapy&#46; It is necessary to pay special attention to the individual risk of each patient of infectious complications&#44; referring to the medical history and investigating their origin&#44; behaviours and travel to risk areas&#46; In the case of <span class="elsevierStyleItalic">S&#46; stercoralis</span>&#44; a mild and fluctuating eosinophilia in patients from endemic areas may be the only abnormality that helps us to establish a suspected diagnosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Membranous glomerulonephritis"
            1 => "<span class="elsevierStyleItalic">Strongyloides stercolaris</span>"
            2 => "Acute kidney disease"
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            0 => "Glomerulonefritis membranosa"
            1 => "<span class="elsevierStyleItalic">Strongyloides stercolaris</span>"
            2 => "Fracaso renal agudo"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The relationship between parasites and glomerulonephritis &#40;GN&#41; is well documented in certain parasitoses&#44; but not in cases of <span class="elsevierStyleItalic">Strongyloides stercolaris</span> &#40;<span class="elsevierStyleItalic">S&#46; stercolaris</span>&#41; where there are few cases described being the majority GN of minimal changes&#46; We report a case of hyperinfestation by <span class="elsevierStyleItalic">S&#46; stercolaris</span> in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient&#46; This case provides a double teaching&#58; first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment&#46;</p></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La relaci&#243;n entre par&#225;sitos y glomerulonefritis &#40;GN&#41; est&#225; bien documentada en determinadas parasitosis&#44; no as&#237; en casos de <span class="elsevierStyleItalic">Strongyloides stercolaris</span> &#40;<span class="elsevierStyleItalic">S&#46; stercolaris</span>&#41;&#44; donde hay pocos casos descritos&#44; siendo la mayor&#237;a GN de cambios m&#237;nimos&#46; Reportamos un caso de hiperinfestaci&#243;n por <span class="elsevierStyleItalic">S&#46; stercolaris</span> en un paciente afectado de una GN membranosa tratado con corticoides por v&#237;a oral con resultado fatal para el paciente&#46; Este caso nos aporta una doble ense&#241;anza&#58; en primer lugar&#44; acerca de una asociaci&#243;n rara de estrongiloidiasis y GN membranosa&#44; y en segundo lugar&#44; sobre la importancia de establecer un diagn&#243;stico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad cl&#237;nica antes de iniciar cualquier tratamiento inmunosupresor&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ortega-D&#237;az M&#44; Puerta Carretero M&#44; Mart&#237;n Navarro JA&#44; Aramendi S&#225;nchez T&#44; Alc&#225;zar Arroyo R&#44; Corchete Prats E&#44; et al&#46; Inmunosupresi&#243;n como desencadenante de un s&#237;ndrome de hiperinfestaci&#243;n por <span class="elsevierStyleItalic">Strongyloides stercolaris</span> en la nefropat&#237;a membranosa&#46; Nefrologia&#46; 2020&#59;40&#58;345&#8211;350&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical microscopy images of the kidney biopsy&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Direct immunofluorescence images of the kidney biopsy&#46;</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Adapted from Abdullah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> and Hsieh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#47;gender&#47;race&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time since start of corticosteroids&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kidney biopsy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resolution&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mori et al&#46; &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">62&#47;male&#47;Japanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; Mesangial matrix expansion with limited tubular damage due to monocyte infiltration and necrosis&#46;IF mesangial IgM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wong et al&#46; &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#47;female&#47;Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; 1&#47;6 SL fibrous&#46; Mild&#47;moderate tubular atrophyIF negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yee et al&#46; &#40;1999&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#47;male&#47;Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; Mesangial hypercellularity&#46;IF C3 granular in GBMEM&#58; pedicle fusion&#44; increased cellularity and mesangial matrix with no immune deposits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morimoto et al&#46; &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#47;female&#47;Japanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46;IF negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hsieh et al&#46; &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#47;female&#47;Taiwanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not quantified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#44; focal lymphocytic interstitial infiltrate&#46; Patchy dilated tubules with signs of epithelial regenerationIF&#58; C3 mesangialEM&#58; podocyte effacement with no electron-dense deposits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sathe and Madiwale &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#47;female&#47;India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PM&#46; Generalised glomerulosclerosis&#46; Interstitial fibrosis and tubular atrophy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyazaki et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#47;male&#47;Japanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; No tubular atrophy or interstitial fibrosisIF negative&#46; EM&#58; podocyte effacement with no electron-dense deposits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gravellone et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#47;male&#47;Ecuadorian58&#47;male&#47;Ecuadorian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified24 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SMesangial GN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ResolutionResolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdullah et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#47;male&#47;Puerto Rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46;IF&#58; linear deposits of IgG along the GBM and kappa chains of undetermined significanceEM&#58; podocyte fusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#46; Ortega &#40;2018&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#47;male&#47;Ecuadorian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MBGN&#46; Tubulointerstitial infiltrate and fibrosis&#46; IF&#58; IgG&#44; kappa&#44; lambda&#44; C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2343766.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Summary of cases of <span class="elsevierStyleItalic">Strongyloides</span> infection with nephrotic syndrome published in the literature&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:23 [
            0 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated <span class="elsevierStyleItalic">Strongyloidiasis</span> in association with nephrotic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Abdullah"
                            1 => "L&#46; Winnicka"
                            2 => "C&#46; Raghu"
                            3 => "V&#46; Zeykan"
                            4 => "J&#46; Singh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000491632"
                      "Revista" => array:6 [
                        "tituloSerie" => "Case Rep Nephrol Dial"
                        "fecha" => "2018"
                        "volumen" => "8"
                        "paginaInicial" => "155"
                        "paginaFinal" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30197904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of severe strongyloidiasis attended at reference centers in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Martinez-Perez"
                            1 => "S&#46; Roure D&#237;ez"
                            2 => "M&#46; Belhassen-Garcia"
                            3 => "D&#46; Torr&#250;s-Tendero"
                            4 => "J&#46;L&#46; Perez-Arellano"
                            5 => "T&#46; Cabezas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pntd.0006272"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS Negl Trop Dis"
                        "fecha" => "2018"
                        "volumen" => "12"
                        "paginaInicial" => "e0006272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29474356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Strongyloides stercoralis</span> hyperinfection&#58; an often missed but potentially fatal cause of anemia and hypoalbuminemia in leprosy patients on long-term steroid therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Gupta"
                            1 => "S&#46; Bhatia"
                            2 => "A&#46;R&#46; Mridha"
                            3 => "P&#46; Das"
                            4 => "N&#46; Khanna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Dermatol Venereol Leprol"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "381"
                        "paginaFinal" => "383"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Strongyloides</span> hyper infection in a steroid dependent leprosy patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Darlong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lepr Rev"
                        "fecha" => "2016"
                        "volumen" => "87"
                        "paginaInicial" => "536"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30226358"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of <span class="elsevierStyleItalic">Strongyloides stercoralis</span> hyperinfection in leprosy patients on long-term steroid therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Prabha"
                            1 => "N&#46; Chhabra"
                          ]
                        ]
                      ]
                    ]
                  ]
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Case report
Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy
Inmunosupresión como desencadenante de un síndrome de hiperinfestación por Strongyloides stercolaris en la nefropatía membranosa
Mayra Ortega-Díaza, Marta Puerta Carreteroa, Juan A. Martín Navarroa,
Corresponding author
juanmartinnav@hotmail.com

Corresponding author.
, Teresa Aramendi Sánchezb, Roberto Alcázar Arroyoa, Elena Corchete Pratsa, Patricia de Sequera Ortiza, Marta Albalate Ramóna, M. Teresa Jaldo Rodrígueza, Laura Medina Zahoneroa
a Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
b Servicio de Anatomía Patológica Hospital Universitario Infanta Leonor, Madrid, Spain
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hence the importance of establishing a suspected diagnosis and appropriate treatment in those patients who are considered at-risk&#46; We report a case of <span class="elsevierStyleItalic">S&#46; stercoralis</span> hyperinfection syndrome in a patient affected by membranous GN treated with oral corticosteroids&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The case discusses a 52-year-old male patient from Ecuador who had been living in Spain for more than one year&#44; with a previous history of hypertension and dyslipidaemia&#44; undergoing treatment with lisinopril and atorvastatin&#46; He was referred to the emergency department after follow-up tests at his health centre showed kidney failure with plasma creatinine &#40;pCr&#41; of 4&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and estimated glomerular filtration rate &#40;eGFR&#41; by CKD-EPI of 13<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; Six months previously&#44; he had pCr of 1&#46;36<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and urinalysis with proteinuria and microscopic haematuria&#46; The complementary tests revealed a glomerular proteinuria of 10<span class="elsevierStyleHsp" style=""></span>g per day with microscopic haematuria&#46; The serological tests &#40;hepatitis B and C virus&#44; HIV&#44; CMV&#44; Epstein&#8211;Barr virus&#41; and autoimmunity tests &#40;antinuclear antibodies&#44; antineutrophil cytoplasmic antibodies&#44; anti-glomerular basement membrane antibodies&#44; proteinogram&#44; complement&#44; extractable nuclear antigens&#41; were negative&#47;normal&#46; The A2 antiphospholipid antibodies were not available at the time&#46; He presented occasional fluctuating mild eosinophilia &#40;1&#8211;12&#37;&#44; with eosinophils 100&#8211;900&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A kidney biopsy was performed with a diagnosis of membranous GN in stage 2&#8211;3&#44; with marked interstitial inflammation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Direct immunofluorescence was positive for granular deposits in the basement membrane for IGG&#44; kappa and lambda chains&#44; and in a lower proportion for C3&#44; with these being negative for the rest of the immunoglobulins and C1q &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In view of these findings with significant interstitial inflammation and given the patient&#39;s kidney failure&#44; it was decided to start treatment with prednisone at doses of 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; In addition&#44; the following were added to the treatment&#58; amlodipine&#44; darbepoetin&#44; furosemide&#44; bicarbonate&#44; atorvastatin&#44; iron&#44; omeprazole&#44; trimethoprim&#47;sulfamethoxazole&#44; calcium and vitamin D&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After one month&#44; he came to the clinic reporting anorexia and nonspecific dyspepsia&#46; Kidney function had improved to pCr of 2&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and eGFR 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; as had proteinuria&#44; to 2<span class="elsevierStyleHsp" style=""></span>g&#47;day&#46; Of note from the blood tests were moderate hyponatraemia &#40;127<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#41; with hyperkalaemia &#40;6&#46;7<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#41;&#44; elevation of CA 125 and corticotropin with cortisol in plasma normal&#46; It was decided to admit the patient to hospital to complete testing and on the fourth day he started to have a low-grade fever&#44; tachycardia&#44; bradypsychia and hyporesponsiveness&#46; A few hours later&#44; he developed a generalised epileptic seizure with meningeal signs&#46; A cranial computed tomography scan was performed which ruled out space-occupying lesions and acute haemorrhage&#59; empirical therapy was initiated with ceftazidime and ampicillin&#44; and a lumbar puncture was performed which showed data compatible with bacterial meningitis&#46; The CSF culture identified <span class="elsevierStyleItalic">Escherichia coli</span>&#46; The cephalosporin was therefore replaced with a carbapenem&#46; The clinical course was poor and after 48<span class="elsevierStyleHsp" style=""></span>h he developed dyspnoea&#44; with severe overall respiratory failure and fluctuations in level of consciousness&#46; He therefore required transfer to the ICU with the diagnosis of septic shock secondary to meningitis for assisted mechanical ventilation and support with inotropic amines&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During his stay in the ICU&#44; he developed bicytopenia which required a blood transfusion&#59; adult respiratory distress syndrome secondary to pneumonia due to <span class="elsevierStyleItalic">Cryptococcus neoformans</span>&#59; new culture of CSF with growth of <span class="elsevierStyleItalic">Enterococcus faecium</span>&#59; oligoanuric renal failure which required CVVH&#59; severe malnutrition and polyneuropathy of the critically ill patient&#46; In the anatomopathological study of the bronchoalveolar lavage &#40;BAL&#41; fluid&#44; an inflammatory infiltrate with eosinophils and the presence of parasites indicative of <span class="elsevierStyleItalic">S&#46; stercoralis</span> was observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; which were also subsequently identified in the stool culture&#46; He received treatment with meropenem&#44; vancomycin&#44; liposomal amphotericin B and subsequently with fluconazole&#44; trimethoprim&#47;sulfamethoxazole&#44; ivermectin and albendazole&#46; While he was being monitored&#44; CMV in blood developed &#40;1000<span class="elsevierStyleHsp" style=""></span>copies&#47;ml&#41;&#44; so ganciclovir was added&#46; Despite the stool culture&#44; BAL culture and blood cultures becoming negative&#44; the patient did not improve clinically and remained in a state of coma vigil&#46; The electroencephalogram revealed a severe slowing down and diffuse suppression of brain activity&#44; and the brain magnetic resonance imaging identified signs of hyperintensity on a T2 sequence in the right frontal parasagittal region and the occipital horn of the right lateral ventricle&#44; indicative of the persistence of the inflammatory&#47;infectious process&#46; Despite maintaining an appropriate antibiotic therapy for the cultures&#44; the patient died after developing respiratory failure due to nosocomial pneumonia caused by <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This case report reveals the devastating prognosis of <span class="elsevierStyleItalic">S&#46; stercoralis</span> hyperinfection in a patient immunosuppressed due to corticosteroids and who&#44; a priori&#44; did not seem to have other risk factors&#46; <span class="elsevierStyleItalic">S&#46; stercoralis</span> is a soil-transmitted helminth which measures 2&#46;5<span class="elsevierStyleHsp" style=""></span>mm in a female adult state and 0&#46;3&#8211;0&#46;6<span class="elsevierStyleHsp" style=""></span>mm in the larval stage&#44; which lives mainly in Eastern Europe&#44; South-east Asia&#44; South America and sub-Saharan Africa&#44; with prevalence rates close to 30&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> Spain was an endemic country&#44; in particular in the Mediterranean area&#44; although in recent decades the number of imported cases have increased as a result of immigration&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> It is transmitted by contact with the soil or by the intake of contaminated food or water&#46; It lives in the upper jejunal mucosa and is reproduced by parthenogenesis&#44; completing its life cycle by transforming from non-infective rhabditiform larvae into infective filariform larvae which self-infect the host crossing the intestinal lumen&#44; reaching the lymph nodes of the wall&#44; and from there the bloodstream&#44; from where it reaches the liver&#44; and subsequently the lungs&#44; kidneys and central nervous system&#44; self-perpetuating its infection&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">When an intestinal or pulmonary invasion of a large number of larvae occurs&#44; it may trigger multiple organ failure which is known as hyperinfection syndrome&#46; It is more common in elderly patients&#44; patients with kidney disease&#44; diabetes&#44; malnutrition&#44; in situations of achlorhydria and patients immunosuppressed due to any cause &#40;leprosy&#44; corticosteroid therapy&#44; HIV&#44; HTLV-I&#44; anti-tumour necrosis factor-alpha therapy&#41;&#44; post solid organ transplant or bone marrow transplant patients<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#8211;12</span></a> and&#44; although rare&#44; it can also occur in immunocompetent patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis of <span class="elsevierStyleItalic">S&#46; stercoralis</span> parasitic infection can be performed by detecting the parasites in faeces or in other biological samples in the case of hyperinfection&#46; Direct viewing of faeces is used routinely in laboratories&#44; but it has a very low sensitivity&#44; with this sensitivity improving somewhat if repeated samples are used&#46; A stool culture in agar and direct or indirect immunoassay methods can also be resorted to&#44; detecting antibodies to <span class="elsevierStyleItalic">Strongyloides</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Ivermectin is considered the treatment of choice when there are symptoms of hyperinfection&#46; Tiabendazole and albendazole achieve comparable remission results in uncomplicated infections&#44; with these being more poorly tolerated than ivermectin&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> In Spain&#44; ivermectin should be requested as a foreign drug and the recommended conventional dose is 0&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;day for two days&#44; with it being necessary to repeat the dose after 15 days&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> In cases of cumulative dose of prednisone above 420<span class="elsevierStyleHsp" style=""></span>mg in four weeks&#44; some authors recommend prophylaxis in patients at risk of infestation&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the ten cases reported in the literature of <span class="elsevierStyleItalic">Strongyloides</span> hyperinfection syndrome&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> 88&#46;9&#37; were males&#44; with a mean age of 48 &#40;24&#8211;79&#41;&#44; with onset of abdominal pain as the most common symptom &#40;88&#46;9&#37;&#41; and&#44; in a lower percentage&#44; fever &#40;66&#46;7&#37;&#41;&#44; pulmonary infiltrates &#40;66&#46;7&#37;&#41;&#44; diarrhoea &#40;44&#46;4&#37;&#41;&#44; eosinophilia &#40;66&#46;7&#37;&#41; and mortality of 22&#46;2&#37;&#46; In overall data&#44; eosinophilia does not exceed 20&#8211;35&#37; and tends to be episodic and non-continuous&#46; There are doubts regarding its prognostic value&#44; as it seems to represent an adequate Th2-type immune response&#44; but the data are contradictory&#46; The suspected diagnosis is fundamental in immunosuppressed patients&#44; especially those on treatment with corticosteroids&#44; with eosinopenia or eosinophilia&#44; with protein-losing enteropathy or malabsorption syndrome&#44; nausea&#44; vomiting and ileus&#44; and in patients from endemic countries&#46; Chan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> report the case of a 72-year-old Vietnamese male&#44; resident in Australia&#44; affected by diabetes mellitus and asthma&#44; who developed hyperinfection syndrome after recent laparoscopic surgery and died on the seventh day after starting treatment with ivermectin&#46; Clinically&#44; it has been associated with signs of pseudo-obstruction and may become complicated with tumour processes&#44; such as colon adenocarcinoma&#44; GIT T-cell lymphoma and MALT lymphoma of the stomach and colon&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> in relation to co-infection with Helicobacter pylori&#44; and resolution when treating both infections&#46; The mechanism assumes the interaction of a parasite antigen with the colon mucosa causing a continuous stimulus of T-lymphocytes&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In an extensive review of cases of strongyloidiasis reported in Spain from 2000 to 2015&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a> 18 cases were gathered&#59; 66&#46;7&#37; were males with a mean age of 40 &#40;21&#8211;70&#41;&#46; A total of 94&#46;4&#37; were of foreign origin&#44; mainly from South America &#40;82&#46;3&#37;&#41; and secondly from West Africa &#40;17&#46;6&#37;&#41;&#46; Only one indigenous case has been reported since 2006&#46; Some 77&#37; of them were immunosuppressed due to corticosteroid therapy&#44; HIV&#44; HTLV and solid organ transplant&#46; The initial symptoms were gastrointestinal in 55&#46;6&#37; of cases&#44; accompanied by a fever in 27&#46;8&#37;&#46; One case had nephrotic syndrome&#44; with no more data&#44; which is why it was not included in the total count&#46; Mortality was 11&#46;1&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are 18 reported cases which associate <span class="elsevierStyleItalic">Strongyloides</span> infection with glomerular disease&#44; 11 of which have histological diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10&#44;16&#8211;23</span></a> Almost all started between four and eight weeks after starting corticosteroid therapy and most of them are defined as MCGN&#46; In general&#44; the diagnosis of GN preceded that of parasitic infection&#44; which was revealed after the corticosteroid therapy&#44; except in the case reported by Hsieh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> which started with the parasitic infection while the GN developed three months later and was resolved after initiating treatment with ivermectin&#46; Four of the patients died&#46; In the other patients the parasitic infection and the kidney disease was resolved&#44; except in one of the cases reported by Gravellone et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> an Ecuadorian affected by focal segmental GN treated with prednisone&#44; in whom the renal impairment persisted after resolution of the <span class="elsevierStyleItalic">Strongyloides</span> infection&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The case described illustrates the high mortality and severity of <span class="elsevierStyleItalic">Strongyloides</span> hyperinfection syndrome triggered by the immunosuppression which is necessary and used routinely in the treatment of glomerular diseases&#46; This case teaches us two things&#46; First&#44; about a rare association of strongyloidiasis and membranous GN&#44; and second&#44; and most importantly&#44; about the significance of establishing a suspected diagnosis and appropriate treatment in the face of certain infections or diseases with little clinical expression in at-risk patients before starting any immunosuppressive therapy&#46; It is necessary to pay special attention to the individual risk of each patient of infectious complications&#44; referring to the medical history and investigating their origin&#44; behaviours and travel to risk areas&#46; In the case of <span class="elsevierStyleItalic">S&#46; stercoralis</span>&#44; a mild and fluctuating eosinophilia in patients from endemic areas may be the only abnormality that helps us to establish a suspected diagnosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Membranous glomerulonephritis"
            1 => "<span class="elsevierStyleItalic">Strongyloides stercolaris</span>"
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            0 => "Glomerulonefritis membranosa"
            1 => "<span class="elsevierStyleItalic">Strongyloides stercolaris</span>"
            2 => "Fracaso renal agudo"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The relationship between parasites and glomerulonephritis &#40;GN&#41; is well documented in certain parasitoses&#44; but not in cases of <span class="elsevierStyleItalic">Strongyloides stercolaris</span> &#40;<span class="elsevierStyleItalic">S&#46; stercolaris</span>&#41; where there are few cases described being the majority GN of minimal changes&#46; We report a case of hyperinfestation by <span class="elsevierStyleItalic">S&#46; stercolaris</span> in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient&#46; This case provides a double teaching&#58; first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La relaci&#243;n entre par&#225;sitos y glomerulonefritis &#40;GN&#41; est&#225; bien documentada en determinadas parasitosis&#44; no as&#237; en casos de <span class="elsevierStyleItalic">Strongyloides stercolaris</span> &#40;<span class="elsevierStyleItalic">S&#46; stercolaris</span>&#41;&#44; donde hay pocos casos descritos&#44; siendo la mayor&#237;a GN de cambios m&#237;nimos&#46; Reportamos un caso de hiperinfestaci&#243;n por <span class="elsevierStyleItalic">S&#46; stercolaris</span> en un paciente afectado de una GN membranosa tratado con corticoides por v&#237;a oral con resultado fatal para el paciente&#46; Este caso nos aporta una doble ense&#241;anza&#58; en primer lugar&#44; acerca de una asociaci&#243;n rara de estrongiloidiasis y GN membranosa&#44; y en segundo lugar&#44; sobre la importancia de establecer un diagn&#243;stico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad cl&#237;nica antes de iniciar cualquier tratamiento inmunosupresor&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ortega-D&#237;az M&#44; Puerta Carretero M&#44; Mart&#237;n Navarro JA&#44; Aramendi S&#225;nchez T&#44; Alc&#225;zar Arroyo R&#44; Corchete Prats E&#44; et al&#46; Inmunosupresi&#243;n como desencadenante de un s&#237;ndrome de hiperinfestaci&#243;n por <span class="elsevierStyleItalic">Strongyloides stercolaris</span> en la nefropat&#237;a membranosa&#46; Nefrologia&#46; 2020&#59;40&#58;345&#8211;350&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Optical microscopy images of the kidney biopsy&#46;</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Adapted from Abdullah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> and Hsieh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a></p>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kidney biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mori et al&#46; &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#47;male&#47;Japanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; Mesangial matrix expansion with limited tubular damage due to monocyte infiltration and necrosis&#46;IF mesangial IgM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wong et al&#46; &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#47;female&#47;Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; 1&#47;6 SL fibrous&#46; Mild&#47;moderate tubular atrophyIF negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yee et al&#46; &#40;1999&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#47;male&#47;Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; Mesangial hypercellularity&#46;IF C3 granular in GBMEM&#58; pedicle fusion&#44; increased cellularity and mesangial matrix with no immune deposits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morimoto et al&#46; &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#47;female&#47;Japanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46;IF negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hsieh et al&#46; &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#47;female&#47;Taiwanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not quantified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#44; focal lymphocytic interstitial infiltrate&#46; Patchy dilated tubules with signs of epithelial regenerationIF&#58; C3 mesangialEM&#58; podocyte effacement with no electron-dense deposits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sathe and Madiwale &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#47;female&#47;India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PM&#46; Generalised glomerulosclerosis&#46; Interstitial fibrosis and tubular atrophy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miyazaki et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#47;male&#47;Japanese&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46; No tubular atrophy or interstitial fibrosisIF negative&#46; EM&#58; podocyte effacement with no electron-dense deposits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gravellone et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#47;male&#47;Ecuadorian58&#47;male&#47;Ecuadorian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not specified24 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SMesangial GN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ResolutionResolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdullah et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#47;male&#47;Puerto Rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&#46;IF&#58; linear deposits of IgG along the GBM and kappa chains of undetermined significanceEM&#58; podocyte fusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#46; Ortega &#40;2018&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#47;male&#47;Ecuadorian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MBGN&#46; Tubulointerstitial infiltrate and fibrosis&#46; IF&#58; IgG&#44; kappa&#44; lambda&#44; C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deceased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2343766.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Summary of cases of <span class="elsevierStyleItalic">Strongyloides</span> infection with nephrotic syndrome published in the literature&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:23 [
            0 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disseminated <span class="elsevierStyleItalic">Strongyloidiasis</span> in association with nephrotic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Abdullah"
                            1 => "L&#46; Winnicka"
                            2 => "C&#46; Raghu"
                            3 => "V&#46; Zeykan"
                            4 => "J&#46; Singh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000491632"
                      "Revista" => array:6 [
                        "tituloSerie" => "Case Rep Nephrol Dial"
                        "fecha" => "2018"
                        "volumen" => "8"
                        "paginaInicial" => "155"
                        "paginaFinal" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30197904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of severe strongyloidiasis attended at reference centers in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Martinez-Perez"
                            1 => "S&#46; Roure D&#237;ez"
                            2 => "M&#46; Belhassen-Garcia"
                            3 => "D&#46; Torr&#250;s-Tendero"
                            4 => "J&#46;L&#46; Perez-Arellano"
                            5 => "T&#46; Cabezas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pntd.0006272"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS Negl Trop Dis"
                        "fecha" => "2018"
                        "volumen" => "12"
                        "paginaInicial" => "e0006272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29474356"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Strongyloides stercoralis</span> hyperinfection&#58; an often missed but potentially fatal cause of anemia and hypoalbuminemia in leprosy patients on long-term steroid therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Gupta"
                            1 => "S&#46; Bhatia"
                            2 => "A&#46;R&#46; Mridha"
                            3 => "P&#46; Das"
                            4 => "N&#46; Khanna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Dermatol Venereol Leprol"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "381"
                        "paginaFinal" => "383"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
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Article information
ISSN: 20132514
Original language: English
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Idiomas
Nefrología (English Edition)