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One year before&#44; her&#160;creatinine level was 0&#46;8mg&#47;dl&#44; GFR&#160;&#40;MDRD&#41; &#62; 60 ml&#47;min&#47;1&#46;73m&#44; and&#160;systemic&#47;urine sediment showed no&#160;abnormalities&#46; In the six weeks prior to&#160;admission&#44; she reported progressive&#160;weakness&#44; followed by fever and dry&#160;cough&#46; She did not present dyspnoea&#44;&#160;chest pain&#44; or diuresis alterations&#46; The&#160;examination revealed blood pressure of&#160;190&#47;80mmHg&#44; breathing well&#44; with&#160;high jugular vein pressure&#44; rhythmic&#160;cardiac sounds with pericardial rub&#44;&#160;normal bilateral hemithorax ventilation&#160;and no oedema&#46; The analysis showed&#160;haemoglobin levels of 7&#46;7mg&#47;dl&#44; urea&#160;217mg&#47;dl&#44; creatinine 4&#46;5mg&#47;dl&#44; potassium 3&#46;6mEq&#47;l&#44; 98&#37; baseline&#160;saturation&#59; in the urine&#59; proteinuria of&#160;&#43;&#43;&#43; and 60 red blood cells&#47;field&#46; The&#160;ECG was normal&#46; The chest radiography&#160;showed severe cardiomegaly &#40;figure 1&#41;&#46;&#160;An emergency echocardiography&#160;showed a moderate-to-severe pericardial&#160;effusion&#46; Ultrasound showed no kidney&#160;alterations&#46;&#160;Treatment was started with doses of&#160;steroids at 1mg&#47;kg&#47;day&#44; and the&#160;patient&#8217;s state improved considerably&#160;in a few days&#46; With regard to the&#160;laboratory results&#44; the direct Coombs&#160;test was negative&#44; haptoglobin was&#160;4g&#47;l&#44; LDH 370U&#47;l&#44; C3 and C4 within&#160;the normal range&#44; ANA was negative&#44;&#160;ANCA was positive&#44; with a p-ANCA&#160;pattern&#46; Reactivity analysed by the&#160;ELISA test corresponded to&#160;antimyeloperoxidase of 146U&#47;ml&#46;&#160;Proteinuria was 2g&#47;24 hours&#46; The&#160;percutaneous renal biopsy of a total of&#160;17 glomerules was compatible with&#160;focal proliferative glomerulonephritis&#44;&#160;with crescents at 50&#37; and significant&#160;tubulointerstitial involvement&#46; A dose&#160;of IV cyclophosphamide was&#160;recommended&#44; and the&#160;echocardiography was repeated &#40;a day&#160;before cyclophosphamide bolus&#160;administration&#41; with no signs of the&#160;pericardial effusion&#46; After a stay of 18&#160;days&#44; she was discharged with a&#160;creatinine value of 1&#46;8mg&#47;dl&#46;&#160;In small-vessel vasculitis&#44; it is possible&#160;to have primary or secondary cardiac&#160;involvement relating to high blood&#160;pressure&#44; immunosuppressants&#44; the inflammatory state and the kidney&#160;disease that can contribute to&#160;developing cardiac hypertrophy&#44;&#160;bacterial endocarditis and coronary&#160;disease&#46;<span class="elsevierStyleSup">1&#44;2&#160;</span>As a primary manifestation of the&#160;disease&#44; cardiac involvement is more&#160;frequent in Churg-Strauss disease&#44;&#160;where 13-47&#37;<span class="elsevierStyleSup">1&#44;3 </span>of all patients have a&#160;myocardial&#44; endocardial or pericardial&#160;lesion&#46; With regard to the incidence&#160;rate for pericardial involvement&#44;&#160;whether in the form of acute&#160;pericarditis and pericardial effusion or&#160;as chronic constrictive pericarditis&#44; its&#160;range is estimated between 8 and 32&#37;&#160;in Churg-Strauss syndrome and 19&#37; in&#160;Wegener&#8217;s granulomatosis&#46;<span class="elsevierStyleSup">5&#160;</span>With regard to microscopic polyangiitis&#44;&#160;its unusual presentation as a pericardial&#160;effusion caught our attention&#44; and in fact&#44;&#160;the literature we consulted contained no&#160;references to such an event&#46; Finding it in inflammatory state and the kidney&#160;disease that can contribute to&#160;developing cardiac hypertrophy&#44;&#160;bacterial endocarditis and coronary&#160;disease&#46;<span class="elsevierStyleSup">1&#44;2&#160;</span>As a primary manifestation of the&#160;disease&#44; cardiac involvement is more&#160;frequent in Churg-Strauss disease&#44;&#160;where 13-47&#37;<span class="elsevierStyleSup">1&#44;3 </span>of all patients have a&#160;myocardial&#44; endocardial or pericardial&#160;lesion&#46; With regard to the incidence&#160;rate for pericardial involvement&#44;&#160;whether in the form of acute&#160;pericarditis and pericardial effusion or&#160;as chronic constrictive pericarditis&#44; its&#160;range is estimated between 8 and 32&#37;&#160;in Churg-Strauss syndrome and 19&#37; in&#160;Wegener&#8217;s granulomatosis&#46;<span class="elsevierStyleSup">5&#160;</span>With regard to microscopic polyangiitis&#44;&#160;its unusual presentation as a pericardial&#160;effusion caught our attention&#44; and in fact&#44;&#160;the literature we consulted contained no&#160;references to such an event&#46; Finding it in this case was achieved by hearing the pericardial rub&#59; together with a compatible radiography&#44; this led us to order the echocardiography that confirmed our diagnosis&#46; She began steroid treatment early&#44; with an excellent response&#46; As a result of this experience&#44; we must consider the possibility of pericardial involvement in this type of vasculitis&#46; Proper examination and evaluation of simple complementary tests that are available in every hospital continues to be the fundamental pillar of a correct diagnostic and therapeutic approach&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10348108&#95;a28&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10348108_a28_f1.jpg" alt="Cardiomegaly without other signs suggesting heart failure&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Cardiomegaly without other signs suggesting heart failure&#46;</p>"
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A case of p-ANCA positive vasculitis with associated pericardial effusion
Un caso de vasculitis p-ANCA positivo con derrame pericárdico asociado
Ana María Suárez Laurésa, L.. Quiñonesa, A.. Torresa, A.. Pobesa, R.. Forascepia
a Servicio de Nefrología, Hospital de Cabueñes, Gijón, España,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;&#160;</span>Microscopic polyangiitis is a&#160;necrotising vasculitis primarily&#160;affecting the glomeruli &#40;vasculitis&#160;limited to the kidney may be the only&#160;manifestation&#41;&#44; and secondly&#44; the&#160;lungs&#44; but it is a systemic process that&#160;may affect small blood vessels in any&#160;part of the body&#46; High blood pressure&#160;is the most common cardiovascular&#160;manifestation&#46;&#160;We present the case of a patient with&#160;sub-acute deterioration of renal&#160;function and affected pericardium who&#160;responded well to steroid treatment&#46;&#160;This 60-year old female patient with a&#160;history of diabetes mellitus that was&#160;diagnosed three years before&#44; with no&#160;microangiopathy or macroangiopathy&#160;and high blood pressure during ten&#160;years which was treated with&#160;carvedilol&#44; hydrochlorothiazide and&#160;valsartan&#46; One year before&#44; her&#160;creatinine level was 0&#46;8mg&#47;dl&#44; GFR&#160;&#40;MDRD&#41; &#62; 60 ml&#47;min&#47;1&#46;73m&#44; and&#160;systemic&#47;urine sediment showed no&#160;abnormalities&#46; In the six weeks prior to&#160;admission&#44; she reported progressive&#160;weakness&#44; followed by fever and dry&#160;cough&#46; She did not present dyspnoea&#44;&#160;chest pain&#44; or diuresis alterations&#46; The&#160;examination revealed blood pressure of&#160;190&#47;80mmHg&#44; breathing well&#44; with&#160;high jugular vein pressure&#44; rhythmic&#160;cardiac sounds with pericardial rub&#44;&#160;normal bilateral hemithorax ventilation&#160;and no oedema&#46; The analysis showed&#160;haemoglobin levels of 7&#46;7mg&#47;dl&#44; urea&#160;217mg&#47;dl&#44; creatinine 4&#46;5mg&#47;dl&#44; potassium 3&#46;6mEq&#47;l&#44; 98&#37; baseline&#160;saturation&#59; in the urine&#59; proteinuria of&#160;&#43;&#43;&#43; and 60 red blood cells&#47;field&#46; The&#160;ECG was normal&#46; The chest radiography&#160;showed severe cardiomegaly &#40;figure 1&#41;&#46;&#160;An emergency echocardiography&#160;showed a moderate-to-severe pericardial&#160;effusion&#46; Ultrasound showed no kidney&#160;alterations&#46;&#160;Treatment was started with doses of&#160;steroids at 1mg&#47;kg&#47;day&#44; and the&#160;patient&#8217;s state improved considerably&#160;in a few days&#46; With regard to the&#160;laboratory results&#44; the direct Coombs&#160;test was negative&#44; haptoglobin was&#160;4g&#47;l&#44; LDH 370U&#47;l&#44; C3 and C4 within&#160;the normal range&#44; ANA was negative&#44;&#160;ANCA was positive&#44; with a p-ANCA&#160;pattern&#46; Reactivity analysed by the&#160;ELISA test corresponded to&#160;antimyeloperoxidase of 146U&#47;ml&#46;&#160;Proteinuria was 2g&#47;24 hours&#46; The&#160;percutaneous renal biopsy of a total of&#160;17 glomerules was compatible with&#160;focal proliferative glomerulonephritis&#44;&#160;with crescents at 50&#37; and significant&#160;tubulointerstitial involvement&#46; A dose&#160;of IV cyclophosphamide was&#160;recommended&#44; and the&#160;echocardiography was repeated &#40;a day&#160;before cyclophosphamide bolus&#160;administration&#41; with no signs of the&#160;pericardial effusion&#46; After a stay of 18&#160;days&#44; she was discharged with a&#160;creatinine value of 1&#46;8mg&#47;dl&#46;&#160;In small-vessel vasculitis&#44; it is possible&#160;to have primary or secondary cardiac&#160;involvement relating to high blood&#160;pressure&#44; immunosuppressants&#44; the inflammatory state and the kidney&#160;disease that can contribute to&#160;developing cardiac hypertrophy&#44;&#160;bacterial endocarditis and coronary&#160;disease&#46;<span class="elsevierStyleSup">1&#44;2&#160;</span>As a primary manifestation of the&#160;disease&#44; cardiac involvement is more&#160;frequent in Churg-Strauss disease&#44;&#160;where 13-47&#37;<span class="elsevierStyleSup">1&#44;3 </span>of all patients have a&#160;myocardial&#44; endocardial or pericardial&#160;lesion&#46; With regard to the incidence&#160;rate for pericardial involvement&#44;&#160;whether in the form of acute&#160;pericarditis and pericardial effusion or&#160;as chronic constrictive pericarditis&#44; its&#160;range is estimated between 8 and 32&#37;&#160;in Churg-Strauss syndrome and 19&#37; in&#160;Wegener&#8217;s granulomatosis&#46;<span class="elsevierStyleSup">5&#160;</span>With regard to microscopic polyangiitis&#44;&#160;its unusual presentation as a pericardial&#160;effusion caught our attention&#44; and in fact&#44;&#160;the literature we consulted contained no&#160;references to such an event&#46; Finding it in inflammatory state and the kidney&#160;disease that can contribute to&#160;developing cardiac hypertrophy&#44;&#160;bacterial endocarditis and coronary&#160;disease&#46;<span class="elsevierStyleSup">1&#44;2&#160;</span>As a primary manifestation of the&#160;disease&#44; cardiac involvement is more&#160;frequent in Churg-Strauss disease&#44;&#160;where 13-47&#37;<span class="elsevierStyleSup">1&#44;3 </span>of all patients have a&#160;myocardial&#44; endocardial or pericardial&#160;lesion&#46; With regard to the incidence&#160;rate for pericardial involvement&#44;&#160;whether in the form of acute&#160;pericarditis and pericardial effusion or&#160;as chronic constrictive pericarditis&#44; its&#160;range is estimated between 8 and 32&#37;&#160;in Churg-Strauss syndrome and 19&#37; in&#160;Wegener&#8217;s granulomatosis&#46;<span class="elsevierStyleSup">5&#160;</span>With regard to microscopic polyangiitis&#44;&#160;its unusual presentation as a pericardial&#160;effusion caught our attention&#44; and in fact&#44;&#160;the literature we consulted contained no&#160;references to such an event&#46; Finding it in this case was achieved by hearing the pericardial rub&#59; together with a compatible radiography&#44; this led us to order the echocardiography that confirmed our diagnosis&#46; She began steroid treatment early&#44; with an excellent response&#46; As a result of this experience&#44; we must consider the possibility of pericardial involvement in this type of vasculitis&#46; Proper examination and evaluation of simple complementary tests that are available in every hospital continues to be the fundamental pillar of a correct diagnostic and therapeutic approach&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10348108&#95;a28&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10348108_a28_f1.jpg" alt="Cardiomegaly without other signs suggesting heart failure&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Cardiomegaly without other signs suggesting heart failure&#46;</p>"
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Article information
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2022 May 94 34 128
2022 April 87 61 148
2022 March 114 52 166
2022 February 95 48 143
2022 January 120 38 158
2021 December 71 44 115
2021 November 79 38 117
2021 October 78 53 131
2021 September 57 39 96
2021 August 78 28 106
2021 July 75 40 115
2021 June 97 27 124
2021 May 105 30 135
2021 April 179 104 283
2021 March 94 24 118
2021 February 92 9 101
2021 January 75 18 93
2020 December 56 14 70
2020 November 56 9 65
2020 October 54 9 63
2020 September 50 10 60
2020 August 71 10 81
2020 July 74 13 87
2020 June 59 17 76
2020 May 76 18 94
2020 April 67 23 90
2020 March 61 17 78
2020 February 75 11 86
2020 January 89 20 109
2019 December 144 30 174
2019 November 62 22 84
2019 October 52 9 61
2019 September 74 16 90
2019 August 66 15 81
2019 July 73 28 101
2019 June 69 30 99
2019 May 73 23 96
2019 April 120 28 148
2019 March 66 34 100
2019 February 59 21 80
2019 January 81 18 99
2018 December 115 37 152
2018 November 127 14 141
2018 October 231 15 246
2018 September 133 16 149
2018 August 76 14 90
2018 July 73 12 85
2018 June 83 14 97
2018 May 81 13 94
2018 April 91 10 101
2018 March 85 11 96
2018 February 71 8 79
2018 January 66 7 73
2017 December 69 10 79
2017 November 65 18 83
2017 October 64 5 69
2017 September 56 9 65
2017 August 38 8 46
2017 July 52 21 73
2017 June 66 10 76
2017 May 51 6 57
2017 April 170 10 180
2017 March 71 4 75
2017 February 37 24 61
2017 January 35 10 45
2016 December 86 9 95
2016 November 75 4 79
2016 October 105 9 114
2016 September 113 8 121
2016 August 166 5 171
2016 July 168 15 183
2016 June 125 0 125
2016 May 132 0 132
2016 April 83 0 83
2016 March 77 0 77
2016 February 96 0 96
2016 January 88 0 88
2015 December 96 0 96
2015 November 87 0 87
2015 October 77 0 77
2015 September 73 0 73
2015 August 69 0 69
2015 July 84 0 84
2015 June 45 0 45
2015 May 61 0 61
2015 April 5 0 5
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?