Statistics

 array:21 [
  "pii" => "X2013251411052142"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2011.Apr.10841"
  "estado" => "S300"
  "fechaPublicacion" => "2011-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2011;31:494-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4778
    "formatos" => array:3 [
      "EPUB" => 297
      "HTML" => 3875
      "PDF" => 606
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699511052145"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2011.Apr.10841"
      "estado" => "S300"
      "fechaPublicacion" => "2011-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2011;31:494-5"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 9705
        "formatos" => array:3 [
          "EPUB" => 359
          "HTML" => 8796
          "PDF" => 550
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Hemorragia pulmonar crónica como primera manifestación de una poliangeítis microscópica asociada a tiroiditis autoinmune"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "494"
            "paginaFinal" => "495"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Chronic pulmonary bleeding as the first sign of microscopic polyangiitis associated with autoimmune thyroiditis"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "10841_108_13821_es_10841_f1.jpg"
                "Alto" => 233
                "Ancho" => 328
                "Tamanyo" => 126007
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Microscopia óptica. Glomérulo con necrosis fibrinoide. Hematoxilina-eosina, x20."
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M. Martínez-Gabarrón, R. Enríquez, A.E. Sirvent, E. Andrada, I. Millán, F. Amorós"
            "autores" => array:6 [
              0 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Martínez-Gabarrón"
              ]
              1 => array:2 [
                "Iniciales" => "R."
                "apellidos" => "Enríquez"
              ]
              2 => array:2 [
                "Iniciales" => "A.E."
                "apellidos" => "Sirvent"
              ]
              3 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Andrada"
              ]
              4 => array:2 [
                "Iniciales" => "I."
                "apellidos" => "Millán"
              ]
              5 => array:2 [
                "Iniciales" => "F."
                "apellidos" => "Amorós"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251411052142"
          "doi" => "10.3265/Nefrologia.pre2011.Apr.10841"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052142?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052145?idApp=UINPBA000064"
      "url" => "/02116995/0000003100000004/v0_201502091411/X0211699511052145/v0_201502091412/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251411052134"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Apr.10824"
    "estado" => "S300"
    "fechaPublicacion" => "2011-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:495-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4616
      "formatos" => array:3 [
        "EPUB" => 338
        "HTML" => 3634
        "PDF" => 644
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Mushroom poisoning: Orellanus syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "495"
          "paginaFinal" => "496"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Intoxicación por setas: síndrome orellánico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S. Álvarez Tundidor, A. González López, A. Nava Rebollo, B. Andrés Martín, J.V. Diego Martín, H. Santana Zapatero, C. Escaja Muga, H. Díiaz Molina, J. Grande Viloria"
          "autores" => array:9 [
            0 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Álvarez Tundidor"
            ]
            1 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "González López"
            ]
            2 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Nava Rebollo"
            ]
            3 => array:2 [
              "Iniciales" => "B."
              "apellidos" => "Andrés Martín"
            ]
            4 => array:2 [
              "Iniciales" => "J.V."
              "apellidos" => "Diego Martín"
            ]
            5 => array:2 [
              "Iniciales" => "H."
              "apellidos" => "Santana Zapatero"
            ]
            6 => array:2 [
              "Iniciales" => "C."
              "apellidos" => "Escaja Muga"
            ]
            7 => array:2 [
              "Iniciales" => "H."
              "apellidos" => "Díiaz Molina"
            ]
            8 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Grande Viloria"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511052137"
        "doi" => "10.3265/Nefrologia.pre2011.Apr.10824"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052137?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052134?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052134/v0_201502091637/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251411052150"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2011.Apr.10879"
    "estado" => "S300"
    "fechaPublicacion" => "2011-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:493-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4618
      "formatos" => array:3 [
        "EPUB" => 316
        "HTML" => 3641
        "PDF" => 661
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Acute kidney failure in the context of a Tako-Tsubo syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "493"
          "paginaFinal" => "494"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fracaso renal agudo en el contexto de un síndrome de Takotsubo"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10879_108_19854_en_10879_f1.jpg"
              "Alto" => 382
              "Ancho" => 600
              "Tamanyo" => 116472
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Transthoracic echocardiogram"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "D. Arroyo, N. Panizo, U. Verdalles, M.E. Vázquez-Álvarez, D. Barraca, B. Quiroga, J. Luño"
          "autores" => array:7 [
            0 => array:2 [
              "Iniciales" => "D."
              "apellidos" => "Arroyo"
            ]
            1 => array:2 [
              "Iniciales" => "N."
              "apellidos" => "Panizo"
            ]
            2 => array:2 [
              "Iniciales" => "U."
              "apellidos" => "Verdalles"
            ]
            3 => array:2 [
              "Iniciales" => "M.E."
              "apellidos" => "Vázquez-Álvarez"
            ]
            4 => array:2 [
              "Iniciales" => "D."
              "apellidos" => "Barraca"
            ]
            5 => array:2 [
              "Iniciales" => "B."
              "apellidos" => "Quiroga"
            ]
            6 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Luño"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511052153"
        "doi" => "10.3265/Nefrologia.pre2011.Apr.10879"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052153?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052150?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052150/v0_201502091637/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Chronic pulmonary bleeding as the first sign of microscopic polyangiitis associated with autoimmune thyroiditis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "494"
        "paginaFinal" => "495"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M. Martínez-Gabarrón, R. Enríquez, A.E. Sirvent, E. Andrada, I. Millán, F. Amorós"
        "autores" => array:6 [
          0 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Martínez-Gabarrón"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "Iniciales" => "R."
            "apellidos" => "Enr&#237;quez"
            "email" => array:1 [
              0 => "nefro&#95;elx&#64;gva&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "A.E."
            "apellidos" => "Sirvent"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Andrada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          4 => array:3 [
            "Iniciales" => "I."
            "apellidos" => "Mill&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "F."
            "apellidos" => "Amor&#243;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real,  "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Sección de Nefrología, Hospital General de Elche, Elche, Alicante,  "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Anatomía Patológica, Hospital General de Elche, Elche, Alicante,  "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hemorragia pulmonar cr&#243;nica como primera manifestaci&#243;n de una poliange&#237;tis microsc&#243;pica asociada a tiroiditis autoinmune"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10841_108_19857_en_10841_f1.jpg"
            "Alto" => 427
            "Ancho" => 600
            "Tamanyo" => 255973
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Optical microscope&#46; Glomerule with fibrinoid necrosis&#46; HE stain&#44; x20&#46;"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Microscopic polyangiitis &#40;MPA&#41; is defined as a non granulomatous&#44; anti-neutrophil cytoplasmic antibodies &#40;ANCA&#41;-positive systemic necrotising vasculitis which affects small vessels&#46; Kidneys and lungs are the most frequently affected organs&#46;<span class="elsevierStyleSup">1</span> Pulmonary bleeding in MPA is usually acute or even fulminant&#46;<span class="elsevierStyleSup">2&#44;3</span> Pulmonary bleeding as part of chronic MPA is not described as often&#46; Autoimmune thyroiditis is associated with glomerulopathies&#44; especially with membranous nephropathy&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">We describe a patient with chronic pulmonary bleeding as a sign of MPA&#59; the examination also showed that she presented with autoimmune thyroiditis&#46;</p><p class="elsevierStylePara">A 54-year-old woman under examination for a year and a half in another hospital for iron deficiency anaemia of several years&#46; She was being treated with orally-administered iron and needed transfusions&#46; They found that she had renal failure&#44; proteinuria and microhaematuria during this examination&#44; and she was referred to us&#46; Patient history&#58; arterial hypertension for a year&#46; Clinically&#44; she presented with important asthenia and medium-effort dyspnoea&#46; Physical examination&#58; she did not present with fever&#44; blood pressure was 140&#47;96mm&#160;Hg&#44; and had no oedemas on lower limbs&#46; The analytical study showed&#58; haemoglobin&#58; 8&#46;6g&#47;dl&#59; iron&#58; 33&#46;5&#181;g&#47;dl&#59; total iron-binding capacity &#40;TIBC&#41;&#58; 264&#181;g&#47;dl&#59; ferritin&#58; 137ng&#47;ml&#59; urea&#58; 67mg&#47;dl&#59; creatinine&#58; 1&#46;50mg&#47;dl&#59; estimated glomerular filtration rate &#40;eGFR&#41; &#40;according to Modification of Diet in Renal Disease &#91;MDRD4&#93;&#41;&#58; 38&#46;46ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#59; uric acid&#58; 7&#46;19mg&#47;dl&#59; total cholesterol&#58; 233mg&#47;dl &#40;LDL&#58; 163&#59; HDL&#58; 33&#46;7&#41;&#59; triglycerides&#58; 178mg&#47;dl&#46; Normal&#47;negative immunoglobulins&#44; antinuclear antibodies &#40;ANA&#41;&#44; anti-DNA&#44; rheumatoid factor &#40;RF&#41;&#44; anti-glomerular basement membrane antibody treatment &#40;anti-MBG&#41; and anti-transglutaminase antibodies &#40;ATA&#41;&#59; positive myeloperoxidase &#40;MPO&#41;-ANCA&#44; negative PR3-ANCA&#46; High resolution electrophoresis &#40;HRE&#41; of serum&#58; no monoclonal band&#46; Thyroid-stimulating hormone &#40;TSH&#41;&#58; 326mIU&#47;l &#40;0&#46;350-4&#46;940&#41;&#44; free thyroxine &#40;T4&#41;&#58; 0&#46;11ng&#47;dl &#40;0&#46;7-1&#46;48&#41;&#59; anti-thyroid peroxidase antibodies &#40;anti-TPO&#41; &#62;1000IU&#47;ml&#46; Negative Mantoux test&#46; Negative hepatitis B surface antigens &#40;HbsAg&#41;&#44; hepatitis B anti-core antibodies &#40;anti-HBc&#41;&#44; hepatitis C antibodies &#40;anti-HCV&#41; and human immunodeficiency virus &#40;HIV&#41; tests&#46; Cytomegalovirus &#40;CMV&#41; serology test and Epstein-Barr virus &#40;EBV&#41;&#58; previous exposure&#46; Urine showed a proteinuria of 1&#46;3g&#47;24hr &#40;moderately selective glomerular proteinuria&#41;&#44; sediment with 60-100 red blood cells &#40;30&#37;-50&#37; dysmorphic&#41; and hyaline-granular casts&#46; Urine culture&#58; negative&#46; Chest X-ray and electrocardiogram &#40;ECG&#41; were normal&#46; Abdominal ultrasound&#58; kidneys of a normal size with slight cortical thinning&#46; Chest computerised tomography &#40;CT&#41; showed images of &#8216;ground-glass opacity&#8217; on both sides in the middle and lower fields and a bronchoscopy with a bronchoalveolar lavage was indicated&#44; showing 80&#37; siderophores&#46; The malignant cell cytology and cell cultures were negative&#46; The patient was interviewed&#44; revealing that she sporadically presented with a slight&#44; dark-coloured expectoration&#46; The renal biopsy &#40;Figure 1&#41; showed a focal and segmental necrotising glomerulonephritis&#44; and approximately a third of the glomeruli were sclerotic&#44; interstitial fibrosis and tubular atrophy in 30&#37; of the cylinder&#46; The immunofluorescence study showed slight deposits of IgM&#44; C3 and C4 on capillary walls and the mesangium&#46; Given the pulmonary bleeding&#44; the positive ANCA&#44; and the focal necrotising glomerulonephritis with scarce immune deposits&#44; MPA was diagnosed&#44; associated with autoimmune thyroiditis-induced hypothyroidism&#46; Treatment with prednisone at 50mg&#47;day was started for 8 weeks&#44; gradually reducing the dosage&#44; and six 750-mg cyclophosphamide boli&#44; which was followed by mycophenolate mofetil at 500mg&#47;8hr and levothyroxine at 75&#181;g&#47;day&#46; At 6 months from diagnosis&#44; the haemoglobin &#40;Hb&#41; was 12&#46;6g&#47;dl&#59; creatinine&#58; 1&#46;4mg&#47;dl&#59; sediment&#58; 10-20 red blood cells&#47;field&#59; ANCA were negative and thoracic CT did not show infiltrates&#46;</p><p class="elsevierStylePara">Pulmonary bleeding symptoms include haemoptysis&#44; coughing&#44; chest pain&#44; dyspnoea&#44; anaemia and acute respiratory failure&#46; Chronic evolution of pulmonary bleeding in MPA with non-specific symptoms and iron deficiency&#44; as occurred with our patient&#44; is less documented&#46;<span class="elsevierStyleSup">2&#44;5</span> However&#44; in Lauque et al&#8217;s study&#44; 28&#37; of patients had symptoms for more than a year before the pulmonary bleeding was diagnosed&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Autoimmune thyroiditis is associated with glomerulopathies&#44; especially with membranous&#44;<span class="elsevierStyleSup">4</span> membranoproliferative<span class="elsevierStyleSup">6</span> and IgA glomerulonephritis&#46;<span class="elsevierStyleSup">7</span> A common pathogenic link is suggested given that the two autoimmune diseases are present at the same time&#46;<span class="elsevierStyleSup">4</span> It is thought that thyroglobulin and thyroid peroxidase released by destroying the thyroid follicles would be deposited in the kidney and <span class="elsevierStyleItalic">in situ</span> immunocomplexes would be formed&#59; depositing of circulating immunocomplexes seems less likely&#46;<span class="elsevierStyleSup">8</span> In the case of autoimmune thyroiditis with ANCA vasculitis&#44; other mechanisms could be involved&#44; such as polyreactive antibody development and regulator and effector T cell alterations&#46;<span class="elsevierStyleSup">8</span> With regards the antibodies&#44; it is worth highlighting that myeloperoxidase shares a certain structural homology with thyroid peroxidase and that it could produce cross-over reactions&#44;<span class="elsevierStyleSup">9</span> but other authors do not support this mechanism&#46;<span class="elsevierStyleSup">10</span> Although the association between autoimmune thyroiditis and ANCA-positive vasculitis does not seem to be common&#44; Tanaka et al<span class="elsevierStyleSup">9</span> found that 4 cases out of a series of 10 with ANCA-positive nephropathy had hypothyroidism&#44; 2 of which were subclinical&#46;</p><p class="elsevierStylePara">To conclude&#44; it is important to consider that pulmonary bleeding in the MPA may evolve over a long period&#44; with no marked haemoptysis or changes visible in the chest X-ray&#44; being the cause of iron deficiency anaemia&#46; For patients with ANCA vasculitis it is convenient to determine thyroid function and anti-TPO antibodies&#44; and for those with autoimmune thyroiditis&#44; the possibility that patients have an underlying nephropathy must be assessed&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10841&#95;108&#95;19857&#95;en&#95;10841&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10841_108_19857_en_10841_f1.jpg" alt="Optical microscope&#46; Glomerule with fibrinoid necrosis&#46; HE stain&#44; x20&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Optical microscope&#46; Glomerule with fibrinoid necrosis&#46; HE stain&#44; x20&#46;</p>"
    "pdfFichero" => "P1-E523-S3023-A10841-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10841_108_19857_en_10841_f1.jpg"
            "Alto" => 427
            "Ancho" => 600
            "Tamanyo" => 255973
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Optical microscope&#46; Glomerule with fibrinoid necrosis&#46; HE stain&#44; x20&#46;"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Villiger PM, Guillevin L. Microscopic polyangiitis: clinical presentation. Autoimmun Rev 2010;9:812-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20656070" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lauque D,\u{A0}Cadranel J, Lazor R, Pourrat J, Ronco P, Guillevin L, et al.\u{A0}Microscopic\u{A0} polyangiitis with\u{A0} alveolar\u{A0} hemorrhage. A\u{A0} study of 29 cases and review of the literature. Groupe d'Etudes et de Recherche\u{A0}sur les Maladies\u{A0}«Orphelines» pulmonaires (GERM«O»P). Medicine (Baltimore)\u{A0}2000;79:222-33."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest 2010;137:1164-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20442117" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Iglesias P, Díez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol 2009;160:503-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19095779" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vuotto F, Queyrel V, Lambert M, Morell-Dubois S, Launay D, Hachulla E, et al.\u{A0}MPO-ANCA related vasculitis presenting as chronic iron deficiency anemia due to paucisymptomatic intra-alveolar haemorrhage. Rev Med Interne 2007;28:484-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17349720" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0022347609000158"
                          "estado" => "S300"
                          "issn" => "00223476"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gurkan S, Dikman S, Saland MJ. A case of autoimmune thyroiditis and membranoproliferative glomerulonephritis. Pediatr Nephrol 2009;24:193-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18008089" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Enríquez R, Sirvent AE, Amorós F, Andrada E, Cabezuelo JB, Reyes A. IgA nephropathy and autoimmune thyroiditis. Clin Nephrol 2002;57:406-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12036204" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ronco P, Debiec H. Pathophysiological lessons from rare associations of immunological disorders. Pediatr Nephrol 2009;24:3-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18853201" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673607605273"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tanaka A, Maeda K, Sawai K, Okuda J, Sugawara A, Kuwahara T. Concealed hypothyroidism in patients with myeloperoxidase antineutrophili cytoplasmic autoantibodies (MPO-ANCA) positive renal disease. Clin Nephrol 1999;52:91-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10480219" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lionaki S, Hogan SL, Falk RJ, Joy MS, Chin H, Jennette CE, et al.\u{A0}Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: a case-control study. Nephrol Dial Transplant 2007;22:3508-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17686815" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003100000004/v0_201502091636/X2013251411052142/v0_201502091637/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35437"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000004/v0_201502091636/X2013251411052142/v0_201502091637/en/P1-E523-S3023-A10841-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052142?idApp=UINPBA000064"
]