Minimal change disease following influenza vaccination and acute renal failure: just a coincidence?
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "414" "paginaFinal" => "415" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Silvina Gutiérrez, Beatriz Dotto, Juan P. Petiti, Ana L. De Paul, M. Elisa Dionisio de Cabalier, Alicia I. Torres, Jorge H. Mukdsi" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Silvina" "apellidos" => "Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Dotto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "Juan P." "apellidos" => "Petiti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Ana L." "apellidos" => "De Paul" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "M. Elisa" "apellidos" => "Dionisio de Cabalier" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 5 => array:3 [ "nombre" => "Alicia I." "apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:4 [ "nombre" => "Jorge H." "apellidos" => "Mukdsi" "email" => array:1 [ 0 => "jmukdsi@cmefcm.uncor.edu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => " Centro de Microscopía Electrónica-FCM-UNC, Córdoba, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Nacional de Clínicas, Córdoba, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Nacional de Clínicas, Córdoba, Argentina, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11370_108_26475_en_11370_f1.jpg" "Alto" => 482 "Ancho" => 323 "Tamanyo" => 207369 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor,</span></p><p class="elsevierStylePara">Since, 1966 different reports have associated minimal change disease (MCD) with different immunogens<span class="elsevierStyleSup">1</span> as well as the presence of acute renal failure (ARF) in the MCD,<span class="elsevierStyleSup">2</span> which pathogenic mechanisms are being debated up to the present.</p><p class="elsevierStylePara">A 44-year old man was admitted to our hospital with edema in his face and legs and cervical lymphadenopathy which occurred 18 days after influenza vaccine (Agrippal<span class="elsevierStyleSup">®</span>, Novartis). The laboratory showed: creatinine 44mg/l, urea 106mg/dl. In the urinalysis was evident: proteinuria 4g/24h and hyaline casts. Serological test (ANA, DNA, ANCAp, ANCAc, C3, C4, HBsAg, HCV and HIV) were negative. Renal biopsy was performed. Light microscopy showed evidence of severe acute tubular injury (Figure 1 A) and a moderate, diffuse interstitial inflammatory infiltrate consisting of mononuclear cells and severe edema. The immunofluorescence did not show deposits of IgG, IgA, IgM, C3 and C1q. Ultrastructural examination showed diffuse foot-process effacement, microvillous transformation and cytoplasmic vacuolization without basement-membrane remodeling (Figure 1 B). Minimal change disease, acute tubular injury, and moderate active interstitial nephritis were diagnosed. The patient started on oral prednisone (60mg/d), furosemide (80mg/d), enalapril (40mg/d), atorvastatin (20mg/d), Espironolactone-A (100mg/d), ranitidine 300 (mg/d) and low-sodium diet. The proteinuria (200mg/24h) and ARF (creatinine 1 mg/l), resolved rapidly.</p><p class="elsevierStylePara">Although, the pathogenic mechanisms proposed for MCD are not exactly known, some evidences suggest a T cells dysfunction with the production of a permeability factor. Moreover, it has been suggested a possible "cross-talk" between dendritic cells and Th lymphocytes with a consequent intrarenal cytokine production.<span class="elsevierStyleSup">3</span> In addition, both the modulation of the actin cytoskeleton at the glomerular diaphragm filtration level that induce by B7-1 expression,<span class="elsevierStyleSup">4</span> and the destabilization of the synaptopodin protein<span class="elsevierStyleSup">5</span> would be others probable causes of visceral epithelial injury.</p><p class="elsevierStylePara">On the other hand, it is unclear because patients with MCD may be more sensitive to develop ARF, compared to other nephrotic glomerulopathies. The mechanism underlying to this clinical-pathological entity has not been fully clarified. Several mechanisms attempt to explain the ARF in the nephrotic syndrome. The extensive interstitial edema observed in the present case, could lead to an increased intrarenal pressure and consequently explains the sharp drop in GFR observed in our patient. This finding is supported by one of the stronger hypothesis that explains this situation: nefrosarca hypothesis.<span class="elsevierStyleSup">6</span> Nevertheless, the hypothesis that links the ARF of nephrotic syndrome with changes in the coefficient of ultrafiltration should be considered.<span class="elsevierStyleSup">7</span> Finally, Chen et al. have hypothesized that cytokines secreted induce the production of endothelin-1, which generate contraction of mesangial cells resulting in a decrease of the filtration area.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">In summary, in the present case the immune response after influenza vaccination generated the podocitopathy known as minimal change disease possibly due to hypersesitivity syndrome. In this clinical-pathological context the patient developed acute renal failure which pathogenic bases are still controversial and debated in the biomedical area.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgements </span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors wish to thank Mrs Elena Pereyra and Mrs Lucía Artino for their excellent technical assistance.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara"><br></br><br></br>The authors declare that there is no conflict of interest associated with this manuscript.</p><p class="elsevierStylePara"><a href="grande/11370_108_26475_en_11370_f1.jpg" class="elsevierStyleCrossRefs"><img src="11370_108_26475_en_11370_f1.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p>" "pdfFichero" => "P1-E536-S3514-A11370-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11370_108_26475_en_11370_f1.jpg" "Alto" => 482 "Ancho" => 323 "Tamanyo" => 207369 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chamberlain MJ, Pringle A, Wrong OM. 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Nat Med 2008;14:931-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18724379" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lowenstein J, Schacht RG, Baldwin DS. Renal failure in minimal change nephrotic syndrome. Am J Med 1981;70:227-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7468609" 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" => "Cameron MA, Peri U, Rogers TE, Moe OW. Minimal change disease with acute renal failure: a case against the nephrosarca hypothesis. 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| 2021 June | 51 | 33 | 84 |
| 2021 May | 29 | 40 | 69 |
| 2021 April | 54 | 78 | 132 |
| 2021 March | 46 | 35 | 81 |
| 2021 February | 20 | 19 | 39 |
| 2021 January | 34 | 14 | 48 |
| 2020 December | 23 | 22 | 45 |
| 2020 November | 41 | 9 | 50 |
| 2020 October | 22 | 19 | 41 |
| 2020 September | 16 | 13 | 29 |
| 2020 August | 37 | 10 | 47 |
| 2020 July | 40 | 13 | 53 |
| 2020 June | 33 | 8 | 41 |
| 2020 May | 52 | 10 | 62 |
| 2020 April | 34 | 21 | 55 |
| 2020 March | 43 | 10 | 53 |
| 2020 February | 52 | 26 | 78 |
| 2020 January | 48 | 18 | 66 |
| 2019 December | 44 | 26 | 70 |
| 2019 November | 38 | 17 | 55 |
| 2019 October | 88 | 13 | 101 |
| 2019 September | 16 | 18 | 34 |
| 2019 August | 16 | 8 | 24 |
| 2019 July | 21 | 21 | 42 |
| 2019 June | 23 | 14 | 37 |
| 2019 May | 22 | 18 | 40 |
| 2019 April | 51 | 24 | 75 |
| 2019 March | 36 | 26 | 62 |
| 2019 February | 18 | 16 | 34 |
| 2019 January | 30 | 19 | 49 |
| 2018 December | 73 | 35 | 108 |
| 2018 November | 102 | 24 | 126 |
| 2018 October | 93 | 17 | 110 |
| 2018 September | 68 | 11 | 79 |
| 2018 August | 47 | 19 | 66 |
| 2018 July | 53 | 13 | 66 |
| 2018 June | 52 | 16 | 68 |
| 2018 May | 67 | 13 | 80 |
| 2018 April | 81 | 9 | 90 |
| 2018 March | 80 | 10 | 90 |
| 2018 February | 65 | 6 | 71 |
| 2018 January | 80 | 8 | 88 |
| 2017 December | 85 | 8 | 93 |
| 2017 November | 64 | 9 | 73 |
| 2017 October | 45 | 9 | 54 |
| 2017 September | 53 | 12 | 65 |
| 2017 August | 36 | 11 | 47 |
| 2017 July | 36 | 11 | 47 |
| 2017 June | 42 | 16 | 58 |
| 2017 May | 41 | 11 | 52 |
| 2017 April | 36 | 13 | 49 |
| 2017 March | 28 | 15 | 43 |
| 2017 February | 38 | 12 | 50 |
| 2017 January | 18 | 9 | 27 |
| 2016 December | 41 | 2 | 43 |
| 2016 November | 63 | 15 | 78 |
| 2016 October | 76 | 6 | 82 |
| 2016 September | 107 | 7 | 114 |
| 2016 August | 140 | 4 | 144 |
| 2016 July | 175 | 13 | 188 |
| 2016 June | 118 | 0 | 118 |
| 2016 May | 133 | 0 | 133 |
| 2016 April | 86 | 0 | 86 |
| 2016 March | 97 | 0 | 97 |
| 2016 February | 119 | 0 | 119 |
| 2016 January | 115 | 0 | 115 |
| 2015 December | 132 | 0 | 132 |
| 2015 November | 111 | 0 | 111 |
| 2015 October | 81 | 0 | 81 |
| 2015 September | 56 | 0 | 56 |
| 2015 August | 63 | 0 | 63 |
| 2015 July | 68 | 0 | 68 |
| 2015 June | 25 | 0 | 25 |
| 2015 May | 44 | 0 | 44 |
| 2015 April | 5 | 0 | 5 |
Show all
