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a prosthetic left hip&#44; and a bilateral inguinal hernia was diagnosed with PMR in August 2010 and prescribed treatment with prednisone at 30mg&#47;day&#46; The patient remained independent for performing activities of daily living and suffered no cognitive deterioration&#46;</p><p class="elsevierStylePara">Upon seeking treatment in the nephrology department &#40;8 months after being diagnosed with PMR&#41;&#44; the patient was on treatment with prednisone at 5mg&#44; omeprazole at 20mg&#47;day&#44; enalapril at 5mg&#47;12 hours&#44; levothyroxine at 25mg&#47;day&#44; and chlorthalidone at 12&#46;5mg&#47;day&#46;</p><p class="elsevierStylePara">The patient was admitted to the nephrology department due to increased volume in the legs and abdominal&#47;scrotal area with 4 days evolution&#46; The patient reported only a slight decrease in the rhythm of diuresis and one occasion of nicturia&#46;</p><p class="elsevierStylePara">A physical exploration revealed a blood pressure of 150&#47;80mm Hg&#44; heart rate at 80bpm&#44; a globular stomach with dullness in the midgut&#44; and pitting oedema in the legs&#44; with no other relevant results&#46;</p><p class="elsevierStylePara">A blood work analysis revealed&#58; creatinine&#58; 0&#46;8mg&#47;dl&#59; cholesterol&#58; 354mg&#47;dl&#59; triglycerides&#58; 104mg&#47;dl&#59; albumin&#58; 2&#46;2g&#47;dl&#59; and total protein&#58; 5mg&#47;dl&#46; Haemogram and clotting tests results were normal&#46; Viral serology for hepatitis B and C and human immunodeficiency virus was negative&#46; In the immunological study&#44; antinuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative&#44; with normal complement&#46; IgG was at 450mg&#47;dl &#40;normal range&#58; 751-1560mg&#47;dl&#41;&#44; and IgM and IgA were normal&#46; An electrophoresis analysis using a blood sample revealed a decrease in albumin with no signs of monoclonal peaks&#46;</p><p class="elsevierStylePara">Tumour markers &#40;carcinoembryonic antigen &#91;CEA&#93;&#44; Ca19-9&#44; alpha-fetoprotein&#44; and prostate specific antigen &#91;PSA&#93;&#41; were all within normal values&#46; Ca125 was at 136IU&#47;ml &#40;normal range&#58; 0-35IU&#47;ml&#41;&#46;</p><p class="elsevierStylePara">A 24-hour urine protein analysis revealed 9&#46;51g&#47;24h&#46; Creatinine clearance was at 77ml&#47;min&#46; Urine electrophoresis also ruled out the presence of monoclonal peaks&#44; with a negative Bence-Jones proteinuria test&#46;</p><p class="elsevierStylePara">A chest x-ray revealed right pleural effusion&#46;</p><p class="elsevierStylePara">A renal ultrasound showed that the kidneys were 11cm in size with no lithiasis or dilation&#46;</p><p class="elsevierStylePara">We performed an abdominal axial computerised tomography&#44; which revealed thickening of the gastric folds&#46; A gastroscopy was requested&#44; which confirmed the existence of thickened pyloric folds&#44; but with no evidence of malignancy in the histopathological analysis&#46;</p><p class="elsevierStylePara">Given the patient&#8217;s state of nephrotic syndrome&#44; we performed a percutaneous kidney biopsy under ultrasound control with the following findings&#58; 5 glomeruli per cross-section&#44; all of which had normal histological characteristics&#46; Immunofluorescence was negative for studied pathological markers &#40;IgG&#44; IgA&#44; IgM&#44; and C3&#41;&#46; Vascular tissue&#44; interstitial spaces and tubules were without lesions&#46; The final diagnosis was of minimal change nephropathy &#40;MCN&#41;&#46;</p><p class="elsevierStylePara">The results of the biopsy led to an increase in the prednisone dose to 1mg&#47;kg&#47;day&#46; One month later&#44; an external consultation revealed clinical and biochemical remission of the nephrotic syndrome&#44; facilitating progressive decreases in the dose of prednisone&#46;</p><p class="elsevierStylePara">Seven months later&#44; when the patient was on maintenance therapy with prednisone at 5mg&#47;day&#44; the nephrotic syndrome relapsed&#44; requiring an increase in prednisone to 50mg&#47;day&#46; After the nephrotic syndrome disappeared again&#44; the dose of prednisone was progressively decreased to 2&#46;5mg&#47;day&#46;</p><p class="elsevierStylePara">After one month of treatment with prednisone at 2&#46;5mg&#47;dl&#44; the patient attended consultation with his GP due to oedema&#46; A laboratory analysis revealed proteinuria at 1&#46;66g&#47;day&#44; for which the dose of prednisone was increased to 10mg&#47;day&#44; which resolved the issue&#46; In the last nephrological follow-up&#44; the patient continued on treatment with prednisone at 10mg&#47;day&#44; with no symptoms or proteinuria&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Renal involvement in PMR is uncommon&#46;<span class="elsevierStyleSup">3</span> The majority of cases involving renal damage are due to amyloid deposits &#40;secondary &#91;AA&#93; amyloidosis&#41;&#46;<span class="elsevierStyleSup">4&#44;5</span></p><p class="elsevierStylePara">Both PMR and MCN can occur as paraneoplastic manifestations of cancer&#46; Sidhom et al&#46; described the case of a patient with PMR that was unresponsive to treatment with prednisone&#59; they found renal cancer during the patient&#8217;s evolution&#44; and symptoms were controlled following a nephrectomy&#46;<span class="elsevierStyleSup">6</span> Alvarez et al&#46; described a patient with MCN as a paraneoplastic manifestation of colon cancer&#46;<span class="elsevierStyleSup">7</span> Another case involved a patient in which these two entities were found as the clinical expression of pancreatic cancer&#46;<span class="elsevierStyleSup">8</span> However&#44; we have not found any case described in the medical literature to date involving the simultaneous occurrence of both entities in the absence of cancer&#44; as occurred in our patient&#46; In our case&#44; given the initial suspicion that the patient had some type of tumour&#44; and as such&#44; that the PMR and nephrotic syndrome were the result of paraneoplastic processes&#44; we performed a biopsy that did not indicate the presence of a tumour&#46;</p><p class="elsevierStylePara">As regards treatment&#44; glucocorticoids are the treatment of choice for both PMR &#40;generally at low doses of 10-15mg&#47;day&#41; and MCN &#40;maximum of 80mg&#47;day&#41;&#46;<span class="elsevierStyleSup">9&#44;10</span> In our case&#44; the increase in the dose of prednisone from 5mg&#47;day to 60mg&#47;day facilitated the remission of the nephrotic syndrome&#44; but a relapse occurred when the dose of prednisone was decreased below the recommended threshold of 10mg&#47;day for the treatment of PMR&#46;</p><p class="elsevierStylePara">In conclusion&#44; we have described two different diseases in the same patient&#44; with no evidence of association with cancer&#44; and whose aetiopathogenesis may possibly be related given the clinical behaviour of both entities&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p>"
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Minimal change nephropathy in a patient with polymyalgia rheumatica
Nefropatía de cambios mínimos en paciente con polimialgia reumática
Manuel Herasa, Ana Saizb, M. José Fernández-Reyesa, Rosa Sáncheza, Álvaro Molinaa, M. Astrid Rodrígueza
a Servicio de Nefrología, Hospital General de Segovia, Segovia,
b Serrvicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid,
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a prosthetic left hip&#44; and a bilateral inguinal hernia was diagnosed with PMR in August 2010 and prescribed treatment with prednisone at 30mg&#47;day&#46; The patient remained independent for performing activities of daily living and suffered no cognitive deterioration&#46;</p><p class="elsevierStylePara">Upon seeking treatment in the nephrology department &#40;8 months after being diagnosed with PMR&#41;&#44; the patient was on treatment with prednisone at 5mg&#44; omeprazole at 20mg&#47;day&#44; enalapril at 5mg&#47;12 hours&#44; levothyroxine at 25mg&#47;day&#44; and chlorthalidone at 12&#46;5mg&#47;day&#46;</p><p class="elsevierStylePara">The patient was admitted to the nephrology department due to increased volume in the legs and abdominal&#47;scrotal area with 4 days evolution&#46; The patient reported only a slight decrease in the rhythm of diuresis and one occasion of nicturia&#46;</p><p class="elsevierStylePara">A physical exploration revealed a blood pressure of 150&#47;80mm Hg&#44; heart rate at 80bpm&#44; a globular stomach with dullness in the midgut&#44; and pitting oedema in the legs&#44; with no other relevant results&#46;</p><p class="elsevierStylePara">A blood work analysis revealed&#58; creatinine&#58; 0&#46;8mg&#47;dl&#59; cholesterol&#58; 354mg&#47;dl&#59; triglycerides&#58; 104mg&#47;dl&#59; albumin&#58; 2&#46;2g&#47;dl&#59; and total protein&#58; 5mg&#47;dl&#46; Haemogram and clotting tests results were normal&#46; Viral serology for hepatitis B and C and human immunodeficiency virus was negative&#46; In the immunological study&#44; antinuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative&#44; with normal complement&#46; IgG was at 450mg&#47;dl &#40;normal range&#58; 751-1560mg&#47;dl&#41;&#44; and IgM and IgA were normal&#46; An electrophoresis analysis using a blood sample revealed a decrease in albumin with no signs of monoclonal peaks&#46;</p><p class="elsevierStylePara">Tumour markers &#40;carcinoembryonic antigen &#91;CEA&#93;&#44; Ca19-9&#44; alpha-fetoprotein&#44; and prostate specific antigen &#91;PSA&#93;&#41; were all within normal values&#46; Ca125 was at 136IU&#47;ml &#40;normal range&#58; 0-35IU&#47;ml&#41;&#46;</p><p class="elsevierStylePara">A 24-hour urine protein analysis revealed 9&#46;51g&#47;24h&#46; Creatinine clearance was at 77ml&#47;min&#46; Urine electrophoresis also ruled out the presence of monoclonal peaks&#44; with a negative Bence-Jones proteinuria test&#46;</p><p class="elsevierStylePara">A chest x-ray revealed right pleural effusion&#46;</p><p class="elsevierStylePara">A renal ultrasound showed that the kidneys were 11cm in size with no lithiasis or dilation&#46;</p><p class="elsevierStylePara">We performed an abdominal axial computerised tomography&#44; which revealed thickening of the gastric folds&#46; A gastroscopy was requested&#44; which confirmed the existence of thickened pyloric folds&#44; but with no evidence of malignancy in the histopathological analysis&#46;</p><p class="elsevierStylePara">Given the patient&#8217;s state of nephrotic syndrome&#44; we performed a percutaneous kidney biopsy under ultrasound control with the following findings&#58; 5 glomeruli per cross-section&#44; all of which had normal histological characteristics&#46; Immunofluorescence was negative for studied pathological markers &#40;IgG&#44; IgA&#44; IgM&#44; and C3&#41;&#46; Vascular tissue&#44; interstitial spaces and tubules were without lesions&#46; The final diagnosis was of minimal change nephropathy &#40;MCN&#41;&#46;</p><p class="elsevierStylePara">The results of the biopsy led to an increase in the prednisone dose to 1mg&#47;kg&#47;day&#46; One month later&#44; an external consultation revealed clinical and biochemical remission of the nephrotic syndrome&#44; facilitating progressive decreases in the dose of prednisone&#46;</p><p class="elsevierStylePara">Seven months later&#44; when the patient was on maintenance therapy with prednisone at 5mg&#47;day&#44; the nephrotic syndrome relapsed&#44; requiring an increase in prednisone to 50mg&#47;day&#46; After the nephrotic syndrome disappeared again&#44; the dose of prednisone was progressively decreased to 2&#46;5mg&#47;day&#46;</p><p class="elsevierStylePara">After one month of treatment with prednisone at 2&#46;5mg&#47;dl&#44; the patient attended consultation with his GP due to oedema&#46; A laboratory analysis revealed proteinuria at 1&#46;66g&#47;day&#44; for which the dose of prednisone was increased to 10mg&#47;day&#44; which resolved the issue&#46; In the last nephrological follow-up&#44; the patient continued on treatment with prednisone at 10mg&#47;day&#44; with no symptoms or proteinuria&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Renal involvement in PMR is uncommon&#46;<span class="elsevierStyleSup">3</span> The majority of cases involving renal damage are due to amyloid deposits &#40;secondary &#91;AA&#93; amyloidosis&#41;&#46;<span class="elsevierStyleSup">4&#44;5</span></p><p class="elsevierStylePara">Both PMR and MCN can occur as paraneoplastic manifestations of cancer&#46; Sidhom et al&#46; described the case of a patient with PMR that was unresponsive to treatment with prednisone&#59; they found renal cancer during the patient&#8217;s evolution&#44; and symptoms were controlled following a nephrectomy&#46;<span class="elsevierStyleSup">6</span> Alvarez et al&#46; described a patient with MCN as a paraneoplastic manifestation of colon cancer&#46;<span class="elsevierStyleSup">7</span> Another case involved a patient in which these two entities were found as the clinical expression of pancreatic cancer&#46;<span class="elsevierStyleSup">8</span> However&#44; we have not found any case described in the medical literature to date involving the simultaneous occurrence of both entities in the absence of cancer&#44; as occurred in our patient&#46; In our case&#44; given the initial suspicion that the patient had some type of tumour&#44; and as such&#44; that the PMR and nephrotic syndrome were the result of paraneoplastic processes&#44; we performed a biopsy that did not indicate the presence of a tumour&#46;</p><p class="elsevierStylePara">As regards treatment&#44; glucocorticoids are the treatment of choice for both PMR &#40;generally at low doses of 10-15mg&#47;day&#41; and MCN &#40;maximum of 80mg&#47;day&#41;&#46;<span class="elsevierStyleSup">9&#44;10</span> In our case&#44; the increase in the dose of prednisone from 5mg&#47;day to 60mg&#47;day facilitated the remission of the nephrotic syndrome&#44; but a relapse occurred when the dose of prednisone was decreased below the recommended threshold of 10mg&#47;day for the treatment of PMR&#46;</p><p class="elsevierStylePara">In conclusion&#44; we have described two different diseases in the same patient&#44; with no evidence of association with cancer&#44; and whose aetiopathogenesis may possibly be related given the clinical behaviour of both entities&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p>"
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ISSN: 20132514
Original language: English
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2021 December 54 19 73
2021 November 74 17 91
2021 October 99 19 118
2021 September 74 16 90
2021 August 100 12 112
2021 July 65 46 111
2021 June 72 10 82
2021 May 73 9 82
2021 April 209 4 213
2021 March 149 23 172
2021 February 119 10 129
2021 January 93 17 110
2020 December 96 9 105
2020 November 92 7 99
2020 October 74 8 82
2020 September 66 3 69
2020 August 75 8 83
2020 July 92 9 101
2020 June 73 14 87
2020 May 68 5 73
2020 April 82 24 106
2020 March 67 11 78
2020 February 96 16 112
2020 January 91 10 101
2019 December 75 14 89
2019 November 69 11 80
2019 October 53 5 58
2019 September 103 12 115
2019 August 72 8 80
2019 July 80 22 102
2019 June 86 8 94
2019 May 85 11 96
2019 April 111 27 138
2019 March 86 18 104
2019 February 71 9 80
2019 January 70 22 92
2018 December 111 33 144
2018 November 113 11 124
2018 October 124 36 160
2018 September 94 10 104
2018 August 77 13 90
2018 July 50 14 64
2018 June 49 16 65
2018 May 69 12 81
2018 April 62 7 69
2018 March 59 13 72
2018 February 50 12 62
2018 January 64 11 75
2017 December 58 6 64
2017 November 53 10 63
2017 October 33 10 43
2017 September 60 12 72
2017 August 41 10 51
2017 July 44 10 54
2017 June 38 3 41
2017 May 39 6 45
2017 April 42 4 46
2017 March 28 2 30
2017 February 29 5 34
2017 January 25 6 31
2016 December 46 9 55
2016 November 68 10 78
2016 October 88 14 102
2016 September 116 5 121
2016 August 173 0 173
2016 July 155 0 155
2016 June 117 0 117
2016 May 103 0 103
2016 April 86 0 86
2016 March 90 0 90
2016 February 94 0 94
2016 January 91 0 91
2015 December 116 0 116
2015 November 84 0 84
2015 October 90 0 90
2015 September 73 0 73
2015 August 78 0 78
2015 July 79 0 79
2015 June 50 0 50
2015 May 63 0 63
2015 April 10 0 10
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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?