Minimal change disease following influenza vaccination and acute renal failure: just a coincidence?
Minimal change disease following influenza vaccination and acute renal failure: just a coincidence?
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"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" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Minimal change disease following influenza vaccination and acute renal failure: just a coincidence?" ] ] "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.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "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. Oliguric renal failure in the nephrotic syndrome. Q J Med 1996;35:215-35. <a href="http://www.ncbi.nlm.nih.gov/pubmed/5912056" 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" => "Jennette JC, Falk RJ. Adult minimal change glomerulopathy with acute renal failure. Am J Kidney Dis 1990;16:432-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2239933" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Heymann F, Meyer-Schwesinger C, Hamilton-Williams EE, Hammerich L, Panzer U, Kaden S, et al. Kidney dendritic cell activation is required for progression of renal disease in a mouse model of glomerular injury. J Clin Invest 2009;119:1286-97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19381017" 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" => "Reiser J, von Gersdorff G, Loos M, Oh J, Asanuma K, Giardino L, et al. Induction of B7-1 in podocytes is associated with nephrotic syndrome. J Clin Invest 2004;113:1390-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15146236" 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" => "Faul C, Donnelly M, Merscher-Gomez S, Chang YH, Franz S, Delfgaauw J, et al. The actin cytoskeleton of kidney podocytes is a direct target of the antiproteinuric effect of cyclosporine A. 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. Nephrol Dial Transplant 2004;19:2642-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15388821" 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" => "Chen CL, Fang HC, Chou KJ, Lee JC, Lee PT, Chung HM, et al. Increased endothelin 1 expression in adult-onset minimal change nephropathy with acute renal failure. Am J Kidney Dis 2005;45:818-25. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15861346" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02116995/0000003200000003/v0_201502091350/X0211699512001070/v0_201502091351/en/main.assets" "Apartado" => array:4 [ "identificador" => "35346" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Director - Casos clínicos breves" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003200000003/v0_201502091350/X0211699512001070/v0_201502091351/en/P1-E536-S3514-A11370.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001070?idApp=UINPBA000064" ]
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| 2021 Marzo | 141 | 41 | 182 |
| 2021 Febrero | 106 | 33 | 139 |
| 2021 Enero | 95 | 26 | 121 |
| 2020 Diciembre | 76 | 15 | 91 |
| 2020 Noviembre | 56 | 17 | 73 |
| 2020 Octubre | 46 | 24 | 70 |
| 2020 Septiembre | 42 | 12 | 54 |
| 2020 Agosto | 34 | 9 | 43 |
| 2020 Julio | 56 | 13 | 69 |
| 2020 Junio | 51 | 30 | 81 |
| 2020 Mayo | 55 | 10 | 65 |
| 2020 Abril | 50 | 13 | 63 |
| 2020 Marzo | 43 | 15 | 58 |
| 2020 Febrero | 61 | 20 | 81 |
| 2020 Enero | 57 | 26 | 83 |
| 2019 Diciembre | 58 | 21 | 79 |
| 2019 Noviembre | 35 | 29 | 64 |
| 2019 Octubre | 43 | 17 | 60 |
| 2019 Septiembre | 36 | 23 | 59 |
| 2019 Agosto | 36 | 16 | 52 |
| 2019 Julio | 34 | 24 | 58 |
| 2019 Junio | 28 | 10 | 38 |
| 2019 Mayo | 45 | 22 | 67 |
| 2019 Abril | 61 | 44 | 105 |
| 2019 Marzo | 35 | 27 | 62 |
| 2019 Febrero | 38 | 25 | 63 |
| 2019 Enero | 52 | 29 | 81 |
| 2018 Diciembre | 96 | 41 | 137 |
| 2018 Noviembre | 115 | 24 | 139 |
| 2018 Octubre | 84 | 20 | 104 |
| 2018 Septiembre | 71 | 28 | 99 |
| 2018 Agosto | 78 | 25 | 103 |
| 2018 Julio | 71 | 14 | 85 |
| 2018 Junio | 56 | 19 | 75 |
| 2018 Mayo | 54 | 15 | 69 |
| 2018 Abril | 71 | 12 | 83 |
| 2018 Marzo | 63 | 13 | 76 |
| 2018 Febrero | 67 | 6 | 73 |
| 2018 Enero | 51 | 8 | 59 |
| 2017 Diciembre | 70 | 8 | 78 |
| 2017 Noviembre | 61 | 15 | 76 |
| 2017 Octubre | 38 | 9 | 47 |
| 2017 Septiembre | 50 | 7 | 57 |
| 2017 Agosto | 40 | 16 | 56 |
| 2017 Julio | 53 | 20 | 73 |
| 2017 Junio | 50 | 12 | 62 |
| 2017 Mayo | 62 | 22 | 84 |
| 2017 Abril | 50 | 11 | 61 |
| 2017 Marzo | 32 | 28 | 60 |
| 2017 Febrero | 41 | 17 | 58 |
| 2017 Enero | 40 | 9 | 49 |
| 2016 Diciembre | 69 | 14 | 83 |
| 2016 Noviembre | 83 | 15 | 98 |
| 2016 Octubre | 111 | 46 | 157 |
| 2016 Septiembre | 123 | 5 | 128 |
| 2016 Agosto | 191 | 7 | 198 |
| 2016 Julio | 183 | 9 | 192 |
| 2016 Junio | 143 | 0 | 143 |
| 2016 Mayo | 152 | 0 | 152 |
| 2016 Abril | 112 | 0 | 112 |
| 2016 Marzo | 113 | 0 | 113 |
| 2016 Febrero | 158 | 0 | 158 |
| 2016 Enero | 131 | 0 | 131 |
| 2015 Diciembre | 141 | 0 | 141 |
| 2015 Noviembre | 122 | 0 | 122 |
| 2015 Octubre | 113 | 0 | 113 |
| 2015 Septiembre | 80 | 0 | 80 |
| 2015 Agosto | 95 | 0 | 95 |
| 2015 Julio | 89 | 0 | 89 |
| 2015 Junio | 44 | 0 | 44 |
| 2015 Mayo | 75 | 0 | 75 |
| 2015 Abril | 29 | 0 | 29 |
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