phenylephrine-hydrochloride and Glomerulonephritis

The ureter is an unusual location for lesions of Wegener's granulomatosis (WG). A patient in whom recurrence of WG after kidney transplantation was manifested by obstructive uropathy due to granulomatous vasculitis (WG) at the ureterovesicle anastomosis, as well as nasal and lung involvement, is reported. The occurrence of WG in the ureter in relation to the processes causing ureteral obstruction and the recurrences of WG after kidney transplantation and its treatment are briefly reviewed.

Topics: Adolescent; Adult; Arthritis, Rheumatoid; Child; Combined Modality Therapy; Diagnostic Errors; Female; Glomerulonephritis; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Kidney Glomerulus; Kidney Transplantation; Lung; Male; Nose; Postoperative Complications; Recurrence; Ureteral Obstruction

Less toxic treatment options for patients with myeloperoxidase (MPO)-ANCA-associated GN are needed. Using an established murine model of focal necrotizing GN mediated by autoimmunity to MPO (autoimmune anti-MPO GN), we assessed the capacity for nasal tolerance induced by nasal insufflation of the immunodominant nephritogenic MPO peptide (MPO409-428) to attenuate this disease. Compared with mice that received an irrelevant immunodominant ovalbumin (OVA) peptide, OVA323-339, mice that received MPO409-428 were protected from the development of humoral and cell-mediated autoimmunity to full-length MPO and the development of GN. In mice with established anti-MPO autoimmunity, nasal insufflation of MPO409-428 as a therapeutic attenuated anti-MPO GN. To investigate the nature of this induced tolerance, we isolated CD4(+) T cells from the upper airway draining lymph nodes of both OVA323-339- and MPO409-428-tolerized mice. Adoptive transfer of CD4(+) T cells from MPO409-428- but not OVA323-339-tolerized mice to animals with established anti-MPO autoimmunity attenuated the subsequent development of GN, confirming that the immunosuppression induced by these T cells is antigen specific. Ex vivo studies showed that nasal tolerance to MPO is mediated by both conventional and induced T regulatory cells. The strong homology between the pathogenic human MPO B cell epitope recognized by ANCA in patients with acute vasculitis and the nephritogenic murine T cell MPO epitope emphasizes the clinical relevance of this study.

Topics: Animals; Antibodies, Antineutrophil Cytoplasmic; Glomerulonephritis; Immune Tolerance; Male; Mice; Mice, Inbred C57BL; Nose; Peptides; Peroxidase

The authors present four cases of Wegener's granulomatosis patients with multiorganic manifestation forms, but with a prevalent involvement in upper-airway. Granulomatosis diseases of the nose include bacterial infections (rhinoscleroma, tuberculosis, syphilis, lupus, and leprosy), fungal infections (rhinosporidiosis, aspergillosis, mucormycosis, candidosis, histoplasmosis, and blastomycosis) and diseases with unspecified etiology (Wegener's granulomatosis, mediofacial malignant granuloma, and sarcoidosis). We consider an interesting experience regarding Wegener's granulomatosis due to its rarity, being an autoimmune systemic disease, with continuous evolution and multiorganic involvement. The beginning of the disease is like upper airway affection, a kind of "persistent cold", being difficult to differentiate it from a common cold in the head, with a prolonged evolution. It is important to mention that we establish the diagnosis of Wegener's granulomatosis starting with Ear Nose and Throat (ENT) clinical exam, followed by other tests and investigations realized in our Clinic and completed with specialty tests (nephrology, internal medicine and dermatology), meaning that we need a close cooperation with these medical specialties. All the patients presented multiorganic involvement. Notably significant for our four cases is the prolonged evolution in a stable condition in one patient.

Topics: Adult; Endoscopy; Female; Glomerulonephritis; Granulomatosis with Polyangiitis; Humans; Inflammation; Larynx; Male; Middle Aged; Nose; Skin

Coxsackievirus B(4) was isolated from the throat, nose, blood, stools and urine of a 9-year-old boy with acute glomerulonephritis and a pneumonitis. Neutralization test showed a greater than fourfold rise in the antibody titre to coxsackievirus B(4). The antistreptolysin O titre was elevated, but the complement component was within the normal range. The importance of the coxsackievirus B(4) in the pathogenesis of acute glomerulonephritis is clearly indicated; however, further investigations are needed to understand the details of the virus-kidney interaction.

Topics: Acute Disease; Antistreptolysin; Blood; Child; Complement System Proteins; Coxsackievirus Infections; Enterovirus; Feces; Glomerulonephritis; Humans; Male; Neutralization Tests; Nose; Pharynx; Pneumonia; Streptococcal Infections; Urine