warfarin and Nephritis

Topics: Adult; Clinical Trials as Topic; Dipyridamole; Female; Glomerulonephritis, IGA; Humans; Male; Nephritis; Warfarin

The management of Henoch-Schönlein purpura nephritis (HSPN) is controversial. It has been revealed that some patients develop end-stage renal disease and aggressive treatment with drugs such as steroids is increasing, and some of them may be overzealous. At our institutes, our treatment decisions are based on the clinical and pathological severity of the case in an attempt to limit the indications for aggressive therapies such as steroids and immunosuppressive agents. Here, we retrospectively examined the efficacy of treatment for HSPN. Renal biopsy was performed in patients with nephrotic syndrome or persistent proteinuria for more than 3 months and patients were classified by treatment. Patients (n=31) with moderately severe HSPN (histological grade I-III and serum albumin [Alb] >2.5 g/dl) were treated with angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers. Patients (n=19) with HSPN exceeding grade III or Alb ≤ 2.5 g/dl received combination therapy comprising prednisolone, immunosuppressants, warfarin, and dipyridamole. All patients showed resolution of proteinuria without renal dysfunction during the observation period (3.76 ± 0.37 years). Our findings support those of some earlier reports that treatment strategies for HSPN should depend on the histological and clinical severity. Furthermore, aggressive therapies, particularly combination therapies, are unnecessary for moderate-severe HSPN.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents; Anticoagulants; Child; Dipyridamole; Drug Therapy, Combination; Female; Humans; IgA Vasculitis; Immunosuppressive Agents; Male; Nephritis; Platelet Aggregation Inhibitors; Prednisolone; Treatment Outcome; Warfarin

Causes of gross hematuria in a patient with end-stage renal disease are limited compared with those in patients with normal renal function. Given the increased likelihood of patients with end-stage renal disease developing renal cell carcinoma, the workup focuses on a careful evaluation of the collecting system. The workup for gross hematuria in a renal transplant recipient is similar; however, the focus shifts toward a more thorough evaluation of the transplanted kidney and bladder because immunosuppression increases the overall risk for malignancy. An immunosuppressed patient also is at risk for infectious processes in the transplanted kidney manifesting as gross hematuria. Concerns for chronic rejection also should be investigated, although microscopic hematuria is more common in this scenario. If this is unrevealing, then close scrutiny of the native kidneys for possible sources of bleeding is warranted. We present an interesting and unusual cause of painless gross hematuria in a patient with end-stage renal disease and transplant nephrectomy 3 months before the onset of bleeding.

Topics: BK Virus; Diagnosis, Differential; Embolization, Therapeutic; Fistula; Graft Rejection; Hematuria; Hepatitis C, Chronic; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Nephritis; Polyomavirus Infections; Postoperative Complications; Renal Artery; Renal Dialysis; Suture Techniques; Thrombosis; Tumor Virus Infections; Urinary Fistula; Urologic Neoplasms; Valsalva Maneuver; Vascular Diseases; Warfarin; Weight Lifting

Topics: Acute Kidney Injury; Aged; Diltiazem; Eosinophils; Female; Humans; Kidney Tubules; Myocardial Infarction; Nephritis; Nitroglycerin; Warfarin

Topics: Azathioprine; Chlorambucil; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Kidney Diseases; Kidney Glomerulus; Nephritis; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Warfarin

Topics: Adolescent; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Nephritis; Nephrotic Syndrome; Steroids; Warfarin

Using the modified model of Masugi's nephritis in rats, the antinephritic effects of sodium chondroitin sulfate (CS) and other drugs were evaluated by determining the biochemical parameters in urine, serum and renal cortex as well as light microscopic observation in kidneys by preventive and curative tests. In the preventive test where drug treatment was initiated at the same time as the injection of anti-kidney serum, CS (200 mg/kg p.o.) was effective in reducing serum triglyceride level, but was ineffective against other parameters. In the curative test where drug treatment was given from the 10th day after the induction of nephritis, CS (200 mg/kg p.o.) resulted in reductions of urinary excretions of protein and enzymes such as alkaline phosphatase and N-acetyl-beta-glucosaminidase, the inhibition of urinary fibrinolytic activity and reduction in levels of serum cholesterol and triglyceride. Moreover, histological examination indicated a significant reduction of the index of glomerular lesions by the treatment of this drug. Of other drugs, dexamethasone (0.1 mg/kg p.o.) was effective in both tests, while warfarin potassium (0.05 or 0.1 mg/kg p.o.) exerted a beneficial effect only in the preventive test. From these results, the effectiveness of CS in the curative test is probably due to promotion of healing of damaged tissue in the kidneys.

Topics: Adrenochrome; Animals; Chondroitin; Chondroitin Sulfates; Dexamethasone; Dipyridamole; Indomethacin; Kidney; Nephritis; Rabbits; Rats; Warfarin

Topics: Adult; Anticoagulants; Blood Coagulation; Female; Heparin; Humans; Male; Middle Aged; Nephritis; Nephrotic Syndrome; Warfarin

Topics: Fibrin; Fibrinogen; Graft Rejection; Half-Life; Heparin; Humans; Iodides; Iodine Radioisotopes; Kidney Transplantation; Nephritis; Thyroid Gland; Transplantation, Homologous; Warfarin

Topics: Animals; Blood Coagulation; Kidney; Kidney Glomerulus; Microscopy, Fluorescence; Nephritis; Rabbits; Serum Albumin, Bovine; Serum Sickness; Time Factors; Warfarin

Topics: Animals; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Fibrin; Fluorescent Antibody Technique; Male; Mice; Microscopy, Electron; Nephritis; Serum Albumin; Serum Globulins; Staining and Labeling; Warfarin

Topics: Animals; Blood Coagulation; Electrons; Fibrin; Fluorescent Antibody Technique; gamma-Globulins; Glomerulonephritis; Immune Sera; Kidney Glomerulus; Microscopy; Microscopy, Electron; Nephritis; Pathology; Phagocytosis; Rabbits; Research; Sheep; Toxicology; Warfarin