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Acute crescentic transformation is a rare but well described event in patients with membranous glomerulonephritis. We report our experience with a 66-year-old Caucasian man presented for rapid decline in renal function. For nearly 10 years, he was suffering from hypertension and mixed sensori-motor polyneuropathy. He performed therapy with prednisone and azathioprine, suspended 1 year before presentation. Moreover, six months before presentation, laboratory tests showed a serum creatinine concentration 220 mol/L and a 24-h protein excretion 0,75 g/d. The physical examination showed oedema and severe hypertension; the 24-h protein excretion was 1,1 gr/d and creatinine concentration was 550.8 mol/L; ANCA and other immunological tests were negative. There was no evidence of SLE, infection or malignancy. The kidney biopsy highlighted a membranous GN with crescentic overlap. The patient was treated with steroid and cyclophosphamide. Because there was no sign of improvement after 2 months, we stopped the cyclophosphamide therapy and the patient started chronic haemodialysis treatment. Unlike membranous nephropathy, patients with superimposed crescentic glomerulonephritis appear to have a more aggressive clinical course. The importance of recognizing this group of patients with membranous nephropathy and crescentic glomerulonephritis is that immunosuppressive therapy may ameliorate the progression of renal damage and in some cases early treatment was associated with useful recovery of renal function.

The Erdheim-Chester disease is a rare form of Langherans cells. Since 1987 it is distinguished from other istiocytosis previously identified. The diagnosis of the disease relies on defined radiological (bone imaging) and pathological (histiocytic infiltration) criteria. Bone disease is crucial but systemic manifestations are reported more frequently at onset. Renal involvement is always asymptomatic at onset of disease or in the follow-up. In this review we analyze the reports of the literature; we highlight 3 pathological mechanisms of renal involvement: renal and retroperitoneal infiltration, urinary tract obstruction, renal arteries stenosis. No treatment to date has demonstrated an improvement in survival of patients with EC. Renal involvement is therefore symptomatic (ureteral stenting, percutaneous nephrostomy) or is adopted a wait-and-see attitude.

Strongyloidiasis is caused by a small intestinal nematode with a complex life cycle. In Italy the infection is endemic in rural areas of the Po Valley. The clinical syndrome of S. stercoralis encompasses a broad spectrum of symptoms and signs and, in the immunocompromised host, larvae can migrate to different organs and tissues. Also immune response seems to play a role in the pathogenesis of the disease. We report a case of strongyloidiasis complicated by Gram-negative sepsis and nephrotic syndrome in an immigrant from South America with a normal immune response. Whereas sepsis cleared up quickly, parasitic clearance was obtained only after treatment with ivermectin and nephrotic syndrome was still present three months after the end of treatment.

SLE begins with renal symptoms in about 30-50% of the patients and after 10 years over 70% of them has complications. In the last years the medical therapy improved the outcome of SLE and its complications. Presently, the survival for lupus nephritis is 80% after five years. The nephritis treatment is divided into remission-inducing treatment that is followed by remission-maintaining treatment. Moreover, it is considered the therapy for preventing or reducing toxic and side-effects from drugs and the therapy for flare-ups. To initiate the specific therapy is important to consider the histological class (WHO). In the remission-inducing treatment steroids are used alone for 3-6 months in class IIB or in association with cyclophosphamide in classes III-IV and V and for flare-ups. For remission-maintaining treatment steroids are used in association with azathioprine. The drugs improved the outcome of nephritis but produced side-effects that determined the suspension of the drug and/or reduction of dosage and/or the use of other drugs like mycophenolate mofetil or rituximab.

Epstein-Barr virus (EBV) is associated with a wide range of clinical manifestations. Neurological involvement (NI) during Infectious Mononucleosis occur in 1-5% of the cases, the only NI is more rare. From January 1995 to December 1996 three patients with NI and EBV infection have been observed in our department. The diagnosis were: meningoradiculitis (1 case), meningoencephalitis (1 case), aseptic meningitis (1 case). The diagnosis was based on the results of the lumbar puncture and on the serology: IgM VCA positive at the onset of the symptoms and a significant increase of the IgG VCA after three weeks. No other etiology was apparent. All the patients have been treated with dexamethasone, glycerol and acyclovir obtaining a complete remission of the disease. In these cases the NI has been the only clinical manifestation of the EBV infection. Therefore the authors believe that it is important recognize that EBV can cause a myriad of neurological illness with or without the stigmata of infectious mononucleosis and recommend the need to suspect this infection in any acute neurologic disorder.

Authors review several methods for diagnosis of Pneumocystis carinii on BAL fluid in AIDS patients aiming to identify ideal routine technic. Giemsa, Gomori and Toluidine Blue staining. Direct and Indirect Immunofluorescence. Immunocytochemical methods were tested and advantages/disadvantages compared on BAL fluid from AIDS patients. Pneumocystis carinii was detected in 7 out 21 cases (33%). Gomori staining and Toluidine Blue staining were chosen for routine Pneumocystis carinii detection while IF technics are deserved as very useful in fields showing high fungal ++ contamination (inducted sputum).

Cefotaxime is a new broad-spectrum injectable cephalosporin which is stable to most beta-lactamases. In this study we have evaluated the antibacterial activity of cefotaxime comparatively with the activity of cephalotin against 66 Gram-negative bacteria and 31 Gram-positive bacteria by using an automated antimicrobial susceptibility determination system. Cefotaxime was markedly more active than cephalotin against Klebsiella pneumoniae, Proteus, Enterobacter, Escherichia coli and Serratia. Against Gram-positive clinical isolates cefotaxime was less active than cephalotin. Regrowth was observed mainly with cephalotin against Gram-negative clinical isolates, therefore the results obtained after a few hours with automated system should be carefully interpreted.