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Poster presentada en el 50th ERA-EDTA Congress (European Renal Association - European Dialysis Transplant Association), celebrado del 18 al 21 de mayo de 2013 en Estambul (Turquia)

Lupus nephritis results from an acute inflammatory and immunological response to renal immune complex deposition. The acute response is characterized by activation of circulating leukocytes and renal parenchymal cells, triggering the production of pro-inflammatory cytokines and growth factors. In all too many cases, this response is followed by a chronic response, which is characterized by excessive deposition of collagen and other extracellular matrix macromolecules and the development of end-stage renal disease. Mechanisms underlying this chronic response in progressive renal disease are not adequately defined. In this overview, potential roles of reactive oxygen species (ROS) generation and transforming growth factor-β (TGF-β) production in the pathogenesis of lupus nephritis are considered. ROS and TGF-β may be key elements of a pathway leading to persistent and excessive matrix deposition in progressive lupus nephritis. Further studies to define the role of this pathway in lupus nephritis may lead to the development of additional, more specific therapeutic targets to prevent progression of renal disease.

We present an unusual case of metastatic renal cell carcinoma (RCC) mimicking diverticulitis in a 76-year-old man with a 16-year history of chronic lymphocytic leukaemia (CLL) and a 2 cm left renal mass. The patient presented with severe abdominal pain and lower gastrointestinal bleeding with anticoagulation from recent pulmonary embolism. His clinical course was troubled by recurrent hospitalisations and complications that delayed investigations and potential treatments. Radiographic findings revealed stable CLL, mild sigmoid diverticulitis and a small renal mass. Small renal masses (less than 4 cm) are considered low risk for metastasising and are, thus, often observed or ablated, rather than resected. Furthermore, gastrointestinal metastases from RCC are rare. This case adds new perspective to the unpredictable nature of RCC and how synchronous malignancies may be masked in patients with long-standing CLL.

Renal biopsy can be extremely valuable in the management of patients with lupus nephritis. It is remarkably common to find pathological evidence of substantial nephron loss in patients with low grade laboratory abnormalities. This is due to compensatory hypertrophy and hemodynamic adjustments within the less diseased nephron mass. It has been shown that the decision to institute immunosuppressive therapy is highly informed by the results of renal biopsy and offers the prospect of achieving more favorable renal outcomes. Kidney biopsies should be evaluated by dedicated renal pathology services experienced in diagnostic light, immunofluorescence and electron microscopy. Biopsies should be classified according to the World Health Organization (WHO) system and specific lesions semiquantitatively scored against a checklist of features comprising activity (reversible) and chronicity (irreversible damage) indices. The renal biopsy findings should be reviewed jointly by pathologists and the clinicians caring for patients with lupus nephritis.

Immune hemolytic anemia in patients after organ transplantation has been reported generally to be graft-cell-derived due to elaboration by the donor's "passenger" lymphocytes of the antibodies directed against the recipient's red cell antigens. In contrast, this report presents a case that illustrates postoperative red cell alloantibody production by the recipient of an orthotopic liver transplant. Anti-Jka, -c, and -S, detected in the recipient's serum 9 days after transplantation, resulted in significant hemolysis. These alloantibodies had not been present in the recipient's serum before transplantation or in the sera of the liver or blood donors. In addition, anti-Jka and -c were eluted from posttransfusion red cells. The patient was transfused during surgery with crossmatch-compatible blood, that carried the alloantigens Jka, c, and S. The liver donor's red cells also carried the Jka, c, and S antigens. The recipient's pretransplantation red cell phenotyping was Jk(a-), c-, S-. The recipient had received only one transfusion 10 years prior to this operation, after which time he was noted to have anti-K. Immunosuppression initially consisted of cyclosporine, azathioprine, and prednisolone. This is believed to be the first report of delayed immune hemolysis due to non-ABO antibodies in a liver transplant patient treated with cyclosporine.