Patients treated with immunosuppressive drugs can develop cancers. The authors present two cases of Kaposi's sarcoma in kidney transplant patients who had been treated with azathioprine, steroids and cyclosporin-A; during this treatment the Langerhans cells decreased and Kaposi's sarcoma appeared. Discontinuation or reduction of the dosage of cyclosporin-A led to complete regression of the illness, and the Langerhans cells reappeared. We suggest that cyclosporin-A damages the immunological function of the epidermal Langerhans cells, and that this is the primary factor in the development of Kaposi's sarcoma.

Cell Count↗

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HBV-related cutaneous periarteritis nodosa in a patient 16 years after renal transplantation: efficacy of lamivudine.

Cutaneous periarteritis nodosa (PAN) is a clinical feature characterized by chronic, benign course; its pathogenesis is unknown. In patients submitted to renal transplantation cutaneous PAN is a rare complication. We report a case of cutaneous PAN associated with the reappearance of hepatitis B antigen 16 years after kidney transplantation. A 44-year-old man underwent successful renal transplantation in June 1980. In December 1996 he presented multiple painful erythematous subcutaneous nodules on both legs. Skin lesion biopsy showed the presence of cutaneous PAN. Six months later laboratory data demonstrated the presence of HbsAg. HBeAg, HBcAb and detectable HBV-DNA serum by polymerase-chain-reaction (PCR) assay. Anti-HBs and anti-HBe proved negative. In July 1998 the laboratory tests showed an important increase of HBV-DNA (5.1 billion by Branched DNA), and so lamivudine (100 mg/day) was introduced. HBV-DNA became undetectable by PCR after 3 months of therapy. Seven months later a new skin biopsy was performed. The typical signs of PAN were no longer evident. As HBV infecion was demonstrated six months after the clinical appearance of the PAN, in a patient who was believed to be immune to the virus, it is possible that, in the early stages, the hepatitis B antigen title was methodologically indeterminable, but sufficient to form circulating immune complexes responsible for vasculitis primer. Lamivudine therapy resulted efficacious in favouring the regression of cutaneous PAN, but its long-term efficacy requires further evaluation as regards potential selection of drug resistant hepatitis B virus (HBV) mutants during treatment.

Adult↗

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[Renal atheroembolic disease: evaluation of the efficacy of corticosteroid therapy].

BACKGROUND: Even though many organs may be involved and clinical manifestations are extremely variable, a sudden worsening of renal function after vascular surgery or invasive angiographic manoeuvres is a clue for the diagnosis of renal cholesterol crystal embolization. In rare cases the disease may also occur spontaneously during anticoagulant or thrombolytic therapy. Renal atheroembolism is becoming increasingly recognized as an important cause of renal failure particularly in elderly men, and is often associated with a bad outcome. To date there is no specific and proven useful treatment apart from a few anecdotal reports on the benefits of corticosteroids. PATIENTS AND METHODS: We report a group of seven patients with cholesterol atheroembolic disease presenting acute renal failure; in six patients the disease appeared after coronary arteriography and PTCA performed in the last four months, and in one patient in an apparently spontaneous form. All the patients presented cutaneous lesions, livedo reticularis, purpuric rush, necrosis of the toes; laboratory data showed an increase of acute phase proteins and eosinophilia. Results. Treatment with prednisolone was begun at a dose of 40 mg/day i.v. for four days; the dose was reduced to prednisone 0.4-0.5 mg/kg/day for 1 week, than gradually reduced further and stopped within a month. Following therapy renal function rapidly improved; clinical symptoms of malaise and abdominal discomfort subsided, with amelioration of skin lesions and cyanosis of toes. CONCLUSIONS: Despite the small number of patients studied, our experience suggests that corticosteroid treatment is an effective therapeutic option in cholesterol renal atheroembolic disease, especially in the more severe cases of acute renal failure.

Acute Kidney Injury↗

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[The institutional accreditation process in the Italian Regions of Emilia Romagna and Lazio: professional contents].

The problems related to the institutional accreditation of the structures of Nephrology, Dialysis and Transplantation has been dealt with in various documents of the Regional Scientific Societies and in Regional Legislative Decrees. Two of these documents are particularly important, one is a special experimental project by the city councillor office for Health Policies issued by the region of Lazio and the other drafted by the Regional Health Agency for the region of Emilia Romagna. What is special about these documents is the fact that nephrologists have actually participated in the drafting process and consequently great attention was given to the professional aspects of the specialised activity. The document issued by the region of Lazio tends to monitor - through criteria, indicators and standards - the various phases of health intervention in Nephrology, by following the different sectors of the process and health care areas identified by the Manual of Accreditation of the Italian Nephrology Society. The document of the region of Emilia Romagna, more complex and articulated, deals systematically with specific requirements (structural, technological, organisational), services, clinical competence and teaching, qualification of diagnostic and therapeutic processes and health care. The Italian Society of Nephrology has been asked to give an official evaluation of both documents. At this particularly uncertain stage, this approach is to be considered as being essential in maintaining consistent performance in the protection of the professional quality of the specialisation in Nephrology.

Clinical Competence↗

PubMedDate not supplied