We reported a biopsy proved case of minimal change nephrotic syndrome in a 72-year-old patient. The minimal change nephrotic syndrome has been steroid sensitive, but the patient had 7 relapses over a span of 5 years. ...We reported a biopsy proved case of minimal change nephrotic syndrome in a 72-year-old patient. The minimal change nephrotic syndrome has been steroid sensitive, but the patient had 7 relapses over a span of 5 years. Each time the dose of steroid is tapered, a relapse of the nephrotic syndrome occurred. Eventually, the patient was complaining of dysphagia and difficulty swallowing. Hospital work-up with barium swallow, endoscopy, and CT of the chest, abdomen and pelvis, revealed a focal stenotic lesion with mild to moderate esophageal dysmotility 7/15/2022. A diagnosis of an ulcerating lesion with biopsy confirmed a neuro-endocrine carcinoma of the gastro-esophageal junction was entertained. The CT of the chest/abdomen/pelvis, 7/19/2022, has shown, an esophageal mass of 5.1 × 5.6 × 7 cm of the gastro-esophageal junction with ulceration. No evidence of spread beyond the esophagus and stomach. The histology revealed a poorly differentiated neuroendocrine tumor of the gastro-esophageal junction. The patient underwent several rounds of chemotherapy, radiation, and surgery culminating in tumor control. His nephrotic syndrome was resolved after the tumor has been controlled by surgery and chemotherapy.展开更多
Objective: To observe the relationship of tumor necrosis factor-o (TNF-a) and nitrogen oxide (NO) with the treatment of frequent relapse nephrotic syndrome (FRNS) and to explore the patho-genesis of FRNS and the thera...Objective: To observe the relationship of tumor necrosis factor-o (TNF-a) and nitrogen oxide (NO) with the treatment of frequent relapse nephrotic syndrome (FRNS) and to explore the patho-genesis of FRNS and the therapeutic mechanism of Shenkangling (肾康灵,SKL) Granule in children. Methods: Sixty children suffering from FRNS were randomly divided into the treated group and control group, 30 in each, and the other 30 healthy children were taken as healthy group. The patients were treated with prednisone for a long-term course, and those with no effect or partial effect shown were treated with additional Tripterygium or Cytoxan in the control group, while in the treated group patients were treated with prednisone and additional SKL. The two groups were compared as to their changes of TNF-a, NO before and after treatment, and the relapses after treatment. Results: The levels of TNF-a and NO in the sick children before treatment were markedly higher than those after treatment and normal group (P< 0. 01). The positive correlation between TNF-o of FRNS cases and relapse risk displayed more significance than that between the relapse of FRNS and NO. The difference between treated group and control group was significant (P<0. 01). Conclusion: TNF-a can be regarded as the monitoring parameter of the active phase in FRNS, and the higher the level, the more possible the relapse would occur. SKL could markedly reduce the relapse rate of FRNS in children.展开更多
目的探讨频繁复发肾病综合征(FRNS)患儿外周血程序性死亡蛋白配体1阳性(PD-L1^(+))B细胞比例及意义,进一步探究FRNS的可能发病机制。方法选取2021年4月至2022年2月该院68例初次发病的原发性肾病综合征(PNS)患儿,随访1年,根据复发的频次...目的探讨频繁复发肾病综合征(FRNS)患儿外周血程序性死亡蛋白配体1阳性(PD-L1^(+))B细胞比例及意义,进一步探究FRNS的可能发病机制。方法选取2021年4月至2022年2月该院68例初次发病的原发性肾病综合征(PNS)患儿,随访1年,根据复发的频次,分为FRNS组(31例)和非频繁复发组(NFRNS,37例)。另选取同期该院门诊28例体检健康儿童作为健康对照组。于研究组患儿糖皮质激素(GC)治疗前、治疗缓解后及健康对照组儿童体检时分别采取静脉血标本。采用流式细胞术检测各组儿童外周血CD19^(+)PD-L1^(+)B细胞比例、CD19^(+)CD24^(hi)CD27^(+)B细胞、CD19^(+)CD24^(hi)CD38^(hi)B细胞。结果GC治疗前,与健康对照组比较,FRNS组、NFRNS组患儿外周血PD-L1^(+)B细胞比例均明显升高(P<0.05),CD19^(+)CD24 hi CD27^(+)B细胞比例均明显降低(P<0.05),CD19^(+)CD24^(hi)CD38^(hi)B细胞比例差异无统计学意义(P>0.05);与NFRNS组比较,FRNS组PD-L1^(+)B细胞比例明显升高(P<0.05),CD19^(+)CD24 hi CD27^(+)B细胞比例明显降低(P<0.05)。GC治疗后,FRNS组较NFRNS组及健康对照组的PD-L1^(+)B细胞比例均明显升高(P<0.05)。与治疗前比较,治疗后FRNS组、NFRNS组患儿外周血PD-L1^(+)B细胞比例均明显下降(P<0.05),CD19^(+)CD24 hi CD27^(+)B细胞比例均明显升高(P<0.05)。FRNS组GC治疗前PD-L1^(+)B细胞比例与总B细胞计数(r=0.528,P=0.002)、IgM(r=0.371,P=0.040)呈正相关,与ALB(r=-0.461,P=0.009)呈负相关。结论FRNS患儿中存在PD-L1^(+)B细胞、CD19^(+)CD24 hi CD27^(+)B细胞比例异常,其可能参与PNS患儿的频繁复发过程。展开更多
文摘We reported a biopsy proved case of minimal change nephrotic syndrome in a 72-year-old patient. The minimal change nephrotic syndrome has been steroid sensitive, but the patient had 7 relapses over a span of 5 years. Each time the dose of steroid is tapered, a relapse of the nephrotic syndrome occurred. Eventually, the patient was complaining of dysphagia and difficulty swallowing. Hospital work-up with barium swallow, endoscopy, and CT of the chest, abdomen and pelvis, revealed a focal stenotic lesion with mild to moderate esophageal dysmotility 7/15/2022. A diagnosis of an ulcerating lesion with biopsy confirmed a neuro-endocrine carcinoma of the gastro-esophageal junction was entertained. The CT of the chest/abdomen/pelvis, 7/19/2022, has shown, an esophageal mass of 5.1 × 5.6 × 7 cm of the gastro-esophageal junction with ulceration. No evidence of spread beyond the esophagus and stomach. The histology revealed a poorly differentiated neuroendocrine tumor of the gastro-esophageal junction. The patient underwent several rounds of chemotherapy, radiation, and surgery culminating in tumor control. His nephrotic syndrome was resolved after the tumor has been controlled by surgery and chemotherapy.
文摘Objective: To observe the relationship of tumor necrosis factor-o (TNF-a) and nitrogen oxide (NO) with the treatment of frequent relapse nephrotic syndrome (FRNS) and to explore the patho-genesis of FRNS and the therapeutic mechanism of Shenkangling (肾康灵,SKL) Granule in children. Methods: Sixty children suffering from FRNS were randomly divided into the treated group and control group, 30 in each, and the other 30 healthy children were taken as healthy group. The patients were treated with prednisone for a long-term course, and those with no effect or partial effect shown were treated with additional Tripterygium or Cytoxan in the control group, while in the treated group patients were treated with prednisone and additional SKL. The two groups were compared as to their changes of TNF-a, NO before and after treatment, and the relapses after treatment. Results: The levels of TNF-a and NO in the sick children before treatment were markedly higher than those after treatment and normal group (P< 0. 01). The positive correlation between TNF-o of FRNS cases and relapse risk displayed more significance than that between the relapse of FRNS and NO. The difference between treated group and control group was significant (P<0. 01). Conclusion: TNF-a can be regarded as the monitoring parameter of the active phase in FRNS, and the higher the level, the more possible the relapse would occur. SKL could markedly reduce the relapse rate of FRNS in children.
文摘目的探讨频繁复发肾病综合征(FRNS)患儿外周血程序性死亡蛋白配体1阳性(PD-L1^(+))B细胞比例及意义,进一步探究FRNS的可能发病机制。方法选取2021年4月至2022年2月该院68例初次发病的原发性肾病综合征(PNS)患儿,随访1年,根据复发的频次,分为FRNS组(31例)和非频繁复发组(NFRNS,37例)。另选取同期该院门诊28例体检健康儿童作为健康对照组。于研究组患儿糖皮质激素(GC)治疗前、治疗缓解后及健康对照组儿童体检时分别采取静脉血标本。采用流式细胞术检测各组儿童外周血CD19^(+)PD-L1^(+)B细胞比例、CD19^(+)CD24^(hi)CD27^(+)B细胞、CD19^(+)CD24^(hi)CD38^(hi)B细胞。结果GC治疗前,与健康对照组比较,FRNS组、NFRNS组患儿外周血PD-L1^(+)B细胞比例均明显升高(P<0.05),CD19^(+)CD24 hi CD27^(+)B细胞比例均明显降低(P<0.05),CD19^(+)CD24^(hi)CD38^(hi)B细胞比例差异无统计学意义(P>0.05);与NFRNS组比较,FRNS组PD-L1^(+)B细胞比例明显升高(P<0.05),CD19^(+)CD24 hi CD27^(+)B细胞比例明显降低(P<0.05)。GC治疗后,FRNS组较NFRNS组及健康对照组的PD-L1^(+)B细胞比例均明显升高(P<0.05)。与治疗前比较,治疗后FRNS组、NFRNS组患儿外周血PD-L1^(+)B细胞比例均明显下降(P<0.05),CD19^(+)CD24 hi CD27^(+)B细胞比例均明显升高(P<0.05)。FRNS组GC治疗前PD-L1^(+)B细胞比例与总B细胞计数(r=0.528,P=0.002)、IgM(r=0.371,P=0.040)呈正相关,与ALB(r=-0.461,P=0.009)呈负相关。结论FRNS患儿中存在PD-L1^(+)B细胞、CD19^(+)CD24 hi CD27^(+)B细胞比例异常,其可能参与PNS患儿的频繁复发过程。
