Glomerulonephritis Focal

It has been shown that subjects with renal diseases such as IgA nephropathy, membranous prohferative glomerulonephritis, focal sclerosis, and lupus nephritis have levels of endothelin that are significantly higher than those in healthy subjects [209]. Increased circulating ET-1 concentrations and urinary excretion of ET-1 have been observed in patients treated with the nephrotoxic immunosuppressive agents cyclosporine A and tacrolimus (FK-506) [210]. Other nephrotoxic agents, such as cisplatin, also increase urinary excretion of ET [211]. In patients with chronic renal disease, urinary excretion of ET-1 is significantly elevated when compared to normal values (Table 10). 

DotmeUy S, Levison DA, Doyle DV. Systemic lupirs erythematosus-like syndrome with focal proliferative glomerulonephritis during D-penicillamine therapy. Br J Rheumatol 1993 32(3) 251-3. 

Glomerulonephritis may be associated with chronic inflammatory bowel disease and has a heterogeneous expression [113]. Minimal change glomerulonephritis, membranous, membranoprohferative, focal glomerulosclerosis, and proliferative crescentic glomerulonephritis have been described and a summary of these case reports is available in the paper of Wilcox et al. [114]. In almost half of these cases, there was no relationship with drug intake such as sulphasalazine or 5-ASA. 

Respiratory symptoms, cough and hemoptysis may occur due to pulmonary infiltrates of Salmonella typhi and secondary pneumococcal infection. Bacteremia leads to focal disease, which presents with osteomyelitis, endocarditis, particularly in valvular disease, meningitis, soft-tissue abscesses, glomerulonephritis and skin lesions. CNS complications, such as meningitis, mental disturbances, delirium or depressed level of consciousness may occur in severe cases. 

Thompson AM, Anthonovych T, Lin R. Focal membranoproliferative glomerulonephritis in heroin users. J Am Soc Nephrol 1973 105A. 

Figure 2 See color insert.) Renal biopsy from a patient with MPA demonstrating crescentic glomerulonephritis with focal and segmental change and an area of fibrinoid necrosis, shown hy arrow. (Haematoxylin and Eosin x200).

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