[Renaliste] (sans objet)

[JMFaivre]

Thks Dear Patricia,

In lyon  Dr denis Fouque consider (your patient is an adult >50 yrs)
you must use Cytoxan pulse with such a Kidney biopsy
its not EBM  and certainly we treat some patients with good pronostic

But after fifty  I agree : steroids alone are  unuseful  or unsatisfactory 
and I 'll add
it s not a classical HSP (a primary IgA disease : HSP or IgA GN pathology)

Dont forget  bladder neoplasia intestinal focus ...bacterial laboratory  in 
cutaneous lesions
biopsy  substance H   colibacille .....

Keep us in touch for this interesting case

Amities
JM Faivre
Chu LYON

I ll send U bibliography..

----- Original Message ----- 
From: "patricia khalil" <patriciakhalil at hotmail.com>
To: <renaliste at nephrodial.org>
Sent: Wednesday, March 14, 2007 8:34 PM
Subject: Re: [Renaliste] (sans objet)


Message de la liste nephrologique francophone RENALISTE
----------------------------------


--------------------------------------------------------------------------------


>
> the complement levels were negative and the ANCA also nno evidence of
> infection, no phayryngitis, no endocarditis.
>
> now the debate would be that if you think it is HSP then you would treat
> only with steroids but if you think it is IgA vasculitis then you would be
> inclined to treat with cytoxan.
> I was trying to get literature also on immune complex crescentic GN but 
> not
> much out there. most of the literature is about antiGBM disease and ANCA
> positive
>
>>From: "JMFaivre" <faivre.j-m69 at wanadoo.fr>
>>Reply-To: Liste de discussion des néphrologues francophones
>><renaliste at nephrodial.org>
>>To: Liste de discussion des néphrologues
>>francophones<renaliste at nephrodial.org>
>>Subject: Re: [Renaliste] (sans objet)
>>Date: Tue, 13 Mar 2007 23:03:14 +0100
>>
>>Message de la liste nephrologique francophone RENALISTE
>>----------------------------------
>>Dear Patricia
>>
>>
>>      Such a Kidney biopsy with cutaneous purpura. creatininemia up to 1.8
>>the urine RBC's and
>>  3.2 g protein/24 hours.  is in deed  vasculitis with IgA_i mmune complex
>>necrotizing glomerulonephritis
>>such as classical HSP
>>
>>The point is : have  you an aetiological factor: streptococcus virus drug
>>....to eradicate
>>any sign of Wegener ?
>>Test ANCA c or p  I-C  IgA-ANCA ....ACAN
>>May be you could observe spontaneous resolution......
>>
>>But in idiopathic case we recommend steroids combined with cytoxan : 3 to 
>>6
>>months
>>to modulate with biological results
>>
>>Best Wishes
>>
>>JM Faivre
>>
>>
>>
>>----- Original Message -----
>>From: "patricia khalil" <patriciakhalil at hotmail.com>
>>To: <renaliste at nephrodial.org>
>>Sent: Tuesday, March 13, 2007 10:18 PM
>>Subject: [Renaliste] (sans objet)
>>
>>
>>Message de la liste nephrologique francophone RENALISTE
>>----------------------------------
>>hi i want to discuss a case with you.
>>
>>
>>I have a patient who is 57 year old white female who has history of
>>schizophrenia and who had developped cutaneous lesions: started with
>>palpable purpura. by the time I saw her she had already necrosis in these
>>lesions. i was consulted aftre 2 weeks from her admission because her
>>creatinine was going up to 1.8 the urine sediemtn showed a lot of RBC's 
>>and
>>she had 3.2 g protein/24 hours. the skin biopsy showed leucocytoclastic
>>vasculitis and the IF was negative for IgA now the renal biopsy showed
>>crescentic glomerulonephritis with IgA.
>>how would you label her? HSP v/s vasculitis with i mmune complex
>>necrotizing
>>glomerulonephritis?
>>would you recommend steroids or combine it with cytoxan?
>>
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>>
>>
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16:51