. RESUMENPresentamos dos pacientes mujeres diabéticas con Pielonefritis enfisematosa bilateral atendidas en nuestro hospital. Ambas tenían más de 50 años de edad. El diagnóstico se realizó por la presencia de gas a nivel de ambos riñones, en la tomografía axial computarizada (TAC) abdominal. Una de las pacientes fue sometida a nefrectomía bilateral y la otra a nefrectomía derecha. Ambas pacientes tuvieron mala evolución pese al tratamiento antibiótico y quirúrgico. Debido a su alta mortalidad hacemos énfasis en el diagnóstico y tratamiento precoz. (Rev Med Hered 2007;18:212-217). PALABRAS CLAVE: Pielonefritis enfisematosa, diabetes, infección urinaria, insuficiencia renal SUMMARYWe report two diabetic women over 50 years old with bilateral emphysematous pyelonephritis attended in our hospital. Diagnosis was confirmed by the presence of gas in the renal parenchyma on abdominal CT scan. Bilateral nephrectomy was performed in one patient and right nephrectomy in the other one. Both cases had unfavourable evolution despite surgical treatment and antibiotic therapy. Due to its high mortality we make emphasis in the diagnosis and precocious treatment. (Rev Med Hered 2007;18:212-217).

SUMMARY IgA Nephropathy is an immune-mediated glomerulonephritis involving a heterogeneous group of patients with a variety of different clinical permutations.A 4-year-old girl with 2-month history of intermittent haematuria, without dysuria or increased frequency of micturition. On examination, she appeared fit and healthy; only with palpebral edema. Urine analysis showed microscopic haematuria (3+) and nephrotic proteinuria. Intravenous urography, and sonnografic study were normal. Her haemoglobin, white-cell count, blood urea and creatinine clearance were normal; the urinary protein excretion was 45mg/m 2 /h. C4 and C3 levels were within normal limits. In view of the duration of haematuria, a renal biopsy was performed. Thirteen glomeruli were present: all showed a diffuse increase in mesangial cells with thickening of the matrix and some necrosis zones. Immunofluorescent examination of the biopsy showed mesangial deposits of IgA and C3. The appearances were characteristic of IgA nephropathy (Rev Med Hered 2005;16:223-227).KEY WORDS: Haematuria, Ig A nephropathy, renal failure. RESUMENLa nefropatía por IgA es una glomerulonefritis inmune que involucra un grupo heterogéneo de pacientes con una variedad de diferentes presentaciones clínicas. Una niña de 4 años de edad acude con historia de 2 meses de enfermedad caracterizada por hematuria intermitente, sin sintomatología miccional. El examen físico solo muestra edema palpebral. El examen de orina revela hematuria macroscópica (3+) y proteinuria 3(+), El estudio sonográfico y la urografía excretoria no mostraron alteraciones; su nivel de hemoglobina, leucocitos y depuración de creatinina fueron normales. La excreción de proteínas en orina fue de 45mg/m2/h. Los niveles de C3 y C4 estuvieron en limites normales.Se procede a una biopsia renal la cual expone un incremento difuso en las células mesangiales con engrosamiento de la matriz y algunas zonas de necrosis. El examen de inmunofluorescencia mostró depósitos mesangiales de Ig A y C3, todos los hallazgos son compatibles con Nefropatía por Ig A. (Rev Med Hered 2005;16:223-227).

HIV associated nephropathy can present as heavy proteinuria or advanced renal insufficiency leading to dialysis dependent renal failure. We report the clinical and histopathological outcome in one patient when HIV disease manifested as HIV nephropathy. A 31 years black male developed progressive renal failure within six weeks serum creatinine increased from 1.2 mg/dl to 3.17 mg/dl. Evaluation revealed HIV antibody positive with CD4 251/ul and nephrotic proteinuria. Renal biopsy showed collapsing glomerulopathy and microcystic dilatation of tubules. The clinical presentation, physiopatology and probable treatment are discussed.

Presentamos el caso de un varón de 52 años de edad que presentaba una lesión ulcerativa en el glande, de 20 años de evolución, habiendo recibido diferentes tipos de tratamiento sin éxito. La lesión presentaba bordes irregulares, consistencia dura y no había dolor. El estudio histopatológico mostró granuloma necrótico, BAAR positivo, sugestivo de TBC.

We report a case of botryomycosis and intestinal strongyloidiasis in a patient with HTLV-1 infection. A 23 year-old female patient from Ayacucho, came with a history of a right foot tumor and chronic foot ulcers. The diagnosis of botryomycosis was established by biopsy of the lesion. Because the mild eosinophilia, a microscopic examination of stools was performed and Strongyloides stercoralis rhabditiform larva were found. HTLV-1 ELISA test, performed in order to discharge association with strongyloidiasis, was positive. The clinical presentation, physiopathology of the botryomycosis and the role of the HTLV-1 infection and strongyloidiasis as predisposing factors for botryomycosis are discussed. ( Rev Med Hered 2002; 13: 74-76 ).