No abstract

c-kit protooncogene encodes a type III transmembrane receptor kinase, the stem cell factor receptor, or KIT. The ligand of the KIT. stem cell factor, is a cytokine that stimulates mast cell growth and differentiation. We have studied immunohistochemically KIT expression in 23 canine mast cell tumors (MCTs), 10 histiocytomas, 5 malignant melanomas, and in 2 cell lines derived from mast cells (HMC-1, human and C2, canine). As expected, KIT was detected both in the human mast cell leukemia cell line (HMC- ) and in the canine mastocytoma cell line C2. In normal canine skin, KIT expression was confined to mast cells. All canine MCTs expressed KIT, although the intensity of the staining reaction varied considerably among the 23 neoplasms. Grade III tumors showed the highest expression of KIT, whereas grade I tumors showed the lowest expression of KIT. Two patterns of KIT expression were detected in mast cells. In normal canine mast cells and in some neoplastic mast cells, KIT appeared mainly on the cell membrane. However, in many canine MCTs, KIT is accumulated in the cytoplasm, usually near the cell nucleus. The meaning of these two patterns is not clear. Expression of KIT could not be detected immunohistochemically in any of the other neoplasias investigated. According to our results, it can be concluded that most, if not all, canine MCT express KIT. Furthermore, there is an inverse correlation between the degree of differentiation and the expression of KIT. Moreover, according to our results, KIT can be used as a reliable immunohistochemical marker for canine mast cells and undifferentiated mast cell tumors.

Results indicated a relationship between intron 11 deletion and MCT and the grade of MCT differentiation. We suggest that intron 11 deletion may be implicated in the pathogenesis of MCT and could be used as a marker for diagnosis and prognosis of canine MCT.

Background and Aims IgA nephropathy (IgAN) is occasionally diagnosed in association with other systemic diseases, such as liver diseases, inflammatory bowel diseases, autoinmune diseases, chronic respiratory tract disorders or chronic infections. In these cases, it is called a “secondary” IgAN. A form of IgAN with rapid progression to end-stage kidney disease (ESKD) has been described in a minority of patients with IgAN. The prognosis of these patients is very poor, with progression to ESKD in 5 years in up to 70% of patients, including those who received immunosuppression. However, in these studies secondary forms of IgAN were excluded. The aim of this study was to describe the renal survival in patients with rapidly progressive secondary IgAN, and to compare the effect of supportive care with treatment of underlying cause versus add-on steroid therapy/immunosuppression on the renal and overall survival of these patients. Method We performed an observational retrospective multicenter study that included patients who had a histological diagnosis of IgAN, with a concomitant comorbidity as a potential cause of IgAN and presented with an agressive course either as acute kidney injury or rapidly progressive glomerulonephritis (defined as progressive decline of >30% of glomerular filtration in <3 months, having at least 2 estimations during that period). Baseline demographic, clinical and laboratory parameters at presentation were registered. We stratified the cohort into two groups; patients who received only supportive measures and treatment of the cause, and those who had an add-on treatment with steroids (± immunosuppressants). Kidney survival was defined as a status free from dialysis at the end of follow-up. Results The study included 95 patients, 79% were males and the mean age was 59.2±16.2 years. Mean peak serum creatinine was 4.4±2.8 mg/dl, median proteinuria was 1.9 g/day (IQR 0.80-3.12), all patients had microscopic hematuria and 49.5% presented with gross hematuria, and 26.3% needed dialysis at presentation. The main associated causes of IgA nephropathy were liver disease in 46.3%, staphylococcal or streptococcal infections in 23.2%, autoinmune rheumatological disorders in 16.8%, respiratory tract disorders in 9.5% and inflammatory bowel disease in 4.2% of cases. 25 patients (26.3%) only received treatment of the cause, while 70 patients (73.3%) received an add-on steroid therapy, 18 patients (18.9%) received as well cyclophosphamide and 20 patients (21.1%) mycophenolate. There were no differences in age, peak serum creatinine, proteinuria, hematuria, need of dialysis at presentation, histological parameters or associated comorbidities between patients treated with steroids ± immunosuppressants and patients who received supportive treatment. After a median follow-up period of 33 months, 28 patients (29.5%) progressed to ESKD and were on maintenance dialysis, and 32 patients (33.7%) died. There were no differences in progression to ESKD between immunosuppressed patients (28.6%) and those who only received treatment of the cause (32%, P = .747). Survival analysis curves showed no significant differences between patients treated only with supportive measures and those who received an add-on steroid and/or immunosuppresive therapy in regards of renal survival (log-rank= 0.003, P = .956) or overall survival (log-rank= 0.871, P = .351). Cox regression analysis showed that the only factor associated with renal survival was serum creatinine at presentation (HR 1.12, 95% CI 1.002-1.252) and need of dialysis at presentation (HR 3.09, 95%CI 1.39-6.86) independent from age, hematuria, hypertension, diabetes or the use of steroids and/or immunosuppression. Conclusion Secondary IgAN that presents with acute kidney injury or rapidly progressive glomerulonephritis has a poor prognosis, particularly when dialysis is needed at presentation. Adding steroid treatment with or without immunosuppression to supportive measures and treatment of the cause of secondary IgA nephropathy is not associated with an improved renal or patient survival.

Background and Aims The clinical profile and complexity of hospitalised patients from Vascular Surgery are similar to those from Nephrology. Also, the majority of patients with peripheral vascular disease has some degree of chronic kidney disease. Therefore, the collaboration of nephrologist as consultants could have a significant impact on the adequate attention of these patients. Our aim was to analyze the epidemiological and clinical characteristics of the vascular surgery patients admitted in a public university hospital of 1000 beds that were attended by a nephrologist during their hospitalization. Method Observational study of a retrospective cohort of 138 patients in a 1 year period (January 1st to December 31st 2018). The following data were considered: nature of the consultation (“Urgent” LESS THAN 24 H TO BE ATTENDER OR “Standar”), reason for consultation/nephrological diagnosis, cause of admission, follow-up period, age, sex, presence of : Diabetes Mellitus (DM), Hypertension (HT) and/or Chronic Kidney Disease (CKD) presence. Results 138 patients, Mean age was 67,8 y (range 35-92 y). 76,81% were men and 23,19% were women. Most frequent cause for consultations were: 1. Patients on Hemodialysis treatment (66 = 47,83%); 2. Exhacerbations of CKD (29 = 21,01%); 3. Acute Kidney Failure (18 = 13,04%); 4. Kidney transplantation (11 = 7,97%); 5. Ionic alterations (7 = 5,07%); 6. Advanced CKD (6=4,35%). Cause of admission: 1. Chronic lower limb ischemia (68=49,27%); 2. Problems related to arteriovenous fistula (Creation of vascular access: 10=7,25% and complications of vascular access: 16=11,59%); 3. Aneurysmatic complications (14=10,14%); 4. Diabetic foot (11=7,97%); 5. Infections (7=5,07%); 6. Deep venous thrombosis (6=4,35%). About 75.35% had DM, 91.30% were hypertensive and 62.32% had both clinical conditions. The average follow-up time was 72 days (range 1-223 days) and 92,03 % need to be follow-up more than 24 hours. About 49,27% of the consultation were urgent. Conclusion The number of patients admitted to vascular surgery department requiring nephrology attention are high and represents an important percentage of the clinical activities and resources demanding to the nephrology service. Exhacerbations of CKD, Diabetes Mellitus and Hypertension are constant clinical conditions in patients admitted to vascular surgery requiring nephrology assessment. Based on these data is important to improve the coordination between both departments and to stablish a specific training program for nephrologist and vascular surgeons in order to optimize the management of this patients.