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OBJETIVO: Avaliar as alterações anatomopatológicas e histopatológicas da pleura e do parênquima pulmonar após a injeção de óleo de copaíba, extrato aquoso de crajiru e polivinilpirrolidona iodado (PVPI) no espaço pleural de ratos. MÉTODO: Foram utilizados 128 Rattus norvegicus var. Wistar, machos, com peso médio 198,9g (± 24,9g), randomizados em quatro grupos: copaíba, PVPI, crajiru e simulação. As substâncias foram injetadas no espaço pleural direito dos animais, os quais foram mortos em 24 h, 48 h, 72 h e 504 h, para análise macro e microscópica da pleura visceral e pulmão direito. RESULTADOS: Macroscopicamente, observou-se intensa reação pleuro-pulmonar no grupo copaíba com significância estatística (p= 0,001) em relação aos outros grupos e entre os diferentes momentos. Microscopicamente, a espessura pleural apresentou maior aumento no grupo copaíba com significância estatística nos tempos 72 h e 504 h. O PVPI provocou reação inflamatória aguda em 24 h e 48 h com melhora em 72 h, porém, na última observação, evidenciou-se lesão crônica pulmonar. O crajiru apresentou-se pouco irritativo e sem significância em relação aos demais. CONCLUSÃO: A copaíba mostrou-se muito irritante; o PVPI, moderadamente irritante, e o extrato aquoso de crajiru apresentou pouca reação inflamatória na pleura e parênquima pulmonar dos animais de experimentação.

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RBRE-137; No. of Pages 4 r e v b r a s r e u m a t o l . 2 0 1 4;x x x(x x):xxx-xxx REVISTA BRASILEIRA DE REUMATOLOGIA w w w . r e u m a t o l o g i a . c o m . b r Available online xxx Keywords: Juvenile systemic sclerosis Nephrotic syndrome Focal segmental glomerulosclerosis Proteinuria Methotrexate a b s t r a c t Renal involvement occurs in 1-12% in juvenile systemic sclerosis (JSSc) patients, mainly with arterial hypertension, proteinuria and scleroderma renal crisis. We report herein a patient who presented nephrotic syndrome (NS) as the first manifestation of JSSc with focal segmental glomerulosclerosis (FSGS). A female patient presented steroid-sensitive NS at the age of 12 years. At 14 years, she had orbital and lower limbs edema, arterial hypertension, sclerodactyly and proximal skin sclerosis. Moderate capillary dilation and mild focal devascularization were observed in nailfold capillaroscopy, compatible with early stage of scleroderma (scleroderma pattern). Percutaneous renal biopsy guided by ultrasound revealed focal segmental glomerulosclerosis and direct immunofluorescence were negative.Therefore, she fullfilled the provisional classification criteria for JSSc. Patient was treated with oral 25-hydroxyvitamin D (800 IU/day), methotrexate (0.5 mg/kg/week) and amlodipin (0.15 mg/kg). Prednisone (60 mg/m 2 /day) was administered for 4 consecutive weeks, followed by alternate-day (40 mg/m 2 ) for 2 consecutive months, with tapering for 4 months and then stopping this medication. Currently she is being treated with methotrexate 15 mg/week, without edema and proteinuria. In conclusion, we reported a rare case of NS with FSGS as the first manifestation of scleroderma. Therefore, renal biopsy is mandatory in JSSc patients with sustained proteinuria or NS. Síndrome nefrótica como a primeira manifestação da esclerodermia sistêmica juvenilPalavras-chave: Esclerose sistêmica juvenil Síndrome nefrótica r e s u m o O envolvimento renal ocorre em 1% a 12% dos pacientes com esclerose sistêmica juvenil (ESJ) e manifesta-se principalmente como hipertensão arterial, proteinúria e crise renal da esclerodermia. Relata-se o caso de uma paciente que manifestou síndrome nefrótica (SN)

Renal involvement occurs in 1%-12% in juvenile systemic sclerosis (JSSc) patients, mainly with arterial hypertension, proteinuria and scleroderma renal crisis. We report herein a patient who presented nephrotic syndrome (NS) as the first manifestation of JSSc with focal segmental glomerulosclerosis (FSGS). A female patient presented steroid-sensitive NS at the age of 12 years. At 14 years, she had orbital and lower limbs edema, arterial hypertension, sclerodactyly and proximal skin sclerosis. Moderate capillary dilation and mild focal devascularization were observed in nailfold capillaroscopy, compatible with early stage of scleroderma (scleroderma pattern). Percutaneous renal biopsy guided by ultrasound revealed focal segmental glomerulosclerosis and direct immunofluorescence were negative. Therefore, she fullfilled the provisional classification criteria for JSSc. Patient was treated with oral 25-hydroxyvitamin D (800 IU/day), methotrexate (0.5mg/kg/week) and amlodipin (0.15 mg/kg). Prednisone (60 mg/m/day) was administered for 4 consecutive weeks, followed by alternate-day (40mg/m) for 2 consecutive months, with tapering for 4 months and then stopping this medication. Currently she is being treated with methotrexate 15 mg/week, without edema and proteinuria. In conclusion, we reported a rare case of NS with FSGS as the first manifestation of scleroderma. Therefore, renal biopsy is mandatory in JSSc patients with sustained proteinuria or NS.