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In IgG4-associated disease, several organs and tissues are often affected, especially kidney tissue, and is characterized by interstitial nephritis, obstructive nephropathy, and in rare cases glomerulopathy (including membra[1]nous nephropathy).IgG4-associated disease was isolated as an independent nosological form in 2003, when patients with type 1 autoimmune pancreatitis were found signs of systemic damage (involvement of the biliary tract, salivary glands, retroperitoneal space), and in 2012 the first international nomenclature of the disease was proposed.The clinical manifestations of IgG4-associated disease are nonspecific and diverse, which determines the difficulties of differential diagnosis, including infections and tumors, and increases the period from the onset of the disease to diagnosis to an average of 2 years. IgG4-associated disease is more likely to develop in middle age and old age. The prevalence of the disease is higher among men than among women. Thus, autoimmune pancreatitis type 1, retroperitoneal fibrosis and tubulointerstitial nephritis are more common in men, and sialoadenitis, dacryoadenitis and thyroiditis are more common in women.In this article, we present a clinical case of IgG4-associated systemic disease with a combined lesion of the tubulo-interstitial and glomerular compartments of kidney tissue with nephrotic syndrome as the only initial manifestation. The combination of IgG4-tubulo-interstitial nephritis with membranous nephropathy is an ex[1]tremely rare pathology. Nephrobiopsy was crucial in the diagnosis of this condition, which allowed the patient to be prescribed proper and timely treatment.
The last decades in maxillofacial surgery and surgical dentistry are marked by the fact that one of the most popular and frequently encountered research topics is the pathology of the salivary glands. Patients with this pathology make up 2.3-5.2% of the total number of persons hospitalized during the year in specialized inpatient departments. The spectrum of these diseases is wide and includes: malformations, traumatic injuries, inflammatory processes of both viral and bacterial nature, reactive dystrophic lesions, salivary stone disease, benign and malignant neoplasms. Sialoadenitis can occur in both acute and chronic forms. At the same time, the ways of penetration of the infectious agent were determined: hematogenic, lymphogenic, contact, intraductal. The most frequently diagnosed inflammatory pathology of the salivary glands is chronic sialoadenitis. The purpose of the study is to identify unsolved problems and determine the directions of further research based on the analysis of available domestic and foreign specialized literature on epidemiology, diagnosis and differential diagnosis of chronic sialoadenitis. Materials and methods. The analysis of specialized literature containing information on the epidemiology, diagnosis and differential diagnosis of chronic sialoadenitis was carried out. The article analyzes periodicals for the last 10 years, as well as basic manuals, monographs, and textbooks without a statute of limitations. The descriptive method is used for the analysis. Results and discussion. Chronic sialoadenitis and sialosis account for 42.0-54.4% of the total pathology of the salivary glands. This is due to: an increase in the number of neoplasms, including malignant ones both in the maxillofacial region and in the salivary glands; an increase in the number of patients with thyroid diseases who use radioactive iodine for therapeutic purposes, which also accumulates in the salivary glands, which causes the appearance of symptoms of xerostomia and sialoadenitis; a significant share of publications indicating the complexity of the differential diagnosis of chronic sialoadenitis and a large number of diagnostic errors. Conclusion. The presented material proves that the task of developing diagnostic and differential-diagnostic tests used in chronic sialoadenitis is socially significant and belongs to the category of priority and determines the need for its early effective solution. The development and implementation of new diagnostic and differential-diagnostic tests developed and scientifically based on the principles of evidence-based medicine, used in patients with chronic sialoadenitis, will reduce the number of complications, improve the quality of life of patients, and increase the level of specialized medical care to the population
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