Publications by authors named "Virgilia Soto-Abraham"

15 Publications

  • Page 1 of 1

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases.

Am J Kidney Dis 2019 12 1;74(6):837-843. Epub 2019 Aug 1.

Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico.

The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.
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http://dx.doi.org/10.1053/j.ajkd.2019.04.026DOI Listing
December 2019

Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association.

J Clin Med 2019 Jan 18;8(1). Epub 2019 Jan 18.

Department of Pathology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14000, Mexico.

Chronic kidney disease (CKD) is increasingly recognized as a risk factor in pregnancy; the differential diagnosis between CKD and preeclampsia (PE) may be of pivotal importance for pregnancy management and for early treatment of CKD. Acknowledging this connection may be useful also in a wider context, such as in the case reported in this paper, which for the first time describes an association between syphilis infection and IgA-dominant glomerulonephritis. A 16-year-old woman, referred to a general hospital due to a seizure, was found to be unknowingly pregnant. Based on hypertension and nephrotic proteinuria, she was initially diagnosed with PE. Immunological tests, as well as hepatitis and HIV tests showed negative results. However, secondary syphilis was diagnosed. In discordance with the PE diagnosis, urinalysis showed glomerular microhematuria with cellular casts. Proteinuria and hypertension did not remit after delivery, which was made via caesarean section, due to uncontrolled hypertension, at an estimated gestational age of 29 weeks. A male baby, weighing 1.1 kg (6.5 centile) was born. The baby was hospitalized in the neonatal intensive care unit, where he developed subependymal hemorrhage and thrombocytopenia, and neonatal syphilis was diagnosed. The mother underwent a kidney biopsy one week after delivery, leading to the diagnosis of IgA-dominant postinfectious glomerulonephritis. Mother and child were treated with support and antibiotic therapy, and were discharged in good clinical conditions four weeks later. Four months after delivery, the mother was normotensive without therapy, with normal kidney function and without hematuria or proteinuria. In conclusion, this case suggests that IgA-dominant postinfectious glomerulonephritis should be added to the spectrum of syphilis-associated glomerulonephritides, and underlines the need for a careful differential diagnosis with CKD in all cases of presumed PE. While diagnosis relies on kidney biopsy, urinary sediment, a simple and inexpensive test, can be the first step in distinguishing PE from other nephropathies.
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http://dx.doi.org/10.3390/jcm8010114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352144PMC
January 2019

Sticky Platelet Syndrome: An Unrecognized Cause of Acute Thrombosis and Graft Loss.

Case Rep Nephrol 2018 22;2018:3174897. Epub 2018 Apr 22.

Nephrology Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.

Introduction: Sticky platelet syndrome (SPS) is a prothrombotic disease that is not well recognized and difficult to diagnose.

Case Report: We present a case of a 49-year-old diabetic woman on ambulatory peritoneal dialysis therapy who underwent a kidney transplant from living-related donor. The donor was her sister with whom she shared one haplotype and absence of donor specific antibodies. The posttransplant evolution was torpid, developing progressive deterioration, which made us suspect a failure in the graft. Doppler ultrasound reported renal vein thrombosis and hypoperfusion of the renal artery. Without clinical improvement, she required a reintervention that ended in graftectomy, in which the histopathological report showed negative C4d with medullary and cortical infarction. Hematological studies were negative for antibodies against phospholipids, with correct levels of proteins C and S and antithrombin. Platelet aggregometry studies were carried out, which were compatible with SPS.

Conclusions: Recognition of SPS in pretransplant studies is difficult if there is no history of previous thrombotic events. However, we must consider this entity in cases of acute thrombosis and loss of the graft of uncertain origin.
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http://dx.doi.org/10.1155/2018/3174897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937576PMC
April 2018

Classification of Acute Rejection Episodes in Kidney Transplantation: a Proposal Based on Factor Analysis.

Iran J Kidney Dis 2018 03;12(2):123-131

Department of Nephrology and Renal Transplantation, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico.

Introduction: Kidney transplantation is considered the ideal treatment for end-stage renal disease. Acute rejection can influence graft survival. The aim of this study was to propose a classification system for acute rejection based on factor analysis.

Materials And Methods: Data were collected from kidney transplant recipients with acute rejection diagnosis based on standard histological variables, the presence of peritubular eosinophils, and immunolabeling for lysozyme and myeloperoxidase in kidney tissue. Factor analysis was employed for data reduction and generation of a new case classification, with orthogonal rotation as a strategy to simplify factors, and principal component analysis was used as an extraction method.

Results: Seventy-nine kidney biopsies were obtained from 74 patients. The total population was divided into humoral rejection (39.2%), cellular rejection (34.1%), and mixed acute rejection (26.7%). No significant differences were found between the three groups in clinical and biochemical variables. We extracted 4 factors using factor analysis. The 1st factor was characterized by the presence of capillaritis, plasma cells infiltration, tubulitis, and inflammation. The 2nd factor included positivity for lysozyme and myeloperoxidase, while the 3rd factor included the presence of eosinophils and glomerulitis. The 4th component consisted of the presence of C4d and endarteritis. The cases belonging to the 3rd factor showed the greatest increase in serum creatinine. The cases belonging to the 4th factor exhibited greater urinary excretion of proteins.

Conclusions: This proposal of classification of acute rejection could contribute to evaluate the prognosis of kidney transplant recipients.
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March 2018

Thrombotic microangiopathy in patients with diabetic nephropathy is associated with low VEGF expression and end-stage renal disease
.

Clin Nephrol 2018 Jun;89(6):429-437

Background: Thrombotic microangiopathy (TMA) has been associated with diabetic nephropathy, but its pathogenesis is unknown.

Objectives: To determine the role of vascular endothelial growth factor (VEGF) expression in patients with TMA and diabetes mellitus.

Materials And Methods: Retrospective cohort study, patients were divided into diabetic nephropathy patients either without thrombotic microangiopathy (DN-TMA) or with thrombotic microangiopathy (DN+TMA). VEGF levels were analyzed using immunohistochemistry. Statistical analysis was performed with SPSS 20.0 software.

Results: There were 36 patients included in this study with a mean age of 47.6 ± 9.3 years. The average time since the diagnosis of diabetes mellitus was 6.8 ± 4.1 years. There were 21 patients (58.3%) with DN+TMA and 15 patients (41.7%) with DN-TMA. Patients with DN+TMA had a higher systolic blood pressure (p = 0.014) and diastolic blood pressure (p < 0.001) as well as proteinuria (p = 0.006), and a lower rate of glomerular filtration at baseline (p = 0.01). VEGF assessment showed lower arteriolar and glomerular expression in patients with DN+TMA (p < 0.001). The VEGF expression levels had an inverse relationship with proteinuria (r = -0.373; p = 0.03) and were directly proportional with glomerular filtration (r = 0.712; p < 0.01). Kaplan-Meier curves showed a higher probability of end-stage renal disease in patients with DN+TMA (log-rank p < 0.012).

Conclusion: TMA is associated with low VEGF expression and end-stage renal disease in patients with diabetic nephropathy.
.
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http://dx.doi.org/10.5414/CN109240DOI Listing
June 2018

A Postmortem Study of Frontal and Temporal Gyri Thickness and Cell Number in Human Obesity.

Obesity (Silver Spring) 2018 01 13;26(1):94-102. Epub 2017 Nov 13.

Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA.

Objective: This study aimed to compare cortex thickness and neuronal cell density in postmortem brain tissue from people with overweight or obesity and normal weight.

Methods: The cortex thickness and neuron density of eight donors with overweight or obesity (mean = 31.6 kg/m ; SD = 4.35; n = 8; 6 male) and eight donors with normal weight (mean = 21.8 kg/m ; SD = 1.5; n = 8; 5 male) were compared. All participants were Mexican and lived in Mexico City. Randomly selected thickness measures of different cortex areas from the frontal and temporal lobes were analyzed based on high-resolution real-size photographs. A histological analysis of systematic-random fields was used to quantify the number of neurons in postmortem left and right of the first, second, and third gyri of frontal and temporal lobe brain samples.

Results: No statistical difference was found in cortical thickness between donors with overweight or obesity and individuals with normal weight. A smaller number of neurons was found among the donors with overweight or obesity than the donors with normal weight at different frontal and temporal areas.

Conclusions: A lower density of neurons is associated with overweight or obesity. The morphological basis for structural brain changes in obesity requires further investigation.
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http://dx.doi.org/10.1002/oby.22036DOI Listing
January 2018

Biopsy-proven renal involvement and prognosis in 13 hispanic patients with primary Sjögren syndrome.

Med Clin (Barc) 2018 01 30;150(2):43-48. Epub 2017 Aug 30.

Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México. Electronic address:

Background: The aim of this study was to describe a case series of 13 Hispanic patients with primary Sjögren syndrome (pSS) and biopsy-proven renal involvement.

Methods: We describe the clinical, serological and histological characteristics as well as the prognosis in a group of patients with pSS and biopsy-proven renal involvement, treated in 2 referral nephrology units in Mexico City.

Results: Thirteen patients with pSS underwent kidney biopsy (KB) over a period of 27 years. The median duration from pSS diagnosis to KB was 13.9 months. Seven patients (54%) had glomerulonephritis and 6 patients (46%) had tubulointerstitial nephritis. All patients were treated with corticosteroids and/or immunosuppressants. Eight patients (62%) remained stable or their renal function improved after a median follow-up of 12 months.

Conclusions: This case series reflects the broad spectrum of renal involvement in pSS. We observed that in our Hispanic population, glomerular involvement was the most frequent abnormality, mainly membranous glomerulopathy, followed by tubulointerstitial disease. Tubular atrophy and interstitial fibrosis were also common biopsy findings. Treatment with corticosteroids or other immunosuppressive agents appear to slow renal disease progression.
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http://dx.doi.org/10.1016/j.medcli.2017.06.050DOI Listing
January 2018

Assessment of urinary TWEAK levels in Mexican patients with untreated lupus nephritis: An exploratory study.

Nefrologia (Engl Ed) 2018 Mar - Apr;38(2):152-160. Epub 2017 Jul 26.

Servicio de Nefrología of the Hospital General de Mexico, Dr. Eduardo Liceaga, Mexico City, Mexico. Electronic address:

Objectives: Urinary levels of TWEAK (uTWEAK) may be correlated with the degree of lupus nephritis (LN) activity. Our objective was to determine the sensitivity and specificity of uTWEAK in Mexican patients with untreated active lupus nephritis.

Methods: An exploratory study was performed; four groups of patients were analyzed as follows: 1) patients with systemic lupus erythematosus (SLE) without renal activity (SLE-LN), 2) patients with SLE with renal activity (SLE+LN), 3) patients with other types of glomerulopathy (glomerulonephritis, GMN), 4) and healthy patients (controls).

Results: In all, 44 patients, with an average age of 35.9±11.5 years, were evaluated. uTWEAK levels were higher in patients with SLE+LN compared with patients in the other groups: SLE+LN 12.88±8.33, SLE-LN 3.12±2.31, GMN 4.36±2.31 and controls 2.41±1.94pg/mg Cr (p=0.007). A total of 72.7% of the cases had renal activity index scores above 12, and 90.9% of the cases had scores of chronicity below 6 points. Receiver Operating Characteristic (ROC) curve analysis revealed that uTWEAK levels above 4.91pg/mg Cr had a sensitivity of 81% and a specificity of 75% for the diagnosis of renal activity due to lupus, with an area under the curve of 0.876 (95% CI: 0.75-0.99). However, no significant correlation was observed between the levels of uTWEAK and the histological findings specific to the activity and chronicity associated with SLE.

Conclusions: Our study revealed that uTWEAK can adequately distinguish renal activity due to lupus, but cannot predict the degree of histological activity in Mexican patients with active lupus nephropathy.
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http://dx.doi.org/10.1016/j.nefro.2017.04.005DOI Listing
November 2018

Multi-imaging assessment of successful surgical treatment of pulmonary artery dilatation and dissection in Marfan syndrome.

Eur Heart J Cardiovasc Imaging 2017 May;18(5):607

Department of Immunology, National Institute of Cardiology "Ignacio Chavez", Juan Badiano N° 1, Colonia Seccion XVI, Tlalpan, Mexico City, P.C. 14080, Mexico.

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http://dx.doi.org/10.1093/ehjci/jew340DOI Listing
May 2017

Heart calcification (idiopathic cardiac osseous metaplasia): a case report.

Arch Cardiol Mex 2014 Apr-Jun;84(2):140-2. Epub 2014 May 3.

Instituto Nacional de Cardiología "Ignacio Chavez", Hospital Director, Mexico.

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http://dx.doi.org/10.1016/j.acmx.2013.06.001DOI Listing
February 2015

Mucinous cystadenoma of the pyelocaliceal system: a report of 3 examples and an analysis of 17 previously published cases.

Ann Diagn Pathol 2013 Jun 9;17(3):239-44. Epub 2013 Jan 9.

Department of Pathology of Médica Sur Clinic and Foundation, Tlalpan, D.F. CP. 14050, México.

We report 3 patients all men between 45 and 64 years of age with unilocular or multilocular mucinous cystadenomas of the kidney. One tumor arose from the renal pelvis, and 2 involved the entire pyelocaliceal system. The tumors measured between 2.4 and 37 cm in greatest dimension. Two patients were asymptomatic, and 1 had recurrent attack of acute pyelonephritis. Microscopically, the morphology and immunophenotype (CK20, MUC2, and CDX2 positive) of the tumors were similar to the colonic adenomas. Two patients were asymptomatic 24 and 64 months after surgery, including the patient with mucinous cystadenoma and intramucosal carcinoma. One patient died of acute myocardial infarction, and his tumor was an autopsy finding. Only 17 cases of mucinous cystadenomas and 5 cases of mucinous cystadenocarcinomas have been reported. Of the 17 mucinous cystadenomas, 2 arose in horseshoe kidneys. The mean size of these neoplasms was 15 cm (2.4-37 cm). Despite their large size, some patients with mucinous cystadenomas were asymptomatic. Sixty percent were associated with renal lithiasis. Thirty percent progressed to mucinous adenocarcinomas, and only 2 cases showed areas of intramucosal carcinomas. Two cases were associated with carcinoid tumors, similar to those reported in the appendix. Most patients were asymptomatic after surgery, and only 1 patient died by abdominal sepsis related to adenomucinosis. The 3 examples of mucinous cystadenomas of the pyelocaliceal system reported here, and those previously published indicate that they are very uncommon neoplasms with morphology and intestinal immunophenotype similar to the colonic adenomas.
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http://dx.doi.org/10.1016/j.anndiagpath.2012.10.008DOI Listing
June 2013

Similarities and differences between primary and secondary Sjögren's syndrome.

J Rheumatol 2010 Apr 1;37(4):800-8. Epub 2010 Mar 1.

Department of Immunology and Rheumatology, Ophthalmology Service, and Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.

Objective: To define the clinical, serological, and histopathological characteristics of primary (pSS) and secondary Sjögren's syndrome (SS).

Methods: Fifty subjects with pSS and 300 with connective tissue diseases (CTD; systemic lupus erythematosus 100, rheumatoid arthritis 100, scleroderma 100) were selected randomly from our patient registry. Selected patients were assessed for fulfillment of the American-European Consensus Group criteria for SS using a 3-phase approach: screening (European questionnaire, Schirmer-I test, wafer test), confirmatory (fluorescein staining test, nonstimulated whole salivary flow, anti-Ro/La antibodies), and lip biopsy (H&E and immunohistochemical staining for anti-CD20 and anti-CD45RO scored by morphometry).

Results: All patients with pSS and 65 with CTD met criteria for SS. Oral symptoms (pSS = 92% and secondary SS = 84%; p = 0.02), parotid enlargement (pSS 56%, secondary SS 9.2%; p < 0.001), and higher prevalence (pSS 82%, secondary SS 41%; p < 0.001) and titers of anti-Ro/La antibodies were more common in pSS. Extraglandular manifestations were similar in both groups, except for Raynaud's phenomenon, which was more common in those with secondary SS (pSS 16% vs secondary SS 41%; p = 0.001). These results remained after 3 different sensitivity analyses. The prevalence of focal infiltration was also similar in both SS varieties; however, a higher B:T cell ratio and higher expression of CD20 cells (2922 vs 607.5 positive cells; p < 0.001) were observed in pSS.

Conclusion: A higher frequency of oral symptoms and parotid enlargement and stronger B cell activity (autoantibody production and lymphocyte infiltration) were observed in pSS. Whether these results reflect a true difference between the 2 disease entities or derive from underlying variables remains uncertain.
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http://dx.doi.org/10.3899/jrheum.090866DOI Listing
April 2010

Cholangiocellular hepatocarcinoma.

Ann Hepatol 2008 Apr-Jun;7(2):161-2

Unidad de Patología, Hospital General de México, O.D. Facultad de Medicina UNAM, México D.F.

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November 2008
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