[Steroid-Dependent Nephrotic Syndrome Due to Minimal Change Glomerulonephritis Treated with Rituximab]

47-year-old woman suffering from minimal lesion glomerulonephritis previously undergone high-dose steroid therapy and subjected to exacerbations of nephrotic syndrome after therapy discontinuation. It was decided to initiate off-label treatment with Rituximab at a dosage of 375 mg/m2 administred at zero-time, one-month and three months with good therapeutic response and resolution of the clinical laboratory picture. The therapy was well tolerated and had no side effects. This scheme could be an alternative to the conventional therapeutic scheme with steroids or other classes of immunosuppressive drugs, especially in order to avoid problems related to prolonged exposure to steroid therapy.

[Identification of Helicobacter pylori and associated gastric lesions]

In this study is presented a silver stain technique for Helicobacter pylori with ammoniacal silver carbonato of Del Río Hortega, in biopsies and surgical specimens embebbed in paraffine. This study was performed between 1999 to 2001, and 717 gastroscopics biopsies were observed, that included: 705 chronic gastritis (98.32%), 11 gastric carcinomas (1.53%), and 1 low-grade lymphoma (0.13%). It is important to note the low incidence of adenocarcinomas and lymphomas from 717 gastroscopic biopsies during the period of 1999-2001, only 11 carcinomas and 1 lymphoma. We added 28 retrospective studies of biopsies and surgical specimens. These latter group included 21 adenocarcinomas and 7 low-grade lymphomas. Hence, there were a total of 745 cases with: 705 chronic gastritis, 32 adenocarcinomas, and 8 low-grade lymphomas. In 705 chronic gastritis, 325 (46.10%) were associated with H pylori, and they were Chronic Superficial Gastritis of Mild (8.62%), Moderate (61.23%), and Severe (12.92%) intensity; and Follicular Gastritis in 17.23%. In a serie of 82 total Follicular Gastritis (82/705), H pylori was founded in 68.29% (56/82). This relative frequency of association between H pylori with Chronic Gastritis in general (46.10%), and with Follicular Gastritis in particular (68.29%), could be explain because: a--many gastroscopic biopsies did not became from antrum, site of H pylori growing. Or b--there was another etiologic factor without morphologic value. There is a clear evidence that H pylori is an important factor in the pathogenesis of these chronic gastritis, from primary Acute Gastritis occurred in children and young patients, to Chronic Superficial Gastritis, Follicular Gastritis, Atrophic Gastritis, intestinal metaplasia, and Peptic Ulcer present in adult patients. Adenocarcinomas were associated with moderate and severe Chronic Superficial Gastritis, Atrophic Gastritis, intestinal metaplasia, and moderate and severe dysplasias of glandular epithelium. H pylori was founded in only 35% of adenocarcinomas, probably related to the presence of atrophic gastritis associated with metaplastic/dysplastic changes, or necrotic tissues, which would possibly explain the absent of H pylori growing under these circumstances. Low-grade lymphomas (MALT-type), arise from lymphatic tissue of the mucosa, and were associated with chronic gastritis, atrophy, and intestinal metaplasia. H pylori was founded in 75% of all lymphomas. Also in this case, there is a clear pathogenic evidence between H pylori infection and the development of low-grade lymphoma, specially in early stages, since it is possible the complete resolution after antibiotic therapy or partial gastrectomy.