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therapy membranous nephropathy

Wen-Wen Han, Li-Jun Tang, Xiang-Lei Kong, Huan Yang, Dong-Mei Xu
The present study aimed to explore the correlation between the dynamic serum levels of phospholipase A2 receptor (PLA2R), aldose reductase (AR) and superoxide dismutase 2(SOD2) antibodies with disease activity and treatment response in patients with idiopathic membranous nephropathy (IMN). The present study included 56 patients with IMN who were diagnosed through a renal biopsy and presenting with nephrotic syndrome. The patients were divided into two treatment groups: One treated with cyclophosphamide (CTX) and one with tacrolimus (FK506)...
March 2019: Experimental and Therapeutic Medicine
Yan-Chun Li, Jing Huang, Xin Li, Su-Mei Zhao
BACKGROUND AND AIMS: Idiopathic membranous nephropathy (IMN), which is considered one of the most common causes of nephrotic syndrome in adult patients, is frequently managed with immunosuppressive agents. Both tacrolimus (TAC) and cyclophosphamide (CTX) are recommended as immunosuppressive agents in the management of IMN. However, profound effects and moderate evidence on the two drugs remains poorly defined at this period. The meta-analysis aims to summarize current best evidence on the efficacy as well as safety of TAC and CTX among IMN patients...
February 9, 2019: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Yifan Shi, Jingyuan Xie, Jingzhi Zhang, Hong Ren
Type IV collagen is a component of the extracellular matrix in the basement membrane. Abnormal secretion or assembly of type IV collagen may lead to kidney lesions resulting in numerous nephropathy symptoms, e.g., Alport syndrome, thin basement membrane nephropathy, and focal segmental glomerulosclerosis. Treatment for type IV collagen-related nephropathy includes drugs, kidney transplantation, gene and cell therapy. However, drugs are not always effective, and kidney transplantation is hindered by the shortage of donors...
February 10, 2019: Zhonghua Yi Xue Yi Chuan Xue za Zhi, Zhonghua Yixue Yichuanxue Zazhi, Chinese Journal of Medical Genetics
Krishna C Keri, Samuel Blumenthal, Varsha Kulkarni, Laurence Beck, Tepsiri Chongkrairatanakul
Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in non-diabetic Caucasian adults over 40 years of age. It has an estimated incidence of 8-10 cases per 1 million. Fifty per cent of patients diagnosed with primary MN continue to have nephrotic syndrome and 30% of patients may progress to end-stage renal disease over 10 years. Although it was recognised as a distinct clinic-pathological entity in 1940s by immunofluorescence and electron microscopy, the pathogenesis and treatment have become more apparent only in the last decade...
January 25, 2019: Postgraduate Medical Journal
Tadasu Kojima, Go Hirose, Shuuhei Komatsu, Taito Oshima, Kentaro Sugisaki, Tomohiro Tomiyasu, Noriko Yoshikawa, Muneharu Yamada, Takashi Oda
BACKGROUND: Anti-glomerular basement membrane (GBM) glomerulonephritis does not usually coexist with another glomerulonephritis such as IgA nephropathy. We present a rare case having a combination of these two diseases, and furthermore, histological evaluation could be performed before and after the development of anti-GBM glomerulonephritis over a period of only10 months. CASE PRESENTATION: A 66-year-old woman was admitted with complaints of microscopic hematuria and mild proteinuria for the past 3 years...
January 25, 2019: BMC Nephrology
Handan Yarkan Tuğsal, Berrin Zengin, Gökçe Kenar, Gerçek Can, Mehtat Ünlü, Fatoş Önen, Merih Birlik
The introduction of tumor necrosis factor-alpha (TNF-α)-targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of spondyloarthritis (SpA). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects ranging from common ones including infections to uncommon renal complications. This report describes a case of infliximab-induced focal segmental glomerulosclerosis (FSGS) in a 40-year-old female patient with ankylosing spondylitis (AS) who presented with asymptomatic proteinuria and microscopic hematuria...
January 23, 2019: Rheumatology International
Shane A Bobart, An S De Vriese, Aditya S Pawar, Ladan Zand, Sanjeev Sethi, Callen Giesen, John C Lieske, Fernando C Fervenza
Kidney biopsy is the gold standard to diagnose membranous nephropathy (MN). Approximately 70%-80% of patients with primary MN have anti-phospholipase A2 receptor (PLA2R) antibodies. We hypothesized that PLA2R antibody testing without kidney biopsy may be a valid strategy to make a non-invasive diagnosis of MN in patients with a negative work-up for secondary causes. The medical records of all Mayo Clinic patients in Minnesota, Florida, and Arizona with serum PLA2R antibody tests between January 2015 and June 2018 were reviewed...
February 2019: Kidney International
Jürgen Floege, Sean J Barbour, Daniel C Cattran, Jonathan J Hogan, Patrick H Nachman, Sydney C W Tang, Jack F M Wetzels, Michael Cheung, David C Wheeler, Wolfgang C Winkelmayer, Brad H Rovin
The Kidney Disease: Improving Global Outcomes (KDIGO) initiative organized a Controversies Conference on glomerular diseases in November 2017. The conference focused on the 2012 KDIGO guideline with the aim of identifying new insights into nomenclature, pathogenesis, diagnostic work-up, and, in particular, therapy of glomerular diseases since the guideline's publication. It was the consensus of the group that most guideline recommendations, in particular those dealing with therapy, will need to be revisited by the guideline-updating Work Group...
February 2019: Kidney International
S Nayak, A Kataria, M K Sharma, A Rastogi, E Gupta, A Singh, S C Tiwari
Hepatitis C virus (HCV) infection has been shown to affect kidneys with various histopathological pattern on the kidney biopsy. These commonly include a membranoproliferative glomerulonephritis (MPGN) pattern with mixed cryoglobulinemia (CG), thrombotic microangiopathy, membranous nephropathy, and vasculitis affecting medium and small vessels of the kidneys causing polyarteritis nodosa. It has been rarely associated with MPGN without detectable CG. We present one such patient who presented to us with HCV-associated MPGN without detectable CG, who recovered completely with directly acting antiviral therapy without any immunosuppression...
November 2018: Indian Journal of Nephrology
Omar Mamlouk, Umut Selamet, Shana Machado, Maen Abdelrahim, William F Glass, Amanda Tchakarov, Lillian Gaber, Amit Lahoti, Biruh Workeneh, Sheldon Chen, Jamie Lin, Noha Abdel-Wahab, Jean Tayar, Huifang Lu, Maria Suarez-Almazor, Nizar Tannir, Cassian Yee, Adi Diab, Ala Abudayyeh
RATIONALE & OBJECTIVE: The approved therapeutic indication for immune checkpoint inhibitors (CPIs) are rapidly expanding including treatment in the adjuvant setting, the immune related toxicities associated with CPI can limit the efficacy of these agents. The literature on the nephrotoxicity of CPI is limited. Here, we present cases of biopsy proven acute tubulointerstitial nephritis (ATIN) and glomerulonephritis (GN) induced by CPIs and discuss potential mechanisms of these adverse effects...
January 6, 2019: Journal for Immunotherapy of Cancer
Xiaofang Yin, Haibo Ge, Ruifen Miao
RATIONALE: Membranous nephropathy (MN), a chronic kidney disease (CKD), due to hypoproteinemia, malnutrition, anemia, long-term intake of immunosuppressive agents, changes in cellular immune state, and decrease in antimicrobial peptides, is a high risk for Mycobacterium tuberculosis (MTB) infection, which can cause tuberculosis (TB). TB manifests by various clinical symptoms. Ocular symptoms is a rare presentation of TB. Here, we describe a case of ocular tuberculosis in a patient with MN...
January 2019: Medicine (Baltimore)
Ayumi Matsumoto, Isao Matsui, Tomoko Namba, Yusuke Sakaguchi, Hitoshi Mizuno, Yuki Shirayama, Karin Shimada, Nobuhiro Hashimoto, Yohei Doi, Satoshi Yamaguchi, Keiichi Kubota, Tatsufumi Oka, Daisuke Mori, Shinichi Akiyama, Takayuki Hamano, Masayuki Mizui, Yoshitsugu Takabatake, Tetsuya Kaneko, Yoshitaka Isaka
Autoantibodies against thrombospondin type 1 domain-containing 7A (THSD7A) cause membranous nephropathy (MN); however, the mechanisms involved in THSD7A expression and immunization are uncertain. We present 2 cases of THSD7A-associated MN accompanied by angiolymphoid hyperplasia with eosinophilia (ALHE), a benign tumor characterized by proliferation of plump endothelial cells. Prednisolone therapy, but not surgical resection of ALHE tumors, successfully suppressed eosinophilia and proteinuria in both cases...
December 13, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ziyong Tang, Yue Wang, Liyuan Tao, Yanhong Guo, Yimu Zheng, Danxia Zheng
BACKGROUND: Immunosuppressive treatment will predispose an idiopathic membranous nephropathy (iMN) patient to opportunistic infections. Disease severity is one of the main concerns for making the treatment decision. Urinary angiotensinogen (UAGT) level has been shown highly correlated with intrarenal renin-angiotensin system (RAS) activity and severity of chronic kidney diseases (CKD). We aimed to test the relationship between the UAGT level and the severity of iMN. METHODS: This cross-sectional study included a total of 48 biopsy-proven iMN patients, 46 minimal change disease (MCD) patients, and 44 healthy volunteers...
December 12, 2018: BMC Nephrology
James M Szymanski, Meryl Waldman, Cathy Conry-Cantilena, Kamille Aisha West
Idiopathic membranous nephropathy is the most common cause of nephrotic syndrome in nondiabetic adults. The antibody most often implicated is the M-type phospholipase A2 receptor (PLA2R) antibody, found in >70% of primary membranous nephropathy cases. First-line therapy is immunosuppressive in nature, but for patients who are treatment-resistant there is a significant risk of end-stage renal disease and mortality. Hypercholesterolemia is not only a side effect of nephrotic syndrome, but also its presence may worsen renal function...
December 10, 2018: Journal of Clinical Apheresis
J Zhang, L Bian, F-Z Ma, Y Jia, P Lin
OBJECTIVE: Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults, but the treatment of MN remains controversial. Rituximab, a possible alternative treatment option, represented a new therapeutic hope for the treatment of membranous nephropathy (MN). We performed a meta-analysis to perform the efficacy and safety of rituximab therapy. MATERIALS AND METHODS: Either randomized controlled trials (RCTs), cohort studies or case studies were eligible for review and were performed in Medline, Embase, Web of Science, Cochrane database with the computerized searches...
November 2018: European Review for Medical and Pharmacological Sciences
Marilena Gregorini, Vincenzo Sepe, Francesca Eleonora Pattonieri, Anna Allesina, Teresa Rampino
BACKGROUND: Post-transplant diabetes mellitus (PTDM) is an emerging problem in kidney transplantation, representing an important risk factor for kidney function loss. Diabetic nephropathy (DN) occurrence in transplanted kidneys is poorly investigated. Current knowledge describes DN recurrence in graft 5.9 years from kidney transplantation however there is little data about PTDM and DN. Here, we report a clinical case peculiar for an early appearance of advanced glomerular diabetic lesions, after kidney transplantation...
December 7, 2018: BMC Nephrology
Tao Wang, Yan Zhang, Fen Ping, Huizhi Zhao, Li Yan, Qiongzhe Lin, Hui Zhang
AIM: Pulmonary infection (PI) is the leading cause of death in patients with primary membranous nephropathy on immunosuppressive therapy. A rating score was thus developed to foresee the risk of PI in such patients. METHODS: We reviewed the charts of the pertinent patients treated during the past three years either with (n=29) or without PI (n=304). Clinical and laboratory data, the usage of cyclosporin A (CysA), and occurrence of PI were recorded. Cox regression analysis and receiver operating characteristic (ROC) curve were respectively used to identify the risk factors and assess their clinical relevance...
November 29, 2018: Nephrology
Atsushi Kitazawa, Ryo Koda, Atsunori Yoshino, Yoshihiko Ueda, Tetsuro Takeda
BACKGROUND: IgG4-related disease (IgG4-RD) is a newly recognized fibroinflammatory condition. The kidney is one of the organs commonly affected by IgG4-RD. Tubulointerstitial nephritis (TIN) is the main feature, and membranous nephropathy (MN) has also been described frequently. In MN, polyclonal immunoglobulins and complements are deposited in granular form along the glomerular basement membranes (GBMs). Unusual cases of monoclonal immunoglobulin deposition disease (MIDD) associated with membranous features have been reported...
November 20, 2018: BMC Nephrology
David J Salant
PURPOSE OF REVIEW: Despite major advances in since the discovery of the phospholipase A2 receptor (PLA2R) as the major autoantigen on podocytes in primary membranous nephropathy, there are still several unanswered questions as highlighted here. RECENT FINDINGS: A substantial body of literature, included in more than 680 articles since 2009, has documented genetic susceptibility to primary membranous nephropathy involving PLA2R1 and class II MHC alleles, the clinical value of anti-PLA2R assays, the significance of epitope spreading of the anti-PLA2R response, discovery of thrombospondin type I domain-containing 7A (THSD7A) as a minor antigen in primary membranous nephropathy, and the ability to transfer disease into mice by infusion of anti-THSD7A sera...
January 2019: Current Opinion in Nephrology and Hypertension
Maciej Fijałkowski, Joanna Stępniewska, Maciej Domański, Kazimierz Ciechanowski, Edyta Golembiewska
Eicosanoids are biologically active molecules that are created in the process of oxidation of arachidonic acid (AA) which is a constituent of the cell membrane phospholipids. Throughout the years it was evidenced by experiments that the lipid and lipid-derived metabolites play an important role in physiological and pathological processes in the kidneys. They are being considered as biomarkers in detecting acute kidney injury, nephrotoxicity, glomerulonephritis and early stages of diabetic nephropathy because of their participation in inflammatory processes and in oxidative stress...
November 19, 2018: Acta Biochimica Polonica
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