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therapy membranous nephropathy

Audrey Uffing, Maria José Pérez-Sáez, Gaetano La Manna, Giorgia Comai, Clara Fischman, Samira Farouk, Roberto Ceratti Manfro, Andrea Carla Bauer, Bruno Lichtenfels, Juliana B Mansur, Hélio Tedesco-Silva, Gianna M Kirsztajn, Anna Manonelles, Oriol Bestard, Miguel Carlos Riella, Silvia Regina Hokazono, Carlos Arias-Cabrales, Elias David-Neto, Carlucci Gualberto Ventura, Enver Akalin, Omar Mohammed, Eliyahu V Khankin, Kassem Safa, Paolo Malvezzi, Michelle Marie O'Shaughnessy, Xingxing S Cheng, Paolo Cravedi, Leonardo V Riella
BACKGROUND: Long-term outcomes in kidney transplantation (KT) have not significantly improved during the past twenty years. Despite being a leading cause of graft failure, glomerular disease (GD) recurrence remains poorly understood, due to heterogeneity in disease pathogenesis and clinical presentation, reliance on histopathology to confirm disease recurrence, and the low incidence of individual GD subtypes. Large, international cohorts of patients with GD are urgently needed to better understand the disease pathophysiology, predictors of recurrence, and response to therapy...
September 12, 2018: BMC Nephrology
He Xu, Bo Fu, Li Xu, Jing Sun
BACKGROUND: Nocardia infection is uncommon in clinical practice, with most cases occuring as the result of opportunistic infection in immunocompromsed patients. Here, we report a case of disseminated nocardiosis with subretinal abscess in a patient with nephrotic syndrome, and whom is receiving immunosuppressive therapy. CASE PRESENTATION: A 58-year-old male presented with decreased vision in his left eye, without redness or floaters, which had persisted for three days...
September 3, 2018: BMC Ophthalmology
Jinil Yoo, Hugo Villanueva, Manimaran Kaliamurthy, John Kang, Lin Lwin
Antiphospholipid antibody syndrome (APS) may occur in a primary form or in association with SLE and seldom presents with nephrotic syndrome (NS). We present a case with APS who developed recurrent NS 6 years apart. The first episode of NS occurred with biopsy findings consistent with lupus nephritis (LN) class V (membranous) with no clear evidence of SLE, and responded to a remission with steroids and MMF. On the 2nd episode, the biopsy revealed negative immunofluorescent (IF) study for immune complexes and EM findings of complete effacement of foot processes and acellular debris in thickened capillary walls, compatible with healed previous episode of membranous LN and minimal change disease (MCD), a nonimmune complex podocytopathy...
2018: Case Reports in Nephrology
Jia Di, Qing Qian, Min Yang, Yaping Jiang, Hua Zhou, Min Li, Yun Zou
The aim of the present study was to observe the efficacy and safety of long-course treatment with tacrolimus combined with low-dose corticosteroids for idiopathic membranous nephropathy (IMN). A total of 76 patients with IMN diagnosed by renal biopsy between March 2012 and January 2016 form The First People's Hospital of Changzhou (Changzhou, China) were selected and randomly divided into a short-course group and a long-course group (each, n=38). Patients in the short-course group were treated with hormone combined with tacrolimus for 12 months, whereas those in the long-course group received the same treatment for 24 months...
August 2018: Experimental and Therapeutic Medicine
Eugene Han, Eugene Shin, Gyuri Kim, Ji-Yeon Lee, Yong-Ho Lee, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha
Although both sodium glucose co-transporter 2 inhibition by dapagliflozin and thiazolidinedione, pioglitazone have glucose-lowering and anti-inflammatory effects, the therapeutic efficacy of their combination on diabetic nephropathy has not been investigated. 9-week-old male db/db mice were randomly assigned to 4 groups and administrated with (1) vehicle, (2) dapagliflozin, (3) pioglitazone, or (4) dapagliflozin and pioglitazone combination. Human proximal tubule (HK-2) cells were treated with glucose or palmitate acid in the presence of medium, dapagliflozin, pioglitazone, or both...
2018: Frontiers in Endocrinology
Steven E Trasino, Xiao-Han Tang, Maria M Shevchuk, Mary E Choi, Lorraine J Gudas
Vitamin A (VA) and its derivatives, known as retinoids, play critical roles in renal development through retinoic acid receptor β 2 (RAR β 2). Disruptions in VA signaling pathways are associated with the onset of diabetic nephropathy (DN). Despite the known role of RAR β 2 in renal development, the effects of selective agonists for RAR β 2 in a high-fat diet (HFD) model of DN are unknown. Here we examined whether AC261066 (AC261), a highly selective agonist for RAR β 2, exhibited therapeutic effects in a HFD model of DN in C57BL/6 mice...
October 2018: Journal of Pharmacology and Experimental Therapeutics
Shun-Lai Shang, Guang-Yan Cai, Shu-Wei Duan, Ping Li, Qing-Gang Li, Xiang-Mei Chen
BACKGROUND: Idiopathic membranous nephropathy (IMN) is one of the most common adult nephrotic syndromes. Some patients with this disorder require immunosuppressive therapy. This retrospective case series was performed to assess the effects of tacrolimus (TAC) combined with Tripterygium wilfordii polyglycoside (TWG) in treating IMN. METHODS: From January 2015 to August 2016, kidney-biopsy-proven IMN patients treated with TAC in the Chinese PLA General Hospital were screened...
July 18, 2018: BMC Nephrology
Wentian Luo, Florina Olaru, Jeffrey H Miner, Laurence H Beck, Johan van der Vlag, Joshua M Thurman, Dorin-Bogdan Borza
Membranous nephropathy is an immune kidney disease caused by IgG antibodies that form glomerular subepithelial immune complexes. Proteinuria is mediated by complement activation, as a result of podocyte injury by C5b-9, but the role of specific complement pathways is not known. Autoantibodies-mediating primary membranous nephropathy are predominantly of IgG4 subclass, which cannot activate the classical pathway. Histologic evidence from kidney biopsies suggests that the lectin and the alternative pathways may be activated in membranous nephropathy, but the pathogenic relevance of these pathways remains unclear...
2018: Frontiers in Immunology
Marc Xipell, Lida M Rodas, Jesús Villarreal, Alicia Molina, Johanna Reinoso-Moreno, Miquel Blasco, Esteban Poch, Fritz Diekmann, Jose M Campistol, Luis F Quintana
Membranous nephropathy (MN) is estimated to cause end-stage renal disease in ∼ 5% of patients, in whom renal transplantation is the therapy of choice. Among patients receiving a transplant for MN, the disease will recur in the graft in 30-50%; among these, graft loss will occur in 50% within 10 years. Several studies have suggested that phospholipase A2 receptor autoantibody (aPLA2R) levels before transplantation might be useful in predicting recurrence, and their titration after transplantation is clinically relevant to assess the risk of recurrence and progression, to guide treatment indications and to monitor treatment response...
June 2018: Clinical Kidney Journal
Muhammad M Javaid, Priyanka Khatri, Srinivas Subramanian
Renal involvement is the most common extrahepatic manifestation of chronic hepatitis B virus (HBV) infection. While membranous nephropathy is the most frequent, the association with focal segmental glomerulosclerosis (FSGS) is not as strong, and only a few cases have been described in the literature. In particular, the tip variant FSGS is extremely rare and to our knowledge has not previously been described in association with chronic HBV infection. The management of such cases can be challenging. Immunosuppression may lead to enhanced viral replication and flare-up of the hepatic disease...
May 2018: Saudi Journal of Kidney Diseases and Transplantation
Naoka Murakami, Yanli Ding, David J Cohen, Anil K Chandraker, Helmut G Rennke
Direct-acting antiviral agents (DAAs) are very effective therapy for chronic hepatitis C infection, and have revolutionized the treatment of hepatitis C in kidney allograft recipients. Although well tolerated in general, rare renal complications have been reported. We describe a case of recurrent membranous nephropathy and acute cellular rejection in a kidney allograft recipient after DAA (ledipasvir/sofosbuvir) therapy, whose allograft function had been stable for more than 30 years. The patient was presented with nephrotic range proteinuria with stable creatinine...
July 3, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
P J Koshy, R Parthsarathy, M Mathew, R Prabakaran, S Kuruvilla, G Abraham
The adult population above the age of 60 years has significantly increased in India, with a life expectancy of 68.4 years in 2016. Data regarding the renal histopathology in these patients are scarce though the number of native kidney biopsies done in this subset of population is increasing. The present study is a retrospective analysis of 231 biopsies from a total of 700 biopsies, from patients above 60 years of age (M = 65.8%; F = 34.2%) with a mean age of 64 ± 6.03 years. The indications for kidney biopsy included nephrotic syndrome (NS) (30...
May 2018: Indian Journal of Nephrology
Roberta Bertelli, Alice Bonanni, Gianluca Caridi, Alberto Canepa, G M Ghiggeri
Minimal Change Disease (MCD) is a clinical condition characterized by acute nephrotic syndrome, no evident renal lesions at histology and good response to steroids. However, frequent recurrence of the disease requires additional therapies associated with steroids. Such multi-drug dependence and frequent relapses may cause disease evolution to focal and segmental glomerulosclerosis (FSGS) over time. The differences between the two conditions are not well defined, since molecular mechanisms may be shared by the two diseases...
2018: Frontiers in Medicine
Soumita Bagchi, Arun Kumar Subbiah, Dipankar Bhowmik, Sandeep Mahajan, Raj Kanwar Yadav, Mani Kalaivani, Geetika Singh, Amit Dinda, Sanjay Kumar Agarwal
Background: Persistent significant proteinuria has been associated with increased risk of progression to end-stage kidney disease in patients with idiopathic membranous nephropathy (IMN). Rituximab (RTX) therapy has given encouraging results in IMN, but most of the studies have used a higher dose, which is limited by the high cost as well as a potential increased risk of infections. Our study aimed to assess the efficacy and safety of low-dose RTX in patients with immunosuppression-resistant IMN...
June 2018: Clinical Kidney Journal
David Massicotte-Azarniouch, Sean Barbour, Paula Blanco, Edward G Clark
Membranous nephropathy (MN) is a common cause of nephrotic syndrome. Rarely, it can present with rapidly-progressive renal failure and hematuria. While this may be due to lupus nephritis, superimposed anti-glomerular basement membrane (GBM) disease, or antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, there have been rare reports of anti-GBM - and ANCA-negative crescentic glomerulonephritis presenting in primary membranous nephropathy (pMN). We present the case of a patient with long-standing pMN who developed acute deterioration of renal function and was found to have a flare of MN along with crescentic glomerulonephritis (GN) despite a negative serum ANCA, anti-GBM, and antinuclear antibody (ANA) work-up...
June 22, 2018: Clinical Nephrology
Murray L Levin, Shubhada Ahya
The case of a female patient with primary membranous nephropathy is presented. She was treated with corticosteroids and chlorambucil after conservative therapy had failed and went into remission for 5 years. Her nephrotic syndrome recurred but did not respond to the same regimen. She had another complete remission after treatment with corticosteroids and cyclosporine, but the nephrosis recurred after 7 years. Again, she failed to respond with retreatment of steroids plus cyclosporine. She was treated with alternate-day steroid plus mycophenolate and, once again, had a complete remission...
May 2018: Case Reports in Nephrology and Dialysis
Xu-Jie Zhou, Fu-De Zhou, Su-Xia Wang, Ming-Hui Zhao
RATIONALE: As suggested by the 2012 KDIGO guidelines, persistent elevation of serum creatinine > 3.5 mg/dl (> 309 μmol/l) (or an estimated glomerular filtration rate < 30 ml/min per 1.73 m is one of contradictions for the use of immunosuppressive therapy in membranous nephropathy. PATIENT CONCERNS: A 45-year-old man with membranous nephropathy negative for serum anti-phospholipase-A2-receptor antibody, showed no response to corticosteroids and cyclophosphamide...
June 2018: Medicine (Baltimore)
Wei Wu, Wei Hu, Wen-Bei Han, Ying-Lu Liu, Yue Tu, Hai-Ming Yang, Qi-Jun Fang, Mo-Yi Zhou, Zi-Yue Wan, Ren-Mao Tang, Hai-Tao Tang, Yi-Gang Wan
Huangkui capsule (HKC), a Chinese modern patent medicine extracted from Abelmoschus manihot (L.) medic, has been widely applied to clinical therapy in the early diabetic nephropathy (DN) patients. However, it remains elusive whether HKC can ameliorate the inchoate glomerular injuries in hyperglycemia. Recently the activation of phosphatidylinositol-3-kinase (PI3K)/serine-threonine kinase (Akt)/mammalian target of rapamycin (mTOR) signaling and its downstream regulator, 70-kDa ribosomal protein S6 kinase (p70S6K), play important roles in the early glomerular pathological changes of DN including glomerular hypertrophy, glomerular basement membrane (GBM) thickening and mild mesangial expansion...
2018: Frontiers in Pharmacology
Wenli Wu, Jin Shang, Chenyang Tao, Shuai Wang, Xiaoru Hu, Shiyi Zhang, Zhanzheng Zhao
BACKGROUND: The presence of antibodies against phospholipase A2 receptor (PLA2R-Abs) in serum at diagnosis is reported to be related to the rate of spontaneous remission in patients with idiopathic membranous nephropathy (IMN); however, there is still lack of enough samples to illustrate this problem. Here, we conducted a comprehensive meta-analysis to investigate the prognostic value of PLA2R-Abs on spontaneous remission for IMN patients in the absence of immunosuppressive therapy. METHODS: A systematic search of the PubMed, EMBASE, and Cochrane Central databases was performed for relevant original articles published until October 2017...
June 2018: Medicine (Baltimore)
Andrew S Bomback, Fernando C Fervenza
BACKGROUND: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. This review focuses on mechanisms involved in the pathogenesis of MN and approaches to treatment of this disease. SUMMARY: Our understanding of the pathogenesis of primary MN has advanced greatly with the identification of M-type phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A as target antigens whose antibodies serve as biomarkers of this disease...
2018: American Journal of Nephrology
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