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therapy membranous nephropathy

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 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
Xiaofang Yu, Jieru Cai, Xiaoyan Jiao, Shu Zhang, Hong Liu, Xiaoqiang Ding
BACKGROUND: Currently, there is an urgent need to find ways of identifying primary membranous nephropathy (PMN) patients who are likely to benefit from calcineurin inhibitors (CNI) or who are resistant to them. In this study, we employed nano-HPLC-MS/MS analysis to identify serum biomarkers that predict the clinical response to CNI therapy in PMN patients. METHODS: The endpoint was complete remission (CR) after CNI treatment. PMN patients were grouped into no-remission (NR) or CR groups to screen predictive candidates using the nano-HPLC-MS/MS analysis...
2018: American Journal of Nephrology
Weihao Li, Yaping Guo, Zhiping Zhang, Feifei Zhang, Xiaomei Liu, Xin Ji, Lixia Liu, Hong Wang
Background: Anti-phospholipase A2 receptor (anti-PLA2R) is a promising biomarker for diagnosis, activity evaluation, therapy monitoring, and prognostic estimation of primary membranous neuropathy (pMN). Difference in methodology may be one cause of the discrepancy in anti-PLA2R-positive percentages in reported studies. In this study, we evaluated the determination consistency of anti-PLA2R using indirect immunofluorescence assay (IIF) and enzyme-linked immunosorbent assay (ELISA). Methods: A total of 113 patients with pMN, 34 with secondary membranous neuropathy (sMN), and 53 healthy control individuals were enrolled...
April 23, 2018: Laboratory Medicine
Ryohei Yamamoto, Enyu Imai, Shoichi Maruyama, Hitoshi Yokoyama, Hitoshi Sugiyama, Kosaku Nitta, Tatsuo Tsukamoto, Shunya Uchida, Asami Takeda, Toshinobu Sato, Takashi Wada, Hiroki Hayashi, Yasuhiro Akai, Megumu Fukunaga, Kazuhiko Tsuruya, Kosuke Masutani, Tsuneo Konta, Tatsuya Shoji, Takeyuki Hiramatsu, Shunsuke Goto, Hirofumi Tamai, Saori Nishio, Arimasa Shirasaki, Kojiro Nagai, Kunihiro Yamagata, Hajime Hasegawa, Hidemo Yasuda, Shizunori Ichida, Tomohiko Naruse, Kei Fukami, Tomoya Nishino, Hiroshi Sobajima, Satoshi Tanaka, Toshiyuki Akahori, Takafumi Ito, Terada Yoshio, Ritsuko Katafuchi, Shouichi Fujimoto, Hirokazu Okada, Eiji Ishimura, Junichiro James Kazama, Keiju Hiromura, Tetsushi Mimura, Satashi Suzuki, Yosuke Saka, Tadashi Sofue, Yusuke Suzuki, Yugo Shibagaki, Kiyoki Kitagawa, Kunio Morozumi, Yoshiro Fujita, Makoto Mizutani, Takashi Shigematsu, Naoki Kashihara, Hiroshi Sato, Seiichi Matsuo, Ichiei Narita, Yoshitaka Isaka
BACKGROUND: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. METHODS: Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively...
April 20, 2018: Clinical and Experimental Nephrology
Weihua Liu, Feiyue Lin, Xin Chen, Lixin Wei, Jiabin Wu
Although the relationship between Kaposi's sarcoma (KS) and renal transplant has been well described, there are rare cases of KS concurrent with membranous glomerulonephritis or other glomerular diseases. In this report, a patient with membranous glomerulonephritis that accepted long-term prednisolone and cyclosporine immunosuppressive therapy developed skin KS. Withdrawal of immunosuppressive treatment resulted in the disappearance of KS.
March 2018: Saudi Journal of Kidney Diseases and Transplantation
Weihao Li, Mingming Zhang, Yaping Guo, Xiaomei Liu, Xin Ji, Junhua Su, Zhiping Zhang, Feifei Zhang
BACKGROUND: Serum secretory phospholipase A2 group IB (sPLA2-IB) is involved in the pathological processes of membranous nephropathy (MN). To date, there is no large-scale study validating the usefulness of circulating sPLA2-IB in the follow-up of patients with MN. This study investigated the role of circulating sPLA2-IB in the evaluation of severity of MN. METHODS: A total of 158 patients with primary membranous nephropathy (pMN), 34 with secondary membranous nephropathy (sMN) and 53 healthy controls were enrolled...
July 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Pei-Mei Zou, Hang Li, Jian-Fang Cai, Zhen-Jie Chen, Chao Li, Xue-Wang Li
Objective To investigate the efficacy and safety of rituximab (RTX) in the treatment of idiopathic membranous nephropathy (IMN) with nephrotic syndrome with a systematic review and meta-analysis. Methods PubMed, Embase, Cochrane Library and Clinical Trials (December 2016) were searched to identify researches investigating the treatment of RTX in adult patients with biopsy-proven IMN. Complete remission (CR) or partial remission was regarded as effective therapy, and the cumulated remission rate was calculated...
March 30, 2018: Chinese Medical Sciences Journal, Chung-kuo i Hsüeh K'o Hsüeh Tsa Chih
Patrick Hamilton, Durga Kanigicherla, Michael Venning, Paul Brenchley, David Meads
Background: Membranous nephropathy is among the most common causes of nephrotic syndrome worldwide, with a high healthcare burden. Treatment using the modified Ponticelli regimen (mPR) has remained the standard of care for decades, but newer therapies such as rituximab offer promising results with reduced side effects. The cost of this treatment, however, is perceived as a barrier to widespread use, especially in resource limited healthcare systems. Methods: We developed a decision-analytic model to estimate the cost-effectiveness of rituximab versus the mPR from the perspective of the National Health Service in the UK over a 1 year, 5 year and lifetime horizon...
March 29, 2018: Nephrology, Dialysis, Transplantation
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