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therapy membranous nephropathy

Mårten Segelmark, Thomas Hellmark
Most patients with anti-glomerular basement membrane (anti-GBM) disease present with rapidly progressive glomerulonephritis with or without pulmonary haemorrhage; however, there are several variants and vigilance is necessary to make a correct diagnosis. Such variants include overlap with anti-neutrophil cytoplasm antibodies-associated vasculitis and membranous nephropathy as well as anti-GBM occurring de novo after renal transplantation. Moreover, patients can present with isolated pulmonary haemorrhage as well as with negative tests for circulating anti-GBM...
October 29, 2018: Nephrology, Dialysis, Transplantation
Vincenzo L'Imperio, Andrew Smith, Elena Ajello, Isabella Piga, Martina Stella, Vanna Denti, Silvia Tettamanti, Renato Alberto Sinico, Federico Pieruzzi, Maurizio Garozzo, Gisella Vischini, Manuela Nebuloni, Fabio Pagni, Fulvio Magni
Membranous Nephropathy (MN) is the most frequent cause of nephrotic syndrome in adults and the disease course is characterised by the "rule of third", with one third of patients experiencing complete remission and the remaining experiencing relapses or progression of the disease. Additionally, the therapeutic approach is not standardised, leading to further heterogeneity in terms of response and outcome. In this pilot study, MALDI-MSI analysis was performed on renal biopsies (n = 13) obtained from two homogeneous groups of patients which differentially responded to the immunosuppressive treatments (Ponticelli regimen)...
October 25, 2018: Proteomics. Clinical Applications
Mohammed Alawami, Samadhi Wimalasena, Rajaie Ghashi, Basil Alnasrallah
BACKGROUND: Venous thromboembolism is a well-established risk in patients with primary membranous nephropathy (MN) due to deficiency in natural anti-coagulants. Recent studies suggested a higher risk of arterial thrombotic events as well in this group. We aimed to identify that risk in our cohort METHOD: We reviewed the data of all patients who had biopsy proven primary membranous nephropathy at our institute between 2003 and 2013. Clinical data were retrospectively reviewed until November 2016...
October 22, 2018: Internal Medicine Journal
Bin Shi, Rong-Rong Zhang, Ying Liang, Xin-Hui Wang, Rui Lang, Ren-Huan Yu
Background: The treatment of adult refractory idiopathic membranous nephropathy with steroid and other immunosuppressant-resistant nephrotic syndromes can be a significant challenge. We evaluated the efficacy and safety of the traditional Chinese medicine Jian Pi Qu Shi Formula (JPQSF) as a promising regimen. Methods: We analyzed 15 consecutive patients with biopsy-proven idiopathic membranous nephropathy who failed immunosuppressive therapy from October 2013 to January 2017...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Johan Noble, Thomas Jouve, Paolo Malvezzi, Lionel Rostaing
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major causes of chronic liver disease. HBV and HCV affect nearly 7% of the world's population. Extra-hepatic complications and particularly renal failure have different mechanisms and manifestations. The underlying mechanism, although differing for each disease, mainly involves the immune system and antibody deposits in the kidney, which can lead to tissue damage. Areas covered: We do not cover in this review hepatorenal syndrome. We report on the renal complications of viral hepatitis (HBV, HCV, hepatitis E), autoimmune hepatitis, cirrhosis, and Wilson's disease...
October 1, 2018: Expert Review of Gastroenterology & Hepatology
J Floege, P Boor, M J Moeller
Glomerulonephritides essentially all belong to the rare diseases; however, they are the most common cause of end-stage renal disease in young adults. Besides obtaining a specific diagnosis via a renal biopsy, assessing the prognosis constitutes the other essential step in the work-up, since this enables a decision to be made on whether supportive care with relatively few adverse effects is sufficient or whether additional immunosuppressive therapy is required. The latter is discussed focusing on the most common European types of glomerulonephritis: immunoglobulin A nephropathy, membranous glomerulonephritis, minimal change nephropathy and focal segmental glomerulosclerosis...
September 24, 2018: Der Internist
Jie-Ming Nie, Hai-Feng Li
Involvement of collagen IV (ColIV) and fibronectin (FN) in the occurrence and development of diabetic nephropathy (DN) and the effects of telmisartan and Salvia miltiorrhiza injection in the treatment of the patients were investigated. Two hundred and fifty-eight patients with stage IV DN were selected as the case group, and another 110 normal healthy subjects were incorporated as the control group. Involved patients were subdivided into different groups according to different treatment therapies; patients in the telmisartan group (T group) were given oral telmisartan; patients in the Salvia miltiorrhiza injection + telmisartan (S + T group) were administered with Salvia miltiorrhiza injection combined with telmisartan treatment, and there was a group of patients who received no intervention as the placebo group...
October 2018: Experimental and Therapeutic Medicine
A Carosso, M Zonca, L Colla, F Borella, L Daniele, C Benedetto
Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerulonephritis and is increasingly encountered in pregnancy. The obstetric and renal outcomes of pregnancy are controversial, however. Women with IgAN are at higher risk of hypertension, preeclampsia and foetal loss; the prognosis is worse for those who have advanced chronic kidney disease and proteinuria. Here we report the case of a 32-year-old nulliparous woman with chronic hypertension who conceived during an active phase of her IgAN, which had been diagnosed 8 years earlier...
October 2018: Case Reports in Women's Health
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...
October 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
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