M. Soler, M. Pino, A. P. Fernández, Llenalia García, M. Ruiz, C. Ramírez-Tortosa
{"title":"Treatment of Idiopathic Membranous Nephropathy (IMN)","authors":"M. Soler, M. Pino, A. P. Fernández, Llenalia García, M. Ruiz, C. Ramírez-Tortosa","doi":"10.5772/intechopen.86741","DOIUrl":"https://doi.org/10.5772/intechopen.86741","url":null,"abstract":"We present a 59-year-old patient with type 2 diabetes mellitus and massive nephrotic syndrome (anasarca) and biochemical syndrome. The renal biopsy showed a membranous nephropathy (MN). In the blood analysis the patient presented antibodies against M-type phospholipase A2 receptor (anti-PLA2R) positive at a very high titer. Given the existence of idiopathic membranous nephropathy (IMN), treatment was started with a modified Ponticelli regimen, with no response, requiring periodic ultrafiltration sessions. Rituximab induces nephrotic syndrome (NS) remission in two-thirds of patients with IMN, even after other treatments have failed. We proposed treatment with rituximab based on published evidence. In IMN, the presence of M-type anti-receptor antibodies of A2 phospholipase is considered highly specific to idiopathic forms, but the presence of such antibodies has not been shown to be associated with a particular clinical profile. Assessing circulating antiPLA2R autoantibodies and proteinuria may help in monitoring disease activity and guiding personalized rituximab therapy in nephrotic patients with IMN.","PeriodicalId":129916,"journal":{"name":"Glomerulonephritis and Nephrotic Syndrome","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126682384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Primary Membranous Nephropathy as a Model of Autoimmune Disease","authors":"P. Hamilton, D. Kanigicherla, P. Brenchley","doi":"10.5772/intechopen.88003","DOIUrl":"https://doi.org/10.5772/intechopen.88003","url":null,"abstract":"Membranous nephropathy is the most common cause of adult nephrotic syndrome worldwide with a significant health care burden. There has been a leap in our understanding of the disease mechanism over the last decade with a remarkably strong genetic component to the development of the disease and its strong association with high affinity antibody—in the form of anti-PLA2R autoantibody in the majority of cases, with a smaller proportion associated with anti-THSD7A autoantibody. New evidence is now providing confirmation of specific elements in the development of the disease pathogenesis, such as involvement of loss of peripheral tolerance. There is a striking correlation between disease activity and anti-PLA2R antibody levels, along with response to treatment; evidence points strongly to these antibodies being pathogenic. The development of membranous nephropathy therefore follows the well appreciated multi-hit step-wise path to autoimmune clinical disease. Given its strong genetic basis and putative pathogenic antibody the disease provides an invaluable model for understanding of autoimmunity. This chapter focuses on the most up to date knowledge of autoimmune membranous nephropathy and provides a paradigm for understanding the underlying disease mechanisms in autoimmunity.","PeriodicalId":129916,"journal":{"name":"Glomerulonephritis and Nephrotic Syndrome","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126962641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Calculation of GFR via the Slope-Intercept Method in Nuclear Medicine","authors":"B. Geist","doi":"10.5772/INTECHOPEN.85739","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85739","url":null,"abstract":"A determination of the glomerular filtration rate (GFR) with high accuracy is of great relevance especially in cases of insufficient kidney function. In nuclear medicine, the standard method is based on blood sample measurements with Cr-51 ethylenediaminetetraacetic acid (Cr-51-EDTA) or Tc-99m diethylene-triamine-pentaacetate (Tc-99m-DTPA), providing very high accuracy and reliability. In particular, the slope-intercept method turned out to be the most appropriate and is therefore routinely used in many hospitals worldwide. For this purpose, blood samples are drawn at certain time points starting 120 minutes after injection, which are then measured together with a standard probe in a gamma counter; based on the results, the GFR calculation is then usually performed automatically with an appropriate software. In this chapter, the mathematical background as well as a step-by-step description of the slope-intercept method is given. In our study, we found that at least three blood samples should be drawn in order to achieve highest quality and reliability. Furthermore, a sample size of at least three blood samples allows an error calculation which provides an estimation of the reliability of the preceding measurement.","PeriodicalId":129916,"journal":{"name":"Glomerulonephritis and Nephrotic Syndrome","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121867334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Childhood Idiopathic Nephrotic Syndrome as a Podocytopathy","authors":"S. Uwaezuoke","doi":"10.5772/INTECHOPEN.85994","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85994","url":null,"abstract":"Idiopathic nephrotic syndrome is the commonest manifestation of glomerular disease in children. The syndrome is characterized by massive proteinuria, hypo-albuminemia, generalized edema, and hyperlipidemia. Although genetic or con-genital forms are now well recognized, nephrotic syndrome is largely acquired. The latter form can be idiopathic or primary (the causes are unknown) and secondary (the causes are known renal or non-renal diseases). Idiopathic nephrotic syndrome consists of the following glomerulonephritides: minimal change nephropathy (MCN), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), mesangial proliferative glomerulonephritis (MesPGN), and membranous nephritis (MN). The etiopathogenesis of nephrotic syndrome has evolved through several hypotheses ranging from immune dysregulation theory and increased glomerular permeability theory to the current concept of podocytopathy. Podocyte injury is now thought to be the basic pathology in the syndrome. The book chapter aims to highlight the mechanisms underlying the pathogenesis of nephrotic syndrome as a podocytopathy.","PeriodicalId":129916,"journal":{"name":"Glomerulonephritis and Nephrotic Syndrome","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133449643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Renal Rehabilitation: A Perspective From Human Body Movement","authors":"J. Collazos, Diana Carolina Zona Rubio","doi":"10.5772/INTECHOPEN.86156","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86156","url":null,"abstract":"The prevalence and incidence of advanced chronic kidney disease has grown progressively in most countries of the world. Hemodialysis is the most common treatment that replaces the renal function, and although it allows to replace the function of the kidney, the patients who undergo it can present numerous alterations that lead to a loss of functional physical capacity and a decrease in the quality of life related to health. It is unknown to what extent low physical activity, uremia and anemia determine the decrease in functional capacity of these patients. The functional tests most frequently used in the published literature are character-ized by their ease of application and their low cost, since they do not require large measuring instruments to quantify basic qualities in subjects with impaired or dysfunction of the renal system from the aerobic capacity, muscle performance and flexibility as axes within the kinetic wellbeing which is committed in the stay of the renal hemodialysis units.","PeriodicalId":129916,"journal":{"name":"Glomerulonephritis and Nephrotic Syndrome","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126424888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biomarkers in Renal Vasculitis","authors":"P. Arseniou, S. Stai, M. Stangou","doi":"10.5772/INTECHOPEN.86489","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86489","url":null,"abstract":"The use of biomarkers in glomerular diseases has been subject of investigation during the last decades, as it can provide worthwhile evidence in diagnosis, but also, it can guide treatment and give information about prognosis and response. Renal biopsy is still the compulsory technique to establish diagnosis, and also to offer information about the severity of renal damage. However, as an invasive method, it cannot be regularly performed during follow up, so the need to find and establish measurement of molecules, easily collected, which are associated with disease pathogenesis and predict renal function outcome seems very attractive to nephrolo-gists. The renal complications of systemic vasculitis are very important for the outcome of the disease, and several substances and molecules, such as inflammatory cells, autoantibodies, cytokines, chemokines and growth factors are produced and may serve as biomarkers to provide useful information for diagnosis, follow up of the disease.","PeriodicalId":129916,"journal":{"name":"Glomerulonephritis and Nephrotic Syndrome","volume":"647 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115826287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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