Glomerular diseases最新文献

{"title":"Preparation and Rationale for a Patient-Centered Clinical Outcome Assessment Set of Fluid Overload for Drug Development in Nephrotic Syndrome.","authors":"Eloise Salmon, Noelle E Carlozzi, Jin-Shei Lai, Catherine Spino, Yujie Wang, Emily Capellari, Rebecca Scherr, Kayla Sifre, Shawn Sullivan, Courtney Hurt, Tina Creguer, Kelly Helm, Richard A Lafayette, Patrick H Nachman, David T Selewski, John Devin Peipert","doi":"10.1159/000539921","DOIUrl":"10.1159/000539921","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid overload is a source of substantial morbidity for adults and children with nephrotic syndrome (NS). Preparation and Rationale for a Fluid Overload in Nephrotic Syndrome Clinical Outcomes Assessment Set for Drug Development (Prepare-NS, 5UG3FD007308) was funded by the US Food and Drug Administration to develop a core set of patient-reported and observer-reported (for young children) outcome measures of fluid overload for use in pharmaceutical trials across the lifespan.</p><p><strong>Methods: </strong>The Prepare-NS study team developed the proposed context of use with input from stakeholders. We conducted a scoping review to assess the available literature on relevant patient- and observer-reported measures and performed secondary analyses of existing qualitative and quantitative data.</p><p><strong>Results: </strong>The outcome set will aim to serve individuals 2 years of age and older with primary NS conditions (specifically focal segmental glomerulosclerosis, minimal change disease, IgM nephropathy, membranous nephropathy, and childhood-onset NS not biopsied). The existing literature describing patient-reported outcomes in NS largely relies on nonspecific measures of health-related quality of life; fluid overload has been associated with lower scores on these measures.</p><p><strong>Conclusion: </strong>To address the gap in measure availability and fluid overload content, the Prepare-NS team has launched a set of qualitative studies for concept elicitation from the population of interest to inform development of new measures. The resulting measures subsequently will undergo psychometric evaluation and validation in a survey study.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"4 1","pages":"172-182"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Membranoproliferative Glomerulonephritis over 20 Years at a Tertiary Referral Center in the UK.","authors":"Hannah O'Keeffe, Joshua Storrar, Chethana Ramakrishna, Sara Metaoy, Constantina Chrysochou, Rajkumar Chinnadurai, Philip A Kalra, Smeeta Sinha","doi":"10.1159/000540672","DOIUrl":"https://doi.org/10.1159/000540672","url":null,"abstract":"<p><strong>Introduction: </strong>Membranoproliferative glomerulonephritis (MPGN) is a pattern of injury seen on kidney biopsy, with various underlying etiologies. The component types, including complement-mediated MPGN, are relatively rare. This study presents longitudinal real-world data over 20 years in a tertiary renal center in the UK.</p><p><strong>Methods: </strong>All patients with an MPGN pattern on kidney biopsy between 2000 and 2020 were identified. After applying exclusion criteria, 38 patients remained. Data including patient demographics, details of the renal histology from the kidney biopsy, baseline laboratory results, treatments received, and clinical outcomes including renal replacement therapy and death were collected from the organization's electronic patient record.</p><p><strong>Results: </strong>Twenty-eight of the cohort had immune complex-mediated MPGN, and 10 had complement-mediated MPGN (8 with C3 glomerulonephritis and 2 with dense deposit disease). Median follow-up was 72 months. Median age was 61 years. Overall, 60.5% were female, and 92.1% white. At presentation, median eGFR was 31.5 mL/min/1.73 m² and uPCR 394 mg/mmol. Here, 78.9% received renin-angiotensin-aldosterone system inhibitors and 71.1% received any immunosuppression. In total, 47.4% progressed to ESKD and 50% died during follow-up.</p><p><strong>Conclusions: </strong>The study found an older patient population than typically reported. Poor outcomes were observed in the overall cohort with progression to ESKD and mortality both at almost 50%. This may be influenced by the older patient population. Individualized management of patients with an MPGN biopsy finding is paramount, with comprehensive evaluation for triggers and complement abnormalities. Going forward, registry enrolment and collaborative studies may enhance knowledge and outcomes.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"4 1","pages":"159-166"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumocystis jiroveci Pneumonia Prophylaxis in patients with ANCA Vasculitis on Rituximab maintenance therapy","authors":"Faten Aqeel, Michael Joseph Cammarata, Dustin Le, D. Geetha","doi":"10.1159/000539993","DOIUrl":"https://doi.org/10.1159/000539993","url":null,"abstract":"Introduction: Although an increased risk of Pneumocystis jirovecii pneumonia (PJP) has been reported in adults receiving rituximab for induction therapy, current evidence is lacking on the utility of PJP prophylaxis in ANCA-associated vasculitis (AAV) patients on maintenance rituximab therapy. The purpose of this study was to compare the incidence of PJP pneumonia and the outcomes of AAV patients with and without PJP prophylaxis. \u0000\u0000Methods: We performed an observational, single-center, retrospective study examining patients with AAV in clinical remission and on rituximab maintenance therapy. We divided the patients into two groups: those with and without PJP prophylaxis. We explored factors associated with PJP prophylaxis use. We additionally looked at several outcomes, including PJP infections, infections requiring hospitalizations, end-stage kidney disease (ESKD), and death. Data were analyzed using T test, Fisher exact test, univariate, and multivariate logistic regression as appropriate.\u0000\u0000Results: A total of 129 patients with mean (SD) follow-up time of 7.2 (5.4) years were included: 44% received PJP prophylaxis and 56% of patients did not. There were no PJP infections in the entire cohort. Lung involvement was associated with increased odds of prescribing PJP prophylaxis (OR 4.09 (95% CI 1.8-9.82)). PJP prophylaxis did not decrease infection rates requiring hospitalizations, ESKD, or death. Glucocorticoid use, however, was associated with increased rates of infections requiring hospitalizations (OR 5.54 (95% CI 2.01-15.4)) and death (OR 4.67 (95% CI 1.36-15.71)) even after adjustment for age, gender, and use of PJP prophylaxis.\u0000\u0000Conclusion: Regardless of the use of PJP prophylaxis during the maintenance phase of AAV management, PJP pneumonia was not observed. AAV patients with lung involvement were more likely to be on PJP prophylaxis.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"117 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141801929","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":"Clinical presentation and treatment outcomes of Renal Medullary Angiitis in ANCA associated vasculitis: A single-center case series.s","authors":"Grant Kirby, Antonio Salas, Abdulrahman K. Alabdulsalam, Alana Dasgupta, D. Geetha","doi":"10.1159/000539553","DOIUrl":"https://doi.org/10.1159/000539553","url":null,"abstract":"Introduction:\u0000Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) with renal involvement primarily affects the renal cortex and presents with key histopathologic findings of a pauci-immune necrotizing and crescentic glomerulonephritis. Infrequently reported and poorly characterized is renal medullary angiitis (RMA), a pathologic variant of AAV primarily involving the renal medulla. This study seeks to describe the presentation and treatment outcomes of RMA.\u0000Methods: \u0000In this single center cohort, renal pathology samples classified as AAV with renal involvement underwent secondary review to determine if they met histopathologic criteria for renal medullary angiitis (RMA). Demographic, clinical, and laboratory data were obtained via electronic medical record review. Descriptive statistical analysis was performed on key variables. \u0000Results:\u0000Of the 136 kidney biopsy samples classified as ANCA associated vasculitis with renal involvement, histopathologic features of RMA were present in 13 cases. The mean (SD) age at the time of RMA diagnosis was 65 (19) years and 54% were female. Most cases presented with extra-renal manifestations of disease. Initial median (IQR)eGFR and proteinuria on presentation was 16 (10-19) mL/min/1.73m2 and 1100 (687-2437)mg respectively. The primary histologic features were high degrees of interstitial inflammation comprised of leukocytes, neutrophils, plasma cells, and eosinophils along with either interstitial hemorrhage or necrosis. All patients were treated with glucocorticoids in combination with either cyclophosphamide, rituximab or mycophenolate. All patients achieved disease remission. During a median (IQR) follow up of 42 (14-68) months, one patient reached ESKD and one patient died. \u0000Conclusions:\u0000In this single center case series, we identified the presence of RMA in 9.5% of AAV samples that underwent secondary review. RMA presented with severe impairment in renal function and multi-system disease. Standard of care immunosuppression for AAV was effective for remission induction in RMA. It remains unclear whether standard prognostication tools are useful in this population. \u0000","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":" 1172","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141823143","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":"Rituximab in Steroid-Dependent Podocytopathies.","authors":"Cláudia Costa, Amélia Antunes, João Oliveira, Marta Pereira, Iolanda Godinho, Paulo Fernandes, Sofia Jorge, José António Lopes, Joana Gameiro","doi":"10.1159/000539922","DOIUrl":"10.1159/000539922","url":null,"abstract":"<p><strong>Introduction: </strong>Rituximab (RTX) has been reported as an effective treatment alternative in primary forms of minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) associated with steroid dependence and frequent relapses. However, the optimal RTX regimen and the outcomes of further doses of RTX remain unclear. This study aimed to evaluate the use of induction and maintenance RTX therapy for adults with primary podocytopathies.</p><p><strong>Methods: </strong>We performed a retrospective case series on adult patients with steroid-dependent podocytopathies who received an induction RTX therapy. Maintenance therapy was performed at physician's discretion. Remission and relapse rates, concomitant corticosteroids and immunosuppressants use, B-cell depletion and adverse events were analyzed.</p><p><strong>Results: </strong>Fourteen patients (mean age at start of RTX 29.1 ± 21.9 years) with MCD (<i>n</i> = 7) or FSGS (<i>n</i> = 7) were treated with 2 doses of 1,000 mg 2 weeks apart (<i>n</i> = 13) or four doses of 375 mg/m² (<i>n</i> = 1) of RTX. At last follow-up (mean 47.3 ± 101.7 months), 10 patients were in complete remission and two remained in partial remission. A reduction in the number of relapses, number of patients under corticosteroids and immunosuppressants, and dose of prednisolone was observed when compared to baseline (14 [100%] vs. 5 [35.7%]; 8/14 [57.1%] vs. 4/12 [33.3%]; 13/14 [92.9%] vs. 7/12 [58.3%]; 20 mg/day vs. 5.25 mg/day, respectively). Maintenance RTX therapy was used in 6 patients, with sustained complete remission. Infusion reactions were observed in 4 patients (one required treatment withdrawal).</p><p><strong>Conclusions: </strong>Our findings support the use of RTX for a steroid-free remission in podocytopathies and suggest that maintenance RTX is well-tolerated and associated with prolonged remission. Further studies are needed to confirm its efficacy and safety and establish the optimal induction and maintenance RTX regimen in steroid-dependent podocytopathies.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"4 1","pages":"129-136"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Dapagliflozin in Patients with Membranous Nephropathy.","authors":"Glenn M Chertow, Hiddo Lambers Heerspink, Patrick B Mark, Jamie P Dwyer, Michal Nowicki, David C Wheeler, Ricardo Correa-Rotter, Peter Rossing, Robert D Toto, Anna Maria Langkilde, Niels Jongs","doi":"10.1159/000539770","DOIUrl":"10.1159/000539770","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the provision of renin-angiotensin-aldosterone-system inhibitors and immunosuppressive therapies, membranous nephropathy often progresses to end-stage kidney disease (ESKD). The objective of this prespecified analysis was to assess the safety and efficacy of dapagliflozin in patients with membranous nephropathy enrolled in the DAPA-CKD trial.</p><p><strong>Methods: </strong>Patients with an estimated glomerular filtration rate (eGFR) of 25-75 mL/min/1.73 m² and urinary albumin-to-creatinine ratio (UACR) 200-5,000 mg/g were randomized to dapagliflozin 10 mg once daily or placebo, along with standard-of-care and followed for median 2.4 years. The primary endpoint was a composite of ≥50% sustained decline in eGFR, ESKD, or kidney or cardiovascular death. Exploratory efficacy endpoints included eGFR slope and UACR.</p><p><strong>Results: </strong>Among DAPA-CKD participants with membranous nephropathy, 19 were randomized to dapagliflozin and 24 to placebo. The mean (SD) age was 59.9 ± 12.1 years, the mean eGFR was 45.7 ± 12.1 mL/min/1.73 m², and the median UACR was 1,694.5 (25%, 75% range 891-2,582.5) mg/g. Two of 19 (11%) patients randomized to dapagliflozin and five of 24 (21%) randomized to placebo experienced the primary composite endpoint. Total and chronic mean eGFR slopes for dapagliflozin and placebo were -3.87 and -4.29 and -2.66 and -4.22 mL/min/1.73 m²/year, respectively; corresponding between-group mean differences were 0.42 and 1.57 mL/min/1.73 m²/year. Dapagliflozin reduced geometric mean (SEM) UACR relative to placebo (-29.3% ± 1.2% vs. -3.6% ± 1.1%; between-group mean difference [95% CI] -26.7 [-50.4, 8.3]). Four (21%) patients randomized to dapagliflozin and seven (29%) randomized to placebo experienced a serious adverse event.</p><p><strong>Conclusion: </strong>In membranous nephropathy, the effects of dapagliflozin on kidney disease progression and albuminuria were generally favorable; there was insufficient power to justify formal inference testing.</p>","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"4 1","pages":"137-145"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation Of Biomarker-Based GFR Estimating Equations in Glomerular Disease","authors":"Antara Mondal, Christina Kobe, Laura H. Mariani, J. Zee","doi":"10.1159/000539353","DOIUrl":"https://doi.org/10.1159/000539353","url":null,"abstract":"Introduction: Glomerular filtration rate (GFR) is typically estimated with equations that use biomarkers such as serum creatinine and/or cystatin-C. The impact of these different biomarkers on GFR estimates in glomerular disease patients is unclear. In this study, we compared the different GFR estimating equations in the Cure Glomerulonephropathy (CureGN) cohort of children and adults with glomerular disease.\u0000\u0000Methods: All available cystatin-C measurements from CureGN study participants were matched to same-day serum creatinine measurements to estimate GFR. To explore the strength of agreement between eGFR values obtained from the \"Under 25” (U25) and Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) equations, we used intraclass correlation coefficients. Multivariable linear mixed effects models were used to determine which factors were independently associated with differences in eGFR values.\u0000\u0000Results: A total of 928 cystatin-C measurements were matched to same-day serum creatinine measurements from N=332 CureGN study participants (58% male, 69% White/Caucasian, 20% Black/African American). Among 628 measurements collected while study participants were under 25 years old, there was moderate agreement (0.731) in serum creatinine vs. cystatin-C U25 equations. Models showed that higher eGFR values were associated with larger differences between the two equations (p <0.001). Among 253 measurements collected while study participants were at least 18 years old, there was excellent agreement (0.891-0.978) among CKD-Epi equations using serum creatinine alone, cystatin-C alone, or the combination of both. Younger age was associated with larger differences between CKD-Epi equations (p=0.06 to p=0.016).\u0000\u0000Conclusion: Excellent agreement between CKD-Epi equations indicates continued use of serum creatinine only for GFR estimation could be appropriate for adults. In contrast, only moderate agreement between U25 equations indicates a need for more frequent measurement of cystatin-C among children and young adults, especially as eGFR increases.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"46 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140970749","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":"Design of a User-Centered Electronic Health Tool for Glomerular Disease Management","authors":"Andrea L. Oliverio, Amanda Peagler, Russell Mitchell, Adina Martinez, Megan Denham, Laura H. Mariani, Jason Cobb, Anju A. Oommen, Gabrielle Alter, Mone Anzai, Yasmine Pang, Jonathan P Troost, Cam Escoffery, Chia-shi Wang","doi":"10.1159/000539169","DOIUrl":"https://doi.org/10.1159/000539169","url":null,"abstract":"Introduction Patients with primary glomerular disease (GN) have unique management needs. We describe the design of a user-centered, patient-facing electronic health (eHealth) tool to support GN management.\u0000Methods We surveyed patients and GN expert nephrologists on disease management tasks, educational needs, and barriers and facilitators of eHealth tool use. Results were summarized and presented to patients, nephrologists, engineers, and a behavioral and implementation science expert in stakeholder meetings to jointly design an eHealth tool. Key themes from the meetings are described using rapid qualitative analysis.\u0000Results Sixty-six patients with minimal change disease, focal segmental glomerulosclerosis, IgA nephropathy, and membranous nephropathy responded to the survey, as well as 25 nephrologists from the NIH-funded Cure Glomerulonephropathy study network. Overall, patients performed fewer management tasks and acknowledged fewer informational needs than recommended by nephrologists. Patients were more knowledgeable about eHealth tools than nephrologists. Nine patient stakeholders reflected on the survey findings and noted a lack of awareness of key recommended management tasks and receiving little guidance from nephrologists on using eHealth. Key themes and concepts from the stakeholder meetings about eHealth tool development included the need for customizable design, trustworthy sources, seamless integration with other apps and clinical workflow, and reliable data tracking. The final design of our eHealth tool, the UrApp System, has 5 core features: “Profile” generates personalized data tracking, educational information, facilitation with provider discussions and inputting other preferences; “Data Tracking” displays patient health data with the ability to communicate important trends to patients and nephrologists; “Resources” provides trusted education information in a personalized manner; “Calendar” displays key events and generate reminders; and “Journal” facilitates information documentation using written or audio notes. \u0000Conclusion Our theory- and evidenced-based, stakeholder-engaged design process created designs for an eHealth tool to support the unique needs of patients with GN, optimized for effectiveness and implementation.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"183 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141015353","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":"The significance of anti-PLA2R in diabetic kidney disease: Truly a false positive?","authors":"Avanti Damle, H. H. Wu, D. Kanigicherla, R. Chinnadurai","doi":"10.1159/000538902","DOIUrl":"https://doi.org/10.1159/000538902","url":null,"abstract":"","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"117 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680614","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":"Glomerulonephritis after Alemtuzumab Treatment for Multiple Sclerosis: A Report of Two Cases","authors":"Abdullah Al-Muhaiteeb, Kamal Alkeay, Ahmad Altaleb","doi":"10.1159/000538492","DOIUrl":"https://doi.org/10.1159/000538492","url":null,"abstract":"Abstract Introduction Alemtuzumab, a humanized monoclonal antibody indicated for the treatment of adult patients with active relapsing-remitting multiple sclerosis (MS), has been associated with increased risk of autoimmune adverse events, including thyroid disorders, immune thrombocytopenia, and renal diseases. Renal immune-mediated adverse events, which have been reported in 0.3% of patients treated with alemtuzumab in MS clinical trials, typically occur within 39 months after the last drug administration. However, no consensus has been reached regarding the management of patients who develop glomerulonephritis after treatment with alemtuzumab. Case Presentation We report the cases of two young adults with MS who developed biopsy-proven severe glomerulonephritis after alemtuzumab treatment. Both patients, including a 32-year-old female patient who developed membranous nephropathy and a 31-year-old male who developed drug-induced podocytopathy, were treated successfully with the calcineurin inhibitor tacrolimus followed by the anti-CD20 antibody rituximab. Conclusion Regular renal function monitoring is required in patients who may rarely develop glomerulonephritis following treatment with alemtuzumab. There is no clear consensus on case management. In both cases, immunosuppressive therapy, which was necessary due to disease severity, resulted in successful remission, highlighting the potential utility of this approach.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"18 6","pages":"84 - 90"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753521","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}