Case Reports in Nephrology and Dialysis最新文献

{"title":"Dapagliflozin May Increase Ultrafiltration and Urine Volume in Nondiabetic Peritoneal Dialysis Patients: A Case Series Report.","authors":"Gong Wenjiang, Chen Jia, Yang Jie, Yu Yan, Li Xue, Cheng Yuan, Yani He, Chen Kehong, Huo Bengang, Cai Mingyu","doi":"10.1159/000552880","DOIUrl":"10.1159/000552880","url":null,"abstract":"<p><strong>Introduction: </strong>Reduced ultrafiltration in peritoneal dialysis (PD) contributes to volume overload, increasing the risk of technique failure and patient mortality. The administration of a sodium-glucose cotransporter 2 inhibitor (SGLT2i) has been shown to increase ultrafiltration volume in mice, suggesting its potential role in improving ultrafiltration. However, whether SGLT2i can improve ultrafiltration and increase urine volume in nondiabetic PD patients remains unclear.</p><p><strong>Case presentation: </strong>We report 6 nondiabetic PD patients with a dialysis history of more than 3 months who received 10 mg of dapagliflozin once daily orally for 6 months, in addition to their conventional treatment regimens. After 6 months, clinically significant increases in ultrafiltration were observed (from 76.8 mL at baseline to 211.3 mL), and 5 patients showed increased urine volume (from 433.3 mL to 646.7 mL). The glucose concentration in the effluent dialysate was higher than that at baseline. No changes in peritoneal transport characteristics, estimated glomerular filtration rate, or residual renal creatinine clearance rate were observed at this point compared with baseline. No adverse effects, such as hypoglycemia or abnormal liver function, were reported in any of the patients.</p><p><strong>Conclusions: </strong>In this preliminary observation, dapagliflozin use was associated with increased ultrafiltration and urine volume in nondiabetic PD patients and presented a favorable safety profile. Further controlled studies are needed to confirm these preliminary findings.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"127-135"},"PeriodicalIF":1.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015732","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":"Preoperative Therapeutic Plasma Exchange for Severe Hypertriglyceridemia-Associated Myocardial Infarction in a Chronic Hemodialysis Patient Undergoing Urgent Coronary Artery Bypass Grafting: A Case Report.","authors":"Girish Vasudeorao Kumthekar, Aditi Pandey, Amol Kulkarni","doi":"10.1159/000553028","DOIUrl":"https://doi.org/10.1159/000553028","url":null,"abstract":"<p><strong>Introduction: </strong>Severe hypertriglyceridemia (HTG) is a well-recognized cause of acute pancreatitis, but its role as a precipitant of acute myocardial infarction (MI) and a barrier to urgent surgical intervention is less frequently documented, especially in patients with end-stage renal disease (ESRD).</p><p><strong>Case presentation: </strong>We report a unique case of a 68-year-old male on chronic hemodialysis who presented with an inferior wall MI. Coronary angiography revealed severe triple vessel disease necessitating urgent coronary artery bypass grafting (CABG). However, laboratory investigations identified critical HTG (1,943 mg/dL), posing significant risks for hyperviscosity and extracorporeal circuit failure. To mitigate these perioperative risks, the patient underwent four sessions of preoperative therapeutic plasma exchange (TPE), which successfully reduced serum triglycerides to 355 mg/dL. Following this stabilization, the patient underwent a successful off-pump CABG and was managed postoperatively with sustained low-efficiency dialysis.</p><p><strong>Conclusion: </strong>This case highlights the clinical utility of TPE as a rapid and effective \"therapeutic bridge\" to enable safe, urgent cardiac surgery in patients with severe HTG. It demonstrates that preoperative lipid-lowering aphaeresis can safely manage metabolic barriers to surgery in complex ESRD patients, potentially expanding the management options for high-risk cardiovascular cases where medical therapy alone is insufficient.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"119-126"},"PeriodicalIF":1.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788629","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":"Dialysis Disequilibrium Syndrome: A Severe Case with Neurologic Recovery - A Case Report.","authors":"Ewalola Ayo Ijaduola, Sana Waheed, Khalid Bashir","doi":"10.1159/000553357","DOIUrl":"https://doi.org/10.1159/000553357","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysis disequilibrium syndrome is a serious complication occurring during hemodialysis initiation and after a break from hemodialysis, with a myriad of neurological symptoms.</p><p><strong>Case presentation: </strong>We report a case of a 68-year-old woman with a history of hypertension, type 2 diabetes mellitus, and recently diagnosed end-stage kidney disease. She presented to the emergency room with disorientation and hypertensive urgency and had started hemodialysis 3 months prior but declined further treatment. Laboratory data revealed blood urea nitrogen of 151 mg/dL, creatinine of 18 mg/dL, bicarbonate level of 5 mEq/L, and potassium of 6.6 mEq/L. A temporary hemodialysis catheter was inserted, and dialysis was initiated with a blood flow rate of 300 mL/min and a dialysate flow rate of 600 mL/min, using an Optiflux 180NRe dialyzer (surface area 1.7 m²) for a duration of 3 h. The patient developed seizure activity after 2 h and 55 min, described as tonic-clonic seizure lasting 5 min. The urea reduction ratio was 57.6%, and the bicarbonate level increased from 5 to 16 mEq/L. She remained in a stuporous state, with no response to stimuli. She was transferred to the intensive care unit and received 20% mannitol 0.5 g/kg (40 g), followed by 3% hypertonic saline (30 mL bolus, then 50 mL/h infusion), with the aim of maintaining a serum sodium concentration between 145 and 155 mEq/L. Forty-eight hours later, she began to open her eyes to voice and consistently followed commands.</p><p><strong>Conclusion: </strong>Our patient's dialysis disequilibrium syndrome severity correlated with the urea reduction ratio and severe metabolic acidosis, highlighting the importance of achieving a low urea reduction ratio (<40%) and a targeted rise in bicarbonate levels, both of which are risk factors for dialysis disequilibrium syndrome. In addition, the use of 3% saline and mannitol is an important preventive and rescue strategy.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"113-118"},"PeriodicalIF":1.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788609","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":"Simultaneous Appearance of Immunoglobulin A Nephropathy and Tubulointerstitial Nephritis and Uveitis Syndrome: A Case Report.","authors":"András Adámy, Selina Berger, Jan Brügger, Manuela Nickler","doi":"10.1159/000552832","DOIUrl":"https://doi.org/10.1159/000552832","url":null,"abstract":"<p><strong>Introduction: </strong>Immunoglobulin A (IgA) nephropathy usually occurs after upper respiratory tract infection. The currently widely accepted pathomechanism involves genetic predisposition, formation of galactose-deficient IgA1, and production of autoantibodies against these IgA, ultimately leading to mesangial deposition of immune complexes. Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease with a suspected autoimmune mechanism, although the exact etiology and pathomechanism are not fully understood. To our knowledge, only a few cases with simultaneous occurrence of these two entities have been reported in common literature so far.</p><p><strong>Case presentation: </strong>A 53-year-old Ethiopian woman presented with a month of postprandial nausea, vomiting, occipital headache, 5 kilogram weight loss and intermittent night sweats. Laboratory examinations revealed hematuria and impaired renal function, histological findings showed acute tubulointerstitial nephritis and glomerulonephritis. Further assessments revealed left-sided anterior uveitis as well as a <i>Helicobacter pylori</i> and <i>Strongyloides</i> infection. We present the case of a middle-aged woman with concurrent IgA nephropathy and TINU syndrome, possibly following a <i>H. pylori</i> and <i>Strongyloides</i> infection. There was rapid and significant improvement of renal disease after glucocorticoid treatment.</p><p><strong>Conclusion: </strong>Further research is needed to elucidate possible causality between IgA nephropathy, TINU syndrome, and the potential trigger factors involved.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"106-112"},"PeriodicalIF":1.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757637","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":"Successful Kidney Transplantation in a Patient with Genetic Hypertension due to a Pathogenic Kelch-Like 3 Mutation: A Case Report.","authors":"Tito Gianni, Hatem Najar, Kiran M Goli, Fitsum T Hailemariam, Maria P Martinez Cantarin, Maitreyee Gupta","doi":"10.1159/000552690","DOIUrl":"10.1159/000552690","url":null,"abstract":"<p><strong>Introduction: </strong>Gordon syndrome (or pseudohypoaldosteronism type II) is a rare form of hyperkalemic, hyperchloremic hypertension that is typically characterized by preserved kidney function. We report the first case of a successful paired exchange kidney transplant in a patient with an atypical presentation of Gordon syndrome due to a pathogenic KLHL-3 mutation who developed end-stage kidney disease, emphasizing the transplant outcomes and renal function.</p><p><strong>Case presentation: </strong>A 24-year-old Caucasian male with early-onset hypertension since the age of 15 years, intermittent hyperkalemia, and non-adherence to thiazide diuretics was admitted with abdominal pain and vomiting. His family history included early-onset hypertension in his brother, father, and paternal grandmother. His blood pressure was 250/160 mm Hg. The laboratory results revealed a creatinine of 9.9 mg/dL, potassium of 3.0 mmol/L, sodium of 136 mmol/L, chloride of 91 mmol/L, bicarbonate of 18 mmol/L, hemoglobin of 10 g/dL, and platelet count of 87,000/μL. Renal ultrasound indicated increased echogenicity in both kidneys, and a glomerulonephritis workup was negative. Despite the use of aggressive antihypertensive therapy, progressive azotemia required hemodialysis. A kidney biopsy showed severe vascular and tubulointerstitial changes, consistent with hypertensive nephrosclerosis. Genetic testing confirmed a heterozygous pathogenic variant in the KLHL-3 gene, diagnosing Gordon syndrome. Five months later, the patient underwent successful living-unrelated kidney transplantation via a paired exchange program. Early post-transplant complications included acute allograft dysfunction due to volume depletion and mild hydronephrosis, which improved with timely intervention, stabilizing creatinine at 1.1-1.2 mg/dL. The patient also developed severe post-transplant anemia secondary to parvovirus B19 infection, which was successfully treated with intravenous immunoglobulin, erythropoiesis-stimulating agents, and blood transfusions. At follow-up, the patient showed excellent allograft function and well-controlled blood pressure on a simplified antihypertensive regimen.</p><p><strong>Discussion and conclusions: </strong>This case highlights an unexpected manifestation of an exceptionally rare disease, Gordon syndrome, due to a pathogenic KLHL-3 variant, uniquely leading to end-stage kidney disease and subsequent kidney transplantation. The impact of pathogenic KLHL-3 mutations on transplant outcomes remains undefined. However, our patient underwent kidney transplantation, resulting in excellent renal allograft function and optimal blood pressure control, thus demonstrating favorable renal transplant outcomes for patients with genetic hypertension.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"90-99"},"PeriodicalIF":1.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419042","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":"Neither Therapeutic Plasma Exchange nor High-Flux Hemodialysis Enhances the Removal of Chlorprothixene in Case of Intoxication despite a Drop in Plasma Levels: A Case Report.","authors":"Maj-Britt Nachtigall, Stephan Scherneck, Bastian Au, Christian Hansen-Hagge, Jan T Kielstein","doi":"10.1159/000551514","DOIUrl":"10.1159/000551514","url":null,"abstract":"<p><strong>Introduction: </strong>Chlorprothixene is a typical antipsychotic, primarily used in the treatment of psychotic disorders. Overdose may result in severe cardiovascular and central nervous system toxicity. Evidence on the effectiveness of extracorporeal elimination is scarce.</p><p><strong>Case presentation: </strong>A 19-year-old female ingested 5 g of chlorprothixene in a suicide attempt. Upon admission to the intensive care unit, she was awake, responsive, and oriented. Initial management included 50 g of activated charcoal. As doses of >2 g chlorprothixene can cause severe intoxication and death, attempts to enhance drug elimination by extracorporeal therapy were undertaken. Therapeutic plasma exchange (TPE) was initiated approximately 3 h after admission, exchanging 5,096 mL of plasma with albumin solution and FFP over 3 h 10 min. This was followed by a 10 h 10 min prolonged intermittent kidney replacement therapy (PIKRT). Serial blood, apheresis, and dialyzate samples were collected to quantify drug removal. Both procedures were well tolerated. The patient remained clinically stable and was transferred to a psychiatric facility 24 h post-admission.</p><p><strong>Conclusion: </strong>Although chlorprothixene plasma levels decreased, the amount of chlorprothixene removed by TPE and PIKRT was negligible, classifying the drug as \"not dialyzable\" per EXTRIP criteria. Given the limited clinical evidence and the pharmacokinetic properties of chlorprothixene, TPE cannot be recommended for the management of chlorprothixene overdose and should not be regarded as a standard treatment option. According to the available literature, this is the first description of chlorprothixene intoxication managed with both TPE and high-flux hemodialysis, highlighting the limited extracorporeal removal of this drug.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"69-74"},"PeriodicalIF":1.0,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249185","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":"Transplant Renal Artery Stenosis Presenting as Posterior Reversible Encephalopathy Syndrome in a Post-Kidney Transplant Patient: A Case Report.","authors":"Mihiran Thanigasalan, Thivacaren Sritharan, Mehatheepan Rasanayagam, Anura Priyantha Hewageegana","doi":"10.1159/000552595","DOIUrl":"10.1159/000552595","url":null,"abstract":"<p><strong>Introduction: </strong>Transplant renal artery stenosis (TRAS) is a reversible cause of severe hypertension and graft dysfunction. Posterior reversible encephalopathy syndrome (PRES) in kidney transplant recipients is commonly attributed to calcineurin inhibitor (CNI) toxicity; however, the biochemical signatures of CNI toxicity and TRAS differ markedly.</p><p><strong>Case presentation: </strong>We report a 32-year-old woman, 5 months post-transplant, presenting with seizures, severe hypertension, and MRI-confirmed PRES. She exhibited hypokalaemia (2.6 mmol/L) and metabolic alkalosis (pH 7.50, bicarbonate 34 mmol/L) - findings less typical of tacrolimus toxicity, which more typically produces a Gordon-like physiology with hyperkalaemia and metabolic acidosis due to excess activity of the NCC (Na-Cl cotransporter). Doppler ultrasound and digital subtraction angiography confirmed TRAS. Percutaneous angioplasty resulted in rapid renal recovery.</p><p><strong>Conclusion: </strong>PRES with hypokalaemia should prompt evaluation for renovascular hypertension rather than tacrolimus toxicity.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"100-105"},"PeriodicalIF":1.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419060","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":"Oxalate Nephropathy-Induced Acute Kidney Injury following Use of an Organic Hair-Treatment Product in an 8-Year-Old Child: A Case Report.","authors":"Arwa Aljishi, Abdulaziz AlHassan, Fatima Alkhalifah, Yousef Almarzooq, Amnah Qaw, Lama AlNemer, Juwan AlNemer","doi":"10.1159/000552212","DOIUrl":"10.1159/000552212","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is defined as an increase in serum creatinine with or without a reduction in urine output, according to the Kidney Disease: Improving Global Outcomes guidelines. Oxalate nephropathy (ON) is a rare cause of AKI in children. We report a case of oliguric AKI associated with exposure to a cosmetic hair-treatment product leading to ON. To our knowledge, there are limited reports of similar pediatric cases in Saudi Arabia.</p><p><strong>Case presentation: </strong>An 8-year-old previously healthy girl presented with facial edema, abdominal distension, oliguria, and hypertension 2 days after a single application of an unidentified hair-treatment product. Laboratory evaluation confirmed severe AKI. Renal biopsy demonstrated acute tubular necrosis with calcium oxalate crystal deposition, confirming ON. She was managed conservatively with cautious fluid administration, intravenous furosemide, correction of electrolyte abnormalities, antihypertensive therapy, and a low-oxalate diet. Renal function normalized within 1 month, with sustained recovery and no evidence of recurrence on subsequent follow-up.</p><p><strong>Conclusion: </strong>Exposure to certain cosmetic hair-treatment products may cause secondary hyperoxaluria and AKI in children, underscoring the need for heightened awareness and stricter regulation of unlabeled cosmetic products to prevent potential nephrotoxicity.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"83-89"},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350948","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":"Obinutuzumab in Crescentic Anti-Glomerular Basement Membrane Disease with Linear IgG Deposition: A Case Report.","authors":"Cheng Xue, Bo Yang, Xin Hong, Yuheng Lu, Yixin Qian, Xinming Li, Nanmei Liu, Jun Wu","doi":"10.1159/000552035","DOIUrl":"10.1159/000552035","url":null,"abstract":"<p><strong>Introduction: </strong>Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune vasculitis that often leads to rapidly progressive glomerulonephritis and poor renal prognosis. Standard treatment typically involves plasmapheresis, corticosteroids, and cyclophosphamide. However, the therapeutic role of obinutuzumab, a B-cell-depleting monoclonal antibody, remains under-explored in anti-GBM disease.</p><p><strong>Case presentation: </strong>We report a 20-year-old male with isolated renal anti-GBM disease following a dental infection, who presented with severe acute kidney injury (creatinine >700 μmol/L), high anti-GBM antibody titers, and crescentic glomerulonephritis on biopsy. Despite initial therapy with plasmapheresis, corticosteroids, and cyclophosphamide, renal function deteriorated. Obinutuzumab (500 mg IV) was administered as adjunct therapy, leading to rapid antibody clearance within 1 month. Remarkably, the patient achieved partial renal recovery and was dialysis-independent by 3 months, with stable stage 3 chronic kidney disease at 5-month follow-up.</p><p><strong>Conclusion: </strong>This case underscores the potential role of obinutuzumab as an innovative adjunctive therapy in severe anti-GBM disease, even in patients with traditionally poor prognostic markers. Early and aggressive multimodal treatment, including B-cell targeting, may improve outcomes in selected cases.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"75-82"},"PeriodicalIF":1.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315917","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":"A Decade-Long Journey of Steroid-Dependent IgA Nephropathy with Minimal Change Disease from Immunosuppressants to Rituximab and then to Obinutuzumab: A Case Report.","authors":"Shuhua Zhu, Duqun Chen, Feng Xu, Zhe Li, Yuanmao Tu","doi":"10.1159/000550743","DOIUrl":"10.1159/000550743","url":null,"abstract":"<p><strong>Introduction: </strong>IgA nephropathy with minimal change disease (MCD-IgAN) is a rare subtype of IgAN with a high rate of response to corticosteroids but a poor prognosis in steroid-dependent (SD) patients.</p><p><strong>Case presentation: </strong>A young male patient with SD-MCD-IgAN, who was treated sequentially with rituximab (RTX) and later with obinutuzumab (OBZ) over a 10-year follow-up period, initially presented with nephrotic syndrome and achieved rapid complete remission (CR) with full-dose corticosteroids. However, during the first 2 years, the patient experienced four relapses despite the addition of various immunosuppressants. These relapses were accompanied by complications such as skin infections, acute kidney injury, and serosal effusions. The initial renal biopsy revealed MCD-IgAN, while a repeat biopsy 8 months later revealed IgAN with focal segmental glomerulosclerosis. RTX (375 mg/m²) was introduced after remission was achieved with full-dose corticosteroids. The patient remained in CR with RTX administered based on CD19⁺ B-cell counts for an initial period of 3 years. Following discontinuation of medication for the subsequent 3 years, the patient experienced a relapse but achieved CR again with low-dose corticosteroids and a single dose of RTX (1.0 g). However, the patient experienced a further relapse after another 3 years of medication cessation. Subsequently, OBZ (1.0 g) was administered along with low-dose corticosteroids, leading to rapid CR and long-term medication-free status.</p><p><strong>Conclusion: </strong>In SD-MCD-IgAN, anti-CD20 maintenance therapy during CR reduces relapse and enables long-term steroid-free remission. If relapse occurs later, it can be controlled with low-dose steroids and resumed anti-CD20 therapy, re-establishing sustained remission.</p>","PeriodicalId":9599,"journal":{"name":"Case Reports in Nephrology and Dialysis","volume":"16 1","pages":"35-45"},"PeriodicalIF":1.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479544","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}