利妥昔单抗治疗双阳性抗gbm抗体和anca相关性肾小球肾炎:亚洲首例报道病例和文献综述。

IF 1 4区 医学 Q3 UROLOGY & NEPHROLOGY
Chang-Ying Chen, Ying-Ren Chen, Wei-Ren Lin, Wei-Hung Lin
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引用次数: 0

摘要

背景:双阳性患者同时表现出抗肾小球基底膜抗体和抗中性粒细胞胞浆抗体。其初始治疗包括诱导环磷酰胺、糖皮质激素和血浆置换,随后进行类似于抗中性粒细胞细胞质抗体相关血管炎的维持治疗。然而,一些患者患有难治性和对环磷酰胺的不耐受,对二线治疗的需求未得到满足。此外,没有提供关于选择免疫抑制剂进行维持治疗的指导。病例介绍:55岁亚洲女性,餐后呕吐,持续高热1个月。患者发生快速进行性肾小球肾炎后诊断为双阳性患者,肌酐水平为332 μmol/L。确诊后不久接受环磷酰胺、糖皮质激素和血浆置换诱导治疗。然而,3个月环磷酰胺剂量后出现肾功能恶化和严重恶心呕吐。给予每周4次的再诱导利妥昔单抗375 mg/m2,随后每6个月给予维持利妥昔单抗500 mg。患者诊断17个月后肌酐水平稳定在208 μmol/L。结论:当一线环磷酰胺无效或不能耐受时,利妥昔单抗可能是双阳性患者诱导治疗的可行选择。此外,利妥昔单抗可能是双阳性患者的有效维持治疗。本病例研究不仅证明了利妥昔单抗对双阳性患者的疗效,而且报告了利妥昔单抗成功治疗该疾病的第一例亚洲病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rituximab for double-positive anti-GBM antibody and ANCA-associated glomerulonephritis: The first reported case in Asia and literature review.

Background: Double-positive patients exhibit both anti-glomerular basement membrane antibody and anti-neutrophil cytoplasmic antibody. Its initial treatment includes induction cyclophosphamide, glucocorticoids, and plasmapheresis, followed by maintenance therapy similar to that for anti-neutrophil cytoplasmic antibody-associated vasculitis. However, some patients suffer from refractoriness and intolerance to cyclophosphamide, creating an unmet need for second-line therapy. Moreover, no guidance has been provided on the choice of immunosuppressant agents for maintenance therapy.

Case presentation: A 55-year-old Asian woman presented with post-prandial vomiting and a persistent high fever for 1 month. She was diagnosed as a double-positive patient after developing rapidly progressive glomerulonephritis, with a creatinine level of 332 μmol/L. She received induction therapy with cyclophosphamide, glucocorticoids, and plasmapheresis soon after diagnosis. However, worsening renal function and severe nausea and vomiting occurred after 3 monthly doses of cyclophosphamide. Four weekly doses of re-induction rituximab at 375 mg/m2, followed by maintenance rituximab 500 mg every 6 months, were administered. The patient had a stable creatinine level of 208 μmol/L 17 months after diagnosis.

Conclusion: Rituximab may be a viable alternative as an induction therapy for double-positive patients when first-line cyclophosphamide is not effective or is not tolerated. Moreover, rituximab may be an effective maintenance therapy for double-positive patients. This case study demonstrates not only the efficacy of rituximab in double-positive patients but also reports the first Asian case of the disorder treated successfully with rituximab.

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来源期刊
Clinical nephrology
Clinical nephrology 医学-泌尿学与肾脏学
CiteScore
2.10
自引率
9.10%
发文量
138
审稿时长
4-8 weeks
期刊介绍: Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.
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