scholarly journals Occurrence of neutrophil dysplasia in the course of severe nephrotic syndrome in a 12-year-old boy on immunosuppressive therapy: Answers

2016 ◽  
Vol 32 (4) ◽  
pp. 605-606
Author(s):  
Lidia Hyla-Klekot ◽  
Paweł Rajwa ◽  
Andrzej Paradysz ◽  
Piotr Bryniarski
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy

scholarly journals A Case of Cytomegalovirus-Induced Oral Ulcer in an Older Adult Patient with Nephrotic Syndrome due to Membranous Nephropathy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Shinichi Sato ◽  
Masato Takahashi ◽  
Tetsu Takahashi ◽  
Junichi Asaumi
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy ◽  
Membranous Nephropathy ◽  
Histopathological Examination ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pneumocystis Pneumonia ◽  
Positive Pressure ◽  
Computed Tomography Images ◽  
Immunocompromised State ◽  
Painful Ulcer

We report a case of cytomegalovirus- (CMV-) induced buccal ulcer in a patient with nephrotic syndrome. An 82-year-old man with membranous nephropathy was on immunosuppressive therapy presented with an ulcer in the oral cavity and was hospitalized. Intraoral examination revealed an inflamed and painful ulcer on the left buccal mucosa. Blood test results showed CMV positivity, and histopathological examination confirmed the diagnosis. Anti-CMV therapy (ganciclovir) was initiated from the third day of hospitalization. However, he developed dyspnea on the 14th day. Computed tomography images of the chest revealed the presence of ground-glass opacities, and noninvasive positive pressure ventilation was initiated under the provisional diagnosis of pneumocystis pneumonia caused by ganciclovir-associated myelosuppression and/or steroid-induced immunocompromised state. The patient died of pneumocystis pneumonia on the 21st day. The patient had received immunosuppressive therapy for renal dysfunction. Immunocompromised patients with CMV infection should be treated with caution, as drugs for CMV may themselves cause myelosuppression, deteriorating the prognosis of the patient.

scholarly journals Factors of corticosteroid resistant nephrotic syndrome progression in children

2020 ◽  
Vol 22 ◽  
pp. 02026
Author(s):  
Natalya Zhuravleva ◽  
Vladimir Buryak ◽  
Sergey Horoshev ◽  
Natalya Mineeva
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy ◽  
Chronic Infection ◽  
Morphological Changes ◽  
Focal Points ◽  
Steroid Resistant ◽  
Steroid Resistant Nephrotic Syndrome ◽  
Ckd Stage ◽  
Therapy Effectiveness ◽  
Disease Experience

Nephrotic syndrome (NS) is one of the most severe kidney pathologies. NS often relapses and becomes resistant to immunosuppressive therapy. In order to identify factors that prevent NS relapses development and possible increase of therapy effectiveness, we have analyzed the course nature of primary (idiopathic) and secondary frequently relapsing steroid-resistant nephrotic syndrome (FRNS) in 22 children who received immunosuppressive therapy (IS) (cyclosporin (CSA) or mycophenolic acid (MPA)). As a result of the study, the following factors of NS progression in observed children were revealed: hereditary predisposition for diseases of urinary system organs; presence of more than 5 small external abnormalities development, greater disease record, presence of herpetic infection and chronic infection focal points. In children with long disease experience, a reliably higher level of proteinuria was identified. At the time of examination, stage I chronic kidney disease was registered in most children, one in five children had stage II CKD. CKD stage was not dependent on the type of immunosuppressive therapy received (p<0.05). For children who had NS activity persistence at the time of the study, it was recommended to re-perform nephrobiopsy in order to verify morphological changes in the kidneys, correction – including the institution of alternative immunosuppressive therapy.

scholarly journals MINIMAL CHANGE DISEASE IN THERAPEUTIC PRACTICE

2021 ◽  
Vol 14 (5) ◽  
Author(s):  
OLGA N. SIGITOVA ◽  
◽  
RUSTEM I. SHAYMURATOV ◽  
ROZALIA R. SHARIPOVA ◽  
LILYA KH. SAFARGALIYEVA ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy ◽  
Clinical Case ◽  
Minimal Change Disease ◽  
Current Data ◽  
Minimal Change ◽  
Steroid Resistance ◽  
Original Research ◽  
Relapsed Disease ◽  
Progressive Course

The disease of minimal changes occurs in 10–15% of adult patients with idiopathic nephrotic syndrome, it often has a relapsing course. Glucocorticoids are effective in achieving remission, but in some patients steroid resistance and progressive course of the disease are observed. Recent studies have investigated the mechanismsof minimal change disease development for the purpose of estimating the prognosis of the disease and the efficacy of immunosuppressive therapy. Aim. The aim of the present study was to review current data on the diagnosis, pathogenetic therapy of minimal change disease, and to demonstrate the clinical case of a relapsed disease in steroid resistant patient. Material and methods. A review of original research in the foreign and domestic literature on the subject over the past 5 years was conducted. Results and discussion. Minimal change disease is clinically manifested by rapid, almost sudden development of nephrotic syndrome (proteinuria, hypoalbuminemia, marked hypercholesterolemia, and massive generalized edema). Arterial hypertension and microhematuria occur occasionally. Glucocorticoids are being prescribed to achieve early remission even before morphological verification of the diagnosis. The course of the disease is mostly benign. The majority of patients with steroid sensitivity have long-term preserved renal function, while steroid resistance is associated with a progressive course leading to terminal renal failure. The presented clinical case is interesting because the unfolded picture of the disease of minimal changes including severe nephrotic syndrome and steroid-resistance, appeared in the patient a year after the disease debut. After receiving combined immunosuppressive therapy for 16 weeks incomplete remission was achieved. Conclusion. Unfortunately, at present, there are no available reliable methods to predict the development of steroid resistance and there are no effective therapies guaranteeing the achievement of remission in such cases.

Immunosuppressive therapy of childhood idiopathic nephrotic syndrome

2002 ◽  
Vol 3 (5) ◽  
pp. 513-519 ◽  
Author(s):  
PA Brogan ◽  
RS Trompeter ◽  
A Abeyagunawardena ◽  
MJ Dillon
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Therapy ◽  
Idiopathic Nephrotic Syndrome

scholarly journals P0314TREATMENT AND OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN ELDERLY PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nessrine Breik ◽  
Mouna Jerbi ◽  
Raja Aoudia ◽  
Soumaya Chargui ◽  
Hanen Guaied ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Side Effects ◽  
Immunosuppressive Therapy ◽  
Older Patients ◽  
Symptomatic Treatment ◽  
The Elderly ◽  
The Other ◽  
Group 4 ◽  
Group 2 ◽  
Group 1

Abstract Background and Aims The increase in life expectancy has led to increasing numbers of elderly patients in all medical disciplines, particularly in nephrology. Idiopathic membranous nephropathy (IMN) is common in the elderly and can lead to significant morbidity and mortality because of the complication of nephrotic syndrome (NS) and immunosuppressive therapy. The aim of this study is to analyze the diagnostic, therapeutic and evolutionary approach of IMN in elderly patiets. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Results Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery were dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (39.28%) and elevated creatinine level in 9 cases (32.14%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone (group 1), three patients received corticosteroid with mycofenolate mofetil (group 2) and one patient received corticosteroid with ciclosporin (group3). Fourteen patients received only symptomatic treatment (group 4). We noted partial remission in group 3, however complete remission in 37.5%, 14.28% and 12.5% from respectively group 1, group 4 and group 2. The side effects of immunosuppressive therapy were infectious complication in 8 patients (28.5%), osteoporosis in 3 patients (10.7%) and Steroid diabetes in one case. The side effects of NS were thrombotic complication in 5 patients (17.85%). Two patients had presented coronary syndrome and two other patients had presented hepatitis C. Two cases of death were noted whose etiology was pulmonary infection in one patient and undeterminate etiology in the other case. Conclusion Treatment of IMN in older patients has unique challenges, reducing the need for renal replacement therapy. Most studies report that the elderly respond to therapy with rates comparable with younger patients but in the other hand elderly are more susceptible to side effects of immunosuppressive therapy.

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