scholarly journals Case study of tacrolimus as an effective treatment for idiopathic membranous glomerulonephritis in pregnancy

2019 ◽  
Vol 13 (3) ◽  
pp. 148-150 ◽  
Author(s):  
GL Irish ◽  
S Jesudason
Keyword(s):  
Nephrotic Syndrome ◽  
Birth Outcome ◽  
Post Partum ◽  
Membranous Glomerulonephritis ◽  
Immunosuppressive Drugs ◽  
Persistent Proteinuria ◽  
Favourable Side Effect Profile ◽  
Tacrolimus Therapy ◽  
Idiopathic Membranous Glomerulonephritis ◽  
In Pregnancy

Background Tacrolimus has been used in pregnant women following transplantation and for management of lupus nephritis. We report a case of successful control of nephrotic syndrome due to membranous glomerulonephritis during pregnancy using tacrolimus. Case report A 26-year-old female presented with severe nephrotic syndrome in her first pregnancy. Post-partum renal biopsy confirmed idiopathic membranous glomerulonephritis. She had persistent proteinuria of 6 g/day with hypoalbuminaemia despite angiotensin receptor blockade. Treatment with tacrolimus monotherapy led to remission of proteinuria, three months prior to conceiving again. She maintained remission with tacrolimus therapy in pregnancy, resulting in a successful birth outcome. Conclusions Membranous glomerulonephritis can be successfully and safely managed with tacrolimus monotherapy during pregnancy. This provides an alternative immunosuppressant with a favourable side effect profile suitable for use in women planning a pregnancy when other immunosuppressive drugs should be avoided.

scholarly journals Pulmonary Embolism Revealing Idiopathic Membranous Glomerulonephritis

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
A. Hamzaoui ◽  
O. Harzallah ◽  
R. Klii ◽  
L. Njim ◽  
S. Mahjoub
Keyword(s):  
Pulmonary Embolism ◽  
Nephrotic Syndrome ◽  
Membranous Nephropathy ◽  
Membranous Glomerulonephritis ◽  
Idiopathic Membranous Nephropathy ◽  
Idiopathic Membranous Glomerulonephritis

We describe a case of a 55-year-old man who presented with pulmonary embolism and who was found to have nephrotic syndrome due to idiopathic membranous nephropathy. There are no other signs of nephrotic syndrome such as edema.

scholarly journals FC 030CONTACTIN-1 IS A NOVEL ANTIGEN IN IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS AND IN CIDP- ASSOCIATED GLOMERULONEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alan Salama ◽  
Janev Fehmi ◽  
Marilina Antonelou ◽  
Jonathan Barratt ◽  
Neil Ashman ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Membranous Glomerulonephritis ◽  
Temporal Correlation ◽  
Node Of Ranvier ◽  
Pathological Process ◽  
Neuronal Protein ◽  
Immune Mediated ◽  
Phospholipase A2 Receptor ◽  
Autoimmune Neuropathy ◽  
Idiopathic Membranous Glomerulonephritis

Abstract Background and Aims Recently a number of antigens have been identified as pathogenic antibody targets in cases of primary membranous glomerulonephritis(MGN), including phospholipase A2 receptor (PLA2R), thrombospondin type 1 domain containing 7A(THSD7A), and NELL-1, while exostosin is found in secondary (lupus associated) MGN. However, other as yet undiscovered antigens are thought to exist. Although rare, there is a recognised association between chronic inflammatory demyelinating polyneuriopathy (CIDP) and nephrotic syndrome. Method We investigated the link between CICP and MGN and the associations with Contactin-1(CNTN1), a node of Ranvier neuronal protein, as a potential common autoantigen, by immunohistochemistry, RT-PCR and proteomic analysis of isolated glomeruli. We tested sera from 468 patients with suspected immune-mediated neuropathies, 295 with idiopathic MGN, and 210 disease controls, for CNTN1 antibodies. Results We describe a series of 16 patients, all presenting with CIDP, nephrotic syndrome due to MGN, and with circulating and deposited anti-contactin-1 (CNTN1) antibodies (IgG4 predominant in those tested) in the kidney. The onset and resolution of both disorders had a close temporal relationship, and the majority of cases were resistant to first-line therapies typically employed for inflammatory neuropathies, but achieved a good outcome with non-standard treatment. Importantly, four (1.4%) further patients with isolated MGN identified from a serum bank of 295 idiopathic MGN patients with no CIDP were also positive for anti-CNTN1 antibodies. CNTN1 protein was detected by mass spectroscopy within glomeruli from patients with CNTN1 antibodies, but not in healthy kidney or anti-PLA2R associated MGN. CNTN1 mRNA was found in renal cortical tissue. Conclusion These data provide evidence that CNTN1 antibodies precipitate both autoimmune neuropathy and MGN. The temporal correlation of these disorders, as well as the presence of CNTN1 protein and antibodies in both peripheral nerve and diseased glomeruli, supports a common antibody-mediated pathological process, and defines a new antigenic target in MGN. CNTN1 antibodies have diagnostic and therapeutic relevance, and may additionally serve as a means of monitoring disease activity in both conditions. Other factors may explain presentation with isolated neurological disease or MGN.

scholarly journals Membranous glomerulonephritis- A case report

1970 ◽  
Vol 6 (3) ◽  
pp. 64-67
Author(s):  
S Laudari
Keyword(s):  
Nephrotic Syndrome ◽  
Case Report ◽  
Clinical Practice ◽  
Renal Insufficiency ◽  
Membranous Glomerulonephritis ◽  
Male Gender ◽  
Medical Sciences ◽  
Persistent Proteinuria ◽  
Male Preponderance ◽  
Worse Prognosis

Membranous glomerulonephritis is a major cause of nephrotic syndrome and chronic renal insufficiency in adults with a male preponderance. This case has been reported as it is rarely encountered in our clinical practice and its natural course of progression is unpredictable despite immunosuppressive therapies. Male gender, older age, hypertension and persistent proteinuria are associated with worse prognosis. Keywords: Membranous glomerulonephritis; therapies; prognosis. DOI: 10.3126/jcmsn.v6i3.4080Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.64-67

Low back pain in pregnancy and post-partum period. Principles for medical rehabilitation

2018 ◽  
Vol 1 (19) ◽  
pp. 22
Author(s):  
Iulia Filipescu ◽  
Mihai Berteanu ◽  
George Alexandru Filipescu ◽  
Radu Vlădăreanu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Post Partum ◽  
Medical Rehabilitation ◽  
Low Back ◽  
Post Partum Period ◽  
In Pregnancy

A case of minimal change disease during pregnancy – Benefits of early diagnosis and use of corticosteroids

2021 ◽  
pp. 1753495X2199021
Author(s):  
Priyanka S Sagar ◽  
Eddy Fischer ◽  
Muralikrishna Gangadharan Komala ◽  
Bhadran Bose
Keyword(s):  
Nephrotic Syndrome ◽  
Early Diagnosis ◽  
Renal Biopsy ◽  
Early Pregnancy ◽  
Minimal Change Disease ◽  
Minimal Change ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Prompt Diagnosis ◽  
In Pregnancy

Nephrotic syndrome presenting in pregnancy is rare and poses a diagnostic and therapeutic challenge. Timing of renal biopsy is important given the increased risk of bleeding and miscarriage, and the choice of immunosuppression is limited due to the teratogenicity profiles of standard drugs. We report and discuss a case of minimal change disease diagnosed by renal biopsy during early pregnancy and treated with corticosteroids throughout the pregnancy. Prompt diagnosis and treatment of glomerular disease in pregnancy are vital to prevent poor maternal and fetal outcomes.

scholarly journals AB0302 USE OF TNF-INHIBITORS BEFORE, DURING AND THE FIRST YEAR AFTER PREGNANCY AMONG WOMEN WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1450.2-1450
Author(s):  
H. Bjørngaard ◽  
H. Koksvik ◽  
B. Jakobsen ◽  
M. Wallenius
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Post Partum ◽  
Tnf Inhibitors ◽  
Treat To Target ◽  
Inflammatory Rheumatic Diseases ◽  
Tnf Inhibitor ◽  
Rheumatic Arthritis ◽  
Quality Register ◽  
In Pregnancy

Background:Treat to target is a goal, also in pregnant women with Rheumatoid arthritis (1). There is increasing evidence on safe use with TNF inhibitors during pregnancy. Adjusted use of TNF inhibitors preconception and throughout pregnancy may stabilize disease activity and prevent flares (2). Low disease activity is also beneficial for the fetus.Objectives:To study the use of TNF-inhibitors among women with Rheumatic arthritis during and after pregnancy.Methods:RevNatus is a Norwegian, nationwide quality register that monitors treatment of inflammatory rheumatic diseases before, during and after pregnancy. Data from RevNatus in the period October 2017 to October 2019 was used to map the use of all types of TNF inhibitors among 208 women with rheumatoid arthritis, diagnosed by the ACR/EULAR criteria. The use of medication was reported at the time of visit in outpatient clinic. The frequency of use of TNF inhibitors registered at seven timepoints from pre-pregnancy to twelve months after delivery.Results:The use of medication was reported at each visit for all the women with rheumatoid arthritis. Most of the women were not using TNF inhibitors before and beyond conception. Most of the women continuing TNF inhibitors beyond conception used certolizumab or etanercept. Adalimumab and infliximab were used in pregnancy (tabell 1).Tabell 1.certoliz-umabetane-rceptadalim-umabgolim-umabinflixi-mabNo TNF-inhibitorBefore pregnancyn=10521% (22)9% (10)3% (3)1% (1)66% (69)1.trimestern=8119% (15)10% (8)71% (58)2.trimestern=8810% (9)10% (9)80% (70)3.trimestern=9111% (10)5% (5)83% (76)6 weeks post partum n=9622% (21)13% (13)1% (1)1% (1)63% (60)6 months post partum n=8824% (21)18% (16)4% (4)1% (1)53% (46)12 months post partum n=8421% (18)17% (15)7% (6)2% (2)53% (43)Conclusion:Most of the women with rheumatic arthritis were not treated with TNF inhibitors before or in pregnancy. Women with rheumatic arthritis that continuing treatment with TNF inhibitors through pregnancy were using certilozumab and etanercept.References:[1]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. 2016;75(5):795-810.[2]van den Brandt S, Zbinden A, Baeten D, Villiger PM, Ostensen M, Forger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther. 2017;19(1):64.Disclosure of Interests:None declared

scholarly journals Paroxysmal Nocturnal Hemoglobinuria in Pregnancy: A Dilemma in Treatment and Thromboprophylaxis

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Arpan Patel ◽  
Athira Unnikrishnan ◽  
Martina Murphy ◽  
Robert Egerman ◽  
Sarah Wheeler ◽  
...  
Keyword(s):  
Arterial Thrombosis ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Post Partum ◽  
Current Treatment ◽  
Safety And Efficacy ◽  
Class A ◽  
Hematologic Disorder ◽  
Prophylactic Anticoagulation ◽  
Risk For Thrombosis ◽  
In Pregnancy

Paroxysmal nocturnal hemoglobinuria (PNH) is a hematologic disorder characterized by an acquired somatic mutation in the phosphatidylinositol glycan class A gene which leads to a higher risk for increased venous and arterial thrombosis. Current treatment for PNH includes eculizumab. Pregnant patients who have PNH have higher risk for thrombosis and hemorrhage with both pregnancy and their underlying PNH. Treatment frequently poses conundrum. The safety and efficacy of eculizumab during pregnancy and breast feeding have not been extensively studied and contraception has been recommended due to potential for teratogenicity. We present a case of a patient who was safely on both eculizumab and modest prophylactic anticoagulation for 6 weeks post-partum.

scholarly journals A patient with systemic lupus erythematosus and lupus nephritis: A 12-year follow-up

2011 ◽  
Vol 68 (8) ◽  
pp. 705-708
Author(s):  
Natasa Jovanovic ◽  
Jasmina Markovic-Lipkovski ◽  
Stevan Pavlovic ◽  
Biljana Stojimirovic
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Nephrotic Syndrome ◽  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus ◽  
Younger Women ◽  
The Right

Introduction. Systemic lupus erythematosus (SLE) is a chronic immunological disease causing a significant morbidity and mortality in younger women and involving several organs and systems, most often the kidneys, being consequently the incidence of lupus nephritis (LN) about 60%. Case report. We reported a 57 year-old patient with the diagnosed SLE in 1995. Pathohistological analysis of kidney biopsy revealed LN type V. The patient was treated with corticosteroid pulses and azathioprine during one year. A remission was achieved and maintained with prednisone, 15 mg daily. Nephrotic relapse was diagnosed in 2006 and the second kidney biopsy revealed recent kidney infarction due to extensive vasculitis. Soon, a cerebrovascul insult developed and CT-scan revealed endocranial infarctus. The patient was treated with corticosteroids and cyclophosphamide pulses (totally VI monthly pulses), and also with low-molecular heparine, anticoagulants and salicylates because of the right leg phlebothrombosis. After the pulses, the patient was adviced to take prednisone 20 mg daily and azothioprine 100 mg daily, and 6 months later mycophenolate mofetil because of persistent active serological immunological findings (ANA 1 : 320) and nephrotic syndrome. Mycophenolate mofetil was efficient in inducing and maintaining remission of nephrotic syndrome. Conclusion. The aim of LN treatment is to achieve and maintain remission, improve patients? outcome, reduce the toxicity of immunosuppressive drugs and the incidence of relapses. Mycophenolate mofetil was shown to be efficient in inducing and maintaining remission of nephrotic syndrome in the frame of LN.

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