Co-occurrence of IgA nephropathy and IgG4-Tubulointersitial nephritis effectively treated with tacrolimus: a case report

Abstract Background Cases of concurrent immunoglobulin A nephropathy (IgAN) and IgG4-related tubulointerstitial nephritis (IgG4-TIN) are rare and previous case reports have lacked important data. KDIGO suggests a treatment with systemic glucocorticoids in IgAN patients. Glucocorticoids are recommended as the first-line therapy for IgG4-TIN. The use of tacrolimus as a long-term maintenance treatment has not been described. We report the case of a man who developed IgAN and IgG4-TIN without abnormalities in extra-renal tissue, without renal function abnormalities or impairment as well, and was treated by tacrolimus as a long-term maintenance during 45 months follow-up. Case presentation A 56-year-old Chinese man first presented to our hospital with the chief complaint of foamy urine for 1 year and hematuria for 3 months, with a medical history of hypertension. Testing revealed a notable increase in serum IgG4 level without abnormalities in renal function or imaging, or in dysfunction other organs. Renal biopsy showed mesangial extracellular matrix proliferation, increased mesangial cell numbers and infiltration of plasma cells. Immunofluorescence showed mesangial positivity for IgA and C3. Immunohistochemistry staining showed widespread IgG4 and increased CD38 and CD138 expression. Electron microscopy showed immune complexes located on the tubular basement membrane. He was diagnosed with IgAN and IgG4-TIN. He received glucocorticoids, leflunomide and tacrolimus to induce remission. He was given tacrolimus as long-term maintenance treatment. When tacrolimus was temporarily withdrawn, proteinuria recurred. After resuming tacrolimus therapy, he again entered complete remission. After 45 months of therapy, he remains in complete remission and the serum IgG4 level is normal. Conclusions The finding of concurrent IgAN and IgG4-TIN without abnormalities in renal function, imaging or extra-renal tissue is rare and their coexistence may be coincidental. Long-term treatment with tacrolimus proved effective and he has remained in remission during 45 months follow-up.

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Abstract 12071: Serum Immunoglobulin G4 Level is an Independent Predictor of Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention over Long-Term Follow-Up

Circulation ◽

10.1161/circ.132.suppl_3.12071 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Aiko Sakamoto ◽

Nobukazu Ishizaka ◽

Jiro Ando ◽

Ryozo Nagai ◽

Issei Komuro

Keyword(s):

Coronary Intervention ◽

Serum Levels ◽

Major Adverse Cardiovascular Events ◽

Immunoglobulin G4 ◽

Serum Igg4 Level ◽

Percutaneous Coronary ◽

Serum Igg4 ◽

Long Term Follow Up ◽

Igg4 Level

Background: Inflammatory processes contribute to the development of atherosclerosis. However, it remains unclear whether immunoglobulin G4 (IgG4)-related immuno-inflammation may affect the progression of cardiovascular disease. We therefore analyzed the relationship between serum IgG4 level and future major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). Methods: We measured serum levels of IgG4 in 562 patients (mean age, 66.9 ± 10.3 years) who underwent coronary angiography from October 2005 to September 2008. Furthermore, a total of 108 patients who subsequently received first PCI were followed-up for a median period of 2721 days (interquartile range [IR] 1591-3183). MACE was defined as cardiac death, acute coronary syndrome, cerebral stroke, and target vessel revascularization. Results: Serum levels of IgG4 were significantly higher in patients with coronary artery disease (34.1 mg/dL, IR 18.7-58.9) than in those without (30.5 mg/dL, IR 15.8-50.3, P=0.045). Among patients who received PCI, 40 (37.0%) patients developed MACE during the follow-up period. Patients with serum IgG4 levels of median or greater (≥37.2 mg/dL) had a significantly higher risk of MACE than those with serum IgG4 levels below median (log-rank test, P=0.017). In Cox regression analysis using age, gender, estimated glomerular filtration rate (eGFR), hypertension, dyslipidemia, diabetes, smoking, and serum levels of high-sensitivity C-reactive protein (hsCRP) as covariates, serum IgG4 level was an independent predictor of MACE (hazard ratio 2.39 per 100 mg/dL increase, 95% confidence interval 1.41-4.07, P=0.001). Conclusions: Elevated serum IgG4 level at baseline significantly predicted MACE after PCI, as well as present coronary stenosis, over long-term follow-up even among patients without apparent IgG4-related disease. IgG4-related immuno-inflammation may play a certain role in the progression of coronary atherosclerosis.

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Long-term maintenance treatment of ulcerative colitis in eastern India: a 15-year follow-up

Tropical Doctor ◽

10.1177/0049475518765291 ◽

2018 ◽

Vol 48 (3) ◽

pp. 207-213 ◽

Cited By ~ 3

Author(s):

Gautam Ray

Keyword(s):

Ulcerative Colitis ◽

Maintenance Treatment ◽

Low Cost ◽

Primary Outcome Measure ◽

Drug Discontinuation ◽

Cancer Complications ◽

Effective Use ◽

Term Maintenance

Clinical data of 65 histologically documented ulcerative colitis patients from January 2001 to December 2013 were prospectively recorded till June 2017 and analysed to determine the outcome of long-term maintenance treatment. Drugs used were 5-aminosalicylates, steroids and azathioprine. Primary outcome measure was relapse. Though 73.8% patients relapsed, most occurred within the first five years with mild to moderate severity and were easily controlled with the same medicines. None had progressive disease; drug discontinuation was possible in six cases. Side effects of drugs were negligible. Rates of surgery, colon cancer, complications and disease-related death were very low. Longer disease duration, azathioprine discontinuation and 5-aminosalicylate use in dose < 2.4 g/d were positively associated with relapses. Biologics were not used in any patient. We conclude that long-term effective use of low-cost drugs in India may obviate the need for newer more expensive drugs.

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Long-term maintenance treatment in ulcerative colitis: a 10-year follow-up

Digestive and Liver Disease ◽

10.1016/s1590-8658(02)80039-1 ◽

2002 ◽

Vol 34 (6) ◽

pp. 419-423 ◽

Cited By ~ 21

Author(s):

G. Bresci ◽

G. Parisi ◽

M. Bertoni ◽

A. Capria

Keyword(s):

Ulcerative Colitis ◽

Maintenance Treatment ◽

Term Maintenance

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Long-term follow-up of differentiated thyroid carcinoma in children and adolescents

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0194 ◽

2020 ◽

Vol 33 (11) ◽

pp. 1431-1441

Author(s):

Montserrat Negre Busó ◽

Amparo García Burillo ◽

Marc Simó Perdigó ◽

Pere Galofré Mora ◽

Maria Boronat de Ferrater ◽

...

Keyword(s):

Complete Remission ◽

Thyroid Carcinoma ◽

Children And Adolescents ◽

Differentiated Thyroid Carcinoma ◽

Radioiodine Treatment ◽

Persistent Disease ◽

Stage 4 ◽

Long Term Follow Up

AbstractObjectivesThe aims were to analyze the clinical features, response to treatment, prognostic factors and long-term follow-up of children and adolescents with differentiated thyroid carcinoma (DTC).MethodsEighty patients with DTC were studied retrospectively. All underwent total or near-total thyroidectomy, and in 75 cases, ablative iodine therapy was recommended. Patients were assessed periodically by tests for serum thyroglobulin levels and whole-body iodine scans. Age, gender, initial clinical presentation, histology, tumor stage, postoperative complications, radioiodine treatment protocol, treatment response, thyroglobulin (Tg), recurrence and long-term disease progression were evaluated.ResultsSeventy patients completed >2 years of follow-up (23 males, 47 females; median age: 14 years; range: 3–18 years). Sixty-two patients showed papillary DTC and eight, follicular DTC. Sixty-five percent presented nodal metastasis and 16%, pulmonary metastasis at diagnosis. Six months after first radioiodine treatment, 36.2% of patients were free of disease. Seven recurrences were documented. At the end of follow-up, overall survival was 100%, and 87.2% of patients were in complete remission. Nine patients had persistent disease. We found a significant association between stage 4 and persistent disease. Hundred percent of patients with negative Tg values at 6 months posttreatment were documented free of disease at the end of the follow-up. The analysis of disease-free survival based on radioiodine treatment protocols used showed no statistically significant differences.ConclusionsDTC in children and adolescents is frequently associated with presence of advanced disease at diagnosis. Despite this, complete remission was documented after treatment in most cases, with a good prognosis in the long-term follow-up. Negative posttreatment thyroglobulin and stage 4 at diagnosis were significant prognostic variables.

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Continuation and long-term maintenance treatment with Hypericum extract WS® 5570 after recovery from an acute episode of moderate depression — A double-blind, randomized, placebo controlled long-term trial

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2008.06.006 ◽

2008 ◽

Vol 18 (11) ◽

pp. 803-813 ◽

Cited By ~ 31

Author(s):

S. Kasper ◽

H.P. Volz ◽

H.J. Möller ◽

A. Dienel ◽

M. Kieser

Keyword(s):

Maintenance Treatment ◽

Acute Episode ◽

Double Blind ◽

Moderate Depression ◽

Term Trial ◽

Hypericum Extract ◽

Term Maintenance

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Long-term follow-up of patients who achieved complete remission after donor leukocyte infusions

Biology of Blood and Marrow Transplantation ◽

10.1053/bbmt.1999.v5.pm10465105 ◽

1999 ◽

Vol 5 (4) ◽

pp. 253-261 ◽

Cited By ~ 87

Author(s):

David L Porter ◽

Robert H Collins ◽

Ofer Shpilberg ◽

William R Drobyski ◽

Jean M Connors ◽

...

Keyword(s):

Complete Remission ◽

Long Term Follow Up

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Renal function following acute renal failure in childhood: A long term follow-up study

Kidney International ◽

10.1038/ki.1989.11 ◽

1989 ◽

Vol 35 (1) ◽

pp. 84-89 ◽

Cited By ~ 23

Author(s):

Helen N. Georgaki-Angelaki ◽

David B. Steed ◽

Cyril Chantler ◽

George B. Haycock

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Follow Up Study ◽

Long Term Follow Up

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Long-term follow-up of renal function in patients after surgery for obstructive uropathy

Pediatric Nephrology ◽

10.1007/s00467-007-0741-6 ◽

2008 ◽

Vol 23 (6) ◽

pp. 937-945 ◽

Cited By ~ 8

Author(s):

Daniela Miklovicova ◽

Olga Cervenova ◽

Andrea Cernianska ◽

Zuzana Jancovicova ◽

Ladislav Dedik ◽

...

Keyword(s):

Renal Function ◽

Obstructive Uropathy ◽

Long Term Follow Up

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Chemotherapy in malignant disease (February 13, 1970): correction

Drug and Therapeutics Bulletin ◽

10.1136/dtb.8.13.52-a ◽

1970 ◽

Vol 8 (13) ◽

pp. 52.2-52

Keyword(s):

Maintenance Treatment ◽

Malignant Disease ◽

Term Maintenance

Table 2 of this article stated wrongly that mercaptopurine and melphalan are unsuitable for long-term maintenance treatment. Both drugs are in fact suitable for this purpose.

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