scholarly journals Rituximab Immunomonitoring Predicts Remission in Membranous Nephropathy

2021 ◽  
Vol 12 ◽  
Author(s):  
Maxime Teisseyre ◽  
Marion Cremoni ◽  
Sonia Boyer-Suavet ◽  
Thomas Crepin ◽  
Sylvia Benzaken ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Serum Albumin ◽  
Treatment Failure ◽  
Membranous Nephropathy ◽  
Lower Serum ◽  
High Baseline ◽  
First Line Therapy ◽  
Patients At Risk ◽  
Independent Risk Factors

Primary membranous nephropathy (pMN) is an autoimmune kidney disease and a common cause of nephrotic syndrome in adults. Rituximab is becoming a first line therapy for patients with persistent nephrotic syndrome with proven safety and efficacy, achieving remission in 60%–80% of cases. For the remaining 20%–40% of patients there is an urgent need to identify early biomarkers of resistance to rituximab to adapt therapeutic management. In nephrotic patients, rituximab is found in the blood more transiently than in other autoimmune diseases without proteinuria, due to rituximab wasting in the urine. However, rituximab immunomonitoring is not routinely performed. We evaluated the predictive value of serum rituximab levels in patients with pMN three months after rituximab injection (month-3) on clinical remission rates six months (month-6) and 12 months (month-12) after injection and investigated predictive factors for serum rituximab levels at month-3. Sixty-eight patients treated with rituximab between July 2015 and January 2020 from two French nephrology centers were included. We identified residual rituximab levels at month-3 as a novel early predictor of remission at month-6 (p <0.0001) and month-12 (p = 0.001). Reduced likelihood of remission in patients with undetectable rituximab at month-3 was associated with lower serum albumin and higher anti-PLA2R1 titers at baseline and with lower serum albumin, higher proteinuria, higher CD19+ counts and higher anti-PLA2R1 titers during follow-up. In multivariate analysis, high baseline proteinuria and undetectable rituximab levels at month-3 were independent risk factors for treatment failure at month-6 and high baseline weight and undetectable rituximab levels at month-3 were independent risk factors for treatment failure at month-12. We identified serum albumin at baseline as a predictive factor for serum rituximab levels at month-3. Patients with serum albumin below 22.5 g/L at baseline had an 8.66-fold higher risk of having undetectable rituximab levels at month-3. Therefore, rituximab immunomonitoring in pMN patients treated with rituximab would allow the detection of patients at risk of treatment failure as early as month-3. Studies are needed to assess whether patients with low residual rituximab levels at month-3 may benefit from an early additional course of rituximab.

scholarly journals P0367STATIN THERAPY AS A PROTECTOR FACTOR OF VENOUS THROMBOEMBOLIC EVENTS IN PATIENTS WITH ANCA-GLOMERULONEPHRITIS ?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
NICOLAS HENRY ◽  
GANSEY Renaud ◽  
DJEMA Assia ◽  
PICCOLI Giorgina ◽  
SUBRA Jean François ◽  
...  
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Statin Therapy ◽  
Lower Serum ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Independent Risk Factors ◽  
Cox Analysis ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims The incidence of venous thromboembolisms (VTE) is greatly increased in patients with anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV). However, its incidence and risk factors in patients with ANCA-glomerulonephritis (ANCA-GN) has been poorly analyzed. Thus, the aim of the present study was to assess the frequency, the risk factors and outcomes of patients with VTE after ANCA-GN diagnosis. Method Patients from the Maine-Anjou AAV registry with a biopsy showing pauci-immune glomerulonephritis between 01/01/2000 and 01/01/2019, were included. VTE events, the site and delay from AAV diagnosis were retrieved from patient’s medical records. Results Among the 165 patients, 133 fulfilled the inclusion criteria and were analyzed. After exclusion of arterio-venous fistulae thrombotic events, VTE episodes were diagnosed in 23/133 (17.3%) at a median delay of 3 months from ANCA-GN diagnosis or relapse. As compared to patients that did not developed VTE, patients with VTE had less frequently PR3 ANCAs (p=0.05), tended to be older (p=0.081), had lower serum albumin at AAV diagnosis (p=0.040) and were less frequently on statin therapy (p=0.028). Univariate cox analysis identified age (HR 1.49 for each 10-year increase, p=0.028), serum albumin at diagnosis (HR 2.21 for each 10g/L decrease, p=0.045), lack of statin therapy (HR 5.26, p=0.008) and rituximab treatment (HR 4.10, p=0.026) to be significantly associated with VTE occurrence. However, after adjustment in the multivariate model, only lack of statin therapy (HR 4.80; p=0.039) was significantly associated with VTE, while serum albumin was borderline (HR 2.20 for each 10 g/L decrease, p=0.067). Patients with VTE developed more frequently end-stage renal disease (p=0.040), but AAV relapse rate and mortality were not significantly different as compared to patients without VTE. Conclusion Patients with ANCA-GN are at high risk of VTE, especially within the first months following AAV diagnosis. We identified the lack of statin therapy as an independent risk factors of VTE development in our cohort. Thus, our results suggest that statins may have anti-thrombotic properties in ANCA-GN, which opens new therapeutic perspectives.

AB0809 PADUA PREDICTION SCORE COMBINED WITH SERUM ALBUMIN FOR THE IDENTIFICATION OF VENOUS THROMBOEMBOLISM OF HOSPITALIZED PATIENTS IN THE DEPARTMENT OF RHEUMATOLOGY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1429.1-1429
Author(s):  
Q. Peng ◽  
L. Long ◽  
J. Liu
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Serum Albumin ◽  
Risk Group ◽  
Assessment Model ◽  
Prediction Score ◽  
Risk Assessment Model ◽  
Systemic Autoimmune Diseases ◽  
Independent Risk Factors ◽  
The Difference

Background:Venous thromboembolism (VTE) includes thrombotic disease of venous system, but primarily includes lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE). Population-based epidemiological studies have shown an association between systemic autoimmune diseases and VTE[1]. The Padua prediction score(PPS) is a new 20-point risk assessment model proposed by Professor Barbar et al[2] in 2010. A large number of researches have shown that low serum albumin concentration is associated with an increased risk of VTE [3],but there is a lack of studies on serum albumin in VTE, and there are no reports on PPS in rheumatology inpatients.Objectives:To investigate the status of VTE in patients in the department of rheumatology, and to explore the value of PPS combined with serum albumin in the identification of VTE in this patient population.Methods:Baseline data of inpatients in rheumatology department were collected at Sichuan Provincial People’s Hospital from September 2018 to September 2020. Occurrence of VTE was compared between high and low risk groups. PPSs were analyzed in VTE and non-VTE patients. Multivariate logistic regression was used to analyze the independent risk factors of VTE. The receiver operating characteristic curve was used to evaluate the probablity of value of rheumatic inpatients with VTE assessed by PPS,serum albumin and PPS with serum albumin. P<0.05 indicates that the difference was statistically significant.Results:A total of 2282 patients were included in this study, and 50(2.2%) had symptomatic VTE. Among the symptomatic VTE cases,38(1.6%) had DVT only,8(0.4%) had PE only, and 4(0.2%) were diagnosed with DVT and PE. PPSs in VTE and non-VTE groups were 3.00(2.00~6.00) and2.00(1.00~2.00) respectively (P< 0.05). One hundred and eighty-eight cases was divided into high-risk group of VTE (PPS≥4), while 2094 cases (PPS<4) were in the low-risk group. Logistic regression analysis showed that known thrombophilic condition, history of VTE, reduced mobility, and D-dimer were independent risk factors of VTE in rheumatology patients, the odd ration(OR) values were 161.90, 26.08, 8.73,and1.04. Serum albumin was the independent protection factor [OR= 0.92(95%CI:0.87~0.98)]. The AUC of PPS model, serum albumin model and the combined predictive model were 0.77, 0.75, 0.84, respectively. The difference between the combined prediction model and PPS model was statistically significant (Z=3.813, P<0.05). The optimal sensitivity of PPS and serum albumin models is 60%, 82%, respectively, and the optimal specificity of is 82.5%,58.6%, respectively. The combination model corresponds to a sensitivity of 62% and a specificity of 90.4%.Conclusion:The incidence of symptomatic VTE was relatively higher in hospitalized patients in rheumatology department. Serum albumin was the protective factor. The combination of albumin and PPS can improve the accuracy of screening for VTE in rheumatology in-patients.References:[1]Tamaki H,Khasnis A.Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides.[J].Vasc Med, 2015, 20: 369-76.[2]Barbar S, Noventa F, Rossetto V,et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score[J]. J Thromb Haemost,2010,8(11):2450–2457.[3]Kunutsor SK,Seidu S,Katechia DT et al. Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein.[J].Ann Med, 2018, 50: 240-248.Disclosure of Interests:None declared

scholarly journals Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases

2020 ◽  
Author(s):  
Xiaohan You ◽  
Ji Zhang ◽  
Qiongxiu Zhou ◽  
Jianna Zhang
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Pneumocystis Pneumonia ◽  
Prednisone Dose ◽  
Primary Nephrotic Syndrome ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Independent Risk Factors ◽  
Cd4 Cell

Abstract Background: The aim of this study was to analysis the clinical features, risk factors and outcomes of patients with primary nephrotic syndrome (PNS) who developed pneumocystis pneumonia (PCP).Methods: We systematically reviewed medical records from 18 PNS patients with PCP admitted to our hospital from April 2007 to April 2019. A total of 180 cases were randomly selected as controls from PNS inpatients without infection. Results: In PCP patients, the mean age at presentation was 48.5 years, mean duration of prednisone treatment was 3.7 months and mean prednisone dose on admission was 31.3 mg/d, the most common clinical manifestation was fever (100%) and average PaO2 on admission was 59.5 mmHg. Eight patients (44.4%) had coexisting infections, most often was cytomegalovirus (4 patients), 11 patients (61.1%) had ICU admission and 9 patients (50%) had mechanical ventilation. PCP patients had more prednisone, more immunosuppressive therapy, lower CD4+ cell counts and hemoglobin, and higher serum creatinine than those without infections (p<0.05). Logistic regression analysis showed that PNS patients with prednisone usage and lower CD4+ cell counts were independent risk factors of more likely to have PCP compared to controls (OR =3.39, p=0.002; OR =0.64, p=0.021p<0.05). All patients survived after treatment. Conclusion: PCP was not unusual in PNS patients, and the most important risk factors were prednisone usage and a lower CD4+ cell count, but however, these patients had a good outcome after enough treatments.

Low serum albumin, aspartate aminotransferase, and body mass are risk factors for frailty in elderly people with diabetes: possible mechanistic role of dehydroepiandrosterone sulfate – a cross-sectional study

2020 ◽  
Author(s):  
Toshihiko Yanase ◽  
Ikumi Yanagita ◽  
Yuya Fujihara ◽  
Chikayo Iwaya ◽  
Yuichi Kitajima ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Serum Albumin ◽  
Body Mass ◽  
Aspartate Aminotransferase ◽  
Dehydroepiandrosterone Sulfate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Independent Risk Factors

Abstract Background: Relatively low dehydroepiandrosterone sulfate (DHEA-S) and high cortisol/DHEA ratio have been suggested to be associated with frailty, evaluated using a physical scale. However, the significance of these two hormones for frailty in elderly patients with type 2 diabetes mellitus (T2DM) has not been assessed using a wider range of measures of frailty, including physical, mental, and social indices. Methods: We performed a cross-sectional study to investigate the significance of these two hormones for frailty in elderly T2DM patients (n=148; ≥65 years), using a broad assessment, the clinical frailty scale, and to reevaluate the risk factors for frailty in elderly T2DM patients. We compared parameters between the non-frail and frail groups using the unpaired t and Mann-Whitney U tests. The Jonckheere-Therpstra test was used to identify relationships with the severity of frailty and risk factors were identified using binary regression analysis. Results: Simple regression analysis identified a number of significant risk factors for frailty, including DHEAS <70 µg/dL and cortisol/DHEA-S ratio ≥0.2. Multiple regression analysis showed that low albumin (<4.0 g/dl) (odds ratio [OR]=5.79, p <0.001), low aspartate aminotransferase (AST) activity (<25 IU/L) (OR=4.34, p =0.009), and low body mass (BM) (<53 kg) (OR=3.85, p =0.012) were independent risk factors for frailty. A significant decrease in DHEA-S and a significant increase in the cortisol/DHEA-S ratio occurred alongside increases in the severity of frailty. DHEA-S concentration positively correlated with both serum albumin and BM. Conclusions: Hypoalbuminemia, low AST, and low BM are independent risk factors for frailty in elderly T2DM patients, strongly implying relative malnutrition in these frail patients. DHEA-S may be important for the maintenance of liver function and BM. A decrease in DHEA-S and an increase in the cortisol/DHEAS ratio may be involved in the mechanism of the effect of malnutrition in elderly T2DM patients.

scholarly journals Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 760
Author(s):  
Hsiao-Chin Wang ◽  
Chen-Chu Liao ◽  
Shih-Ming Chu ◽  
Mei-Yin Lai ◽  
Hsuan-Rong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Treatment Failure ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Neurological Sequelae ◽  
Independent Risk Factors

It is unknown whether neonatal ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) pathogens and inappropriate initial antibiotic treatment is associated with poor outcomes after adjusting for confounders. Methods: We prospectively observed all neonates with a definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and March 2020. All clinical features, therapeutic interventions, and outcomes were compared between the MDR–VAP and non-MDR–VAP groups. Multivariate regression analyses were used to investigate independent risk factors for treatment failure. Results: Of 720 neonates who were intubated for more than 2 days, 184 had a total of 245 VAP episodes. The incidence rate of neonatal VAP was 10.1 episodes/per 1000 ventilator days. Ninety-six cases (39.2%) were caused by MDR pathogens. Neonates with MDR–VAP were more likely to receive inadequate initial antibiotic therapy (51.0% versus 4.7%; p < 0.001) and had delayed resolution of clinical symptoms (38.5% versus 25.5%; p = 0.034), although final treatment outcomes were comparable with the non-MDR–VAP group. Inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. The VAP-attributable mortality rate and overall mortality rate of this cohort were 3.7% and 12.0%, respectively. Independent risk factors for treatment failure included presence of concurrent bacteremia (OR 4.83; 95% CI 2.03–11.51; p < 0.001), septic shock (OR 3.06; 95% CI 1.07–8.72; p = 0.037), neonates on high-frequency oscillatory ventilator (OR 4.10; 95% CI 1.70–9.88; p = 0.002), and underlying neurological sequelae (OR 3.35; 95% CI 1.47–7.67; p = 0.004). Conclusions: MDR–VAP accounted for 39.2% of all neonatal VAP in the neonatal intensive care unit (NICU), but neither inappropriate initial antibiotics nor MDR pathogens were associated with treatment failure. Neonatal VAP with concurrent bacteremia, septic shock, and underlying neurological sequelae were independently associated with final worse outcomes.

Membranous Nephropathy in Pregnancy

2020 ◽  
Vol 51 (4) ◽  
pp. 304-317 ◽  
Author(s):  
Zi-ning Liu ◽  
Zhao Cui ◽  
Ying-dong He ◽  
Yi-miao Zhang ◽  
Fang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Membranous Nephropathy ◽  
Fetal Loss ◽  
Urinary Protein ◽  
Fetal Outcomes ◽  
Child Bearing ◽  
Phospholipase A2 Receptor ◽  
Birth Weight Percentile

Background: Primary membranous nephropathy (pMN) is less common in women of child-bearing age. The kidney risk factors to adverse maternal-fetal outcomes and the effects of pregnancy on pMN process need to be investigated. Methods: We retrospectively screened all the patients with biopsy-proven pMN from 2008 to 2018. Any cases of pregnancy that occurred at the time of pMN diagnosis or during follow-up were included in the study. Clinical and pathological data were collected from all patients at the time of kidney biopsy and their gestational results were recorded. Results: Of the 27 pregnancies with gestational time of 35.9 ± 4.5 weeks, 10 adverse maternal-fetal events occurred, including fetal loss (11%), preterm delivery (26%), and severe preeclampsia (15%). The kidney parameters were relatively stable with all preserved kidney function. Time-averaged urinary protein (p < 0.001) and serum albumin (p < 0.001), maximum urinary protein (p = 0.001) and minimum serum albumin (p = 0.01) before week 20, anti-phospholipase A2 receptor (PLA2R) positivity (p = 0.03), and no remission during pregnancy (p = 0.004) were risk factors to adverse maternal-fetal outcomes. Time-averaged urinary protein and serum albumin correlated with the birth weight percentile of neonates. Conclusions: Pregnancy in pMN patients showed risks to adverse maternal-fetal events. Heavy proteinuria, especially before week 20 of gestation, severe hypoalbuminemia, positive anti-PLA2R, and no remission were risk factors to worse outcomes.

scholarly journals Risk factors for low bone density in pediatric nephrotic syndrome

2011 ◽  
Vol 51 (2) ◽  
pp. 61
Author(s):  
Corina Lisa ◽  
Madarina Julia ◽  
Pungky A. Kusuma ◽  
Tonny Sadjimin
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Bone Density ◽  
Bone Mineral ◽  
Serum Calcium ◽  
Corticosteroid Treatment ◽  
Mean Difference ◽  
Mineral Density ◽  
Lower Serum ◽  
Steroid Dependent

Background Disturbances in bone mineral metabolism and side effects of corticosteroid treatment may cause decreased bone density in patients v.ith nephrotic syndrome (NS).Objectives To compare the prevalence oflow bone mineral density (BMD) in children with and 'Without NS and to assess the effect of corticosteroid treatment on bone density in NS patients. Methods We conducted a retrospective, cohort study in children aged 5-18 years diagnosed 'With NS for more than 2 months prior to data collection, and in children v.ithout NS as a control. BMD was assessed on calcaneal bone wlith ultrasound bone densitometry. Serum calcium, albumin, creatinine and phosphate levels were also assessed.Results The prevalence of low BMD was significantly higher in NS patients than non􀁂NS subjects, 73.3% (22 in 30) vs. 33% (11 in 33), respectively. The prevalence ratio was 6.3 (95% CI 2.1 to 18.9). NS patients had lower serum calcium levels, With mean difference of -0.17 (95% CI -0.27 to -0.07 mMollL), P<0.009, and lower serum albumin, with mean difference of  -0.88 (95% CI -1.27 to -0.49 gIL); P<O.OO 1, than non􀁂NS subjects. After adjusting for other risk factors, we found NS to be an independent risk factor for low BMD. Steroid-resistant and steroid-dependent patients had lower BMD than steroid-sensitive subjects (P=0.02). There was also a significant correlation between the onset of corticosteroid treatment and BMD (r=O.3; P=0.02).Conclusions NS patients had higher risk for low BMD compared to normal subjects. Response to steroid treatment influences the severity of impaired bone density.

scholarly journals Serum albumin concentration and risk of end-stage renal disease: the REGARDS study

2017 ◽  
Vol 33 (10) ◽  
pp. 1770-1777 ◽  
Author(s):  
Carl P Walther ◽  
Orlando M Gutiérrez ◽  
Mary Cushman ◽  
Suzanne E Judd ◽  
Joshua Lang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
Serum Albumin ◽  
End Stage Renal Disease ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Lower Serum ◽  
Regards Study ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT Background Serum albumin concentration is a commonly available biomarker with prognostic value in many disease states. It is uncertain whether serum albumin concentrations are associated with incident end-stage renal disease (ESRD) independently of urine albumin-to-creatinine ratio (ACR). Methods A longitudinal evaluation was performed of a population-based community-living cohort from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Participants were ≥45 years of age at study entry and had serum albumin, creatinine, cystatin C and spot urine ACR measured at the baseline visit (n = 19 633). Estimated glomerular filtration rate (eGFR) was from the Chronic Kidney Disease Epidemiology Collaboration combined creatinine-cystatin C equation. Baseline serum albumin concentration was the predictor variable, and hazard ratios (HRs) for incident ESRD (from US Renal Data System linkage) were calculated in sequentially adjusted models. Results Age at study entry was 63.9 ± 9.7 years, 62% of the participants were female and 40% were black. Mean eGFR at baseline was 83.3 ± 20.8 mL/min/1.73 m2. Over a median 8-year follow-up, 1.2% (n = 236) developed ESRD. In models adjusted for baseline eGFR, ACR and other ESRD risk factors, the HR for incident ESRD was 1.16 [95% confidence interval (CI) 1.01–1.33] for each standard deviation (0.33 g/dL) lower serum albumin concentration. The HR comparing the lowest (&lt;4 g/dL) and highest quartiles (≥4.4 g/dL) of serum albumin was 1.61 (95% CI 0.98–2.63). Results were qualitatively similar among participants with eGFR &lt;60 and ≥60 mL/min/1.73 m2, and those with and without diabetes. Conclusions In community-dwelling US adults, lower serum albumin concentration is associated with higher risk of incident ESRD independently of baseline urine ACR, eGFR and other ESRD risk factors.

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