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Noone D, Yeung RSM, Hebert D. Outcome of kidney transplantation in pediatric patients with ANCA-associated glomerulonephritis: a single-center experience. Pediatr Nephrol 2017; 32:2343-2350. [PMID: 28766066 DOI: 10.1007/s00467-017-3749-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/30/2017] [Accepted: 06/26/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Data on kidney transplant outcomes for pediatric patients with end-stage renal disease (ESRD) secondary to anti-neutrophil cytoplasmic antibody glomerulonephritis (ANCA GN), particularly granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), is limited. We describe our experience of kidney transplantation in pediatric ANCA GN patients. METHODS We performed a retrospective review of patients with ANCA GN who developed ESRD and were transplanted at a single center between the years 2000 and 2014. RESULTS Since 2000, there were seven pediatric patients with ANCA GN (four MPA) transplanted. Mean age at ANCA GN diagnosis was 11.8 ± 2.8 (range, 7.2-15.4) years. All seven were ANCA (three anti-PR3/four anti-MPO) positive. Estimated glomerular filtration rate (eGFR) at diagnosis was 11.7 ± 6.3 ml/min/1.73 m2. All received steroids and cyclophosphamide and three (23.3%) received plasma exchange. Six were dialysis dependent by 6 months post diagnosis. Time from diagnosis to transplant was 30 ± 12 (range, 17-48) months. Six of the seven received a deceased donor transplant. All patients received induction therapy and standard maintenance immunosuppression post transplant. Median duration of follow-up post transplantation was 27 months (range, 13-88 months). Median eGFR at last follow-up was 77 ml/min/1.73 m2 (range, 7.9-83.5). One patient lost her transplant to acute cellular rejection following non-adherence to immunosuppression after 21 months of stable transplant function. No patient had recurrence of vasculitis, either renal or extra-renal. CONCLUSIONS Short-term patient and allograft survival in pediatric patients with ESRD secondary to ANCA GN seems excellent, with no recurrence of vasculitis post transplant in this small cohort.
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Affiliation(s)
- Damien Noone
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Rae S M Yeung
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Diane Hebert
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Salazar-Exaire D, Ramos-Gordillo M, Vela-Ojeda J, Salazar-Cabrera CE, Sanchez-Uribe M, Calleja-Romero MC. Silent Ischemic Heart Disease in a Patient with Necrotizing Glomerulonephritis due to Wegener's Granulomatosis. Cardiorenal Med 2012; 2:218-224. [PMID: 22969778 DOI: 10.1159/000339551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/09/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE: Wegener's granulomatosis (WG) is a necrotizing vasculitis that mainly affects the respiratory tract and kidneys, but can also affect other systems such as the eye, joints, skin, muscles, nerves, and gastrointestinal tract. Cardiac involvement is traditionally believed to be rare. We report a patient with silent myocardial infarction (MI) and review previously reported cases showing this association. METHODS: A Medline database search of cases published between January 1978 and July 2008 both in English and Spanish, reporting silent MI complicating WG, was conducted. RESULTS: We describe a typical patient with WG who had both respiratory and renal involvement and died unexpectedly following a silent MI after a period of clinical improvement induced by treatment with prednisone and cyclophosphamide. We report necropsy findings and the association with 5 additional cases of WG with silent MI reported in the literature. CONCLUSIONS: Clinicians should be aware of potential cardiac involvement due to WG. Careful evaluation of each patient, with or without cardiac symptoms, using ECG, echocardiogram, and myocardial enzymes is prudent.
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Morimoto S, Nakajima F, Morita T, Someya K, Kusabe M, Nakahigashi M, Yurugi T, Fukui M, Okamoto T, Jo F, Toyoda N, Iwasaka T. A Japanese case of proteinase 3 antineutrophil cytoplasmic autoantibody-associated pauci-immune-type crescentic glomerulonephritis without valvular endocarditis. Clin Exp Nephrol 2011; 15:419-423. [PMID: 21331743 DOI: 10.1007/s10157-011-0407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
A 74-year-old male without recent medical treatment visited our hospital complaining of fever and lack of appetite. Upon examination severe azotemia, proteinuria, and urinary occult blood were noted, and the patient was admitted. Results of a blood test showed that his proteinase 3 antineutrophil cytoplasmic autoantibody (PR3-ANCA) level was high. A transthoracic echocardiogram indicated normal cardiac function and no valvular regurgitation or stenosis. Necrotizing glomerulonephritis accompanied by cellular crescentic bodies, but not granuloma, was noted on renal biopsy. An immunofluorescence study demonstrated no immunofluorescence staining in the glomerulus or in the tubulointerstitial or vascular compartments. No lesion was present in the lung or upper respiratory tract. The patient was diagnosed with PR3-ANCA-associated pauci-immune-type crescentic glomerulonephritis and treated with steroids. This treatment resulted in rapid normalization of C-reactive protein, and the PR3-ANCA level slowly decreased and converted to negative. The renal function, however, did not improve, and maintenance dialysis was introduced. No pulmonary or upper airway lesion has developed during 18 months of follow-up. PR3-ANCA-positive crescentic glomerulonephritis accompanied by valvular endocarditis has been described by several reports in Japan; however, this case was not complicated by valvular endocarditis. To our knowledge, this is the 4th case report describing PR3-ANCA-associated crescentic glomerulonephritis in Japan.
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Affiliation(s)
- Satoshi Morimoto
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan.
| | - Fumitaka Nakajima
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka, 570-0021, Japan
| | - Tatsuyori Morita
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Kazunori Someya
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Makiko Kusabe
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Mitsutaka Nakahigashi
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takatomi Yurugi
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Masayoshi Fukui
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka, 570-0021, Japan
| | - Takayuki Okamoto
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka, 570-0021, Japan
| | - Fusakazu Jo
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Nagaoki Toyoda
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Toshiji Iwasaka
- Second Department of Internal Medicine, Kansai Medical University, 2-3-1, Shin-machi, Hirakata, Osaka, 573-1191, Japan
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