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Morozumi K, Takeda A, Otsuka Y, Horike K, Gotoh N, Watarai Y. Recurrent glomerular disease after kidney transplantation: An update of selected areas and the impact of protocol biopsy. Nephrology (Carlton) 2014; 19 Suppl 3:6-10. [DOI: 10.1111/nep.12255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Kunio Morozumi
- Department of Nephrology and Kidney Transplantation; Japanese Red Cross Nagoya Daini Hospital; Nagoya-City Japan
| | - Asami Takeda
- Department of Nephrology and Kidney Transplantation; Japanese Red Cross Nagoya Daini Hospital; Nagoya-City Japan
| | - Yasuhiro Otsuka
- Department of Nephrology and Kidney Transplantation; Japanese Red Cross Nagoya Daini Hospital; Nagoya-City Japan
| | - Keiji Horike
- Department of Nephrology and Kidney Transplantation; Japanese Red Cross Nagoya Daini Hospital; Nagoya-City Japan
| | - Norihiko Gotoh
- Department of Nephrology and Kidney Transplantation; Japanese Red Cross Nagoya Daini Hospital; Nagoya-City Japan
| | - Yoshihiko Watarai
- Department of Nephrology and Kidney Transplantation; Japanese Red Cross Nagoya Daini Hospital; Nagoya-City Japan
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Nakamura G, Homma N, Sakamaki Y, Toyama M, Unno M, Kuroda T, Narita I. Mizoribine as a safe and effective combined maintenance therapy with prednisolone for anti-neutrophil cytoplasmic antibody-associated vasculitis in a hemodialysis patient. CEN Case Rep 2013; 2:139-143. [PMID: 28509286 PMCID: PMC5418497 DOI: 10.1007/s13730-012-0050-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/04/2012] [Indexed: 11/28/2022] Open
Abstract
A 77-year-old man developed severe renal insufficiency due to proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, and was started on hemodialysis (HD). Because his renal insufficiency appeared to be irreversible, he was maintained on oral prednisolone (PSL) at 5 mg/day. However, a disease flare-up with alveolar hemorrhage occurred. Serology revealed elevated levels of PR3-ANCA and C-reactive protein (CRP). The patient was given pulse therapy with a quarter dose of methylprednisolone (m-PSL) (250 mg, 3 days), followed by oral PSL at 15 mg/day. As a supplemental treatment, he was given 25 mg of mizoribine (MZR) immediately after each HD session. Subsequently, the levels of PR3-ANCA and CRP decreased, and the alveolar hemorrhage resolved. The dose of MZR to be given was determined by measuring the patient's serum concentrations of MZR at various time points after the HD session. The maintenance dose of MZR was finally set at 50 mg. At present, the oral PSL dosage has been tapered to 10 mg/day, and the patient has achieved a state of remission without any side effects.
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Affiliation(s)
- Gen Nakamura
- Division of Nephrology, Niigata Prefectural Shibata Hospital, 2-8, Motomachi 1-chome, Shibata, Niigata, 957-8588, Japan.
| | - Noriyuki Homma
- Division of Nephrology, Niigata Prefectural Shibata Hospital, 2-8, Motomachi 1-chome, Shibata, Niigata, 957-8588, Japan
| | - Yuichi Sakamaki
- Division of Nephrology, Niigata Prefectural Shibata Hospital, 2-8, Motomachi 1-chome, Shibata, Niigata, 957-8588, Japan
| | - Mio Toyama
- Division of Nephrology, Niigata Prefectural Shibata Hospital, 2-8, Motomachi 1-chome, Shibata, Niigata, 957-8588, Japan
| | - Megumi Unno
- Division of Nephrology, Niigata Prefectural Shibata Hospital, 2-8, Motomachi 1-chome, Shibata, Niigata, 957-8588, Japan
| | - Takeshi Kuroda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Cyuuou-ku, Niigata, 951-8510, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Cyuuou-ku, Niigata, 951-8510, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Iwatani H, Nagasawa Y, Oka K, Isaka Y, Imai E. Valvular injury in a patient with PR3-ANCA-associated glomerulonephritis. Nat Clin Pract Nephrol 2008; 4:576-82. [PMID: 18762796 DOI: 10.1038/ncpneph0943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 08/01/2008] [Indexed: 11/08/2022]
Abstract
Background An 11-year-old boy who had hematuria at a routine health check-up was later diagnosed with proteinase 3 (PR3) antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. Despite treatment with corticosteroids and immunosuppressants, he went on to develop end-stage renal disease. The patient received a renal transplant at the age of 16 years, but relapse of PR3-ANCA-related nephritis to the graft occurred three times. Each relapse was successfully treated with corticosteroids and immunosuppressants. An echocardiogram at the age of 19 years revealed moderate-to-severe aortic regurgitation. The patient died of pneumonia when he was 24 years old. Autopsy revealed a perforation in the noncoronary cusp of the aortic valve and recurrence of crescentic glomerulonephritis in the transplanted kidney.Investigations Physical examinations, urine and blood analyses, renal biopsies, echocardiograms and autopsy.Diagnosis PR3-ANCA-associated glomerulonephritis, recurrence of crescentic glomerulonephritis to the graft, aortic regurgitation and perforation in the noncoronary cusp of the aortic valve.Management Immunosuppressants and corticosteroids.
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Abstract
Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction after pediatric renal transplantation. We report the unusual occurrence of early graft dysfunction following kidney transplant in two pediatric cases. Both subjects had biopsy proven recurrence of CGN in less than a week after transplantation. We were able to sustain the renal function in one of them following aggressive treatment. Hence, early recurrence of CGN should be considered in the differential diagnosis of early graft dysfunction.
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Affiliation(s)
- Supriya Jain
- Departments of Pediatrics, Pathology and Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
Despite important therapeutic improvements, permanent organ failure may develop in primary systemic vasculitides and affect the heart, the lungs, and especially the kidneys. In systemic vasculitides associated with antineutrophil cytoplasmic antibodies (AASV), end-stage renal failure develops in 20% of cases. Renal transplantation became a beneficial option in these patients, with a graft and patient survival comparable to that in nondiabetic patients. This review summarizes the current knowledge on indications and contraindications for renal transplantation in AASV and discusses the impact of posttransplant immunosuppression on the course of the patients.
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Affiliation(s)
- Wilhelm H Schmitt
- Vth Medical Clinic (Nephrology, Endocrinology), University-Clinic Mannheim, Faculty of Clinical Medicine of The University of Heidelberg, Germany.
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