Rituximab in Systemic Lupus Erythematosus and Lupus Nephritis
Treatment options for systemic lupus erythematosus (SLE) and lupus nephritis (LN) have high associated morbidity and mortality. Side effects, particularly from long-term corticosteroid usage, limit patient adherence, with subsequent impacts on treatment efficacy. In addition, a subset of patients with SLE/LN fails to respond to current standard immunotherapy. There is an urgent need to develop steroid-sparing treatment regimens as well as novel therapies for the management of refractory disease. Rituximab is a chimeric mouse/human monoclonal antibody directed against the B cell CD20 receptor. It has been used in the treatm...
Source: Nephron Clinical Practice - November 28, 2014 Category: Urology & Nephrology Source Type: research
Lower Plasma Sodium Is Associated with a Microinflammatory State among Patients with Advanced Chronic Kidney Disease
Background/Aims: Lower serum sodium levels have been associated with increased mortality among patients with chronic kidney disease (CKD). Our aim was to analyze the independent factors associated with lower sodium levels among nondialysis patients with advanced CKD and to evaluate the evolution of these patients in comparison to those with higher plasma sodium over a 1-year period. Methods: We included 72 patients with CKD stages 4 and 5 without clinically evident cardiopathy or liver disease. Bioelectrical impedance and echocardiography were performed to analyze the possible relation between plasma sodium and volume stat...
Source: Nephron Clinical Practice - November 28, 2014 Category: Urology & Nephrology Source Type: research
The Effects of Acute Kidney Injury on Long-Term Renal Function and Proteinuria in a General Hospitalised Population
Conclusions: We describe a method of remote patient recruitment which could be employed more widely for prospective observational studies. Even mild AKI is associated with long-term renal dysfunction. Further investigation using this methodology is now underway. (Source: Nephron Clinical Practice)
Source: Nephron Clinical Practice - November 28, 2014 Category: Urology & Nephrology Source Type: research
Rituximab in Primary Membranous Nephropathy: First-Line Therapy, Why Not
The ideal treatment of patients with primary membranous nephropathy (MN) and persistent nephrotic syndrome (NS) is still a matter of debate. This is a major issue since these patients may progress to end-stage kidney disease (ESKD) in 5-10 years. Steroids, alkylating agents, and calcineurin inhibitors have been suggested to achieve NS remission and prevent ESKD in this population. Treatment benefits, however, are uncertain and are often offset by serious adverse events (SAEs). Evidence that B cells play a crucial role in the pathogenesis of the disease, both as precursors of autoantibody-producing cells and as antigen-pres...
Source: Nephron Clinical Practice - November 24, 2014 Category: Urology & Nephrology Source Type: research
Rituximab in Primary Membranous Nephropathy: First-Line Therapy, Why Not?
The ideal treatment of patients with primary membranous nephropathy (MN) and persistent nephrotic syndrome (NS) is still a matter of debate. This is a major issue since these patients may progress to end-stage kidney disease (ESKD) in 5-10 years. Steroids, alkylating agents, and calcineurin inhibitors have been suggested to achieve NS remission and prevent ESKD in this population. Treatment benefits, however, are uncertain and are often offset by serious adverse events (SAEs). Evidence that B cells play a crucial role in the pathogenesis of the disease, both as precursors of autoantibody-producing cells and as antigen-pres...
Source: Nephron Clinical Practice - November 21, 2014 Category: Urology & Nephrology Source Type: research
Relationship between HSP70-2 A+1267G Polymorphism and Cardiovascular Events of Chinese Peritoneal Dialysis Patients
Conclusion: The G allele of the HSP70-2 A+1267G polymorphism confers survival advantages in non-diabetic PD patients. The role of HSP in the pathogenesis of cardiovascular disease in renal failure patients needs further investigation.Nephron Clin Pract (Source: Nephron Clinical Practice)
Source: Nephron Clinical Practice - November 20, 2014 Category: Urology & Nephrology Source Type: research
Complement and Glomerular Diseases
The complement pathway is a central part of the innate immune system and also modulates adaptive immunity. It is implicated in the pathogenesis of glomerular disease by a number of clinical findings. These include the presence of complement components in renal biopsy samples, decreases in circulating levels indicating consumption, the presence of autoantibodies to complement proteins and the association of genetic mutations with disease either in individuals or within families. Further support and mechanistic insights comes from animal models. This review provides an overview of the role of complement in glomerular disease...
Source: Nephron Clinical Practice - November 18, 2014 Category: Urology & Nephrology Source Type: research
Limitations of Standard Immunosuppressive Treatment in ANCA-Associated Vasculitis and Lupus Nephritis
Introduction of the standard immunosuppressive treatment has dramatically changed the outcome of patients with both ANCA-associated vasculitis and lupus nephritis, transforming them from incurable diseases with very high short-term mortality to chronic debilitating diseases with much lower short-term, but still relatively high long-term, morbidity/mortality. Long-term morbidity with damage accumulating partly due to the adverse events of the available treatment (namely gonadal toxicity, malignancy, bone disease, cataracts, diabetes, and thromboembolic and cardiovascular disease) has become a major concern. Although cycloph...
Source: Nephron Clinical Practice - November 18, 2014 Category: Urology & Nephrology Source Type: research
Population-Based Estimated Reference Creatinine Values: A Novel Method of a Robust Electronic Acute Kidney Injury Alert System
Conclusion: Population-based estimated reference Cr measurements from community blood test results is a more robust method of baseline Cr value estimation in generating potential e-AKI alerts to help early recognition and treatment of AKI cases leading to improved outcome.Nephron Clin Pract (Source: Nephron Clinical Practice)
Source: Nephron Clinical Practice - November 18, 2014 Category: Urology & Nephrology Source Type: research
Rituximab in the Treatment of Anti-Neutrophil Cytoplasm Antibody-Associated Vasculitis
The introduction of cyclophosphamide and high-dose glucocorticoids for anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) has allowed a reduction in 1-year mortality from 80% to 10-20%. AAV is now a chronic disease, and greater emphasis has turned to improving treatment-related toxicity, reducing relapses and providing alternative treatments for refractory disease. Rituximab, an anti-CD20 B cell-depleting therapy, has been used for over a decade in patients with AAV. Rituximab offers a significant advance in the treatment of these diseases. It has an established role for remission induction and is now be...
Source: Nephron Clinical Practice - November 14, 2014 Category: Urology & Nephrology Source Type: research
Circulating Endotoxaemia and Frequent Haemodialysis Schedules
Conclusion: More frequent HD regimens are associated with lower levels of circulating ET compared with conventional HD. Reduced ET translocation may be related to the greater haemodynamic stability of these treatments, with superior maintenance of splanchnic perfusion.Nephron Clin Pract (Source: Nephron Clinical Practice)
Source: Nephron Clinical Practice - November 11, 2014 Category: Urology & Nephrology Source Type: research
Eculizumab in the Treatment of Membranoproliferative Glomerulonephritis
A major shift in our understanding of the membranoproliferative glomerulonephritis (MPGN) lesion is the focus on which components of the complement pathway are involved in mediating renal injury. Hence, MPGN is no longer classified solely by ultrastructural findings on biopsy but instead divided into immune complex-mediated lesions versus complement-mediated lesions. This emphasis on complement, in turn, leads to interest in therapies that target complement as potential disease-modifying agents. Eculizumab, the first available anticomplement therapy, blocks at the level of C5 and has revolutionized the treatment of complem...
Source: Nephron Clinical Practice - November 10, 2014 Category: Urology & Nephrology Source Type: research
Anti-Phospholipase A2 Receptor Antibodies and the Pathogenesis of Membranous Nephropathy
Since the early 2000s, considerable advances have been achieved in the understanding of molecular pathomechanisms of human membranous nephropathy (MN), inspired by studies of Heymann nephritis, a faithful experimental model. These studies led to the identification of neutral endopeptidase, the type-M phospholipase A2 receptor (PLA2R), and cationic bovine serum albumin as target antigens of circulating and deposited antibodies in neonatal alloimmune, adult ‘idiopathic', and early childhood MN, respectively. A genome-wide association study further showed a highly significant association of the PLA2R1 and the HLA-DQA1 loci ...
Source: Nephron Clinical Practice - November 10, 2014 Category: Urology & Nephrology Source Type: research
Biologic Therapy in Lupus Nephritis
This position paper critically analyzes the available controlled data regarding biologic therapy in lupus nephritis (LN). Rather than an exhaustive review of all published evidence, the stress is put on the unmet medical needs in LN, the design of trials aimed at testing the effect of a biologic in LN, the possible reasons for LN trial failures and the future of biological therapy in LN.Nephron Clin Pract (Source: Nephron Clinical Practice)
Source: Nephron Clinical Practice - November 10, 2014 Category: Urology & Nephrology Source Type: research
Pathogenesis of Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis and Potential Targets for Biologic Treatment
Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (AAV) are autoimmune diseases in which the small vessels are inflamed. Clinical observations suggest a pathogenic role for ANCA. Such a role is supported by in vitro experimental data and animal models, particularly for myeloperoxidase-ANCA. An in vivo pathogenic role of ANCA directed to proteinase 3 has, however, not been fully substantiated. Additionally, the pathogenic role of B cells, T cells, and the alternative pathway of complement in AAV have been elucidated. Insight into these pathogenic pathways involved in AAV has opened and will further open...
Source: Nephron Clinical Practice - November 10, 2014 Category: Urology & Nephrology Source Type: research
