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Risks and Adverse Reactions Associated with Hemapheresis
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
Plasma exchange with albumin also causes depletion of immunoglobulins.26 If, in addition, the patient is under immunosuppression as is often the case, the possibility of complicating infections arises. Indeed such infections have been reported in patients treated for rapidly progressive glomerulonephritis.827 There must be many variables involved such as the type of vascular access used.7 In addition to their inherent hazards bacterial infections may also cause a worsening of the underlying disease process.28 The prevention of infections in patients at unusually high risk requires special attention. For example, quite apart from the obvious need for excellence in hygiene and nursing care, it may be worth considering the prophylactic administration of immune serum globulin for immunosuppressed patients undergoing a series of closely spaced plasma exchanges, e.g., 3 or 4 ℓ exchanges, three times a week for two or three weeks. Admittedly, the data to support this recommendation are not at hand.
Noninfectious Pulmonary Manifestations of Renal Disease In Children
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Stephen T. Lawless, H. Jorge Baluarte
Henoch-Schonlein purpura (HSP) or anaphylactoid purpura is a leukoclastic vasculitis of the small blood vessels of the skin, kidney, gastrointestinal tract, lungs, liver, heart, and spleen. There is a nonthrombocytopenic purpuric rash on the lower extremities and buttocks with joint swelling, diarrhea, hematochezia associated with colicky abdominal pain, and nephritis. It occurs 1 to 3 weeks after an upper respiratory infection. Rarely, pulmonary hemorrhage, perihilar patchy infiltrates, reticulonodular changes and pneumonic processes may be present.24 Rapidly progressive glomerulonephritis may follow. If chronic renal failure results, signs of uremic pneumonitis appear. IgA deposits in dermal capillaries or renal biopsy support the diagnosis of HSP.
Rapidly progressive glomerulonephritis after introduction of certolizumab pegol: a case report
Published in Modern Rheumatology Case Reports, 2021
Masashi Funada, Masao Nawata, Aya Nawata, Tetsu Miyamoto, Kazuyoshi Saito, Yoshiya Tanaka
RTX is effective in the management of TNF inhibitor-induced AAV. Patients with rapidly progressive glomerulonephritis due to AAV may require treatment with immunosuppressive drugs such as CY in addition to corticosteroids. In the 15 cases of TNF inhibitor-induced AAV described in previous studies, corticosteroids were administered in 14 cases, and CY was concurrently administered in seven cases. One patient underwent CY monotherapy. Remission was observed in cases where CY was administered along with corticosteroids. On the other hand, RTX, an anti-CD20 monoclonal antibody, has been shown to induce remission when administered concurrently with corticosteroids in patients with AAV and renal involvement, demonstrating effects comparable to that of CY [26]. RTX is widely used in the traditional treatment of MPA; however, the aforementioned study is the only one to report its use in the management of TNF inhibitor-induced AAV. In addition, unlike CY, RTX is not associated with the risk of irreversible amenorrhoea, and has a long-term safety profile in preservation of fertility. Furthermore, studies have demonstrated the effectiveness of RTX in the treatment of rheumatoid arthritis [27,28] (not approved in Japan) . Similarly, in the present case, RTX was effective in preventing relapse of joint-related symptoms during remission and after reduction of the steroid dose.
Relationship between autoantibodies to erythropoietin receptor and renal outcome in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis
Published in Biomarkers, 2020
Trang Thi Thu Tran, Akinori Hara, Kiyoki Kitagawa, Shinji Kitajima, Tadashi Toyama, Yasunori Iwata, Norihiko Sakai, Miho Shimizu, Shuichi Kaneko, Kengo Furuichi, Takashi Wada
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a heterogeneous and multisystem disorder of unknown aetiology characterized by inflammation and necrosis of small and medium-sized blood vessels (Ntatsaki et al.2014). The major clinicopathologic categories of AAV are microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA) (Ntatsaki et al.2014). During the disease course, renal involvement, characteristically rapidly progressive glomerulonephritis, is a major feature (Guillevin and Terrier 2014). Along with impaired renal function, the major abnormal laboratory findings are typically non-specific inflammatory markers, including elevated C-reactive protein (CRP), elevated white blood cell count and low haemoglobin levels (Guillevin and Terrier 2014).
Eosinophilic granulomatosis with polyangiitis: the multifaceted spectrum of clinical manifestations at different stages of the disease
Published in Expert Review of Clinical Immunology, 2020
Alvise Berti, Sara Boukhlal, Matthieu Groh, Divi Cornec
Constitutional symptoms are present in half of the cases at relapse. Mononeuritis multiplex is a cause of severe relapse and occurs in as many as 36% of the patients [11]. Renal manifestations are less frequent than the neurological ones and occur in an average 9 years after diagnosis [9]. In a study, the most common presentations were rapidly progressive glomerulonephritis and chronic kidney disease. Symptoms were hematuria, proteinuria, and renal dysfunction in all patients and dialysis was initially required in half of the patients. Most renal biopsies showed pauci-immune segmental necrotizing glomerulonephritis. In the same cohort, only 14% of patients returned to normal renal function during the follow-up. Gastrointestinal involvement, which is a severity criterion, is rarely reported during follow-up in EGPA patients [11]. Heart involvement is a main cause of death of patients with EGPA and is responsible for a third of deaths observed during the follow-up of different cohorts, by myocardial infarction, cardiac insufficiency, or arrhythmia [3]. Cardiac events are related to specific heart involvement of EGPA and cardiovascular complications and occur in approximately 8–20% of EGPA patients [3,15]. They affect the prognosis with a 5-year survival rate of 91% for patients without versus 78% in patients with cardiac involvement [3].