Nephrotic Syndrome In Adult Patients Research Articles

Нефротический синдром: причины и дифференциальный диагноз (часть 1)

Nephrotic syndrome (NS), characterized by proteinuria >3.5 g daily and hypoalbuminemia (± oedema and dyslipidemia) is one of the leading manifestations of various glomerular diseases, both primary and secondary (systemic autoimmune diseases, diabetes mellitus, amyloidosis, monoclonal gammapathy, malignancy, infections, drugs, etc). Kidney biopsy is usually required to establish the cause of NS in adult patients and to choose optimal treatment. In a review article, the authors discuss the most common ethiological factors of NS and its differential diagnosis.

POS-477 COMPLICATIONS RELATED TO ADULT ONSET MINIMAL CHANGE DISEASE: A STUDY OF 48 PATIENTS

Minimal change disease (MCD) is a glomerular nephropathy that generally responds well to corticosteroids with good long-term outcomes. However, in some cases, it can cause several complications related to the nephrotic syndrome (NS) increasing the morbidity and mortality associated with this pathology. The aim of this study is to describe complications related to NS in adult patients with MCD. This is a retrospective study including adults having NS with biopsy proven MCD over a period of 13 years in our nephrology department. Were collected data related to complications due to NS. Forty height adults with biopsy proven MCD were analyzed. Functional acute renal failure was noted in 15 patients (31.25%) during their follow-up with a mean average time to onset of 2.79 +/-2.1 years. Infectious complications were noted in 13 patients (27.08%): bacterial infections in 79.9% of cases (especially cutaneous, urinary and pulmonary infections), viral infections in 13.4% of cases (mucocutaneous herpes and varicella) and fungal infections in 6.7% of cases (systemic candidiasis). There were no cases of thromboembolic complications in our series. Complications related to NS due to MCD are dominated by functional renal failure and infections. They are quite common and should therefore be prevented whenever possible.

Kidney Biopsy Is Required for Nephrotic Syndrome with PLA2R+ and Normal Kidney Function: The Con View.

The main obstacle to medical progress is dogma.—Gabriel Richet Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in adult patients of European decent (1,2). This morphologic pattern of injury is characterized by thickening of the glomerular capillary wall on light microscopy, presence of Igs (usually IgG and C3) deposition along the capillary walls on immunofluorescence microscopy, and subepithelial deposits along the glomerular basement membrane on electron microscopy (EM) (3). Primary MN, responsible for approximately 80% of cases, is a renal-limited autoimmune disease caused by circulating antibodies targeting antigens on the surface of the podocyte (4). The target antigen has been identified as the M-type phospholipase A2 receptor 1 (PLA2R) in 70%–80%, the thrombospondin type-1 domain containing 7A (THSD7A) in 1%–5%, and the recently described neural EGF-like 1 protein (NELL-1) in 5%–10% of cases (5⇓–7). In approximately 20% of patients, MN is secondary to infections (hepatitis B), systemic autoimmune diseases (SLE), drugs (nonsteroidal anti-inflammatory drugs), or malignancy (8). Traditionally, the gold standard for diagnosis of MN has been a kidney biopsy. However, the recent availability of assays for PLA2R has revolutionized the way we approach MN. There are two validated and commercially available assays for anti-PLA2R antibody: one is an ELISA, which provides a quantitative antibody titer and is 66.9% sensitive and 99.6% specific, and the other is a semiquantitative immunofluorescence assay test (IFA), which is 77.1% sensitive and 100% specific reported as positive, indeterminate, or negative. A large body of evidence supports a central role for serology in diagnosis and management of MN. The evidence is most explicit for PLA2R-associated MN, as this is the most common and longest recognized form. To start, the specificity of anti-PLA2R antibodies for a diagnosis of MN is close to 100% (9). Positive anti-PLA2R …

A comparison of cyclophosphamide versus tacrolimus in terms of treatment effect for idiopathic membranous nephropathy: A meta-analysis

Background and aimsIdiopathic membranous nephropathy (IMN), which is considered one of the most common causes of nephrotic syndrome in adult patients, is frequently managed with immunosuppressive agents. Both tacrolimus (TAC) and cyclophosphamide (CTX) are recommended as immunosuppressive agents in the management of IMN. However, profound effects and moderate evidence on the two drugs remains poorly defined at this period. The meta-analysis aims to summarize current best evidence on the efficacy as well as safety of TAC and CTX among IMN patients. MethodsWe searched the publications on comparison of the safety and efficacy of TAC versus CTX for IMN up to April 2018. After rigorous reviewing on the quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest. ResultsModerate-strong evidence indicated that tacrolimus and cyclophosphamide had comparable effects on remission rate (either CR or PR) (p>0.05). No significant differences were found in the following parameters: the rates of diarrhea, glucose intolerance (or diabetes mellitus), gastrointestinal syndrome, as well as hypertension because of adverse effects (p>0.05). However, patients with TAC therapy had a higher chance to develop urinary tract infection (p=0.010) and tremor (p=0.006). Additionally, remarkably higher risk existed in leukopenia among the CTX group as compared with the TAC group (p=0.03). ConclusionThis meta-analysis presents a comprehensive assessment of current available evidence for the therapy of IMN, indicating a comparable remission rate with both TAC and CTX, while the long-term effects are needed for further verification. Nevertheless, different adverse effect profiles of two groups need careful consideration. Remarkably higher rates of urinary tract infection and tremor were observed among TAC group, while higher risk of leukopenia was found among CTX group. Further research into the treatment efficacy of both drugs is warranted to confirm the present conclusions.

A comparison of cyclophosphamide versus tacrolimus in terms of treatment effect for idiopathic membranous nephropathy: A meta-analysis

Background and aimsIdiopathic membranous nephropathy (IMN), which is considered one of the most common causes of nephrotic syndrome in adult patients, is frequently managed with immunosuppressive agents. Both tacrolimus (TAC) and cyclophosphamide (CTX) are recommended as immunosuppressive agents in the management of IMN. However, profound effects and moderate evidence on the two drugs remains poorly defined at this period. The meta-analysis aims to summarize current best evidence on the efficacy as well as safety of TAC and CTX among IMN patients. MethodsWe searched the publications on comparison of the safety and efficacy of TAC versus CTX for IMN up to April 2018. After rigorous reviewing on the quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest. ResultsModerate-strong evidence indicated that tacrolimus and cyclophosphamide had comparable effects on remission rate (either CR or PR) (p>0.05). No significant differences were found in the following parameters: the rates of diarrhea, glucose intolerance (or diabetes mellitus), gastrointestinal syndrome, as well as hypertension because of adverse effects (p>0.05). However, patients with TAC therapy had a higher chance to develop urinary tract infection (p=0.010) and tremor (p=0.006). Additionally, remarkably higher risk existed in leukopenia among the CTX group as compared with the TAC group (p=0.03). ConclusionThis meta-analysis presents a comprehensive assessment of current available evidence for the therapy of IMN, indicating a comparable remission rate with both TAC and CTX, while the long-term effects are needed for further verification. Nevertheless, different adverse effect profiles of two groups need careful consideration. Remarkably higher rates of urinary tract infection and tremor were observed among TAC group, while higher risk of leukopenia was found among CTX group. Further research into the treatment efficacy of both drugs is warranted to confirm the present conclusions.

Comprehensive identification of immune-associated biomarkers based on network and mRNA expression patterns in membranous glomerulonephritis

BackgroundMembranous glomerulonephritis (MGN) is the most common cause of nephrotic syndrome in adult patients. Despite extensive evidences suggested that many immune-related genes could serve as effective biomarkers in MGN, the potential has not been sufficiently understood because of most previous studies have concentrated on individual gene and not the entire interaction network.MethodsHere, we integrated multiple levels of data containing immune-related genes, MGN-related genes, protein–protein interaction (PPI) networks and gene expression profiling data to construct an immune or MGN-directed neighbor network (IOMDN network) and an MGN-related genes-directed network (MGND network).ResultsOur analysis suggested that immune-related genes in the PPI network have special topological characteristics and expression pattern related to MGN. We also identified five network modules which showed tighter network structure and stronger correlation of expression. In addition, functional and drug target analyses of genes in modules indicated that the potential mechanism for MGN.ConclusionsCollectively, these results indicated that the strong associations between immune and MGN and showed the potential of immune-related genes as novel diagnostic and therapeutic targets for MGN.

A Study on Clinico Pathological Spectrum of Nephrotic Syndrome in Adult Patients in a Teaching Hospital in Eastern India

A Study on Clinico Pathological Spectrum of Nephrotic Syndrome in Adult Patients in a Teaching Hospital in Eastern India

Histopathological study of nephrotic syndrome in adults: A Moroccan report.

The reported causes of nephrotic syndrome (NS) varies between different countries. In this retrospective study, we aimed to evaluate the underlying causes of NS in adult patients who underwent renal biopsy in a region of Morocco and we also determined the distribution of histopathological diagnoses with regard to the age subgroups and genders from January 2007 to December 2016. Patients were divided into four groups according to age at the time of renal biopsy. A total of the 257 patients with NS were included in this study. The mean age of the patients was 40.9 ± 16.7 years; male gender was preponderant (61.9%). One hundred and sixty-six (64.6 %) and 81 (35.4%) patients were diagnosed as primary and secondary glomerulonephritis, respectively. The most common diagnosis in NS was membranous nephropathy (MN) (22.2%), followed by minimal change disease (MCD) (20.6%), and lupus nephritis (LN) (13.6%). Among the patients aged 15-30, 31-45, 46-60, and >61 years, the most common cause of NS was MCD (32.1%), MN (29.6 %), MN (26.1%), and amyloidosis (AM) (28.2%), respectively. The proportion of patients with MCD and LN decreased in parallel with patient age and the proportion of patients with renal AM increased in parallel with patient age. Among the female patients aged 15-30 and 31-45 years, LN was the leading cause of NS (41.5 and 36.7%, respectively). Among the male patients aged 15-30 years, MCD was the leading cause of NS (43.2%). Our study over 10 years represents an important data of regional variations of glomerular diseases presenting with adult-onset NS.

Cyclosporin A in adult patients with Henoch-Schönlein purpura nephritis and nephrotic syndrome; 5 case reports

Henoch-Schönlein purpura (HSP) is usually followed by mild renal involvement, but heavy proteinuria may also occur. Limited experience with cyclosporin A in children shows reduction of proteinuria. In this report, the use of cyclosporin A in 5 adult HSP patients with nephrotic-range proteinuria is described. Cyclosporin A in combination with prednisolone was given in 3 patients with HSP nephritis and nephrotic syndrome after a course of other immunosuppressive drugs and in 2 patients as initial treatment. All patients showed complete or partial remission of nephrotic syndrome with cyclosporin A and preserved stable renal function over a follow-up period of 5 years. We conclude that the combination of cyclosporin A with corticosteroids is effective in inducing remission of nephrotic syndrome in adult patients with HSP nephritis.

Minimal-Change Glomerulopathy and Carcinoma

We describe 2 patients with minimal-change glomerulopathy (MCG) associated with an undifferentiated carcinoma of unknown origin and urothelial carcinoma. Oliguric acute renal failure and histopathological changes consistent with acute tubular necrosis were also observed. Fourteen other cases of MCG complicating solid tumors reported in the literature are reviewed. MCG should be included in the nephropathies which cause nephrotic syndrome in adult patients with carcinoma.

The Place of Steroids in the Nephrotic Syndrome.

s1 May 1968The Place of Steroids in the Nephrotic Syndrome.D. A. K. Black, M.D., F.R.C.P.D. A. K. Black, M.D., F.R.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1178_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA multicenter controlled trial was begun in 1962, under the auspices of the Medical Research Council, to evaluate steroids in the nephrotic syndrome in adult patients. Only patients whose biopsies showed glomerulonephritis were included, under the histological categories "minimal glomerular change," "proliferative," and "membranous." Patients were randomly allocated to "prednisone" and "control" groups. Both groups received diuretic and other general treatment, but the "prednisone" group received in addition prednisone in the range of from 20 to 40 mg/day for at least 6 months.In patients with minimal glomerular change, there was a significant and prompt reduction in proteinuria in the... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Manchester, PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1968Volume 68, Issue 5Page: 1178-1179KeywordsBiopsyDiureticsGlomerulonephritisProteinuriaSteroids Issue Published: 1 May 1968 PDF DownloadLoading ...