Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego · 2022
[Efficacy of rituximab in minimal change disease, an atypical renal manifestation of antiphospholipid syndrome].
Клинический случайАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Długosz Gabriela, Masajtis-Zagajewska Anna, Nowicki Michał
Аннотация
UNLABELLED: Antiphospholipid syndrome (APS) is defined as presence of antiphospholipid antibodies along with hypercoagulable events. Renal involvement in APS usually manifests as thromboembolic complications observed in large blood vessels or small intrarenal vessels (APS nephropathy). We report a rare case of glomerulitis associated with APS and being characterised by features different from typical APS nephropathy.
A CASE REPORT: A 23-years-old patient was admitted to the nephrology department with steroid-sensitive, steroid-dependent nephrotic syndrome secondary to minimal change disease, first diagnosed at the age of 18 months. Subsequent thromboembolic events, such as deep vein thrombosis, unilateral thrombosis of the popliteal artery, and pulmonary embolism, led to the diagnosis of antiphospholipid syndrome. The patient also had a history of acute kidney injury. On the day of admission, the patient had normal renal function and was taking an increased dose of prednisone owing to nephrotic syndrome relapse. In the past, attempts to reduce the dosage of glucocorticoids were made using cyclophosphamide, cyclosporin A, mofetil mycophenolate, and their combinations. It rendered ineffective as nephrotic syndrome relapses occurred. The patient's eligibility for the rituximab treatment was established in a series of diagnostic tests which excluded any contraindications. No adverse effects were observed during or after intravenous infusion of the drug.
CONCLUSIONS: The case emphasizes a rare renal clinical manifestation of APS in nephrologist's practice. The combination of anti-CD20 monoclonal antibody and anticoagulants is highly likely to be the optimal solution for this problem.
A CASE REPORT: A 23-years-old patient was admitted to the nephrology department with steroid-sensitive, steroid-dependent nephrotic syndrome secondary to minimal change disease, first diagnosed at the age of 18 months. Subsequent thromboembolic events, such as deep vein thrombosis, unilateral thrombosis of the popliteal artery, and pulmonary embolism, led to the diagnosis of antiphospholipid syndrome. The patient also had a history of acute kidney injury. On the day of admission, the patient had normal renal function and was taking an increased dose of prednisone owing to nephrotic syndrome relapse. In the past, attempts to reduce the dosage of glucocorticoids were made using cyclophosphamide, cyclosporin A, mofetil mycophenolate, and their combinations. It rendered ineffective as nephrotic syndrome relapses occurred. The patient's eligibility for the rituximab treatment was established in a series of diagnostic tests which excluded any contraindications. No adverse effects were observed during or after intravenous infusion of the drug.
CONCLUSIONS: The case emphasizes a rare renal clinical manifestation of APS in nephrologist's practice. The combination of anti-CD20 monoclonal antibody and anticoagulants is highly likely to be the optimal solution for this problem.