ABSTRACT
INTRODUCTION: Etanercept, a systemic inhibitor of α-TNF, is used for treatment of various autoimmune disorders. We report a case of spontaneous resolution of etanercept-induced lupus nephritis. CASE DESCRIPTION: A 57-year-old female patient taking etanercept for psoriasis presented with laboratory-and histology-confirmed lupus nephritis. After stopping etanercept, there was normalization of proteinuria, hematuria, serum complements, anti-dsDNA antibody, and resolution of the acute glomerular inflammatory process on repeat kidney biopsy. CONCLUSION: This case demonstrates serology- and biopsy-confirmed resolution of active lupus nephritis upon withdrawal of etanercept.
Subject(s)
Autoantibodies/immunology , Immunoglobulin G/adverse effects , Lupus Nephritis/chemically induced , Lupus Nephritis/pathology , Autoantibodies/drug effects , Blood Chemical Analysis , Creatine/blood , Etanercept , Female , Humans , Immunoglobulin G/therapeutic use , Kidney/ultrastructure , Microscopy, Electron , Middle Aged , Psoriasis/drug therapy , Receptors, Tumor Necrosis Factor/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , UrinalysisABSTRACT
The angiotensin-converting enzyme (ACE) gene in humans contains an insertion-deletion polymorphism in its intron 16. Because of its involvement with the renin-angiotensin system, the insertion-deletion polymorphism of the ACE gene has been widely investigated in different populations and in case-control studies. However, similar studies for Arab populations are limited in number. Therefore we have investigated the frequencies of the *I and *D alleles of the ACE gene among Sudanese, Somalis, and Arab nationals of the United Arab Emirates and Oman using previously described methods. Our data indicate a preponderance of the *D allele among the Arab and African populations studied (Sudanese, 0.64; Somalis, 0.73; Emiratis, 0.61; and Omanis, 0.71).
Subject(s)
Genetics, Population/methods , Peptidyl-Dipeptidase A/genetics , Africa, Eastern , Alleles , Humans , Middle East , Polymerase Chain Reaction , Polymorphism, GeneticABSTRACT
We report the case of a 46-yr-old man with a 16-yr history of type I diabetes mellitus who developed rapid onset of nephrotic syndrome. Renal biopsy revealed diabetic nephropathy, characterized by thickened glomerular basement membranes (GBM), mild nodular glomerulosclerosis, and focal arteriolar hyalinization. Immunofluorescent (IF) studies showed strong granular IgM staining along glomerular loops, with subepithelial and intramembranous immune complex deposits along glomerular capillary loops demonstrated by electron microscopy (EM). These findings are consistent with membranous glomerulopathy with IgM as the predominant immunoglobulin. In addition, there were large aggregates of electron-dense material composed of numerous ring or spherical particles, ranging from 200 to 400 nm, in Bowman's space, which corresponded to eosinophilic aggregates on light microscopy (LM) and strong IgM stained materials by IF studies.
Subject(s)
Diabetic Nephropathies/diagnosis , Glomerulonephritis, Membranous/diagnosis , Immunoglobulin M/immunology , Diabetic Nephropathies/immunology , Glomerulonephritis, Membranous/immunology , Humans , Male , Middle AgedABSTRACT
Transplantation of kidneys with pre-existing glomerulonephritis (GN) has rarely been reported. Little is known of the subsequent evolution of donor pathology in the recipient. We report a transplant using a donor with systemic lupus erythematosus (SLE) and a history of remote acute renal failure but normal renal function at death. Although the screening harvest biopsy was unremarkable, time zero post-implantation renal biopsy showed evidence of lupus nephritis (LN). Sequential protocol biopsies demonstrated gradual resolution of the donor pathology, and renal function was stable despite severe cardiac disease in the recipient. Studies examining the role of functional and biopsy data on outcomes in expanded criteria renal transplantation are reviewed, and the limits of guidance from use of this data are discussed. Pre-existing mild GN may not be an absolute donor exclusion for candidates willing to accept expanded criteria donors. Use of expanded pool kidneys should be guided by functional, biopsy and demographic information, as no single factor alone predicts outcome.
Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation , Lupus Erythematosus, Systemic , Lupus Nephritis , Tissue Donors , Tissue and Organ Procurement/methods , Acute Kidney Injury , Follow-Up Studies , Humans , Kidney Transplantation/adverse effects , Lupus Nephritis/etiology , Male , Medical Records , Middle AgedABSTRACT
Campath-1H has been used successfully for induction and has resulted in a low rate of acute cellular rejection (ACR) in renal transplantation in combination with various postoperative immunosuppression regimens. This study was undertaken to investigate the extent of monocyte involvement in ACR, with or without Campath-1H induction. We found that monocytes represented the majority of inflammatory cells in grades Ib or higher ACR, but not with Ia type of ACR, regardless of the status of Campath-1H induction. Cases of ACR, following Campath-1H induction, appear to demonstrate a 'pure form' of monocytic ACR, whereas monocytes were mixed with many other types of inflammatory cells in the cases of ACR in the absence of Campath-1H induction. In addition with Campath-1H induction, the cases of monocyte-predominant ACR were found to uniformly exhibit a good response to corticosteroid treatment. We conclude that monocyte-predominate ACR may represent a severe form of rejection, with or without Campath-1H treatment.
Subject(s)
Antibodies, Monoclonal/pharmacology , Antibodies, Neoplasm/pharmacology , Graft Rejection/prevention & control , Kidney Transplantation , Monocytes/drug effects , Adolescent , Adult , Aged , Alemtuzumab , Antibodies, Monoclonal/immunology , Antibodies, Monoclonal, Humanized , Antibodies, Neoplasm/immunology , Antigens, CD/immunology , Antigens, Neoplasm/immunology , CD52 Antigen , Female , Glycoproteins/immunology , Humans , Kidney/drug effects , Kidney/pathology , Male , Middle AgedABSTRACT
Campath-1H (alemtuzumab), a humanized monoclonal antibody against CD52, can cause more profound depletion of lymphocytes than monocytes. The resultant imbalance of lymphocytes and monocytes after Campath-1H treatment of a renal-transplant recipient may lead to an acute rejection dominated by monocytes. We report such a case of acute transplant rejection in a 49-yr-old man who received a living non-related kidney transplant and was treated with preoperative Campath-1H and postoperative immunosuppression. An initial post-transplant renal biopsy showed diffuse mild acute rejection with 95% CD68-positive monocytes, but only 5% CD3-positive T lymphocytes. Inflammatory cells in the renal biopsy were negative for CD34 and CD1a stains, suggesting non-involvement of CD34-derived dendritic cells in the acute rejection. After steroid treatment for 2 wk, the patient's serum creatinine concentration diminished to 1.5 mg/dl. The histopathological features of acute rejection were absent in a second biopsy of the transplanted kidney. In summary, this case is an instance of monocyte-mediated acute rejection of a transplanted kidney.
