Mykofenolan mofetilu w leczeniu nefropatii toczniowej

Mycophenolate mofetil (MMF) is an antiproliferativeagent, which has been used with positive clinical effectfor therapy in nephropathy due to systemic lupuserythematosus for many years. Many randomizedcontrolled trials have documented the value ofthe drug in induction and maintenance therapy foractive lupus nephritis. It is currently believed that theefficacy of MMF was at least equivalent to cyclophosphamide.That’s why it is considered to providean alternative for a standard treatment of lupusnephritis. This review presents current experiencein using MMF in therapy of different types of lupusnephropathy.Mykofenolan mofetilu (MMF), lek antyproliferacyjny,od wielu lat jest stosowany z pozytywnym efektemklinicznym w terapii nefropatii w przebiegu toczniarumieniowatego układowego. W wielu randomizowanych,kontrolowanych badaniach klinicznychpotwierdzono skuteczność leku, zarówno w terapiiindukcyjnej, jak i podtrzymującej jej aktywnychpostaci. Obecnie uważa się, że efektywność MMFjest przynajmniej podobna do efektywności cyklofosfamidu,zatem stanowi on alternatywę dla standardowejterapii nefropatii toczniowej. W artykuleprzedstawiono aktualne doświadczenie dotyczącezastosowania MMF w terapii różnych postaci nefropatiitoczniowej

COVID-19 and vasculitis case report and review of the literature

ANCA-associated vasculitis related to COVID-19 infection is uncommon in clinical practice. Differential diagnosis could be challenging due to similar symptoms. We present a case of 65-year-old woman with SARS-COV-2 infection and de novo presentation of ANCA-associated vasculitis. She was admitted to the hospital due to dyspnea and fatigue. In addition the antigen test for SARS-CoV-2 infection was positive. Laboratory tests revealed acute kidney injury (AKI) and anemia. This paper describes clinical course, laboratory and radiographic features and treatment of this rare condition. We also have performed a review of the literature concerning autoimmune diseases triggered by SARS-CoV-2 infection

Gastrointestinal tract involvement in granulomatosis with polyangiitis

Abstract Introduction: Granulomatosis with polyangiitis (GPA) is a necrotising vasculitis of small arteries and veins. In its classical manifestation GPA affects the upper and lower respiratory tract and kidneys. However, other organs, including those of the gastrointestinal tract, may be affected as well. Aim: To present the clinical manifestations of gastrointestinal tract involvement in patients with GPA. Material and methods: We analysed case records of 34 patients with GPA treated in the Department of Nephrology, Transplantology, and Internal Medicine of the Medical University of Gdansk from 1991 to 2009. Results: In 9 of 34 patients, 2 men and 7 women, aged 18 to 74 years, gastrointestinal complications were observed in the course of GPA. In two of them a localised and in seven a generalised type of GPA was diagnosed. The main symptoms relating to gastrointestinal tract were: oral mucosa ulcerations, gum mucosa hypertrophy, dyspepsia, vomiting, stomachache, gastrointestinal haemorrhage, diarrhoea, and symptoms of gastrointestinal tract perforation. Two patients required urgent surgical treatment. In 2 of the 5 patients who developed gastrointestinal bleeding, it was the direct cause of death. The histopathological confirmation of specificity of changes in gastrointestinal tract was established only in 2 cases. Tissue samples collected during endoscopy usually revealed only nonspecific inflammation or the presence of ulcers. Conclusions: Therapeutic strategies accepted for GPA treatment are effective in treating patients with gastrointestinal involvement in the course of the disease. Some complications require surgical intervention

Antiphospholipid Syndrome in Renal Allograft Recipients—A Long-Term Multicenter Analysis

Antiphospholipid syndrome (APS) is a devastating autoimmune disease and in renal transplant recipients may result in allograft thrombosis or in extra-renal manifestation, mostly venous thromboembolism. There are many non- and immune risk factors affecting renal allograft in recipients with APS. However, renal allograft outcome in recipients with APS without APS nephropathy remains unknown. Aim: The aim of the study was to assess renal allograft function and survival in recipients with APS. Methods: Retrospective, multicenter study included 19 adult renal recipients with definite APS (primary or lupus-related) from three Polish transplant centers. Renal allograft function was assessed using serum creatinine concentration (SCr1) at 3rd month post-transplant and at the end of the observation (SCr2) and glomerular filtration rate (GFR) was estimated based on modification of diet in renal disease (MDRD) formula. General linear model was used to assess 12 month GFR change over time. Kaplan-Meier curves and restricted mean survival time were used for allograft survival. Matched control group consisted of 21 stable renal recipients without history of thrombosis and without anticoagulation/antiplatelet treatment. Results: The study group differs in induction therapy (p = 0.019), high-urgency procedure (p = 0.04), proteinuria (p = 0.0058), primary disease (lupus) (p p = 0.0046) and shorter time since engraftment to SCr2 (p = 0.016). Primary APS was more often diagnosed post-transplant (p = 0.0005). Allograft biopsy revealed thrombotic microangiopathy (TMA) with acute rejection (AR) or isolated AR vs AR or chronic rejection in controls but did not reach significance (p = 0.054). Renal allograft function was inferior in the study group but did not reach significance: mean SCr2 (mg/dL) was 2.18 ± 1.41 and 1.5 ± 0.68 in controls, respectively, p = 0.27; mean GFR2 (ml/min/1.73m2) was 39.9 ± 20.83 and 51.23 ± 19.03, respectively, p = 0.102. Renal allograft duration was inferior in patients with APS and was (in years) 11.22 ± 1.44 vs. 14.36 ± 0.42, respectively, p = 0.037, in patients with primary APS (p = 0.021), in patients with APS diagnosed post-transplant (p = 0.012) but not in lupus-related APS (p = ns). Fifteen year renal allograft survival was inferior in APS vs. controls (73,86% vs. 90.48%, respectively, p = 0.049). Conclusions: Recipients with APS are at higher risk for allograft loss due to immune and non-immune causes. Renal allograft survival was inferior in recipients with APS and renal function remains impaired but stable