2 research outputs found
Pregnancy-Associated Atypical Hemolytic Uremic Syndrome: A Case Report with <i>MCP</i> Gene Mutation and Successful Eculizumab Treatment
Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is a rare condition characterized by microangiopathic hemolytic anemia and kidney injury from thrombotic microangiopathy. P-aHUS occurs in approximately 1 in 25,000 pregnancies and is strongly related to complement dysregulation and pregnancy-related disorders, such as preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, resulting in adverse perinatal and fetal outcomes. Complement dysregulation in P-aHUS is commonly attributed to genetic mutations or autoantibodies affecting complement factors, including CFH, CFI, and MCP. We present a case of a 25-year-old primigravida who experienced severe preeclampsia and HELLP syndrome followed by the development of complicated P-aHUS during the early postpartum period. The patient exhibited severe clinical manifestations, including hypertensive emergency, central nervous system involvement, renal impairment, and microangiopathic hemolytic anemia. Timely initiation of eculizumab therapy resulted in successful disease remission. Further genetic analysis revealed a likely rare pathogenic MCP gene variant
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy
Objective: To evaluate the immunosuppressive treatment response to modified Ponticelli regimen (MPR) and oral
corticosteroid (OC) plus tacrolimus (TAC) in patients with primary membranous nephropathy (PMN).
Methods: Retrospective cohort analytical study. Adults patients (>18 years old) with diagnosis of refractory PMN
(>50% increase in serum creatinine or a level >1.5mg/dl or proteinuria refractory to 6 months of supportive
treatment), proved by renal biopsy and immunofluorescence between 2008 and 2016 from the Nephropathy
Registry of Colombia (NEFRORED©) were included. Immunosuppressive treatment response was evaluated
from baseline to 6 months after the start of therapy.
Results: 128 patients with PMN were included, of which 74 (57%) were female. The most frequent syndromic
diagnosis was nephrotic syndrome 90 (70%), followed by asymptomatic urinary disorders 31 (25%). Chronic
kidney disease manifested concomitantly in 7 (5%) patients. At the end of 6 months, 86 (67%) cases achieved
some degree of remission: 23 (18%) complete response (CR) and 63 (49%) cases with partial response (PR), while
42 (33%) cases did not achieved remission. In the TAC+OC group, CR and PR were seen in 14 (20%) and 33 (47%)
patients, respectively; and 9 (16%) and 30 (51%) patients in the MPR group, respectively. No statistically
significant differences were found when comparing the immunosuppressive treatment response rate with both
treatment groups (p > 0.05).
Conclusions: In the PMN, both immunosuppressive treatments (TAC+OC vs MPR) are comparable. We suggest a
clinical follow-up of the anti-PLA2R/THSD7A titres at 6/12 months to be correlated with renal function in
subsequent studies